Dealing with Pediatrics/ Infants

[Tachy55]

Any tips for patient assessment when dealing with pediatrics or infants, particularly pertaining to LOC assessment, normal activity versus not, and sick versus not-sick. Now obviously the family is going to be a huge input but any tips for dealing with children since they cant advocate for themselves would be great. Overall I'm not very comfortable yet in pediatric assessments.

 

[gonefishing]

Any tips for patient assessment when dealing with pediatrics or infants, particularly pertaining to LOC assessment, normal activity versus not, and sick versus not-sick. Now obviously the family is going to be a huge input but any tips for dealing with children since they cant advocate for themselves would be great. Overall I'm not very comfortable yet in pediatric assessments.

The familys usually always helpful. Mom or Dad know the child better than you the person thats known them for less than 5 minutes. The best thing to do is let mom or dad hold them. This makes the child feel secure. Don't seperate them from eachother. Ask mom or dad questions whats do you notice different per usual? How long has this been going on? What have you tried? What makes it better if anything? You than begin your assessment all while asking these questions. Airway, skin color, work of breathing, loc, do they act like any normal kid their age would? Do they look normal? Vitals, temp. Monitor in route.

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[VentMonkey]

Any tips for patient assessment when dealing with pediatrics or infants, particularly pertaining to LOC assessment, normal activity versus not, and sick versus not-sick. Now obviously the family is going to be a huge input but any tips for dealing with children since they cant advocate for themselves would be great. Overall I'm not very comfortable yet in pediatric assessments.

Practice makes perfect. It's hard dealing with kids when you don't have any of your own (I was terrified of them when I was a new tech, and before I became a parent; now I just fling 'em around). You sort of hit the nail on the head with utilizing family, specifically mom. Now, there are caveats such as a new mother, but even then, there are innate maternal instincts that shouldn't be discounted.

All in all you'll know a very sick child from a not-so-sick one (flaccidity, color,listlessness, poor output, persistent fevers etc., etc., etc.). Over time it should improve, but brush up on pediatric assessments if you're unsure, or uneasy of your abilities in this department. If a parent tells that their child's behavior "just doesn't seem right" to them, believe them, you typically can't go wrong with this approach. Oh, and don't be afraid to touch them. I saw this a lot in newer providers/ trainees in my FTO days. I was taught a bottom-up approach, so start with those chubby legs (thighs are a decent cap refill assessment spot as well), and work your way up ever so gently. Some kids won't stop crying regardless of your approach; it ain't personal, they're gonna do them, you do you.

 

[StCEMT]

All in all you'll know a very sick child from a not-so-sick one (flaccidity, color,listlessness, poor output, persistent fevers etc., etc., etc.).

This. I haven't seen toooo many, but the ones that stand out were obvious that we needed to work a bit faster.

That being said, trust parents most times, but take what they say with a grain of salt. I had one arguing with Grandma that her daughter was just being whiny. 2 y/o, crying a lot and couldn't be calmed, had been and still was reaching at one ear, think she had a fever too...we were called just because Mom wouldn't let Grandma take take her to an urgent care. Mom was just being a lazy *******.

 

[EpiEMS]

2 y/o, crying a lot and couldn't be calmed, had been and still was reaching at one ear, think she had a fever too

Sounds like we need RLS transport to the nearest Level 1 here

 

[VentMonkey]

2 y/o, crying a lot and couldn't be calmed, had been and still was reaching at one ear, think she had a fever too...

My money's on good ol' otitis media. I saw so many of these when I was an ED tech at an ED in SoCal; triage had its benefits.

Pulling, tugging, grabbing at their ears almost always meant they had some sort of middle ear infection. Also, the first question out of my mouth is almost always something to the effect of "how are they acting to you, mom or dad?"

It not only opens up dialogue, but shows you're taking into account their (the parents) input. As a parent myself, trust me, it means a lot.

 

[NysEms2117]

you can tell with children easier then adults sometimes, most often they will just simply look sick. Big big thing to remember, a crying child is a breathing child @VentMonkey is dead on in his post........ yet again

 

[StCEMT]

Pulling, tugging, grabbing at their ears almost always meant they had some sort of middle ear infection. Also, the first question out of my mouth is almost always something to the effecf of "how are they acting to you, mom or dad?"

It not only opens up dialogue, but shows you're taking into account their (the parents) input. As a parent myself, trust me, it means a lot.

That's when we got the "whiny" response. Had to explain to her that her 18-24 month old daughter doesn't have the same vocabulary we do and that "whining", crying, and tugging at her ear was a way of showing something wasn't right and just because she was seen a week ago and checked out fine, doesn't mean she can't be sick now.

Otherwise I agree. Parents are often good resources, although some areas tend to misuse EMS for their kids.

 

[VentMonkey]

@VentMonkey is dead on in his post........ yet again

 

[NomadicMedic]

I don't love card courses, but thought EPC was a really good class to learn the assessment tools to determine sick/not sick with kids and if you don't have kids, it can help you learn that they are not just small adults and come with thier own set of instructions.
If you can take EPC, it's worth it.