Prehospital Paediatric Examinations
Prehospital Paediatrics Examinations: Techniques for Paramedics and EMTsPaediatric examinations are a vital component of clinical assessment in emergency and prehospital settings. They involve a systematic evaluation of the child’s overall condition, airway, breathing, circulation, disability (neurological status), and exposure, with consideration for age-specific norms and developmental stages. These assessments help paramedics and prehospital clinicians detect signs of respiratory distress, shock, altered consciousness, injury, infection, and other life-threatening paediatric emergencies.
In this series, we explore the fundamentals of paediatric examination in the prehospital environment, including essential techniques, red flag indicators, and condition-specific considerations. Whether you’re assessing a febrile child, respiratory distress, trauma, or altered mental status, this guide is designed to enhance your paediatric assessment skills and equip you to recognise and manage paediatric emergencies with confidence and clinical accuracy.
Prehospital Paediatric Examinations – Articles
Prehospital Paediatric Examinations – Resources
🔗 Prehospital use of the paediatric observation priority score – Journal Of Paramedic Practice
This article, published in the Journal of Paramedic Practice, examines the implementation of the Paediatric Observation Priority Score (POPS) by ambulance staff within a Welsh health board. The retrospective study reviewed 121 paediatric patient records over three months, revealing that while POPS was accurately applied when used (82% accuracy), overall compliance was low (32.3%). The findings highlight the need for enhanced education and training to improve the consistent use of POPS in prehospital settings, aiming to better identify and manage seriously unwell children.
📥Paediatric Assessment Triangle
The Paediatric Assessment Triangle (PAT) is a rapid, visual tool used by paramedics and emergency clinicians to assess a child’s clinical status within seconds. It focuses on three key areas: appearance, work of breathing, and circulation to the skin. The PAT helps identify critically ill children and guides early intervention decisions in the prehospital setting—without requiring equipment. It is an essential component of paediatric assessment in emergency care.
📖 Quiz: FLACC Pain Score
Test your understanding of the FLACC Pain Score with this quiz designed for paramedics, students, and emergency care professionals. Covering key pain behaviours, scoring criteria, and assessment techniques for infants and young children, this quiz helps reinforce clinical knowledge and effective paediatric pain management.
Prehospital Paediatric Examinations – Did You Know?
Children can compensate for shock longer than adults
Children often maintain blood pressure despite significant blood loss or serious illness, as their cardiovascular system compensates effectively for longer periods compared to adults. This means that by the time hypotension occurs, the child may already be in advanced shock, making it a late and critical sign of deterioration. Early recognition of more subtle indicators—such as persistent tachycardia, delayed capillary refill, cool or mottled skin, changes in respiratory effort, and altered mental status—is vital. Prompt prehospital paediatric examination of these early warning signs allows for timely intervention, helping to prevent rapid decompensation and improve outcomes in paediatric emergencies.
Airway anatomy differs significantly in children
Children have proportionally larger tongues, smaller and more compliant airways, and a higher, more anterior glottic position compared to adults. These anatomical differences significantly increase the risk of airway obstruction, particularly in unconscious or supine children, or those with airway swelling or secretions. Even minor airway narrowing can lead to significant resistance and compromised ventilation due to their smaller diameter. Effective airway management in paediatric patients requires careful positioning—such as using a neutral head position or slight sniffing position—and the correct selection of age-appropriate airway adjuncts, including oropharyngeal or nasopharyngeal airways. Understanding these differences is vital for ensuring safe and effective airway assessment and intervention in the prehospital setting.
Normal vital signs vary widely with age
A heart rate or respiratory rate that is normal for a toddler may be abnormal for an older child. Always interpret paediatric observations using age-specific reference ranges.
Fever is a common cause of altered consciousness in children
Febrile convulsions and sepsis can both present with altered mental status. A careful history and full examination are key to identifying the underlying cause.
Bruising patterns can indicate non-accidental injury
Bruises in non-mobile children, or in unusual locations (such as the face, ears, neck, or torso), may suggest safeguarding concerns. Thorough examination and documentation are essential.
Prehospital Paediatric Examinations – CPD Reflection Prompts
Reflective practice is a key part of continuing professional development (CPD) and clinical improvement. Use these prompts below to guide your self-reflection on a recent patient assessment.
Reflect on your recent paediatrics assessments in the field and consider the following prompts to guide your CPD entry:
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jWhat went well during your paediatrics examination?
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jWhat challenges did you encounter?
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jHow did your findings affect your clinical decision-making?
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jWhat would you do differently next time?
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Consider writing this reflection in your CPD portfolio or ePortfolio using the Gibbs Reflective Cycle or What? So What? Now What? framework. This reflective exercise not only enhances clinical self-awareness but also provides documented evidence of learning that can count towards your annual HCPC CPD requirements. Keeping detailed, structured reflections like this is essential for maintaining your registration and demonstrating safe, effective, and reflective practice as a healthcare professional. This can count toward your annual HCPC CPD requirements.
Prehospital Paediatric Examinations – FAQs
Frequently Asked Questions about Prehospital Paediatric Examinations in Paramedic Practice
What is the paediatric assessment triangle (PAT)?
The paediatric assessment triangle is a rapid visual and clinical assessment tool used to evaluate appearance, work of breathing, and circulation to the skin, helping identify sick children within seconds.
Why do children deteriorate quickly in emergencies?
Children have higher metabolic rates and smaller physiological reserves than adults. Once compensation fails, they can deteriorate rapidly, making early recognition and intervention crucial.
How are paediatric airway assessments different from adults?
Children have anatomical differences such as larger occiputs, smaller airways, and more anterior larynxes. These factors require careful airway positioning and appropriate equipment sizing.
What are key signs of respiratory distress in children?
Signs include nasal flaring, grunting, intercostal or subcostal recessions, tracheal tug, head bobbing, and cyanosis. Increased work of breathing is often the first sign of deterioration.
How should pain be assessed in children?
Age-appropriate pain scales—such as FLACC (face, legs, activity, cry, consolability) for young children or Wong-Baker faces scales—help clinicians assess and manage pain effectively in paediatric patients.
