Developmental stages:1. Neonate(birth to one month)- the time when problems

may arise from congenital problems or birth problems,when ill will be fussy or listless

2. Infant (one month to twelve months)- followsmovements with eyes, active, developing a personality,anxious with strangers, cries for mom, is used to beingundressed, wants to be warm emotionally and physically

3. Toddler (one year to three years)- starting to assertindependence but do not like being separated fromparents, may not like being touched or undressed, tendto be uncooperative, frightened easily and overreact,may understand more than they let you know, may wantfavorite toy or object

4. Pre-school ( three years to six years)- motor skills being refined, very aware of their bodies, may feel an injury is their fault, curious, communicative and cooperative if you explain what you are doing

5. School age (six years to twelve years)- cooperates, but wants explanations and wants their opinion listened to, able to give own history, can complete with parents if necessary, fear pain and punishment, worries about being separated from parents, does not like body exposed, worries about death and disability, may regress in an emergency

6. Adolescent ( twelve years to eighteen years)- feel they are indestructible, vary in physical and emotional development, not comfortable with their changing bodies, usually modest and are embarrassed about being examined, need rescuers respect, wants to be treated as an adult, but may need the support of a child. ***An adolescent patient involved in an accident which seems minor in nature( like a bike crash) may be most concerned of their vanity!!!!!

Assessment techniques for peds. and children: Approach- slow, take your time. Start at the feet and work

up as long as the ABC’s are intact. Introduce self by first name and ask child’s name. Smile. Never lie. Be physically on the child’s same level, allow child to hold favorite toy or object. May want to do lung sounds before they start crying.

Involve parents- may be a source of information, do not separate child unless absolutely necessary, give adults emotional support and keep them informed, and involve them with care when practical.

Communication- speak at the level of the patient (no big words). Talk calmly, non-judgmental, honest and direct. Do not display any postures that may imply fear or harm to child.

Assessment cont 1. General impression- Assess mental status, patients effort of

breathing, color, quality of crying or speech 2. Interaction with parent- does child’s behavior seem normal

for age, is child playing, is child moving around, is the child attentive or non attentive, does the child make eye contact with you, does he or she recognize parent, or does the child respond to parents calling.

Airway Anatomical and Physiological concerns 1. Infants and children have smaller airways throughout the

respiratory system and are therefore easily blocked by secretions and airway swelling.

2. The tongue is large relative to small mandible and can easily block airway in an unconscious infant or child.

3. Positioning the airway is different in infants and children, do not hyperextend the neck (head-tilt-chin-lift)

4. Infants are obligate nose breathers, so suctioning a secretion filled nasopharynx can dramatically improve breathing problems in an infant.

5. Children can compensate well for short periods of time with respiratory emergencies by Increasing breathing rate and increased effort of breathing, unfortunately this is followed by a rapid decompensation due to rapid respiratory muscle fatigue and general fatigue of the infant.

Recognizing Respiratory Emergencies in Children

1. Upper airway obstruction- Stridor on inspiration 2. Lower airway disease- Wheezing and increased breathing effort

on exhalation, and rapid breathing (tachypnea) without stridor 3. Complete airway obstruction- No crying, no speaking, cyanosis,

or no coughing Oxygen therapy Use of child non rebreather mask is indicated for shock and most respiratory problems. Children may be uncomfortable with having a mask placed on their face; the EMT may have to modify their approach to providing O2 to children. Try inserting O2 tubing into a paper cup or hold the mask a few inches from the patients face.

Medical Emergencies in children:1. Altered level of consciousness-

a) Common causes- Hypoxia, seizures, fever, diabetes,poisonings/ingestion’s, meningitis

b) Signs and symptoms- genially depends on cause,use pediatric Glasgow Coma Scale to determineseverity

c) Management- ABCCV, 02, Poison Control Centerif poisoning, rapid transport.

2. Seizuresa) Causes- fever, poisonings, head trauma, meningitis,

hypoxia, diabetes, seizure disorderb) Signs and symptoms- postictal, apenic, still seizing,

warm to touch and flushed if febrile, caudalstiffness if meningitis

a) Management – ABCCV, 02, ventilatory assist if status seizures, position for emesis, have suction ready protect patient from harm, cooling measures if indicated (remove heavy cloths, tepid water don’t cool to quickly), rapid transport.

3. Respiratory distress disorders- A) Croup (Laryngo-trachea-bronchitis) viral infections

from 6 months to 4 years Partial airway obstruction due to swelling in airway,

Inspiratory stridor, recent upper respiratory infection, and onset usually at night, barking cough seal like.

B) Epiglottitis- bacterial infection 3 years to 7 years old Partial airway obstruction due to swelling of epiglottis,

Inspiratory stridor, no recent illness, sudden onset at night high fever, tripod position, drooling because it hurts to swallow.

