EMT Review: Infants and Children

Differences in body structure

Faster breathing rate, faster pulse.
Larger head: more prone to head injuries. Need shoulder padding when in a supine position.
Larger tongue: more prone to airway obstruction.
Narrower airway: more prone to airway obstruction.
Higher Epiglottis: more prone to aspirations.
Relies more on the diaphragm to breath: minimal chest movement, assess breathing by looking at abdominal movement.
More pliable ribs: less protection of internal organs.
More fragile lung tissue: more prone to pulmonary contusion.
Smaller blood volume: more prone to shock from blood loss.
Faster metabolic rate: need enough oxygen to support metabolism, more prone to hypoxia.
Larger skin surface area to body volume ratio: more prone to hypothermia.

Keep infants and children warm.
Elevate the shoulders with padding when in a supine position.
Look for movement of the abdomen instead of chest movement when assessing breathing.
Back slaps used for infants instead of abdominal thrusts.
Blow-by oxygen for infants who would not tolerate a mask.
Cap refill for infants is assessed by pressing on the forearm.
Patent airway is especially important because the airway is more prone to compromise in infants and children.
Report any child abuse or neglect.
Use "baby" sized cervical collars and immobilization devices.

Respiratory failure is the leading medical cause of cardiac arrest in infants and children.
Early signs
- Nasal flaring.
- See-saw respirations.
- Abnormal breathing sounds: stridor, grunting, wheezing.
- Neck muscle use.
- Retractions: neck, intercostals, below the rib cage, above the clavicles and sternum.
Late signs
- Cyanosis.
- Weakness and altered mental status.
- Rapid but shallow breathing.
- Head bobbing.
Respiratory arrest
- Breathing rate less than 10 per minute.
- Irregular breathing.
- Limp and unresponsive.
- Decreased heart rate.
- Weak pulse and blood pressure.

Croup: infection of the upper airway. Signs include the "seal bark" cough, stridor, and respiratory distress. Apply humidified oxygen to such patients.
Epiglottitis: infection of the epiglottis. Pain upon swallowing, drooling, fever, stridor, and respiratory distress. Do not insert anything into the airway because anything can irritate and cause swelling that can completely block the airway. Apply oxygen and PPV if needed.
Asthma: airway inflammation and swelling. Administer prescribed MDIs and apply humidified oxygen.
Bronchiolitis: infection of the bronchioles lining. Causes wheezing, fever, rapid heart and respiratory rate, and shortness of breath.
Cardiac arrest: Choose an appropriate AED that is suitable for infants. For infants and children, when heart rate drops below 60, begin chest compressions.
Meningitis: infection of the brain and spinal cord lining. Signs include fever, infection, lethargy, malaise, and rash. Wear a mask and use gloves and gowns if meningitis suspected.