Infants & Children

Infants & Children

• Defining the Pediatric Patient– Newborns & Infants (birth to 1 YOA)

• do not like to be separated from their parents

• exhibit minimal stranger anxiety

• used to being undressed but like to feel warm

• younger infants follow movement with their eyes

• older infants are more active, exhibiting more personality

• do not want to be “suffocated” with oxygen mask

Infants & Children

– Toddlers (1 to 3 YOA)• do not like to be touched, do not like to be separated

from parents

• may believe injury or illness is a punishment for being bad

• do not like having their clothes removed

• frighten easily, overreact, have a fear of needles & pain

• may understand more than they communicate

• begin to assert their independence

• do not want to be “suffocated” by oxygen mask

Infants & Children

– Preschool (3 to 5 YOA)• do not like to be touched• do not like to be separated from parents• are modest, do not like their clothing removed• may believe injury or illness is a punishment for

being bad• generally have a fear of blood, pain & permanent

injury• are curious, communicative & can be cooperative• do not want to be “suffocated” by oxygen mask

Infants & Children

– School age (6 to 12 YOA)• cooperates but likes their opinions heard

• generally fear blood, pain, disfigurement and permanent injury

• usually modest and do not like their bodies exposed

Infants & Children

– Adolescent (12 to 18 YOA)• want to be treated as adults

• generally feel that they are indestructible but may have fears of permanent injury & disfigurement

• vary in their emotional & physical development

• may not be comfortable with their changing bodies

• may or may not be modest

Infants & Children

• Key anatomical & physiological differences– Head

• Child’s head larger and heavier in proportion to their body until about age 4

• Soft spot (fontanelle) until about 18 months of age– sunken fontanelle may indicate dehydration

– bulging fontanelle may indicate elevated intracranial pressure (bulging normal when crying)

Infants & Children

– Airway & Respiratory System• mouth & nose smaller & more easily obstructed

than in adults

• in infants & newborns the tongue takes up more space proportionately in the mouth than in adults

• newborns & infants are obligate nose breathers

• trachea is softer & more flexible

• trachea is more narrow & more easily obstructed

• chest wall is softer, use diaphragm more

Infants & Children

– Chest & Abdomen• less developed and more elastic chest structures

• labored or distressed breathing more obvious from a distance

– muscles above the sternum and between the ribs will pull inward when breathing is labored

– Body Surface• BSA is larger in proportion to body mass, making

infants and small children more prone to heat loss

• BSA calculation different for burns

Infants & Children

– Blood Volume• smaller volumes

– infant 500-600ml

– child 2-31/2 liters

– adolescent 2-31/2 liters

• children may lose up to 40% blood volume before signs and symptoms of serious loss

Infants & Children

• Airway and Oxygen Therapy– Airway

• be careful not to hyper extend airways of newborns, infants, toddlers, preschoolers

– Supplemental oxygen• Hypoxia is the underlying reason for many of the

most serious medical problems seen in children– inadequate oxygen will have an immediate effect on the

heart rate and the brain

• Use the blow-by technique to deliver oxygen

Infants & Children

• Interacting with the Pediatric Patient– ID yourself– Let the child know parents have been (are being)

called– Determine life-threatening problems & treat them

first– Let child have or hold a toy– Kneel at child’s eye level– Smile

Infants & Children

• Interacting with the Pediatric Patient– Touch or hold a hand or foot, if they don’t want

to be touched they will usually tell you. Don’t push the issue

– Explain any (& all) equipment you are using & what you are going to do with it

– Make eye contact without staring– Speak directly to the child– Make sure the child understands you

Infants & Children

• Interacting with the Pediatric Patient– NEVER LIE TO THE CHILD

• Tell them when it might hurt

• Be honest with their questions but do not give false reassurances

Infants & Children

• Interacting with the Pediatric Patient– Gain confidence & establish emotional control

of all people around the scene in order to better treat the child & the parent

– Let the parent hold the child when possible

Infants & Children

• Assessment– Forming a General Impression (check)

• Mental Status

• Effort of Breathing

• Skin color

• Quality of cry

• Interaction with the environment or others

• Emotional state

• Response to you

• Tone & body position

Infants & Children

• Identifying Patient Priority– A patient is a high priority if:

• you have a poor general impression of the patient

• they are unresponsive or listless

• has a compromised airway

• is in respiratory arrest or has inadequate breathing or is in respiratory distress

