Pediatric Trauma

4.1. What are the Features Specific to Pediatric Patients?

There are specific differences between children and adults to be considered in emergency settings. Children are at a disproportionately increased risk for different reasons:

• High respiratory rate: Children are more vulnerable to aerosolized agents, chemicals, carbon monoxide, etc.
• Less fluid reserve: Children are more susceptible to dehydration.
• Less circulating volume: Smaller amounts of blood loss can lead to hypovolemic shock.
• Developmental vulnerabilities: Infants and toddlers are less able to escape a disaster; they cannot follow directions or make immediate choices.
• Anatomic and physiologic differences:
  • Prominent occiput: Flexion of the neck on spine boards.
  • Increased amount of secretions: May require more suctioning.
  • Infants <3 months are obligate nose breathers: Susceptible to anatomic obstruction and infections.
  • Relatively larger tongue compared with mandible: May make use of bagvalve-mask or intubation difficult.
  • Large adenoids: Bleeding is common, especially with nasal intubations.
  • Flexible omega-shaped epiglottis, with anterior location: Intubation and visualization of the larynx require lifting the epiglottis with a straight blade.
  • Smaller diameter of the subglottic region until about age 8; therefore, noncuffed endotracheal tubes (ETTs) are used until ~8 years of age to avoid cuff trauma.