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Children are not just small adults. This standard mantra is heard in EDs around the world. About one third of all ED visits are by children. The ABCs of resuscitation are the same as in adults, but nearly every other aspect of the management of children is fundamentally different from that of adults. Anatomic, physiologic, and developmental differences of children give rise to a unique epidemiology, pathophysiology, and differential diagnosis. Key elements of the medical history must often be elicited from caretakers, not from the child. It may be difficult to perform a physical examination on a child, and cardinal signs of disease are different. Diagnostic testing can cause pain, or even potential harm. Drugs require weight-based dosing, and equipment selection must be tailored to the child’s size. Disposition may require transfer to a specialized children’s hospital. Finally, even though the child is the primary patient, management must be family centered and often involves addressing the fears and stresses of family members.


There are differences in the environments of pediatric and general EDs. Pediatric EDs treat more children with underlying medical problems than do general EDs, and general EDs treat more children with injuries. Children visiting pediatric EDs are usually sicker, they have longer wait times to see a physician, and their length of stay in the ED is longer.


This chapter highlights the unique features of the emergency care of children. General principles are discussed with specific examples derived from common complaints. Chapter e109.1, Assessment of the Child in the Emergency Department: A Practical Application of Normal Child Development, provides a comprehensive review of the normal child, including a primer on developmental stages, family-centered care, and age-specific physiologic norms.


Pediatric age groups are divided into neonates(birth to 1 month), infants (1 month to 1 year), toddlers (1 to 3 years), school-aged children (3 to 12 years), and adolescents (12 to 18 years). Significant anatomic and physiologic changes occur across these age groups.


Neonates undergo the most profound changes as they transition from metabolic and respiratory dependence on the placenta to independence as air-breathing beings. The cardiovascular and respiratory systems switch from near complete shunting of blood flow away from the lungs to typical adult circuitry and dependence on the lungs for oxygenation as the ductus arteriosus closes (see Chapter 122A, Pediatric Heart Disease: Congenital Heart Defects). Oxygen-avid fetal hemoglobin changes to adult hemoglobin with predictable changes in hemoglobin levels throughout the first years of life. The neonatal and infant immune systems depend on passive maternal humoral protection transferred through the placenta and breast milk until cellular and humoral defenses mature. Immunologic immaturity predisposes to bacterial and viral systemic infections early in life. The neurologic system is characterized by rapid growth, differentiation, and myelinization and changes in the balance of excitatory and inhibitory neurotransmitters, which account for susceptibility to seizures.


Anatomically, growth and development of every organ system characterizes ...

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