The emergency physician must have a reasonable knowledge of the developmental stages to identify abnormal or delayed development.
Observation of the young child during history taking provides much insight regarding the severity of the child’s condition.
Often, the best examination occurs while the parent is holding the child in her lap or arms.
Good history taking can minimize the need for blood work.
Minimizing radiation exposure, the “as low as reasonably achievable” (ALARA) principle is particularly important in children.
The approach to children in the emergency department (ED) is completely different than for the adult. The physician gets one attempt to engage the patient, greet the parent, perform the examination, and formulate a treatment plan. This chapter focuses on deconstructing the visit and empowering the emergency physician to be comfortable with and competently treat the child.
Knowledge of age-specific biologic variables is required to identify abnormalities. Tables 1-1, 1-2, 1-31–3 provide quick reference for normal pediatric respiratory rate, heart rate, and blood pressure.
TABLE 1-1Normal Respiratory Rates for Children ||Download (.pdf) TABLE 1-1 Normal Respiratory Rates for Children
|Age (y) ||Respiratory Rate (breaths/min) |
|<1 ||24–38 |
|1–3 ||22–30 |
|4–6 ||20–24 |
|7–9 ||18–24 |
|10–14 ||16–22 |
|15–18 ||14–20 |TABLE 1-2Normal Heart Rates for Children ||Download (.pdf) TABLE 1-2 Normal Heart Rates for Children
|Age (y) ||Heart Rate (beats/min) |
|<1 ||100–160 |
|1–10 ||70–120 |
|>10 ||60–100 |TABLE 1-3Normal Blood Pressure for Children ||Download (.pdf) TABLE 1-3 Normal Blood Pressure for Children
|Age ||Systolic BP (mm Hg) |
|0–28 d (full term) ||>60 |
|1–12 mo ||>70 |
|1–10 y ||>70 + 2 × age in y |
|>10 y ||>90 |
The ED must be prepared for the pediatric patient.4 The American Academy of Pediatrics and the American College of Emergency Physicians have established a list of recommended pediatric resuscitation equipment and emergency medications.5 Dosing medication for children is challenging, especially in a dire situation. Several tools are available to help providers with weight-based dosing. These include the length-based Broselow tape and chart with corresponding colors for dosing, the Best Guess and APLS methods, which involve calculations based on age, computer support programs such as the PEMSOFT calculator software package with dosing calculators and algorithms, and Pediatric Advanced Life Support (PALS) or regional children’s hospital code cards. Having a pharmacist present at pediatric codes is invaluable.
PREPARING FOR THE EXAMINATION