Pediatric ABC’s
In a nutshell……..
Approach to Pediatric Patients
They are not just “little adults”.
They have structural differences.
They have metabolic differences.
They respond differently to pain, emotions,
environment.
They required a different approach, treatment
and interventions.
Anatomic/Physiological Differences in
Child vs.. Adult
ABCD’s
Airway
Breathing
Circulation
Development
What are the differences?
Airway
Anatomic and Physiological Differences
• Children have smaller upper and lower airways.
• Supporting airway cartilage not developed until
school years.
• Pediatric larynx is more anterior than adults; and
narrowest portion is at level of cricoid cartilage –
adults are wide.
• They have larger tongues which easily obstruct
the airway of an unconscious child.
Airway
• Their heads are typically larger and neck muscles
weaker, which contributes to airway obstruction.
• Neonates/infants are obligate nose breathers. A
simple clogged nose and obstruct a baby’s airway.
• They are more susceptible to obstruction from
mucous, edema, food, liquids, etc…
E.g.: 1mm swelling in a 4mm airway of a neonate
vs. 10mm airway of an adolescent=
50% airway reduction vs. 20% airway reduction
Breathing
Chest Wall:
• Cartilaginous ribs of infants/children are twice as
compliant as adults, and chest wall will retract
during respiratory distress. E.g.: Indrawing,
retraction.
• Structurally children’s ribs are horizontally
oriented which contributes to decreased chest
expansion.
• Their intercostal muscles are poorly developed,
therefore infants rely on diaphragm/abdominal
muscles to breath.
Breathing
• Alveoli increase in size and number during
childhood so lung volumes increase.
• Lung compliance is low in infants and
increases as the child grows.*
• They have less compensatory reserve, they
tire easily.
• Children have a metabolic rate that is twice
that of an adult which causes increased O2
demands.
Circulation
• The myocardium of a child/infant is less
compliant so they tend to increase heart rate
(HR) rather than stroke volume (SV) to increase
and maintain cardiac output (CO).
• Fall in HR will produce a significant fall in CO.
• They have less blood volume, so small blood loss
can cause hypovolemic shock. (70-80cc/kg)
• They have strong compensatory mechanisms to
maintain CO. (late signs)
Signs of Poor Systemic Perfusion
Tachycardia
Irritability, then lethargy
Decreased urine output
Mottled colour or pallor
Cool extremities with delayed capillary refill.
Metabolic acidosis
***Late Signs***
Hypotension, Bradycardia
Development
Approaching children.
Talking to children.
Determining their level of understanding.
Tools to convey information to small children.
Family presence and involvement.
Coping with distraught children and very ill
children.
Summary
Pediatric Patients are not “Little Adults”.
Assessment
When assessing…..
Determine if the child “looks good” or “looks
bad”
Colour and skin perfusion
Level of activity
Responsiveness
Feeding and digestion
Social/family dynamics.
Questions?