The Injured Child

Question 1

why do children get injured

Answer 1

• Interaction between
o Stage of development
 Anatomical, behavioural, locomotor, physiological, psychological
o Their environment
o Those around them
• Think about
o Audio-visual cues, written warnings, climbing, inquisitive nature, playing, risky behaviour

Question 2

what injuries to chidlren sustain?

Answer 2

•	Fractures 
o	Buckle fracture of distal radius
o	Clavicle fracture
o	Toddler’s fracture of tibia 
o	Greenstick fracture 
o	Growth plate injuries 
•	Wounds
•	Burns and scalds 
•	Head injury
•	Drowning
o	Confounders
	Cold
	Alcohol
	Drugs
	Hypoglycaemia

Question 3

why do children injure differently? size

Answer 3

Smaller target and as such a relatively greater amount of energy is absorbed for the same force of impact. There is a large surface area:volume ratio and as such heat loss is significant in small children. Children have relatively larger heads than adults, so it is easily injured. Children have a small mass and as such drug doses and fluid requirements differ from adults. Different equipment and techniques have to be used for children.

Question 4

why do children injure differently? skeleton

Answer 4

The bones of children are incompletely calcified and as such they are soft and springy. This leads to them deforming rather than breaking on impact. They are poor at absorbing energy. As such they provide less protection for vital organs.

Question 5

why do children injure differently? inside

Answer 5

Children have less elastic connective tissue that leads to shearing and degloving. Crowding of poorly protected vital organs: liver, spleen, bladder are intra-abdominal.

Question 6

why do children injure differently? metabolism

Answer 6

Thermoregulation is difficult for children. They have little brown fat and an immature shivering mechanism. Children are poikilothermic (internal temperature varies considerably). It is important to remember environmental conditions e.g. RTCs.

Children are prone to hypoglycaemia as there is little glycogen stored in the liver. This can be exacerbated by hypothermia and vice versa. Hypoglycaemia develops quickly in sick children.

Question 7

why do children injure differently? mechanism of injury

Answer 7

Always take a good history of the injury. Read the wreckage and consider if the injuries fit with the story. Remember non accidental injury.

Question 8

injury patterns in children

Answer 8

SCIWORA
•	Spinal
•	Cord 
•	Injury
•	Without
•	Radiological
•	Abnormality
Lap belt syndrome

Question 9

how do children respond to injury? psychology

Answer 9

•	Communication difficulties
o	Too young or afraid to describe symptoms
o	Have to rely on non-verbal cues
o	Good rapport essential
•	Fear affects vital signs
•	Distressed parents
•	Effects on staff

Question 10

how do children respond to injury? long term effects

Answer 10

Psychological recovery from trauma. Effects on normal growth and development

Question 11

how do children respond to injury? life threatening trauma resp failure

Answer 11

•	Respiratory Obstruction
o	Birth asphyxia
o	Croup
o	Epiglottitis
o	Foreign body inhalation
o	Bronchiolitis
o	Asthma
o	Pneumothorax
•	Respiratory Depression
o	Poisoning
o	Convulsions
o	Raised intra-cranial pressure
	Head injury
	Acute encephalopathy
•	Meningitis
•	Encephalitis

Question 12

how do children respond to injury? life threatening trauma CV failure

Answer 12

•	Fluid Loss
o	Gastroenteritis
o	Burns
o	Trauma
•	Fluid Maldistribution
o	Sepsis
o	Anaphylaxis
o	Heart failure