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Trauma management: Unique pediatric considerations

Authors
Lois K Lee, MD, MPH
Gary R Fleisher, MD
Section Editor
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

Children have unique anatomy and physiology compared with adults, which must be taken into consideration when managing pediatric trauma patients. This review will cover specific anatomical and physiologic differences between children and adults that affect medical care. The approach to the injured child is discussed separately. (See "Trauma management: Approach to the unstable child" and "Approach to the initially stable child with blunt or penetrating injury".)

PEDIATRIC ANATOMY

Airway — Several features of the airway in infants and children can make airway management challenging in patients with major trauma:

Small oral cavities and relatively large tongues and tonsils predispose to airway obstruction, especially in semiconscious or comatose patients. (See "Emergency airway management in children: Unique pediatric considerations", section on 'Anatomic considerations'.)

The relatively large occiput in the infant or child naturally flexes the neck in the supine position, causing airway obstruction as well as potentially exacerbating any unstable cervical spine injury. (See "Pediatric cervical spine immobilization", section on 'Neutral position'.)

The larynx is more cephalad and anterior in the neck, making adequate visualization during endotracheal intubation more difficult. Other factors to consider include the short trachea, the U-shaped, floppy epiglottis in infants and young children, and the maximal anatomic narrowing that occurs at the cricoid ring. (See "Emergency airway management in children: Unique pediatric considerations", section on 'Anatomic considerations'.)

             

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Literature review current through: Nov 2016. | This topic last updated: Mon Aug 08 00:00:00 GMT+00:00 2016.
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