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 Body Surface 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 years 15 to 30 Adolescent 12-18 years 12 to 20

Infants & Children Blood Pressure Normal Ranges

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 Burns 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