Anatomical Differences in Children You Should Know for the EMT Exam

By Arthur Hsieh

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.