Are Kids Just Tiny Adults? Pediatric Variations in Medical Assessment and Treatment

Most healthcare professionals, including some pediatricians, would rather treat adults than children. That should come as no surprise. If you’ve ever had to draw blood from a young child, you know how heartbreaking it can be for everyone in the room. Maybe in the building. Those screams can be dramatic!

The emotional pain we feel as practitioners, let alone parents, can be as equivalent to the physical pain the child experiences. It adds new meaning to the expression, “This is going to hurt me more than you.”

Unfortunately, the desire to avoid such emotional pain, along with other challenges, often discourages even the most knowledgeable and skilled doctors, nurses, emergency medical technicians (EMTs), and other healthcare providers from assessing and treating children. In some ways, they’re just little adults. In other ways, they’re not. And what we don’t know about their similarities and differences compared to adult patients can hurt them. That is particularly true when it causes us to withhold medical care when that care is most needed.

To some degree, we often fear what we don’t fully understand, and in some ways, we have been conditioned to fear those differences. In a lot of medical education, this fear is often instilled by the frequent cautionary statement, “They are not just little adults,” with little explanation of what those differences are and why they might matter.

In this post, drawing from how we teach medical education at The National Center for Outdoor & Adventure Education (NCOAE), I highlight the differences and similarities between children and adults that matter most in medical assessment and treatment, especially in emergency situations. My hope is to make future healthcare providers more comfortable and confident in providing children with the life-saving care they may need, especially in remote areas like that one’s our instructors travel through here at NCOAE.

Highlighting the Differences Between Children and Adults

Children, especially very young children, are not just little adults. They differ in the following ways that are relevant to medical assessment and treatment:

• Growth and development are accelerated, leading to dramatic changes in size and weight from the time the child is born through their late teens.
• Communication skills, especially verbal skills, are a work in progress.
• Children’s heads are proportionally larger, and their neck muscles less able to support the head.
• Tongues are larger in proportion to the mouth space. 
• The pediatric heart is less able to pump strongly and is more dependent on the speed of the pumps than the volume of blood delivered with each pump.
• Teeth are more prone to become dislodged. 
• The opening to the trachea is more funnel shaped.
• Muscle mass has not yet fully developed.
• The skin is thinner and takes up more surface area compared to their “insides.”

Noting Similarities Between Children and Adults

Despite their differences, children are, medically speaking, just little adults in the following ways:

• They have the same body parts, systems (digestive, circulatory, respiratory, and so on), and physiology as adults, although these may be in different stages of development.
• They are still impacted by words and can communicate in other ways. Before even their first year, the average infant gains a basic understanding of “yes” and “no.”
• Their heads hold their brain, and their neck is the most movable part of their spine.
• Their tongue is a wonderful indicator of an open path for the air to travel to the lungs.
• Their trachea serves as a cartilaginous tunnel that allows air to move into and out of the lungs. 
• Their heart has the same ability to respond to sickness and injury.
• Their teeth indicate development and overall health. 
• Their muscles enable movement, and their muscles and nerves work in concert for assessing and responding to the environment.
• Their skin provides protection from extreme temperature and environmental harm.

Modifying Medical Treatments for Children and Teenagers

The similarities in anatomy, biology, physiology, and communication between adults and children require similarities in assessment and treatment, but often with modifications. Healthcare providers often change up their approach to patient assessment and treatment in the following ways:

• Medication doses are adjusted according to the patient’s age and size.
• Communication with caregivers becomes more important both for assessment and treatment.
• Providers must be more cautious with the head and brain. Positioning, padding, and movement are more careful and well thought out.
• Tongue manipulation is more likely to require direct manual control.
• The heart is less likely to pump enough blood when slow. The heart-rate threshold for starting chest compressions is lower.
• When delivering artificial respiration, the emergency responder must position the child’s head in a more neutral position than the head tilt recommended for adults to ensure the airway is open. 
• Teeth must be considered a more likely airway blockage.
• Providers must be more thoughtful about possible hypothermia when the patient is not shivering. 

Recognizing Commonality in Pediatric and Adult Patient Assessment and Treatment

Although we often need to modify our approach for children, some aspects of assessment and treatment are the same regardless of age:

• Modesty protection is still important, even for the “undeveloped.” 
• Communication with the patient can still play a vital role, regardless of the patient’s level of verbal communication.
• Head appearance and brain function (mental status) are very accurate indicators of when oxygen needs to be given. 
• Tongue swelling in the presence of possible allergic reaction requires epinephrine. 
• Heart operation is connected closely with skin color, temperature, and moisture level. 
• A blocked trachea along with unresponsiveness calls for chest compressions. 
• Teeth should be cared for and transported when found.
• Muscles must be assessed for cold and be warmed when necessary to prevent/treat hypothermia.

The takeaway message here is that, regardless of whether you view kids as little adults or as something very different, you should never hesitate to intervene in their illness or injury to the degree you’re able to help. Modify your approach accordingly, and don’t allow fear to taint your judgment.

Few responsibilities in EMS carry more weight than caring for a child. Children deserve steady, skilled care when they’re at their most vulnerable. As EMS practitioners trained at NCOAE, we should embrace every opportunity to intervene when a pediatric patient is sick or injured.

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About the Author: Todd Mullenix is the Director of Northwest EMS education at The National Center for Outdoor & Adventure Education in Wilmington, North Carolina.

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