Infants and Children Mosby items and derived items

Outline • Differences in A&P • Assessment Mosby items and derived items © 2007,

High Anxiety… • It is a natural human reaction to feel a high level of anxiety when faced with a seriously ill or injured child • Lack of familiarity adds to anxiety Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Airway Differences • Trachea more narrow – More easily obstructed • Tongue larger • Back of head relatively large compared to rest of body Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Head Size • Larger head can occlude the airway Mosby items and derived items

Head Size • Padding may be necessary Mosby items and derived items © 2007,

Airway Considerations • Carefully measure a suction tip to avoid over-insertion and trauma – Use a bulb syringe to suction the nose and mouth of an infant or toddler • Use tongue blade to insert OPA • Nasal airways are not used in infants and children Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Other Differences • Compensate well but only for a short period of time • Can deteriorate rapidly • Lose heat quickly Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Assessment • Family-centered care • “Doorway” assessment – – Interaction with environment Playing Moving around Attentive to voices, faces, activity – Eye contact Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

• Communicate at eye level • Involve family Mosby items and derived items

Respiratory Status • • • Breathing effort Chest expansion Nasal flaring Retractions Noisy breathing

Circulation • Palpate brachial pulse for infants and toddlers • Palpate radial pulse for older children • Assess skin color, temperature, and moisture Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Common Conditions • Problems with airway/breathing • Circulatory failure • Seizures • Altered mental status • SIDS Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Respiratory Distress • If untreated, may lead to respiratory failure and respiratory arrest • Signs – Infant with RR > 60 breaths/min – Child with RR > 30– 40 breaths/min – Nasal flaring – Muscle retractions between the ribs Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Respiratory Failure • • • RR < 20 breaths/min (infant) RR < 10 breaths/min (child) Limp muscle tone Unresponsive Slow or absent pulse Cyanosis Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Kids Decompensate Rapidly • The infant or child in respiratory distress may decompensate rapidly • Continuously monitor the airway, breathing, pulse, level of consciousness & skin color Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Circulatory Failure Causes • Trauma • Congenital heart defects • Poisoning and accidental overdose

Circulatory Failure Signs • Increased heart rate • Absent pulses in the extremities • Pale, cool skin • Altered mental status Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Seizure • Involves abnormal electrical activity in the brain, often accompanied by convulsions • Convulsions can be dramatic but seizures are not usually life threatening • Prolonged seizures are of particular concern Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Seizure Causes • • • Fever • Trauma (especially to the head) Epilepsy • Inadequate oxygen to Infections the brain Poisoning Low blood sugar • Unknown causes Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

History is Important! • Is this the first seizure the child has had? – If not, is this seizure different from the usual pattern? • Does the child take medications for seizures or other problems? • Could the child have taken other medication or poisonous substances? • Has the child been ill or injured recently? Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Seizure Management • If the seizure is ongoing, or another seizure occurs, observe and be able to describe the seizure • Move objects by which the patient could be injured out of the way • Ask all bystanders, except the parents, to leave the area Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Seizure Management • Never force anything into patient’s mouth – Can’t swallow their tongue – May cause trauma/bleeding and airway obstruction • Never restrain patient • Place soft object under head if necessary Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Seizure Management • Make sure the airway is clear – Once the seizure stops keep the airway open if the patient is unresponsive or place in the recovery position • Ventilate patient if cyanotic – Although it may be difficult, if the patient is cyanotic during the seizure, attempt to ventilate, if possible Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Altered Mental Status • Causes – Low blood sugar – Poisoning – Seizure – Infection – Head injury – ↓ O 2 to brain Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

SIDS • May occur in the first year of life • Causes are not fully understood • Some risk factors • Often the baby is discovered in the morning or at naptime Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

SIDS Management • Interacting with the parents may be the most important role – Calm and comfort the parents as much as possible – Realize that the parents may display a range of emotions including grief, guilt, disbelief and anger – Avoid making any statements that might suggest the parents are to blame Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

SIDS Management • Attempt to resuscitate unless obvious signs of death • Although all infant deaths are not SIDS you do not to make that determination Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Motor Vehicle Crashes • Unrestrained children may sustain head and neck injuries • Improperly restrained children may have abdominal and lower spine injuries • Many infant car seats and booster seats are improperly installed, leading to injury Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

• Wearing a helmet is important in preventing head injuries Mosby items and

Pedestrian vs Vehicle • Children struck by a vehicle are prone to head, spine,

Specific Injuries • Head – The head is proportionally larger and heavier, and is much more easily injured • Chest – Ribs are softer and more pliable – Underlying injuries may occur without rib fracture Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Specific Injuries • Abdomen – The location of the organs is more prominent, so they are less protected • Extremities – Managed the same as in adults Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Child Abuse and Neglect • Abuse = improper or excessive actions so as to cause injury or harm • Neglect =giving insufficient attention to someone requiring that attention • Can occur in any kind of family in any environment • All healthcare providers must be able to recognize signs and symptoms of abuse and neglect Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Possible Indicators • Fresh cigarette burn to palm Mosby items and derived items ©

Possible Indicators Human bites Mosby items and derived items © 2007, 2004 by Mosby,

Possible Indicators “Dunking” burns to the feet Mosby items and derived items © 2007,

Abuse Signs and Symptoms • Multiple bruises in various stages of healing • Injuries that are inconsistent with the story given as to their cause • Patterns of injury such as cigarette burns, belt or whip marks, handprints • Repeated calls to the same address Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Abuse Signs and Symptoms • Scalding burns with a “glove” pattern • Untreated burns • Parents seem unconcerned with the injury • Conflicting stories from child & caregiver; or from two different caregivers • The child is afraid to discuss how the injury occurred Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Shaken Baby Syndrome • Violent shaking of an infant or small child can lead to severe injuries of the brain – There may be no visible external injuries – Can be fatal • Often the child will present with seizures – When responding to an infant or child with a seizure keep shaken baby syndrome in mind Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Neglect • • Lack of adult supervision Appearance of malnutrition Unsafe/unsanitary living environment Untreated chronic illness (asthma, seizures, or diabetes without prescriptions refilled) • Untreated injuries or acute illness Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Abuse / Neglect Management • Don’t accuse the parents – This can create an unmanageable scene and delay transport • Report what you see and hear, not your interpretation of these findings Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Need for Debriefing • Make use of CISM resources available to you as needed – Injury, death, abuse or neglect of a child can lead to strong emotional responses on the part of healthcare providers – Recognize your feelings and any signs or symptoms of post-traumatic stress in yourself and others involved in the call Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Summary • Children and infants have special needs due to their differences in size and overall proportions • Principles of care the same as in adults, but techniques and equipment may need to be altered • Be alert to different patterns of injury than in an adult Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.