Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

abnormal for age. Temperature is an often forgotten but important vital sign in injured
children. The child’s ability to control body temperature is affected not only by the BSA
to mass ratio but also by thin skin and lack of substantial subcutaneous tissue. These
factors increase evaporative heat loss and caloric expenditure. In fact, hypothermia is a
significant risk factor for poor outcomes in many illnesses/injuries. Considerations of
methods to maintain and restore normal body temperature are critical to the resuscitation
of children. These can include thermal blankets, warmed resuscitation rooms, warmed
intravenous fluids, and warmed inhaled gases.
Children have a higher minute ventilation per kilogram of body weight than adults. This
means that over the same period of time, they are exposed to relatively larger doses of
aerosolized biological and chemical agents than are adults. The result is that children
suffer the effects of these agents much more rapidly. Children are also more likely to
absorb more of the substance from the lungs before it is cleared or diffused through
ventilation.
Fluid resuscitation, drug dosages, and equipment sizes are based on the child’s weight.
Estimating the weight of a child can be difficult, particularly for health care workers with
limited pediatric experience. An easy, quick method for determining a child’s weight is to
use the Broselow–Hinkle Pediatric Resuscitation Measuring Tape ® . This tool rapidly
provides many common drug dosages and fluid resuscitation volumes. Health care
providers should also make appropriate fluid choices for resuscitation. Children who
receive large volumes of hypotonic fluid are at risk of hyponatremia and seizures.
Limited glycogen stores and a higher relative metabolism in children than in adults puts
children at a higher risk of hypoglycemia. Children compensate for cardiovascular and
pulmonary problems with tachycardia and tachypnea (their ability to increase stroke
volume and tidal volume is limited).
Immunologic Differences
Children have an immature immunologic system, which places them at higher risk of
infection. Immunologically, children have less herd immunity from infections such as
smallpox and a unique susceptibility to many infectious agents. For example, Venezuelan
equine encephalitis is usually a brief, self-limiting infection in adults. In children, it can
be severe, and life-threatening encephalitis develops in 4% of victims. Children
immunized with the current smallpox vaccine are over-represented with serious side
effects such as encephalitis.
Developmental Differences
Developmental differences between children and adults are also readily apparent.
Children, especially infants and toddlers, might be unable to describe symptoms or
localize pain. Children rely on parents or others caregivers for food, clothing, and shelter.
Infants especially are vulnerable when their food sources are eliminated or contaminated.
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