• there is a possibility of shock

• \has uncontrolled bleeding

Infants & Children

• Focused History, Vitals & Detailed Physical– Normal Vital Sign Ranges

• Newborn 120 to 160

• Infant 0-5 months 90 to 140

• Infant 6-12 months 80 to 140

• Toddler 1-3 years 80 to 130

• Preschooler 3-6 years 80 to120

• School-age 6-12 years 70 to110

• Adolescent 12-18 years 60 to105

Infants & Children

– Normal Respiration Rates• Newborn 30 to 50

• Infant 0-5 months 25 to 40

• Infant 6-12 months 20 to 30

• Toddler 1-3 years 20 to 30

• Preschooler 3-5 years 20 to 30

• School-age 6-12 years15 to 30

• Adolescent 12-18 years 12 to 20

Infants & Children

– Blood Pressure Normal Ranges• Systolic Diastolic

Approx. 80 plus 2 xage

Approx. 2/3systolic

Preschooler 3-6 years

average 99 (79-116)

average 65

School-age 6-12 years

average 105 (80-122)

average 57

Adolescent 12-18 years

average 115 (94-140)

average 59

Infants & Children

• Ongoing Assessment– every 5 minute for unstable/ 15 minutes for

stable• Reassess mental status

• Maintain airway

• Monitor breathing

• Reassess pulse

• Monitor skin color, temperature & moisture

• Reassess vital signs

Infants & Children

• Additional Concerns– Fever

• Any child 1-5 YOA with temperature above 103oF must be evaluated at the hospital

• Any child from 5 to 12 YOA with a body temperature above 102oF must be evaluated at the hospital

• When in doubt, transport

• Seizures - children can tolerate a high temperature, it is the rapid rise in temp that causes a seizure

Infants & Children

• Fever– Care

• Remove clothing, but do not let child become chilled

• If the result of hyperthermia cool with moist towel (tepid water temp)

• DO NOT– submerge in cold water or cover with towel soaked in ice

water

– use rubbing alcohol (toxic absorption/ fire hazard)

Infants & Children

• Hypothermia– Causes

• cold air and/or cold water temps

• ingestion of alcohol or drugs

• metabolic problems

• brain disorders

• sepsis

• shock

Infants & Children

• Diarrhea and Vomiting– Can cause dehydration– Infants are more susceptible than adults– Care

• Monitor airway & breathing

• Give oxygen

• Save sample of vomitus

Infants & Children• Croup (laryngotracheobronchitis)

– Viral infection of upper airway– Most often in children 6 months - 4 YOA– Mostly in fall & winter– Edema of the larynx – Signs & Symptoms

• slow onset

• child generally wants to sit upright

• barking cough

• Fever (100-101oF)

Infants & Children

• Croup (Care)– Position of comfort– Cool humidified air (oxygen if available)– Check for

• inspiratory stridor

• nasal flaring

• tracheal tugging

• tracheal retraction

– Activate EMS if airway becomes obstructed

Infants & Children• Epiglottitis

– Acute infection & inflammation of the epiglottis

– Bacterial infection (usually Haemophilus influenza)

– Usually children over 4 YOA

Infants & Children– Signs & Symptoms

• Rapid onset

• Prefers to sit up

• Brassy cough (not a barking cough)

• High fever (102-104oF)

• Occasional stridor

• Pain upon swallowing, sore throat

• Shallow breathing & Dyspnea

• Drooling

• Epiglottis red & swollen (do not attempt to visualize)

Infants & Children

• Epiglottitis (Care)– Position of comfort– Cool humidified air (oxygen if available)– Activate EMS ASAP

Infants & Children

• Treatment Summaries– Airway Obstructions– Respiratory Distress– Seizures– Altered mental status– Poisoning– Shock– Near-drowning

Infants & Children

• Treatment Summaries– Sudden Infant Death Syndrome (SIDS)

• Sudden unexplained death during sleep of an apparently healthy baby in its first year of life

• 6500 - 7500 babies each year

• Not caused by:– external suffocation or vomiting or choking

– may possibly be related to nerve cell development in the brain or in the tissue chemistry or the respiratory system or in the heart

Infants & Children

• Typical SIDS patient– will show periods of cardiac slowdown– temporary cessation of breathing (sleep apnea)– eventually infant will stop breathing and will

not begin again on their own• It is not up to you to diagnose

• All you know is respiratory or cardiac arrest

• You show treat the patient unless– rigor mortis is present

• Be sure to treat emotional trauma of parent

Infants & Children

• Trauma– Pediatric considerations

• MVAs– unrestrained children tend to have head & neck injuries

– restrained children tend to have abdominal injuries

• Children Struck by Autos– head injury &

– abdominal injury with possible internal bleeding

– lower extremity injury

Infants & Children

• Other Pediatric Trauma Considerations– PASG

• Use them only if they fit the patient

• Do not inflate the abdominal compartment

• indicated for the treatment of the pediatric trauma patient with signs of severe hypoperfusion & pelvic instability

– Burns

Infants & Children

• Care for the Trauma Patient– Assure airway (use modified jaw thrust)– Suction as necessary– Provide high conc. Oxygen– Ventilate with BVM as needed– Transport immediately– Continue to reassess en route– Assess and threat other injuries en route if time

permits