1. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Infants and Children

2. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Outline Differences in A & P Assessment Common Conditions Child Abuse

3. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. High Anxiety… It is a natural human reaction to feel a high level of anxiety when faced with a seriously ill or injured child Lack of familiarity adds to anxiety

4. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Airway Differences Trachea more narrow –More easily obstructed Tongue larger Back of head relatively large compared to rest of body

5. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Head Size Larger head can occlude the airway Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

6. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Head Size Padding may be necessary Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

7. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Airway Considerations Carefully measure a suction tip to avoid over-insertion and trauma –Use a bulb syringe to suction the nose and mouth of an infant or toddler Use tongue blade to insert OPA Nasal airways are not used in infants and children

8. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Other Differences Compensate well but only for a short period of time Can deteriorate rapidly Lose heat quickly

9. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assessment Family-centered care “Doorway” assessment –Interaction with environment –Playing –Moving around –Attentive to voices, faces, activity –Eye contact

10. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Communicate at eye level Involve family Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

11. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Respiratory Status Breathing effort Chest expansion Nasal flaring Retractions Noisy breathing Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

12. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Circulation Palpate brachial pulse for infants and toddlers Palpate radial pulse for older children Assess skin color, temperature, and moisture

13. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Common Conditions Problems with airway/breathing Circulatory failure Seizures Altered mental status SIDS

14. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Respiratory Distress If untreated, may lead to respiratory failure and respiratory arrest Signs –Infant with RR > 60 breaths/min –Child with RR > 30–40 breaths/min –Nasal flaring –Muscle retractions between the ribs

15. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Respiratory Failure RR < 20 breaths/min (infant) RR < 10 breaths/min (child) Limp muscle tone Unresponsive Slow or absent pulse Cyanosis

16. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Kids Decompensate Rapidly The infant or child in respiratory distress may decompensate rapidly Continuously monitor the airway, breathing, pulse, level of consciousness & skin color

17. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Circulatory Failure Causes Trauma Congenital heart defects Poisoning and accidental overdose

18. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Circulatory Failure Signs Increased heart rate Absent pulses in the extremities Pale, cool skin Altered mental status

19. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Involves abnormal electrical activity in the brain, often accompanied by convulsions Convulsions can be dramatic but seizures are not usually life threatening Prolonged seizures are of particular concern Seizure

20. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Seizure Causes Fever Epilepsy Infections Poisoning Low blood sugar Trauma (especially to the head) Inadequate oxygen to the brain Unknown causes

21. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. History is Important! Is this the first seizure the child has had? –If not, is this seizure different from the usual pattern? Does the child take medications for seizures or other problems? Could the child have taken other medication or poisonous substances? Has the child been ill or injured recently?

22. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Seizure Management If the seizure is ongoing, or another seizure occurs, observe and be able to describe the seizure Move objects by which the patient could be injured out of the way Ask all bystanders, except the parents, to leave the area

23. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Seizure Management Never force anything into patient’s mouth –Can’t swallow their tongue –May cause trauma/bleeding and airway obstruction Never restrain patient Place soft object under head if necessary

24. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Seizure Management Make sure the airway is clear –Once the seizure stops keep the airway open if the patient is unresponsive or place in the recovery position Ventilate patient if cyanotic –Although it may be difficult, if the patient is cyanotic during the seizure, attempt to ventilate, if possible

25. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Altered Mental Status Causes –Low blood sugar –Poisoning –Seizure –Infection –Head injury –↓ O 2 to brain

26. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. SIDS May occur in the first year of life Causes are not fully understood Some risk factors Often the baby is discovered in the morning or at naptime Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

27. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. SIDS Management Interacting with the parents may be the most important role –Calm and comfort the parents as much as possible –Realize that the parents may display a range of emotions including grief, guilt, disbelief and anger –Avoid making any statements that might suggest the parents are to blame

28. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. SIDS Management Attempt to resuscitate unless obvious signs of death Although all infant deaths are not SIDS you do not to make that determination

29. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Motor Vehicle Crashes Unrestrained children may sustain head and neck injuries Improperly restrained children may have abdominal and lower spine injuries Many infant car seats and booster seats are improperly installed, leading to injury

30. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Wearing a helmet is important in preventing head injuries Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

31. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Pedestrian vs Vehicle Children struck by a vehicle are prone to head, spine, abdominal, and femur injuries

32. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Specific Injuries Head –The head is proportionally larger and heavier, and is much more easily injured Chest –Ribs are softer and more pliable –Underlying injuries may occur without rib fracture

33. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Specific Injuries Abdomen –The location of the organs is more prominent, so they are less protected Extremities –Managed the same as in adults

34. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Child Abuse and Neglect Abuse = improper or excessive actions so as to cause injury or harm Neglect =giving insufficient attention to someone requiring that attention Can occur in any kind of family in any environment All healthcare providers must be able to recognize signs and symptoms of abuse and neglect

35. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Possible Indicators Fresh cigarette burn to palm

36. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Possible Indicators Human bites

37. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Possible Indicators “Dunking” burns to the feet

38. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Abuse Signs and Symptoms Multiple bruises in various stages of healing Injuries that are inconsistent with the story given as to their cause Patterns of injury such as cigarette burns, belt or whip marks, handprints Repeated calls to the same address

39. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Abuse Signs and Symptoms Scalding burns with a “glove” pattern Untreated burns Parents seem unconcerned with the injury Conflicting stories from child & caregiver; or from two different caregivers The child is afraid to discuss how the injury occurred

40. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Shaken Baby Syndrome Violent shaking of an infant or small child can lead to severe injuries of the brain –There may be no visible external injuries –Can be fatal Often the child will present with seizures –When responding to an infant or child with a seizure keep shaken baby syndrome in mind

41. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Neglect Lack of adult supervision Appearance of malnutrition Unsafe/unsanitary living environment Untreated chronic illness (asthma, seizures, or diabetes without prescriptions refilled) Untreated injuries or acute illness

42. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Abuse / Neglect Management Don’t accuse the parents –This can create an unmanageable scene and delay transport Report what you see and hear, not your interpretation of these findings

43. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Need for Debriefing Make use of CISM resources available to you as needed –Injury, death, abuse or neglect of a child can lead to strong emotional responses on the part of healthcare providers –Recognize your feelings and any signs or symptoms of post-traumatic stress in yourself and others involved in the call

44. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Summary Children and infants have special needs due to their differences in size and overall proportions Principles of care are the same as in adults, but techniques and equipment may need to be altered Be alert to different patterns of injury than in an adult

45. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Questions?