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  1. Brain growth and development occurs most rapidly in the first 5 years of life. Notable changes of the face and skull are seen in this young period. During adolescence these features approach adulthood.

  2. Neonate and young infants are considered preferential nasal breathers. Any obstruction to the nares (eg, secretions) often leads to increased work in breathing.

  3. A proportionately larger tongue, young epiglottic shape (long, narrow, and omega), and a cephalad larynx can affect airway management (eg, intubation). Similar to adults, the vocal cord region is the narrowest point of the airway in children.

  4. The airway dimensions (short trachea, less acutely angled right main bronchi) of neonate and young children predispose them to mainstem intubation. Meticulous placement of the endotracheal tube is needed because of limited size.

  5. Young pediatric patients have immature skeletal muscle and cartilaginous thorax (ie, compliant chest). These features can promote respiratory fatigue during increased demands in breathing (eg, illness).

  6. The caudal level of the dura and spinal cord encompasses about two to three interspaces lowered in a neonate compared to an adult. By the first year of life, they are in the adult position.

An understanding of the anatomic changes that occur from birth through late adolescent is essential in the care for the pediatric patient. Pediatric growth may seem continuous but oftentimes occurs in sporadic stages of development (eg, infancy, childhood, adolescence) where rapid changes may be divided by a period of relatively slower or uniform pace.


Infants and young children have a relatively large head to the size of their total body. This is attributed to the rapid growth and development of the brain. At birth, the head is one-fourth the total body length and is 25% of an adult size.1 In the first year of life, the brain completes half its growth and by the age of 5, approximately 90% of cranial growth has occurred.2,3 The occiput is also noted to be prominent in these early years. At birth, the anterior and posterior fontanelles are palpable. The posterior fontanel closes first, often in the first several months.4 The anterior fontanel closes by the age of 2.5 Except for the metopic suture, which closes completely during the first year of life, the remaining cranial sutures do not fully fuse until adulthood.6,7 As the child matures, the body size increases relative to head size.

The face matures at a different rate compared to the head (cranium). At birth, the cranium-to-face ratio is 8:1. By the first year of life the ratio is 6:1. The facial characteristic presents as a prominent forehead and eyes in early childhood. During late adolescence, the ratio reaches adult level of 2:1. The facial complex of the nose, maxilla, and mandible increases in size with the role of development (ie, phonation and mastication). In infancy, the mandible is small with a ...

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