Special Considerations for Pediatric Trauma Patients

Adapted from "Pediatric Trauma" by the Long Beach Fire Training Center and the Long Beach Fire Department. Used with permission. Thank you, Long Beach!

Consider these unique pediatric characteristics when assessing and treating young trauma patients.

Characteristic	Prehospital considerations
Because children are smaller, they are more susceptible to a wide range of injuries.	The EMT-I should consider the mechanism of injury in relation to the relative size of the child. Appropriate equipment must be selected for the child's size.
Children have larger heads in proportion to the rest of their bodies.	Children tend to land on their heads when they fall. Spinal immobilization techniques may need to be modified to ensure proper alignment. Extra padding may be needed under the shoulders to maintain a neutral, inline position of the head.
Children have more elastic connective tissue that allows for more stretching and tearing.	Serious spinal cord injury can occur without any visible signs of trauma. If the child has any signs of a deficit or if the mechanism of injury is serious, suspect serious injury and take appropriate precautions.
Children's organs are closer together. More organs can be injured when energy is released during a traumatic situation.	Children may initially look uninjured and suddenly deteriorate. The mechanism of injury and frequent reassessment of the patient can help the EMT-I recognize potentially serious pediatric trauma.
The child's skeleton is not fully calcified and has many active growth centers. This allows the child to withstand severe force without breaking bones. The lack of external injury can be deceptive. Your patient may have severe internal injury to the organs!	Initial and ongoing assessments are essential to detect subtle changes in the pediatric trauma victim. EMT-Is should develop an acute index of suspicion based on the mechanism of injury. Even minor injuries can result in damage to growth plates and should be evaluated by a physician. Remember that the E.R. nurses and physicians cannot see the scene—they rely on you to relay significant details regarding the mechanism of injury. For example, vehicle speed, ejection distance, extrication time and fall height.
Children have less body fat and a larger surface area in relation to body weight so they can lose heat very rapidly.	Cover and maintain body temperature. Observe for hypothermia.
Total circulating volume per unit of body weight is approximately 80-90 mL/kg, greater than an adult by 25%.	Estimated blood loss is significantly related to relative body weight. For example, a blood loss of 150 mL in a 25 kg child is approximately 10% of her/his circulating volume.
Blood pressure is an unreliable indicator of shock in the pediatric trauma victim.	Children can maintain a normal blood pressure until the late stages of shock. Careful observation for other indictors such as skin signs, capillary refill, tachycardia, and tachypnea.

Posted 11.12.03

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