Children are not young adults!
This was the opening speech of the first Pediatrics lecture in my medical school.
As Emergency Physicians, we deal with everything and everyone at the same time; in some instances, the segmentation between types of patients blurs. The pediatric patient in the middle might be a challenge if you are not working in an independent Pediatrics Emergency Department.
In some situations, you will have to make decisions by conscious contemplation rather than pattern matching, which we mostly depend on in our approach.
Having had the privilege of working in an independent Pediatrics ED, I realized how much easier decision making becomes when you have a set of mind prepared to deal with a child.
Health problems for children differ from those of adults. A child’s response to disease and stress varies with age and development; therefore, it’s fundamental to approach children in a way that identifies and tackles the differences.
Judge by appearance
We use heuristics frequently in our practice, perhaps the most popular among which is the (sick/not sick) paradigm. When it comes to children, appearance is of particular importance.
The look might be deceptive in adults, but it’s not the case in children; as they say, the eyes don’t lie, but it can be lied to.
For its virtual implication, appearance represents the first component of the Pediatrics assessment triangle, our quick and orderly assessment tool for children.
Power and authority
Children can’t consent or advocate for themselves, a parent or legal guardian approval is required to deliver health care. The most notable exception to this is the emergency situation, in which consent is not required, and care can be delivered if parents are not present and even against their wishes. The emergency situation gives the emergency physician the highest authority in decision making in children, which is a titanic responsibility.
The Math geek
Dosing for most medications in children is weight dependent. It might be good practice for your brain but can also represent a dilemma if you are giving verbal orders and your phone is not with you. My colleague once said I was terrible at Math; that’s why I went to medical school; I think she made a good point.
ED is a noisy environment, but the Pediatrics ED is on another level of noise. Other than natural sounds found in the ED and crying fussy children, you will also encounter countless children’s music and disturbing games. It might sound nihilistic and resentful, but I have to be forthright, the current children’s entertaining materials lack educational value and taste, and it needs resuscitation.
In the end, the smile on a child’s face is one of the most satisfying experiences ever and a blessing. Establishing a rapport with a child is the key to a proper exam. Children won’t trust anything that’s not genuine, and care should be delivered with love and passion. You might also need to learn some tricks and give some treats to accomplish that, in the hope that you reach the fruitful outcome of drawing a smile on God’s angelic creatures.