Approach to the Acute Child

Question 1

In what ways are children different from adults?

Answer 1

• Anatomical differences
• Physiological differences
• Compensate well and decompensate quickly
• Communication challenges
• Parents usually present

Question 2

How do children’s airways differ to adults?

Answer 2

• Large head to body size
• Short necks
• Large tongue
• Obligate nasal breathers
• Nasal passages easily obstructed
• Compressible floor of mouth and trachea
• High anterior larynx

Question 3

How does children’s breathing differ from adults?

Answer 3

• Small total surface area for air tissue interface
• Lower airways small- easily obstructed
• Diaphragmatic breathing
• Fewer type I (slow twitch) fibres- easy fatigue
• Soft non-calcified bones- v. compliant chest wall- recession and in-drawing
• Horizontal ribs- less expansion

Question 4

How do children’s respiratory system differ physiologically from adults?

Answer 4

• Higher metabolic rate/ oxygen consumption (Respiratory rate higher and gradually falls)
• Oxygen dissociation curve shifted left in neonates (HbF predominance) (Neonates tolerate slightly lower saturations)
• Immature lung vulnerable to insult
• Apnoea may occur in babies

Question 5

How do children’s cardiovascular system differ physiologically from adults?

Answer 5

• Circulating blood volume- 70-80 ml/kg (Small loss can make a big difference)
• Circulation changes from in-utero to ex-utero (PDAs/ PFO may remain open for several months)
• ECG features vary with age
• Stroke volume increases with size (Heart rate higher and gradually falls)
• Systemic vascular resistance progressively rises from birth

Question 6

What does bradycardia indicate in a child?

Answer 6

Life threatening pathology

Question 7

Why are babies more susceptible to infections?

Answer 7

Immature immune system

Question 8

Why can communication with children be difficult?

Answer 8

• Babies have no or limited language
• Talkative children can become quiet
• They get scared
• Play is useful

Question 9

What are the normal vitals for a <1 year?

Answer 9

Heart rate
110-160

Respiratory rate
30-40

Systolic BP
80-90

Question 10

What are the normal vitals for 1-2 years old?

Answer 10

Heart rate
100-150

Respiratory rate
25-35

Systolic BP
85-95

Question 11

What are the normal vitals for 2-5 years?

Answer 11

Heart rate
95-140

Respiratory rate
25-30

Systolic BP
85-100

Question 12

What are the normal vitals for 5-12 years?

Answer 12

Heart rate
80-120

Respiratory rate
20-25

Systolic BP
90-110

Question 13

What are the normal vitals for >12 years?

Answer 13

Heart rate
60-100

Respiratory rate
15-20

Systolic BP
100-120

Question 14

viral induced wheeze?

Answer 14

older kid (more than 1 year)
wheeze and NO crepitations
typical urticaria symptoms- blocked nose, fever

Question 15

bronchiolitis presentatentpaion?

Answer 15

less than 1 year old
wheeze AND crepitations
typical URTI symptoms- blocked nose, temp

Question 16

treatment for viral induced wheeze?

Answer 16

Start multi-dose salbutamol

Sats monitoring applied
Consider oxygen if sats dropping 
Start salbutamol MDI
Observe in PAU 
Repeat observations in 60 mins
Senior review
Any parental questions?