Emergency Medicine

336 Paediatric Emergencies

GENERAL ASSESSMENT

1 It is essential to be able recognize the sick or seriously ill child, and to under-

stand the key differences between children and adults.

2 Knowing what is abnormal and identifying the sick child is impossible,

unless the doctor can first distinguish ‘normal’ paediatric physiological and

developmenta l parameters (see Tables 11.1 and 11.2).

3 Early recognition and immediate management of impending respiratory,

circulatory or neurological failure will reduce mortality and secondary

morbidity.

(i) Figure 11.1 is a paediatric resuscitation chart that allows drug

doses, endotracheal tube sizes and defibrillator settings to be

read according to the age, weight or body length – whichever is

known.

Table 11.1 Developmental milestones in early childhood

Age Developmental milestones

Neonate Symmetrical antigravity movement of four limbs

Cries

Looks at faces, responds to light

Startles to loud noises

6 months Sits erect with support

Alert and interested

Localizes sound

1 year Crawls on all fours

Walks holding onto furniture

Understands simple commands

Babbles

Socially responsive

2 years Runs, manages stairs

Joins words: simple phrases

Dry by day

3–4 years Stands on one foot momentarily

Speaks full (three-word) sentences

Gives full name

Dry by night

5 years Skips/hops/stands on one foot

Fluent speech

Dresses self unaided