Developmental stages:

1. Neonate(birth to one month)- the time when problems

may arise from congenital problems or birth problems,
when ill will be fussy or listless
2. Infant (one month to twelve months)- follows
movements with eyes, active, developing a personality,
anxious with strangers, cries for mom, is used to being
undressed, wants to be warm emotionally and physically
3. Toddler (one year to three years)- starting to assert
independence but do not like being separated from
parents, may not like being touched or undressed, tend
to be uncooperative, frightened easily and overreact,
may understand more than they let you know, may want
favorite toy or object
4. Pre-school ( three years to six years)- motor skills being
refined, very aware of their bodies, may feel an injury is
their fault, curious, communicative and cooperative if you
explain what you are doing
5. School age (six years to twelve years)- cooperates, but
wants explanations and wants their opinion listened to, able
to give own history, can complete with parents if
necessary, fear pain and punishment, worries about being
separated from parents, does not like body exposed,
worries about death and disability, may regress in an
emergency
6. Adolescent ( twelve years to eighteen years)- feel
they are indestructible, vary in physical and
emotional development, not comfortable with their
changing bodies, usually modest and are embarrassed
about being examined, need rescuers respect, wants
to be treated as an adult, but may need the support of
a child. ***An adolescent patient involved in an
accident which seems minor in nature( like a bike
crash) may be most concerned of their vanity!!!!!
 Assessment techniques for peds. and children:
Approach- slow, take your time. Start at the feet and work
up as long as the ABCs are intact. Introduce self by first
name and ask childs name. Smile. Never lie. Be physically
on the childs same level, allow child to hold favorite toy or
object. May want to do lung sounds before they start crying.
Involve parents- may be a source of information, do not
separate child unless absolutely necessary, give adults
emotional support and keep them informed, and involve
them with care when practical.
Communication- speak at the level of the patient (no big
words). Talk calmly, non-judgmental, honest and direct. Do
not display any postures that may imply fear or harm to
child.
 Assessment cont

1. General impression- Assess mental status, patients effort of

breathing, color, quality of crying or speech
2. Interaction with parent- does childs behavior seem normal
for age, is child playing, is child moving around, is the child
attentive or non attentive, does the child make eye contact with
you, does he or she recognize parent, or does the child respond
to parents calling.
 Airway Anatomical and Physiological concerns

1. Infants and children have smaller airways throughout the

respiratory system and are therefore easily blocked by secretions
and airway swelling.
2. The tongue is large relative to small mandible and can easily
block airway in an unconscious infant or child.
3. Positioning the airway is different in infants and children, do not
hyperextend the neck (head-tilt-chin-lift)
4. Infants are obligate nose breathers, so suctioning a secretion filled
nasopharynx can dramatically improve breathing problems in an
infant.
5. Children can compensate well for short periods of time with
respiratory emergencies by
Increasing breathing rate and increased effort of breathing,
unfortunately this is followed by a rapid decompensation due to
rapid respiratory muscle fatigue and general fatigue of the infant.
Recognizing Respiratory Emergencies in Children

1. Upper airway obstruction- Stridor on inspiration

2. Lower airway disease- Wheezing and increased breathing effort
on exhalation, and rapid breathing (tachypnea) without stridor
3. Complete airway obstruction- No crying, no speaking, cyanosis,
or no coughing

Oxygen therapy
Use of child non rebreather mask is indicated for shock and most
respiratory problems. Children may be uncomfortable with having a
mask placed on their face; the EMT may have to modify their
approach to providing O2 to children. Try inserting O2 tubing into a
paper cup or hold the mask a few inches from the patients face.
 Medical Emergencies in children:
1. Altered level of consciousness-
a) Common causes- Hypoxia, seizures, fever, diabetes,
poisonings/ingestions, meningitis
b) Signs and symptoms- genially depends on cause,
use pediatric Glasgow Coma Scale to determine
severity
c) Management- ABCCV, 02, Poison Control Center
if poisoning, rapid transport.
2. Seizures
a) Causes- fever, poisonings, head trauma, meningitis,
hypoxia, diabetes, seizure disorder
b) Signs and symptoms- postictal, apenic, still seizing,
warm to touch and flushed if febrile, caudal
stiffness if meningitis
 a) Management ABCCV, 02, ventilatory assist if status
seizures, position for emesis, have suction ready protect
patient from harm, cooling measures if indicated
(remove heavy cloths, tepid water dont cool to
quickly), rapid transport.
3. Respiratory distress disorders-
A) Croup (Laryngo-trachea-bronchitis) viral infections
from 6 months to 4 years
Partial airway obstruction due to swelling in airway,
Inspiratory stridor, recent upper respiratory infection, and
onset usually at night, barking cough seal like.
B) Epiglottitis- bacterial infection 3 years to 7 years old
Partial airway obstruction due to swelling of epiglottis,
Inspiratory stridor, no recent illness, sudden onset at night
high fever, tripod position, drooling because it hurts to
swallow.
C) Bronchiolitis- respiratory illness similar to asthma.
Airway inflammation below the trachea. Usually infant to 2
years of age.
Cough, may or may not have fever, wheezing.

