1. Infants & Children

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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)

8. 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

9. 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

10. Infants & Children Blood Volume smaller volumes
infant ml
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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. Infants & Children Focused History, Vitals & Detailed Physical
Normal Vital Sign Ranges
Newborn to 160
Infant 0-5 months to 140
Infant 6-12 months to 140
Toddler 1-3 years to 130
Preschooler 3-6 years 80 to120
School-age 6-12 years 70 to110
Adolescent years 60 to105

19. 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 years 12 to 20

20. Infants & Children
Blood Pressure Normal Ranges

21. 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

22. 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

23. 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)

24. Infants & Children Hypothermia Causes cold air and/or cold water temps
ingestion of alcohol or drugs
metabolic problems
brain disorders
sepsis
shock

25. Infants & Children Diarrhea and Vomiting Can cause dehydration
Infants are more susceptible than adults
Care
Monitor airway & breathing
Give oxygen
Save sample of vomitus

26. 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 ( oF)

27. 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

28. Infants & Children Epiglottitis
Acute infection & inflammation of the epiglottis
Bacterial infection (usually Haemophilus influenza)
Usually children over 4 YOA

29. Infants & Children Signs & Symptoms Rapid onset Prefers to sit up
Brassy cough (not a barking cough)
High fever ( oF)
Occasional stridor
Pain upon swallowing, sore throat
Shallow breathing & Dyspnea
Drooling
Epiglottis red & swollen (do not attempt to visualize)

30. Infants & Children Epiglottitis (Care) Position of comfort
Cool humidified air (oxygen if available)
Activate EMS ASAP

31. Infants & Children Treatment Summaries Airway Obstructions
Respiratory Distress
Seizures
Altered mental status
Poisoning
Shock
Near-drowning

32. 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
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

33. 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

34. 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

35. 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

36. 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