EMS chapter 24 - care for infants and children

much of this is in more depth in other chapters

what does PAT stand for?

pediatric assessment triangle

what does SIDS stand for?

sudden infant death syndrome.

It is when an infant dies and you can’t find the cause even after a thorough investigation (death scene investigation, autopsy, and review of clinical history)

what does SUID stand for?

Sudden unexpected infant death (roughly 3,400 deaths a year).
Causes: SIDS (41%), accidental suffocation in bed (27%), unknown cause (32%)

How to gain a child’s trust

1. approach slowly, establish eye contact from safe distance, get permission to get closer

2. be at eye level

3. if gardien/care giver isn’t there, tell child someone will call them

4. be friendly, gentle, and calm (even when you need to be firm)

5. ensure child understands what you say

6. determine life threatening injuries, care for them

7. examine (in secondary) from toes to head

8. tell child what you will do BEFORE you do it

9. dont lie

care for infants vs toddlers vs early childhood vs adolescent

infants: generally dislike oxygen masks. warm hands+stethoscope before care. Chest heart +lungs, then head

toddlers: generally dislike oxygen masks. check from toe to head. Give child options (ex: do you want me to check the foot or arm first?)

Early childhood: are modest - don’t remove any clothing. Allow child to give you history

Adolescent: they feel indestructible. Responder of same gender examines if possible. Might do assessment away from their parents

fontanel

soft spots on a baby’s head. It pulsates w/ each heart beat. If it’s sunken, the baby may be dehydrated. Sometimes they bulge when the child is crying - wait until they’re quiet to assess

difference between adult and child body proportions

children have larger head and tongue in comparison to their body. Airway is smaller in proportion to an adult as well.

abdominal injuries in children

they’re more susceptible to injury because they’re less protected by abdominal muscles (especially liver and spleen, which are large for size of the cavity).

skin and blood in children

large amount of skin surface area compared to total mass.

They have much less blood - infants have around 12 oz of blood total. By age 8, roughly 2 liters of blood.

Pulse rates in children/infants

newborn to 3 months: 85-205
3 months to 2 years: 100-190
2 to 10 years: 100-190
greater than 10 years: 60-100

pulse quality signs

rapid: exertion, anxiety, pain, fever, dehydration, blood loss, shock

slow: head injury, drugs, some poisons, some heart problems, lack of oxygen

Irregular: arrhythmia (abnormal electrical activity in heart)

how to use PAT

1. appearance - are they alert (AVPU)? Normal behavior?

2. work of breathing

3. circulation - skin color (pale, flushed) and condition (blotchy, uniform color?) Check capillary refill

retractions

the inward movement of the soft tissue between the ribs (intercostal muscles) when a child breathes in

how to do finger sweeps on children/infants

with your gloved, little finger

administering oxygen for infants (or smaller children)

use blow-by, or put a paper cup around the oxygen tubing

croup

upper respiratory infection (affects larynx, trachea, and bronchi) - common in children + infants, barking like cough or stridor

DO NOT ATTEMPT TO EXAMINE THE MOUTH

epiglottitis

inflammation of the epiglotis - signs/symptoms are sudden onset, rapid fever, cold-like symptoms, difficulty swallowing, drooling, chin thrusted out, mouth wide open.
DO NOT ATTEMPT TO EXAMINE THE MOUTH

BP in children

adolescent: 113-131 over 64-83
middle childhood (6-12): 96-115 over 57-76
early childhood (3-6): 88-106 over 42-63

slow moving and slow response meaning in children?

it often means low oxygen levels.

giving child oxygen

tell them to breath in normally, then blow out forcefully (like blowing out birthday candles). Breathe at same time as them (to show how to do it)

signs of decompensatedd shock (for children and infants)

• Decreasing heart and respiratory rates

• Decreasing blood pressure

• Weak or absent pulse

• Delayed capillary refill

• Decreased urine output (info from parents/caregiver) indicates dehydration

• Altered mental status

• Pale, cool, moist skin

• Sunken fontanels in infants

care for fever if the they’re hot to touch

• Undress the child down to underwear or diaper, but do not allow them to become chilled.

• Cover the child with a towel soaked in tepid (not cold) water if the fever is the result of heat exposure. If the child starts to shiver, stop the cooling process and cover them with a light blanket.

• Place damp, cool cloths on the child’s forehead.

• Call for the transport of any child who has had a seizure. If the child is seizing, monitor airway and breathing.

Be cautious of hypothermia

lividity meaning

when blood has pooled along whatever side the child was lying on

rule of 9’s version for children

• 18% to the head and neck

• 18% to the chest and abdomen

• 18% to the entire back

• 14% to each leg

• 9% to each arm

• 1% to the genital area

signs and symptoms of abuse

• Depression

• Withdrawal

• Extreme anxiety

• Low self-esteem

• Feelings of shame and guilt

• Fear

• Lack of normal social skills because of isolation

• Avoidance of eye contact

• Extreme passiveness or compliance

• History or indications of self-harm

• Substance abuse

• Increased tension or anxiety when the abuser is present

care for sexual abuse

• Dress wounds and provide other appropriate care for injuries.

• Save any evidence of sexual abuse, such as soiled or stained clothing. Do not let the child use the bathroom to urinate or defecate. If the child must go to the bathroom, try to collect it in a container for hospital examination. Do not let the child drink any fluids or eat anything. Do not wash the child or let the parent wash the child or change their clothes.

• Minimize embarrassment by covering the child with a blanket if necessary.

• Arrange for transport

• Provide emotional support and reassurance. Try to engage them with toys or age-appropriate conversation or games.

shaken-baby syndrome

form of child abuse that occurs when an abuser violently shakes an infant or small child, creating a whiplash-type motion that causes acceleration-deceleration injuries.
signs:

• unresponsive

• pale

• not eating or acting normal or not breathing

• vomiting

• tired or irritable

checking car seats in car crashes

Did the seat move, even a little? Was the safety seat in the rear or front seat? Was the safety seat a rear-facing or forward-facing seat? Is there structural damage to the seat?