General signs of early respiratory distress

Nasal flaring
Tracheal tugging
Retractions- intercostals, supraclavicular, subcostal
Abdominal retractions
Anxiety
Audible wheezing
 Recognition continue
Stridor
Grunting
Cyanosis
Altered mental status
Poor peripheral perfusion
Altered Mental Status
Severe use of accessory muscles (late sign)
Management of respiratory distress
ABCCV, 02
Do not examine or place anything in the patients
mouth
Rapid transport
 Dehydration:
Causes- vomiting and or diarrhea, lack of fluid intake,
prolonged fever
Signs and Symptoms- history of vomiting or diarrhea
by itself or as a part of another illness,(skin may be
warm and dry due to infection not pale cool diaphoretic)
sunken eyes, decreased number of wet diapers,
depressed fontannelles (infants), altered level of
consciousness, may be hypotensive
ABCCV, 02, rapid transport *** manage hypotension
Abdominal pain
Appendicitis, influenza, gas/indigestion, bacterial
infection of the bowels
Abdominal cramps or pain, tenderness to palpation,
distention of belly, knees pulled up, fever, vomiting,
diarrhea, constipation, blood in emesis or stool,
dehydration or shock
 ABCCV, 02, allow patient to assume comfortable
position, nothing by mouth, rapid transport.
Poisonings
Generally accidental ingestion of poisons or toxic
substances.
Unexplained altered level of consciousness, unusual
odors or stains on childs skin/ breath or cloths, open
containers in the area vomiting.
ABCCV, 02, be prepared for vomiting (position
patient for drainage), rapid transport, Poison Control
Center.
 Foreign object ingestion:

Children are natural vacuums cleaners they explore

their world by placing things in their mouths like
buttons, beads, change, marbles, peas, corn, Cat box
Almond Rocas etc.
Abnormal discharges, abdominal pain, patient choking,
vomiting
ABCCV, symptomatic treatment, if complete obstruction
attempt removal by approved CPR methods, if partial
obstruction try to keep the patient calm, supportive care
and transport, reassess pt. regularly.
Pediatric Shock
Failure of the cardiovascular system to provide an
adequate supply of blood due to trauma or medical
emergencies.

Altered level of consciousness, cool clammy skin(

though children not in puberty may not sweat therefor not
clammy), decreased activity, rapid thready pulse, pale
skin, anxiety, delayed capillary refill. May have flat neck
veins(early sign of hypotension, hypo perfusion).
ABCCV, 02, keep child warm, rapid transport. Remember
the very young and old may have delayed signs and
symptoms of shock yet deteriorate rapidly
 Meningitis:
Viral or bacterial infection of the lining of the brain
and spinal cord (meninges). Majority of cases is children
from one month to five years.
Fever, altered level of consciousness, headache, stiff
neck, sensitivity to light, seizures, rash, moving or
touching patient seems to cause pain.
ABCCV, 02, be prepared for seizures, vomiting, rapid
transport.
 Child Abuse:*Pay attention to S&S
Child abuse- improper or excessive action so as to
injure or cause harm. Physical, psychological or sexual.
Neglect- (giving insufficient attention or respect to
someone who has a claim to that attention). Cloths
abnormally unclean, less than normal response
behaviors for age, bad diaper rashes, child left without
proper caregiver, bottles unclean, appear
undernourished.
Physical- slap marks, reoccurring broken bones,
multiple bruises in various stages of healing, accidental
injuries dont match the history, bite marks, burns
(cigarette, iron, object), unexplained altered level of
consciousness
Sexual- obvious results of sexual assaults, significant
history (rare).
Multiple bruising
Multiple bruises with object shape
Cigarette burns
 Care for a patient of abuse or neglect

ABCCV, Symptomatic care, treat and care for any

injuries the patient may have, provide emotional
support, dont ask child to talk about it, follow gut
feelings (remember you MUST report on suspicion), if
suspected sexual follow guidelines discussed for
evidence preservation.
 SIDS (Sudden Infant Death Syndrome)
Sudden and unexpected death of an apparently healthy
infant, usually under one year of age, and due to an
undeterminable cause. All races, all ethnicity and all
social-economic groups are affected. Usually 2-6 month
old infant who has been asleep.
Maternal risk factors- cigarette smoking, drug abuse,
teenage mothers, short inter-pregnancy intervals, delay
in obtaining prenatal care.
Infant factors- pre-term infants, low birth weights,
slower or delayed growth during infancy, multiple
gestations (twins).
Lividity, pinpoint hemorrhages that appear to be
bruises on body, frothy, blood tinged mucous from
mouth and or nose, rigor mortis, found in unusual
position, indentation from pressure of solid object.
 Assess the scene for infant position, unusual objects in
area infant found, unusual environmental conditions,
any medications
Do an in-depth history as to what happened, where
and how patient was found, when baby last seen, had
patient been ill prior.
Initiate BLS care if obvious death criteria not present
ABCCV CPR, notify law enforcement
Care for family, be ready to advise the parents the
infant is deceased, and why no care is being given.
Prepare for stages of the death and dying process
intervene as necessary, family may be hysterical.
Remember dont transport the infant for the benefit of
the parents if the infant meats the obvious death criteria.
IF IN DOUBT TREAT AND TRANSPORT.
 Infants and children with special needs

1. Tracheostomy tube- some complications seen: obstructions,

bleeding, air leak, dislodged, or infected. The EMT needs to provide
and maintain an open airway, suction and transport.
2. Ventilators- There are many types of home ventilators the parents
should be familiar with the operation of the machine. If the machine
is having some of malfunction or the EMT needs to transport the
patient to a medical facility the EMT needs to assure the patient has a
good airway, provide BVM assistance if needed and transport the
patient
3. Central lines- IV lines that are placed near the heart for long term
use. Some complications you may encounter are: cracked line,
infection, clotting off or bleeding. If the patient is actively bleeding
provide bleeding control and rapid transport O2 if patient condition
requires.