Principles of Pediatric Care

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What are the three major pediatric milestones?

1. Putting things in mouth and crawling

2. Showing attachment to caregiver

3. Speech Patterns

Pediatric Milestons from 2 months to 2 yrs?

6-12 months:

Crawl independently + Put things in mouth = choking hazard

9-12 months:

Stand support, may begin to take steps

12-18 months:

Walk independtly, maybe run.

18 months - 2 yrs:

Climbs stairs w help

Newborn vs Infants

Newborn less than a month

Infant 1 month - 1 yr

Infant: increase RR and greater surface area-volume ratio (Greater heat loss)

Do pediatrics have difference in head size?

Yes, they have fontanelles: soft spots on newborn’s head where bones have not yet fused.

close at 7-18 months

*sunken fontanelles are a sign of possible dehydration

*large occipital region can block airway

Pediatric Anatomic differences in Head.

Nose and nares smaller/narrower

Tongue larger % of oropharynx

Cricoid ring narrowest point of airway, (glottis is narrowest point for adults)

Infant Tidal volume and blood volume

Tidal Volume: 6-8 mL vs 500 ml in adult

Blood Volume: 80 ml/kg, normally 70 mL/kg

Abnormal signs

Not Crying

Lethargy: Severely Ill Sign
Dehydrated

Bolus dosing

Newborn (0-28 days): 10 mL/kg can repeat twice, max out at 30/mL kg total
Over 1 month: 20 mL/kg, may repeat twice (max our at 60 mL/kg total)

IO sizing

Adult: Yellow

Over 6 months: Blue

Under 6 months: Pink

BGL site for infant

Sole of the foot

Sign of Pediatric Respiratory Distress

Nasal Flaring and Seesaw Breathing

Normal Pediatric Vital Signs

Elevated HR, RR,

Decreased SBP

Normal temp

Under age of 3, BP generally not appropriate.

Capillary refill (<2 sec) a strong predictor of adequate perfusion

Pediatric GCS

Respiratory Distress

Less than 2y/o: nasal suction first

Over 2y/o: consider bronchodilators

Stridor: humidified O2

Bronchiolitis

Lower airway infection (viral) (2 month - 2 yr)

Most common: November-April

Increased mucous secretions, Increased lower airway edema

Signs: Fever, cough, dyspnea, expiratory wheezing, inspiratory rales

Treatment: SpO2 > 95, nebulized bronchodilators, and IV if dehydrated

Laryngotracheobronchitis (Croup)

Lower airway infection (viral) (6 month - 3 years)

Condition gets worse at night: inspiratory stridor, hoarseness, seal bark

Expiratory Stridor severe case

Treatment: Nebulized O2, Nebulzied epi

Epiglottitis

Lower airway infection (2 yr - 6 yr)

Almost completely occluded airway

Pertussis

Bacterial infection

S/S Whoop coughing

Febrile Seizures

A seizure triggered by rapid rate of fever increasing

Sudden Infant Death Syndrome (SIDS)

Brief Resolved Unexplained Event (BRUE)

Sudden onset always transport, start CPR in absence of death

Common cause of SIDS

Preventable Sleep-Related (suffocation) death

Pediatric MVC

Birth - 2: rear facing car seat

2 - 4: forward facing car seat

4 - 8: booster seat

8+ seat belt

*Improper restrained child usually activates trauma

*pediatrics often sustain blunt force trauma

Children compensation?

compensate very well due to cardiovascular mechanisms until they cant decompensate very quickly

What causes cardiac arrests in pediatric populations

Hypoxia is the most common cause of arrests in pediatrics

When do you start compressions in infant?

HR below 60

Estimating pediatric body weight