There are several major anatomical differences between children and adults that can affect your assessment and treatment on the EMT exam and in a real situation. These differences are more pronounced in younger children (infant through preschool age); they begin to disappear as the children age into school age and adolescence. By the time they are 18, most of the changes are complete.
| Body System | Anatomical Findings | Assessment and Treatment |
|---|---|---|
| Respiratory | Smaller, softer, and shorter upper airway Proportionally larger tongue Flatter nose and face Intercostal and accessory muscles not well developed |
Airway is blocked more easily and requires more careful
positioning to maintain patency. Pad under shoulders to place head and neck in a more neutral position. May be more difficult to create a mask seal when providing ventilation; continuously check mask seal when ventilating. Children breathe faster as they compensate; slow breathing is an especially bad sign. Prepare to ventilate earlier in a pediatric situation compared to an adult scenario. May use abdominal muscles to help breathe, causing “seesaw” motion between chest and abdomen. |
| Cardiovascular | Greater ability to constrict blood vessels Lesser ability of heart to contract Less blood volume |
Will maintain adequate blood pressure for longer time than
adults, but crash (decompensate) faster; monitor vital signs
closely. Does not take much blood loss to cause shock; control bleeding early. Heart rates can be much higher in children. |
| Nervous | More fragile brain tissue Thinner subarachnoid space Brain demands greater amounts of oxygen and glucose |
Mental status and level of consciousness key indicators of
adequate oxygenation and circulation; pay close attention to how
the child interacts. More susceptible to primary and secondary brain injuries. |
| Gastrointestinal | Liver and spleen less protected by lower ribcage Less well protected by undeveloped abdominal muscles |
Greater chance of blunt trauma to internal organs; palpate
carefully and thoroughly. Greater chance of shock due to gastrointestinal injuries. |
| Musculoskeletal | Normal openings in newborn skull (fontanelles) Head proportionally larger to body as compared to adult Proportionally larger occiput Ribcage more pliable, less protective of internal organs Long bones more flexible |
May observe normal bulging in infant’s head during
assessment or may be sign of infection. Younger children tend to fall headfirst, increasing chance of brain injury; check mental status early and often and look through the scalp for signs of an injury. May need to pad more to immobilize spine.Greater chance of blunt trauma to chest and abdomen; palpate thoroughly and carefully. Greater chance of partial (greenstick) fractures of long bones. |
| Integumentary | Proportionally greater body surface area than adults Proportionally less fat; thinner skin layers |
Greater chance of hypothermia when exposed — must keep
younger children covered. More serious burn trauma compared to adults. |