Paediatric - Differences Between Children & Adults

Question 1

Size & Proportions

Answer 1

• have big head in comparison to body
• rapid growth & development
• weight is VITAL
  
  • wt(kg) = 2(age + 4)
  • to work out estimate of child’s weight in emergency situations where scales aren’t able to be used, as meds are done by weight & fluid overload can occur easily as kidneys are immature
• total body weight that is water:
  
  • full term infant - 75%
  • child - 65%
  • adult - 50-55

Question 2

Fluid Requirements

Answer 2

• 3-10kgs - 100mls/kg/day IV, or 150mls/kg/day oral
• 10-20kgs - 1000mls + 50lbs/kg for each kg over 10kg per day
• > 20kgs - 1500mls + 20mls/kg for each kg over 20kgs per day

Question 3

Respiratory Differences

Answer 3

• smaller airway diameter
• flexible larynx
• large tongue
• obligatory nose breathers (if have cold, won’t be able to feed)
• smaller lung capacity
• diaphragmatic breathers
• poorly developed intercostal muscles

Question 4

Circulatory Differences

Answer 4

• stroke volume, less circulatory volume
• extracellular fluid (blood / plasma) makes up a large percentage of total body fluid
• blood pressure
• higher body surface to volume ratio
• myocardium less compliant
• decreased ability to concentrate urine

Question 5

Metabolism

Answer 5

• high glucose needs, low glycogen stores
• increased caloric requirements
• breast milk & digestion

Question 6

Neurological Differences

Answer 6

• large head, poorly developed neck muscles
• underdeveloped communication skills
• continuing growth & development
• incomplete myelinisation (signals don’t get sent from brain to peripheries effectively)
• emotionally & cognitively immature
• poor thermoregulation (overheat & get cold quickly)
• fontanelles

Question 7

Communication

Answer 7

• development & acquisition of language skills (can’t localise pain, or describe pain)
• parental involvement
• cognition & understanding
• literal thinkers (ie - take everything said to be truth)
• imagination
• perception
• egocentric