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Advanced Study | Pediatrics Part Eight

SIDS: Sudden Infant Death Syndrome: unexplained after post-mortem exam. Third leading cause of death in children age 1 month to 1 year. 3,400 annually. Peak age 2-4 months. 95% occur by 6 months. More males, during sleep, more in winter esp. January. Native Americans/Blacks, premature, multiples, soft bedding, overheating, young cigarette-smoking moms.

  • Try to determine the scene as the baby was found, esp. if they have been removed from the bed
  • Continue CPR if the parents started
  • Be compassionate, don’t give the impression of any wrongdoing
  • Stress that SIDS can’t be predicted or prevented

Child Abuse/Maltreatment

Child Abuse:   any recent act or failure to act that results in imminent risk of serious physical or emotional harm, death, sexual abuse or exploitation by a parent or caretaker. 1 million children annually, over half are under 7, 56% of those are under 4. The most important thing for an EMT to remember is to be nonjudgmental. Document everything. Treat physical injuries as appropriate. Protect the child from further abuse. Reporting is mandatory to hospital/local authorities:

  • Physical abuse: Bruises, welts, burns (glove), fractures, dislocations, wounds in various levels of healing, inappropriate reactions, acting out behavior, withdrawal
  • Sexual abuse: bruises, bleeding on genitals, torn underwear, pain on urination, STCs
  • Emotional abuse: withdrawal, fearfulness, lags in development, sleep disorders
  • Neglect: failure to thrive, malnutrition, unclean, poor teeth
  • Maltreatment: intentional physical abuse or neglect, emotional abuse or neglect and sexual abuse
  • Neglect: failure of a parent or guardian to provide for the child’s basic needs and an adequate level of care
  • Shaken Baby Syndrome: can cause fatal intracranial trauma without signs of external head injury. Retinal hemorrhage, CNS injury, bleeding, concussion, soft tissue swelling, skull fracture, hypotension

Special Needs: any condition that interferes with usual growth and development: hearing impaired, mental retardation, tracheostomy, gastrostomy, cerebral palsy, spina bifida, etc.

  • Cognitive Disabilities: some degree of impaired adaptation in learning, social adjustment or maturation. Actual physical evaluation is all the same, the major difference is the child’s level of understanding and ability to communicate
  • Physical Disabilities: some limitation of mobility, attend to ABCs and don’t let devices get in the way
  • Chronic Illnesses: any disease/situation that extends for a prolonged period
  • Assistive Technology
    • Tracheostomy: temporary or permanent. Airway trauma or weak respiratory muscles. Watch for mucus plugs
    • Central Venous Access Devices: extended access to a vein. Several types of devices, but they all end at the superior vena cava or the right atrium.
    • Implanted ports are accessed using a Huber needle
    • Vagus nerve stimulator: over 12 yo, stops the progression of seizure activity
    • Apnea Monitors: alarm sounds if a breath is not detected in a certain period of time
    • Gastrostomy Tube or Button: children who can’t take food by mouth. The tube may have become dislodged, there may be internal bleeding
  • Medications: find out what they are taking and when their last dose was
  • Latex Allergies: especially in kids with spina bifida, assemble a latex-free kit
  • Family Issues: Stressful for the entire family
  • General Considerations: special needs kids are at risk for medical complications or traumatic events. Infections, decreased reflexes, paralysis. Look for Medical Tags
  • Pain Management: pain in children is often underestimated, includes verbal and nonverbal expressions
  • Family Involvement: always keep the parents and caregivers involved
  • Transport Guidelines: critically ill or injured kids need a pediatric trauma center

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