Pediatric Emergencies

Children are not simply small adults. They have unique anatomical, physiological, and psychological differences that affect assessment, treatment, and communication. Understanding these differences is essential for providing effective prehospital care to pediatric patients.

Pediatric Assessment Triangle (PAT)

The PAT is a rapid, across-the-room assessment performed in the first 15-30 seconds without touching the child. It evaluates three components:

Appearance (TICLS)

• Tone -- Is the child moving, or limp?
• Interactiveness -- Does the child respond to you, make eye contact?
• Consolability -- Can the child be comforted by a caregiver?
• Look/Gaze -- Does the child focus on objects/faces or have a vacant stare?
• Speech/Cry -- Is the cry strong or weak? Is speech age-appropriate?

Work of Breathing

• Nasal flaring
• Retractions (suprasternal, intercostal, subcostal, substernal)
• Head bobbing (infants)
• Accessory muscle use
• Audible abnormal sounds (wheezing, stridor, grunting)
• Grunting is an ominous sign indicating the child is trying to create auto-PEEP

Circulation to Skin

• Skin color: pink, pale, mottled, cyanotic
• Obvious bleeding

Pediatric Vital Sign Ranges

Quick formula for minimum systolic BP: 70 + (2 x age in years) for children 1-10 years

Fever and Febrile Seizures

Fever Management

• Fever itself is not dangerous in most cases -- it is the body's response to infection
• High concern: infants under 3 months with fever >100.4 degrees F (38 degrees C) -- always transport
• Remove excess clothing and blankets
• Do NOT give medications for fever reduction in the field unless per local protocol

Febrile Seizures

• Occur in children ages 6 months to 5 years
• Typically associated with temperatures >102 degrees F (39 degrees C)
• Usually generalized tonic-clonic, lasting <5 minutes
• Child is postictal (confused, sleepy) afterward
• Generally benign but frightening for parents
• EMT management: protect from injury, manage airway, transport for evaluation

Pediatric Respiratory Emergencies

Respiratory emergencies are the leading cause of cardiac arrest in children (unlike adults where cardiac causes predominate).

Croup (Laryngotracheobronchitis)

• Viral infection causing upper airway swelling
• Age: typically 6 months to 3 years
• Barking (seal-like) cough and inspiratory stridor
• Often worse at night
• "Steeple sign" on X-ray
• Treatment: keep child calm, humidified oxygen, avoid agitating the child

Epiglottitis

• Bacterial infection causing supraglottic swelling -- life-threatening
• Rapid onset of high fever, severe sore throat, drooling
• Tripod positioning and refusal to lie down
• Muffled "hot potato" voice
• Do NOT examine the throat -- may cause complete airway obstruction
• Treatment: keep child calm, allow position of comfort, high-flow O2, rapid transport

Bronchiolitis (RSV)

• Viral lower airway infection, most commonly respiratory syncytial virus (RSV)
• Age: typically under 2 years
• Wheezing, crackles, nasal flaring, retractions
• Copious nasal secretions
• Treatment: gentle suctioning of secretions, oxygen as needed, transport

Dehydration Assessment

Non-Accidental Trauma (NAT) / Child Abuse

EMTs are mandatory reporters -- you are legally required to report suspected child abuse.

Red Flags for NAT

• Injuries inconsistent with the reported mechanism ("fell off the couch" but has spiral fracture)
• Bruises in various stages of healing (different colors = different ages)
• Patterned injuries (belt marks, cigarette burns, bite marks)
• Injuries in unusual locations (back, buttocks, genitals, ears)
• Delay in seeking medical care
• Caregiver story changes or is inconsistent between caregivers
• Child is excessively fearful, withdrawn, or overly compliant
• Multiple ED visits for injuries

EMT Responsibilities

• Document findings objectively and thoroughly
• Note the environment and interactions between child and caregiver
• Report to appropriate authorities (Child Protective Services, law enforcement)
• Do NOT confront the caregiver or accuse them of abuse
• Your job is to report, not to investigate

SIDS / SUIDS

• Sudden Infant Death Syndrome (SIDS): Unexplained death of an infant under 1 year
• Sudden Unexpected Infant Death Syndrome (SUIDS): Broader term including SIDS and other causes
• Highest risk: 1-4 months of age, during sleep
• Scene assessment is critical -- note sleeping position, bed sharing, environment
• If no obvious signs of death (rigor mortis, lividity), begin resuscitation
• Provide compassionate support to devastated family members
• Preserve the scene for investigation

Pediatric Medication Dosing

• Pediatric doses are weight-based (mg/kg)
• Use a length-based resuscitation tape (Broselow tape) when weight is unknown -- it estimates weight based on the child's length and provides pre-calculated medication doses and equipment sizes
• Common weight estimation: weight (kg) = (age in years + 4) x 2 (for children 1-10 years)
• Always verify doses against local protocols