Definition & Overview
A paediatric emergency is defined as a serious condition that threatens the life of an infant, child, teen, or young adult, thus, requires immediate medical attention. Paediatric emergencies can be caused a particular illness, an injury, or by ingesting a foreign object or poison.
It is widely recognized that children have unique needs, particularly when they require immediate medical attention. The first person to notice that the child requires emergency medical assistance should administer first aid procedures while waiting for emergency medical personnel to respond. Therefore, adults with children in their homes should be aware of basic first aid procedures and be familiar with the characteristics of an emergency.
Emergency medical services (EMS) and hospital emergency departments should also be fully equipped to handle these cases. This includes having the right personnel, doctors, and medical equipment for children.
Cause of Condition
A paediatric emergency can be caused by a wide variety of factors. The most common are acute medical problems, such as persistent high fever, breathing difficulties, severe infections, seizures, dehydration, and severe allergic reactions. Major injuries, such as fractures, burns, head injuries, and severe bodily trauma caused by falls and vehicular accidents also qualify as paediatric emergencies.
Persistent high fever - Fevers are usually a symptom of an underlying medical condition. In most cases, fevers are not a cause of concern. However, if a child’s fever reaches 104F, it can cause a seizure, which is why it requires immediate medical attention. It is also possibly a sign of a life threatening infection.
Breathing difficulties - If a child finds it difficult to breathe or is not breathing at all, it is considered as a paediatric emergency. First responders, whether medically trained or not, should check for any obstructions and attempt first aid to help the child breathe.
Seizures or convulsions - Seizures or convulsions can be caused by a high-grade fever or by an underlying medical condition, such as epilepsy. Parents or guardians of children with known medical conditions that can cause a seizure should be familiar with the procedures on how to provide an immediate response to the condition.
Although minor injuries like cuts, animal bites, and sprains may not result in an immediate life threatening condition, these are also considered as emergencies since they can quickly escalate into a serious condition.
Sudden Infant Death Syndrome (SIDS) is also considered a paediatric emergency, but unlike other types of paediatric emergencies, the cause of this condition is unknown. Not even performing an autopsy would reveal the cause. The best way to avoid this condition is to minimize the risks, such as sleeping together with the parents, using soft crib beddings, and avoiding smoking or the use of illegal substances during pregnancy.
The key symptoms that a child would display will depend on the cause of the emergency. However, most symptoms include breathing difficulties, severe high fever, seizures or convulsions, and severe blood loss due to an injury.
If a child is involved in a major accident or has incurred a head injury, it’s important to remember that moving the child immediately may cause more harm than good. The child may display a variety of symptoms, but as long as the child is breathing, it’s best to wait for medically trained emergency personnel to attend to the child.
Who to See & Types of Treatment Available
The first responders should attempt to provide emergency assistance only if they have received medical training, which is why parents and guardians of children should be trained in providing first aid. If not, contacting emergency personnel would be the next best alternative.
If you have not received any medical training and believe that you are faced with a paediatric emergency, you should perform the following steps:
- Force yourself to calm down and breathe normally
- Check if you are in any imminent danger
- Try to assess the situation so that you can describe it by phone if needed
- Check for any visible obstructions that may prevent the child from breathing
- Contact emergency medical services for further instructions
It’s important to understand that not all doctors are trained to handle paediatric emergencies. Emergency Paediatric Physicians are the best doctors to see for these types of situations. The physician will first assess the situation using the Paediatric Assessment Triangle (PAT). In some cases, the most visible injury is not the most serious, which is why the doctor needs to perform a systematic assessment using the PAT approach.
PAT involves the key features of an overall paediatric cardiopulmonary assessment, which are appearance, work of breathing, and circulation to the skin. This is performed using direct observation without the assistance of any devices, such as a stethoscope, blood pressure monitor, pulse oximeter, etc.
When assessing a paediatric emergency, appearance is the most important parameter to gauge the illness or injury. The specific factors that a doctor would be looking at and assessing are the Tone, Interactibility, Consolability, Look/Gaze, and Speech/Cry (TICLS).
Even if you have not received any medical training, knowing the following factors will help you describe the situation to a medical emergency personnel by phone.
Tone: Check to see if the child is moving and if there is good muscle tone
Interactibility: Check to see if the child is alert or is able to respond
Consolability: Are you able to comfort the child?
Look/Gaze: Can the child look at you or does the child have an “empty” look?
Speech/Cry: Can the child speak or cry in a spontaneous and strong manner? Is the child’s response weak or hoarse?
Remaining calm is the key to handling a paediatric emergency. It’s important that you are fully aware of your surroundings and what is happening to the child, and that you are able to communicate this to the emergency medical personnel clearly so that they can provide you with additional instructions and that they can assess the situation without actually being at the location.