Acute Paediatric Care

Question 1

Differences in a childs airway from an adults

Answer 1

Large head to body size
Short necks
Large tongue 
Obligate nasal breathers 
Nasal passages easily obstructed 
Compressible floor of mouth and trachea 
Higher anterior larynx

Question 2

Differences in a childs breathing from an adults

Answer 2

Small total surface area for air tissue interface
Lower airways small and easily obstructed
Diaphragmatic breathing
Fever type I (slow twitch) fibres - easy fatigue
Soft non calcified bones - v compliant chest wall and so recession and in drawing
horizontal ribs - less expansion
Accessory muscles being used
- head bobbing signs

Question 3

Differences in respiratory in children vs adults

Answer 3

High metabolic rate / O2 consumption 
- resp rate higher and gradually falls 
Oxygen dissociation curve shifted left in neonates (HbF predominance)
Immature lungs vulnerable 
Apnoea may occur in babies

Question 4

CVS changes in children vs adults

Answer 4

Circulating blood volume 70-80ml/kg so a small loss can make a big difference
Circulation changes from in utero to ex utero
ECG features vary with age
Stroke volume increases with size (HR higher and gradually falls)
Systemic vascular resistance progressively rises from birth
- BP lower and rises

Question 5

What indicates life threatening pathology, but may be seen in anorexia?

Answer 5

Bradycardia (<60)

Question 6

What does the large surface area : weight loss in children mean?

Answer 6

Rapid heat loss / hypothermia

Question 7

What does an immature immune system at birth mean?

Answer 7

Babies are more susceptible to infections

Question 8

Oxygen sats in adults vs children

Answer 8

Adults sit much higher

90 / 92% cut of for normal childrens sats

Question 9

What does a bilateral wheeze in a child indicate?

Answer 9

Viral

Question 10

What accessory muscles / signs are there when a child is struggling to breath?

Answer 10

Head bobbing (babies)
Tracheal tug
Costal recession 
- intercostal 
- subcostal