EMT-Basic Exam: The Basics of Pediatric Care (Infants and Children) - Developmental Differences in Infants and Children

Infants and children differ significantly from adults on both a physical and an emotional level. As an EMT-Basic, it’s your job to understand the anatomical, physiological, and even psychological differences between adults and children in order to administer proper care.
About 16 percent of the NREMT cognitive exam will feature questions about pediatric care. 

Developmental Differences in Infants and Children
Children go through several developmental stages in which their bodies and minds undergo significant changes; they are learning and growing all the time. Treating very young children is challenging because they often can’t communicate their needs in the ways that adults do. As an EMT, it is your job to recognize the common signs and symptoms that will help you identify injuries or illnesses in young children, even when they cannot tell you what is wrong.

The following guide describe the various stages of childhood development. You will most likely need to modify the way in which you treat patients based on where they fall on this developmental scale.

1. Newborns and Infants
Babies who are less than 1 month old are called newborns, while babies under 12 months of age are infants. Children this young are generally easier to assess and treat if their parents are present; however, they don’t necessarily fear strangers, so brief separation may not affect them negatively.
Newborns and infants struggle to maintain their body temperature, so EMT-Basics should attempt to keep the surrounding environment warm. When infants lose body heat, their circulation slows and they use more oxygen in an attempt to raise their body temperature.
As you examine newborns and infants, it is important to note the following vital signs:
- Respiratory rate
- Skin color
- Activity level
- Interest level in environment
- Interaction with parents/EMT-Basics
- Use of accessory muscles when breathing

2. Toddlers
Children between 1 to 3 years of age are referred to as toddlers. Toddlers don’t like to be touched, and they especially don’t like removing their clothing when they are uncomfortable. If you must remove the child’s clothing during the examination, ask the child’s parents or family members to assist you. Move the clothing aside and replace it quickly. This will make the child more comfortable as you perform the examination.
Remember to assess toddlers on their level by kneeling or sitting beside them; this will make them feel less frightened. Let them know what you’re doing just before you perform the action. For example, if you must use a needle on a toddler, be honest and explain that it might hurt for a moment. Don’t wait too long before performing the procedure, otherwise the child may grow afraid or upset during the process.
Use simple words when speaking with toddlers. Reassure them that they aren’t in trouble and that they aren’t being punished. Examine the heart and lungs first, showing the child the tools you are using as you go, and then move to the trunk and head. Always be prepared to deal with uncooperative, upset, and scared children. The best thing to do when dealing with uncooperative or scared children is to be patient with them, use a gentle tone of voice, and do your best to comfort them.

3. Preschool Children
A child between the ages of 3 and 5 years old is a preschool child. These children respond negatively to being separated from their parents, having their clothing removed, or having oxygen masks placed on them. Portable suction units may also scare preschool children who don’t understand exactly what is going on around them. As with toddlers, if removing the clothing becomes necessary, do so quickly and ask a trusted family member for help if the child is uncomfortable.
Preschool children may understand that pain and injuries are typically “bad.” They may have also developed a fear of blood at this age. If fear is evident, clean the area quickly or cover the area so they cannot see it.
When speaking to preschool children, ask them simple questions about what happened to them or how they are feeling. Don’t hesitate to ask them to perform easy tasks or follow simple directions. Explain the steps you are taking to ensure their health and safety and show them the tools you use as you work. Inspect your young patient’s most painful areas at the end of your assessment. By this point in the exam, you will have gained the patient’s trust and he or she will be more likely to cooperate with you.

4. School-Age Children
Children between the ages of 6 and 12 years old are considered school-age children. While they embrace their independence, they also rely on their parents for guidance and support, especially in emergencies. Most are afraid of blood and pain and may be embarrassed during the physical examination. Respect their modesty; replace clothing shortly after you have moved it to inspect an area.
Most school-age children will respond to direct questions and follow directions well. If you tell them that you need their help, they will perform tasks to the best of their abilities. If you need to perform a task such as administering an IV or a needle, have the child count down to the needle prick. This allows the child to feel as though he or she is in control. If you abide by the patient’s countdown, he or she will grow to trust you.

5. Adolescents
Children 12 to 18 years of age are adolescents. These children should be treated as adults and may choose to be examined away from their parents. Respecting adolescents’ privacy and modesty helps build trust between the EMT-Basic and the patient. Adolescents are often concerned with permanent disfigurement, scarring, loss of function, and death. Be straightforward and honest with adolescent patients about their injuries or illness.

Related Topics You Should Review:
- Using oxygen masks on newborns, infants, and toddlers
- Anatomical and physiological concerns regarding children’s airways
- Performing modified jaw thrusts on children
- Using portable or onboard suction units on children
- Inserting an oral or nasopharyngeal airway