KIDS ARE NOT SMALL ADULTS, EVEN DURING CRISIS
Some of the most basic instincts of any biological group is the need to protect the progeny in time of peril. Most human cultures see the care for children as one of the highest values. As children have distinctive biological, physiological, psychological, and developmental attributes, it is crucial that pediatric needs are incorporated into every facet of disaster, mass casualties, and preparedness planning. Furthermore, emergency responders, medical professionals, and health care entities may not always have adequate pediatric-adjusted resources, training, equipment, or facilities available, and therefore preparedness must include the ability to provide the special expertise and training that ensure optimal care of children.1
Children exhibit significantly higher rates of mortality during disasters as compared to the adult population. This trend probability increases further for children under five years of age.2
Part of the reason for this observation rests in the different physiological makeup of children. Children are smaller in size and therefore, absorb higher impact from external forces that are generated during a disaster. Their organs are proportionately larger, closer together, and not as well-protected as are adult organs, further rendering them at greater risk for traumatic injuries. Fluid and electrolyte balance may be difficult to maintain in young children, and they have less circulatory reserve due to smaller circulating volumes. Therefore, young children are at greater risk for severe dehydration and circulatory collapse when exposed to diarrhea, vomiting, hypovolemia, or blood loss. Children also metabolize drugs differently, thereby requiring varying dosages of drugs, antidotes, and specialized equipment for medication administration. Their increased body surface area-to-mass ratio and decreased subcutaneous tissue make them more vulnerable to hypothermia. Furthermore, children are more susceptible to the effects of radiation exposure and require a more vigorous medical response in these occasions.3
The biological response to various infectious pathogens may be significantly different in children than that of adults, resulting in a significantly different immunologic response, clinical presentation, or treatment requirement. Their decreased herd immunity also makes them more susceptible to many infectious agents.
Children have a higher metabolic rate, faster heart rate, higher respiratory rate, and less subcutaneous tissue compared to adults. This increases their susceptibility to airborne chemicals and biological agents that may more readily and promptly be absorbed through children’s skin or mucosal barriers and more rapidly spread throughout their circulatory system. Chemical agents with high vapor density that are heavier than air, including certain gases such as sarin and chlorine, settle close to the ground, in the “airspace” used by children.1–3
These unique pediatric traits are not always fully considered in planning and preparedness efforts and may not be sufficiently addressed during disaster response. This is especially true for the specific challenges such as biological, chemical, or nuclear threats.
PEDIATRIC SPECIFIC VULNERABILITIES IN DISASTERS AND MASS CASUALTY EVENTS