Prehospital Academy Lesson 40.1
The Pediatric Patient
This lesson provides a foundational overview of pediatric patients, emphasizing the key anatomical, physiological, and emotional differences between children and adults. For EMTs, recognizing these distinctions is crucial for adapting assessment techniques and providing age-appropriate care in the prehospital setting.
Key Differences: Children vs. Adults
Children are not simply "mini-adults." Their bodies and responses to illness and injury differ significantly, requiring a tailored approach to emergency medical care.
Anatomical Differences:
Larger head relative to body size (especially infants), increasing risk of head injury.
Softer, more pliable bones and open growth plates, leading to different fracture patterns.
Larger tongue and epiglottis, smaller airways, making airway obstruction more likely.
Proportionately larger body surface area, leading to greater heat loss and risk of hypothermia.
Less developed abdominal musculature and more exposed organs, increasing vulnerability to abdominal trauma.
Physiological Differences:
Higher metabolic rate and oxygen demand.
Faster heart rate and respiratory rate.
Limited ability to compensate for blood loss (tend to "crash" suddenly after prolonged compensation).
Immature immune system, making them more susceptible to infections.
Limited glycogen stores, increasing risk of hypoglycemia.
Emotional and Developmental Differences:
Varying levels of cognitive and emotional development influence their ability to communicate symptoms and cooperate with care.
Separation anxiety is common, especially in toddlers.
Fear of medical procedures and personnel.
Reliance on caregivers for history and reassurance.
Developmental Stages and EMT Approach
EMTs should tailor their approach based on the child's age and developmental stage.
Infants (Birth to 12 months):
Physical: Begin to control gaze (0-2 months), recognize caregivers (2-6 months), sit without support and crawl (6-12 months), begin teething.
Cognitive/Emotional: Babble (6-12 months), may speak first words (by 12 months), develop object permanence, separation anxiety starts around 6-12 months.
EMT Approach: Keep warm, support head and neck. Involve parents/caregivers. Speak softly, use gentle touch. Distraction with toys.
Toddlers (1-3 years):
Physical: Walk, run, climb, explore.
Cognitive/Emotional: Developing language, "no" is common, temper tantrums, strong separation anxiety, egocentric.
EMT Approach: Perform assessment on parent's lap if possible. Allow child to hold a comfort item. Offer simple choices. Explain procedures in simple terms (e.g., "I'm going to count your fingers"). Avoid lying.
Preschoolers (3-5 years):
Physical: More coordinated, tricycle, jump.
Cognitive/Emotional: Magical thinking, vivid imagination, fear of mutilation, want to please, developing social skills.
EMT Approach: Explain procedures simply. Allow them to "help." Use praise. Reassure them that they did nothing wrong.
School-aged Children (6-12 years):
Physical: Organized sports, rapid growth.
Cognitive/Emotional: Understand cause and effect, modest, desire control, peer influence.
EMT Approach: Talk to the child, explain what you are doing, respect modesty. Ask about school and friends. Allow them some control where appropriate.
Adolescents (13-18 years):
Physical: Puberty, rapid physical changes.
Cognitive/Emotional: Seek independence, body image concerns, peer importance, risk-taking behavior, concrete thinking can become abstract.
EMT Approach: Treat as an adult. Respect privacy. Explain procedures thoroughly. Allow for questions. Inquire about drugs/alcohol/sexual activity discreetly if relevant.
General Principles for Pediatric Assessment and Care
Maintain Scene Safety: As always, ensure the environment is safe.
Parental Involvement: Involve parents/caregivers as they are a valuable source of information and comfort.
Pediatric Assessment Triangle (PAT): A rapid, hands-off assessment tool:
Appearance (tone, interactiveness, consolability, look/gaze, speech/cry)
Work of breathing (abnormal breath sounds, abnormal posture, retractions, flaring)
Circulation to the skin (pallor, mottling, cyanosis)
Least Invasive First: Start with non-invasive assessment and interventions.
Keep Warm: Children lose heat rapidly.
Age-Appropriate Equipment: Use correct size equipment (e.g., blood pressure cuffs, airway adjuncts).
Reassessment: Children can decompensate rapidly; frequent reassessment is critical.
Critical Thinking Questions
You are called to a scene involving a 3-year-old with a high fever and difficulty breathing. How would your initial approach and assessment differ from that of an adult patient, considering the child's developmental stage and physiological differences?
Explain the significance of the Pediatric Assessment Triangle (PAT) and how each component guides your initial impression of a pediatric patient.
A 9-month-old infant presents with signs of severe dehydration. What physiological differences in an infant make them more susceptible to rapid dehydration compared to an adult?
How would you communicate with and gain the cooperation of a fearful 6-year-old patient who needs an arm splinted?
Discuss the anatomical reasons why airway obstruction is a greater concern in pediatric patients than in adults.