Chapter 27: Pediatrics in Pandemics

INTRODUCTION

In a time of pandemic or crisis, providers are often called upon to care for patients who are not within their area of expertise. Providers may be called upon to care for patients who are older or younger than their usual specialty, which may be out of their comfort zone. Oftentimes, children can be a challenge for those trained in wartime or crisis medicine. Modern conflicts have been taking an increasing toll on civilians and children, and close coordination of care requires collaboration.¹

Pandemics often pose their own challenges, as children may present differently, and may require specific treatment different from their adult counterparts. Each illness can pose its own challenge, but there are some overarching themes that can be applied to the care of the pediatric population.

GENERAL CONSIDERATIONS IN CHILDREN

For all infectious diseases, children are not simply to be thought of as small adults. Though some principles of initial stabilization can be applied from adults to children, there are specific things needed to appropriately care for children. The physiology can change across the spectrum of ages seen within the pediatric population. The American Academy of Pediatrics has a Disaster Preparedness Advisory Council, which has drafted documents to assist in the care of children. The lack of recognition of a child’s special healthcare needs can lead to unneeded harm to them.² Pediatric populations also can have different presentations of illnesses that may be subtler than in their adult counterparts. Many pediatric illnesses present with fever and nonspecific symptoms such as fatigue and decreased oral intake, which can overlap with the initial symptoms of infectious pandemics. This provides for a diagnostic challenge, which should be recognized by clinicians prior to evaluating children.

Medications

The general approach to pediatric dosing is weight based. Medication that can be titrated to smaller doses is important. Often, standard formulations can result in overdosing in an infant or child. Dosing guidelines using weight-based dosing should be readily available to those caring for this population.

Understanding available routes is also important to the care of the patient. Not every child can swallow pills, and not every medication has a liquid form easily available. Optimal care during a pandemic requires people to be resourceful and have some knowledge of whether medications can be crushed and compounded into a liquid or used as a suppository.

Many medications do not currently have pediatric indications. Knowledge and rapid application of pathophysiology will be important in preparation for a pandemic. Stockpiles available to people from disaster preparedness organizations do not always have parity between children and adult needs.² Planning prior to an illness, using a model and thought that includes children will be important for optimal care of the pediatric population.

Equipment

In disaster preparedness, ...