h. Children have faster heart rates.
i. Young children's extremities are likely to appear mottled. This condition may
be a response to cold because of an immature temperature control rather than a
response to poor circulation.
j. Children have more skin surface area in relation to body weight than an adult.
This means that a child loses more fluid across damaged skin; for example, a severely
burned child may lose a great deal of fluid.
k. A child has less muscle and fat mass than an adult. Therefore, a child has
less padding and is more vulnerable to blunt trauma than an adult.
l. A child's abdominal organs are relatively larger than an adult's. A child's
diaphragm is lower than adults. A child, therefore, is more likely to suffer injuries to the
liver, spleen, and duodenum.
Section II. PATIENT ASSESSMENT
PEDIATRIC PATIENT HISTORY
The goals in taking the history of a pediatric patient are the same as the goals of
taking an adult's history. You are gathering information and establishing a relationship
with the patient. There are some important differences in the way you achieve these
goals with a pediatric patient as opposed to an adult patient. You may not always be
able to obtain the whole history from the patient. You can ask the mother or father or, if
necessary, bystanders. Do not discount the child's information if he is able to give
information. His information may be an important source of data about his injury. As
you take a child's history, remember the following points.
a. You may ask questions using a neutral object; for instance, a doll or a teddy
bear. A very young child may not be able to describe where he feels pain. If you ask,
however, where his teddy bear hurts, he may be able to tell you. He will probably be
describing the area in which he feels pain.
b. Older children are more accurate in their descriptions than adults. An older
child's ability to communicate has grown, but he has not yet learned, as adults have, to
be careful about what he says publicly.
c. Respect the confidentiality and privacy of the adolescent patient. An
adolescent is sometimes unusually concerned about whether or not he is in good
health. When you have examined his healthy lungs, for example, tell him that his lungs