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Principles of paediatric trauma
An injured child compensates well for blood loss — tachycardia is the first sign and low blood pressure a very late one — so shock is recognised by pulse, perfusion and conscious level, the child is warmed, fluids are given by weight and CT is limited using the PECARN rules.
Why it matters in the exam
Trauma is the leading cause of death in children over one year of age. Anatomical differences explain injury patterns: a relatively large head (head injuries are common), a compliant chest wall (pulmonary contusion without rib fractures — the common chest injury in children; a rib fracture indicates great force or abuse), large and less protected abdominal organs, and a large surface area leading to rapid heat loss. Spinal cord injury without radiographic abnormality (SCIWORA) is typical of children.
Assessment and resuscitation: the minimum acceptable systolic blood pressure is roughly 70 plus twice the age in years. Start with a crystalloid bolus of 20 mL/kg, and if the child stays unstable move early to blood (10–20 mL/kg of red cells). If there is no vein — intraosseous access. A child who has received more than 40 mL/kg of blood and is still unstable needs haemorrhage control, and with an abdominal injury — surgery. Hypothermia worsens coagulopathy and acidosis (the "lethal triad"), so the room, fluids and blood products are warmed.
The PECARN rules reduce unnecessary CT: for head injury there are separate rules for children under and over two years, and for blunt abdominal trauma a child without abdominal wall trauma or a "seat-belt sign", with GCS 14–15, no abdominal tenderness, no abdominal pain, no vomiting, no chest wall trauma and no decreased breath sounds is at very low risk of an injury needing intervention. FAST is less sensitive in children. Classic patterns: a pedestrian struck by a car — femur fracture, chest or abdominal injury and head injury; a bicycle handlebar — pancreatic and duodenal injury; a lap belt — Chance fracture and bowel injury.
Key points
- Tachycardia is the first sign of shock; low blood pressure — late.
- Bolus 20 mL/kg, blood 10–20 mL/kg.
- Pulmonary contusion is the common chest injury in children.
- Warm the child — hypothermia worsens coagulopathy.
- PECARN reduces unnecessary CT.
Summary table
| Topic | In the child | Exam meaning |
|---|---|---|
| First sign of shock | Tachycardia | Low blood pressure is a late sign |
| Fluids | Bolus 20 mL/kg, blood 10–20 mL/kg | Above 40 mL/kg of blood and still unstable — surgical haemorrhage control |
| Chest | Compliant wall | Pulmonary contusion without rib fractures; rib fracture — great force or abuse |
| Body temperature | Rapid heat loss | Warm the room, fluids and blood products |
| CT | PECARN rules | Spare radiation in the low-risk child |
A free exam question
איזה מ בין המצבים הבאים מעלה חשד ל חבלה( מכוונת(Non accidental injury ? (the question as examined, in Hebrew)
- א. בן 6 שנים עם שבר מרוסק .בעצם הבריח
- ב. בת 3 .שנים עם שבר פינתי במטפיזה של הפמור
- ג. בן 16 חודשים עם שבר עם תזוזה משמעותית בטיביה
- ד. בן שנה וחצי עם שבר קווי בגולגולת
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Sources
- ATLS Advanced Trauma Life Support Student Course Manual, 10th edition (2018) — Pediatric Trauma
- PECARN clinical prediction rules for head CT and intra-abdominal injury in children, 2009 and 2013 — Derivation and validation
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.