LITTLE PEOPLE
Children, though we may affectionately refer to them as “Little People” or other cute names to describe their diminutive size, are NOT to be treated as just LITTLE patients.
Nationally, it is estimated that LESS than ten percent of serious emergency transports involve young pediatric patients. Officially, pediatric refers to those from newborn to 21 years of age; according to the US Department list of approximate age ranges for these phases of life are: (1) infancy, between birth and 2 years of age; (2) childhood, from 2 to 12 years of age; and (3) adolescence, from 12 to 21 years of age. With few exceptions, young adults at least 18 years old can make their own decisions about receiving or rejecting medical care. In the rare case of an “emancipated minor”, they have the right to make medical decisions for themselves even if not yet 18 years of age.
Responders encountering a very young child will often find a youngster who is scared, probably unable to voice their problem, and possibly uncooperative in submitting to a thorough examination. In addition, young children are often accompanied by scared parents who might not be willing to let “a stranger” handle their child, or who insist on THEIR version of what the child is suffering from. In any case, there are definite challenges for the EMS providers in ascertaining the problem and beginning treatment.
When an ambulance crew shows up to a scene involving a child, they need to be aware of the surroundings – not just for the crew’s safety, but also for any clues regarding the child’s condition. For example, if the crew responds to a child having difficulty breathing and upon entering the premises they find more than one individual suffering from headaches, flushed, or also having difficulty breathing, they should immediately suspect something such as CO poisoning EVEN IF THE CHILD IS THE ONLY ONE WITH SEVERE INDICATIONS. Situational awareness might also point to abuse, neglect, ingested poisons, environmental problems, and more. This could be an important way to begin assessing the non-verbal child’s ailments.
Responding crews should use the “Pediatric Assessment Triangle” (from “Academic Life in Emergency Medicine” https://bit.ly/4bxzeY5) to gather their first-look impression of a sick or injured child: Appearance, Work of Breathing, Circulation to Skin. Appearance will be based upon your initial view of the child and include their movement (age appropriate); Breathing should include normal or struggling, sounds, and rate; Skin includes, pale, flushed, diaphoretic, and cyanosis. Immediately after your initial assessment, move on to the ABCDEs.
It's important to understand the anatomical differences in a young child. Their head-to-body proportion is bigger than that of an adult. Children have less blood in their system and are more likely to bleed out from a wound. Their airways are generally smaller and their tongues larger, which can lead to more severe choking problems. A child’s skin is thinner which can lead to less temperature control and easier dehydration. A rapid heart rate is often the first sign of shock, which can progress quite rapidly.
First responders will often be anxious when treating a young child with an injury or illness. The younger the child, normally, the less they can relay their symptoms and pain. Using a quick and thorough assessment is your best action to take care of your young patient. Working with your team and providing rapid and safe transport to a medical facility should be your main goal.
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