Compiled from
“Brady Emergency Care – Ninth Edition” 2001
Chapter 31 – Infants and Children
Assessment
 Pediatric Vital signs differ slightly from adults with
typically higher pulse and respiration rates, and lower
blood presssures.
 Younger patients may not be able to convey symptoms
well making assessment more critical.
 Respiratory failure and shock can occur more easily in
children and should be top of mind.
 Assess children with the assistance of parent or
caregiver when possible.
Vital Signs – Respiration rates
 Newborn
 Infant (1-5 mos)
 6 mos – 5 yrs
 6-10 yrs
 Adolescent
30-50
25-40
20-30
15-30
12-20
Note these are normal rates – conditions/stress may elevate these.
Lower rates should prompt consideration of assisted ventilations.
Vital Signs – Pulse Rates
 Newborn
 Infant (1-5 mos)
 6-12 mos
 Toddler (1-3 yrs)
 Preschool (3-5 yrs)
 School age (6-10yrs)
 Adolescent (11-14)
120-160
90-140
80-140
80-130
80-120
70-110
60-105
Vital Signs – Blood Pressure
 3-5yrs
 6-10yrs
 11-14yrs
78-116
80-122
88-140
Notes – BP rarely measured on children under 3
Above numbers are systolic. Diastolic is typically 2/3 systolic.
Respiratory Difficulty - Symptoms





Stridor / crowing / grunting
Muscle retractions in ribs/shoulders
Flared nostrils
Cyanosis
Decreased or increased rate
Respiratory Difficulty - Treatment
 Treat with O2, maintain airway, consider blocked
airway for young children.
 Ventilate at 20 breaths/min
 Use pediatric BVM – watch rise/fall – appropriate
volume
 Position head neutral / sniffing position
 Small trachea / large tongue
Shock
 Causes
 dehydration
 infection
 trauma
 blood loss
 allergy
 poisoning
 Signs
 rapid respirations
 cold
 weak peripheral pulse
 decreased urine output
 altered mental status
 no tears when crying
Ventilate an infant and child mannequin.
Shock - Treatment
 Maintain Airway
 High flow O2
 Keep warm
 Immediate transport
 Suction carefully – vegas nerve
Fever
 Various causes
 Cool cautiously
Seizures
 Various causes – History?
 Maintain airway
 Treat for shock
 Transport – Epilepsy patients or other history may
defer transport.
Altered Mental Status
 Causes
 Poisoning
 Injury
 Illness
 Treatment
 Airway
 Treat for shock
 Transport (Immediate) – Diabetic deferral
Poisoning
 Determine substance if possible
 Call Medical Control (ER Doc on duty) or AMR
 Treatment
 Maintain airway
 Treat for shock
 Transport
Near Drowning
 Rule out causes
 Injuries
 Illness
 Treatment
 CPR
 Maintain airway
 Treat for hypothermia
 Treat for shock
 Treat any trauma
Trauma - Injury Patterns / anatomy
 Head – larger in proportion / lead with their head
 Chest – elastic ribs allow internal injuries with no
outer signs
 Abdomen – belly breathers, watch abdomen for
respirations
Burns
 Consider percentages of burned area – rule of nines.
 Sterile dry dressings
 Avoid hypothermia
Abuse and Neglect
 Psychological
 Neglect
 Physical
 Sexual
Physical Abuse Injury Patterns
 shaped welts
 swelling
 poorly/partially healed bruises
 high instance of broken bones or injuries
 bites
 burns
Determining Signs of Abuse
 Multiple visits for the same patient or siblings
 Past injuries – note back and buttocks
 Poorly healed wounds/fractures (i.e. no treatment
received)
 Cigarette burns, bilateral burns, glove/stocking pattern.
 Caregiver responses:
 Different stories for the same injury
 Unconcerned
 Difficulty controlling anger
 Depression
 Refusal of transport / reluctant to give history
Physical Abuse –
Treatments and Procedures
 Treat injuries as per protocols
 Document well
 Gather information in a passive manner
 DO NOT accuse or pass judgment
 DO report your suspicions to AMR staff and IC
 Verify documentation
Special Needs Children
 Tracheostomy tubes –obstruction, dislodged,
bleeding.
 Suction tube, maintain airway
 Ventilators – maintain airway and manually ventilate
as needed.
 Central IV line – infection, bleeding, clooted, cracked.
 Apply pressure and dress as needed.
 Gastric tubes – Assure airway, asses mental status –
hypoglycemic
 Shunts – Maintain airway as necessary