C) Bronchiolitis- respiratory illness similar to asthma. Airway inflammation below the trachea. Usually infant to 2 years of age. Cough, may or may not have fever, wheezing. General signs of early respiratory distress Nasal flaring Tracheal tugging Retractions- intercostals, supraclavicular, subcostal Abdominal retractions Anxiety Audible wheezing

Recognition continue Stridor Grunting Cyanosis Altered mental status Poor peripheral perfusion Altered Mental Status Severe use of accessory muscles (late sign) Management of respiratory distress ABCCV, 02 Do not examine or place anything in the patients

mouth Rapid transport

Dehydration: Causes- vomiting and or diarrhea, lack of fluid intake,

prolonged fever Signs and Symptoms- history of vomiting or diarrhea

by itself or as a part of another illness,(skin may be warm and dry due to infection not pale cool diaphoretic) sunken eyes, decreased number of wet diapers, depressed fontannelles (infants), altered level of consciousness, may be hypotensive

ABCCV, 02, rapid transport *** manage hypotension Abdominal pain Appendicitis, influenza, gas/indigestion, bacterial

infection of the bowels Abdominal cramps or pain, tenderness to palpation,

distention of belly, knees pulled up, fever, vomiting, diarrhea, constipation, blood in emesis or stool, dehydration or shock

ABCCV, 02, allow patient to assume comfortableposition, nothing by mouth, rapid transport.

Poisonings Generally accidental ingestion of poisons or toxic

substances. Unexplained altered level of consciousness, unusual

odors or stains on child’s skin/ breath or cloths, opencontainers in the area vomiting.

ABCCV, 02, be prepared for vomiting (positionpatient for drainage), rapid transport, Poison ControlCenter.

Foreign object ingestion: Children are natural vacuums cleaners they explore

their world by placing things in their mouths like buttons, beads, change, marbles, peas, corn, Cat box Almond Rocas etc.

Abnormal discharges, abdominal pain, patient choking, vomiting

ABCCV, symptomatic treatment, if complete obstruction attempt removal by approved CPR methods, if partial obstruction try to keep the patient calm, supportive care and transport, reassess pt. regularly.

Pediatric Shock Failure of the cardiovascular system to provide an

adequate supply of blood due to trauma or medical emergencies.

Altered level of consciousness, cool clammy skin( though children not in puberty may not sweat therefor not clammy), decreased activity, rapid thready pulse, pale skin, anxiety, delayed capillary refill. May have flat neck veins(early sign of hypotension, hypo perfusion).

ABCCV, 02, keep child warm, rapid transport. Remember the very young and old may have delayed signs and symptoms of shock yet deteriorate rapidly

Meningitis: Viral or bacterial infection of the lining of the brain

and spinal cord (meninges). Majority of cases is children from one month to five years.

Fever, altered level of consciousness, headache, stiff neck, sensitivity to light, seizures, rash, moving or touching patient seems to cause pain.

ABCCV, 02, be prepared for seizures, vomiting, rapid transport.

Child Abuse:*Pay attention to S&S Child abuse- improper or excessive action so as to

injure or cause harm. Physical, psychological or sexual. Neglect- (giving insufficient attention or respect to

someone who has a claim to that attention). Cloths abnormally unclean, less than normal response behaviors for age, bad diaper rashes, child left without proper caregiver, bottles unclean, appear undernourished.

Physical- slap marks, reoccurring broken bones, multiple bruises in various stages of healing, accidental injuries don’t match the history, bite marks, burns (cigarette, iron, object), unexplained altered level of consciousness

Sexual- obvious results of sexual assaults, significant history (rare).

Multiple bruising

Multiple bruises with object shape

Cigarette burns

Care for a patient of abuse or neglect ABCCV, Symptomatic care, treat and care for any

injuries the patient may have, provide emotional support, don’t ask child to talk about it, follow “gut” feelings (remember you MUST report on suspicion), if suspected sexual follow guidelines discussed for evidence preservation.

SIDS (Sudden Infant Death Syndrome) Sudden and unexpected death of an apparently healthy

infant, usually under one year of age, and due to anundeterminable cause. All races, all ethnicity and allsocial-economic groups are affected. Usually 2-6 monthold infant who has been asleep.

Maternal risk factors- cigarette smoking, drug abuse,teenage mothers, short inter-pregnancy intervals, delayin obtaining prenatal care.

Infant factors- pre-term infants, low birth weights,slower or delayed growth during infancy, multiplegestations (twins).

Lividity, pinpoint hemorrhages that appear to bebruises on body, frothy, blood tinged mucous frommouth and or nose, rigor mortis, found in unusualposition, indentation from pressure of solid object.

Assess the scene for infant position, unusual objects inarea infant found, unusual environmental conditions,any medications

Do an in-depth history as to what happened, whereand how patient was found, when baby last seen, hadpatient been ill prior.

Initiate BLS care if obvious death criteria not presentABCCV CPR, notify law enforcement

Care for family, be ready to advise the parents theinfant is deceased, and why no care is being given.Prepare for stages of the death and dying processintervene as necessary, family may be hysterical.Remember don’t transport the infant for the benefit ofthe parents if the infant meats the obvious death criteria.IF IN DOUBT TREAT AND TRANSPORT.

Infants and children with special needs 1. Tracheostomy tube- some complications seen: obstructions,

bleeding, air leak, dislodged, or infected. The EMT needs to provide and maintain an open airway, suction and transport.

2. Ventilators- There are many types of home ventilators the parents should be familiar with the operation of the machine. If the machine is having some of malfunction or the EMT needs to transport the patient to a medical facility the EMT needs to assure the patient has a good airway, provide BVM assistance if needed and transport the patient

3. Central lines- IV lines that are placed near the heart for long term use. Some complications you may encounter are: cracked line, infection, clotting off or bleeding. If the patient is actively bleeding provide bleeding control and rapid transport O2 if patient condition requires.