By Jointra Editorial Team, Certified EMT
EMS providers are less frequently called to pediatric emergencies than adult ones, which means less clinical exposure and often more anxiety. Understanding the physiological differences between children and adults is the foundation for confident, competent pediatric care.
Airway: Children have a proportionally larger occiput that causes neck flexion when supine — neutral position for airway opening requires a folded towel under the shoulders in infants. The larynx is higher and more anterior (harder to visualize on intubation). The tongue is proportionally larger. The trachea is shorter and narrower — a small amount of edema can dramatically reduce airway diameter.
Chest wall: More compliant than adults — meaning children can tire from the work of breathing more quickly. Retractions are a reliable sign of respiratory distress.
Head: Proportionally larger head = greater force on the neck in deceleration injuries = higher risk of cervical spine injury without obvious fracture.
Compensated shock: Children compensate for shock much more effectively than adults — heart rate and systemic vascular resistance increase dramatically to maintain blood pressure. A child can lose 25–30% of blood volume before showing hypotension. By the time you see a BP drop in a pediatric patient, they are in decompensated shock. This is critical.
Normal vital signs by age (approximate):
| Age | Heart Rate | Respiratory Rate | Systolic BP | |---|---|---|---| | Newborn | 100–160 | 40–60 | 60–90 | | 1 year | 90–150 | 25–50 | 70–100 | | 3 years | 80–130 | 20–30 | 80–110 | | 6 years | 70–120 | 18–25 | 90–110 | | 10 years | 60–110 | 15–20 | 95–120 |
Drug dosing: Weight-based. Use a length-based tape (Broselow tape) for rapid weight estimation in the field.
A rapid, 30-second visual assessment before laying a hand on the child:
1. Appearance — tone, interactivity, consolability, look/gaze, speech/cry 2. Work of breathing — abnormal sounds, abnormal positioning, retractions, nasal flaring 3. Circulation to skin — pallor, mottling, cyanosis
The PAT immediately tells you how sick the child is and guides your pace of intervention.
Respiratory distress is the most common serious pediatric emergency. Croup, bronchiolitis (RSV), asthma, and foreign body aspiration are the most frequent causes. The child in a tripod position with accessory muscle use needs immediate treatment.
Febrile seizures are the most common type of seizure in children 6 months to 5 years. Usually brief, generalized, and self-resolving. Still warrants EMS evaluation to rule out more serious causes.
Sepsis presents subtly in children. Look for fever or hypothermia, tachycardia, altered mental status, and skin findings (mottling, prolonged capillary refill).
A distressed child is a distressed parent. Keep the caregiver involved and calm — their anxiety directly affects the child's cooperation. Whenever safe to do so, allow a parent to hold the child during assessment and treatment.