A child is not simply a little adult, so do not treat them like one.
Blood volume is around 80ml/kg.
As well as the above differences, it is important to remember that a child has a relatively large surface area compared to body volume and a high anterior larynx/floppy epiglottis.
Common presenting illnesses
Note that the acute management (below) is the same for any acutely unwell child.
- Bronchiolitis/URTI/croup (28%)
- Gastroenteritis (8.8%)
- Seizures/epilepsy (6.6%)
- Pneumonia/LRTI (6.2%)
- Asthma (5.7%)
- Viral illness (5.2%)
- Head injury (2.3%)
- Abdominal pain (3.5%)
- UTI (2.2%)
- Open and normal- loud crying or speaking to you etc
- Compromised- if they are unconscious, a child’s airway is always compromised due to relatively large tongue and floppy epiglottis. Alternatively, if they have vomited/bled in the mouth. The use of head tilt/chin lift, suction and adjuncts are all recommended in maintaining an airway.
- Obstructed- if the child is conscious then cough encouragement, back slaps (5) and thrusts (5 chest for infant <1yr or 5 abdo for >1yr). If unconscious, the obstruction should be removed where possible (e.g. with suction)
- Assess pulse rate (see above for normal), temperature, BP (note HYPOTENSION IS A PRETERMINAL SIGN- over 40% blood loss), capillary refill is often more useful than BP, Urine output (<2ml/kg/hr in infants and <1ml/kg/hr in children is abnormal)
- To manage, if large bore IV access impossible, intra-osseous (tibia) access may be a useful alternative- give 20ml/kg of 0.9% saline (unless contraindicated)
- AT THIS POINT, REASSESS IF NOT or SLOWLY IMPROVING
- Check BM
- AVPU; Pupils; Neurological exam
- Remember to check front and back; check patient notes, minimise heat loss, document findings etc