Neonatal and Pediatric Patients
Core concepts
Pediatric and neonatal care is weight-based and developmentally sensitive. Understand the pediatric assessment triangle: appearance, work of breathing, and circulation. Know age-specific airway anatomy, respiratory rates, blood pressure norms, and equipment sizing. Doses, fluids, and defibrillation energy are weight-based. Neonatal resuscitation emphasizes warmth, drying, stimulation, airway positioning, and positive-pressure ventilation when needed. Recognize dehydration, hypoglycemia, sepsis, seizures, congenital heart disease, and nonaccidental trauma.
Traps
A frequent mistake is applying adult vital-sign thresholds to children. Another is giving a full adult fluid bolus; pediatric boluses are typically smaller and reassessed. Epinephrine concentration and route are high-risk traps. Children compensate well and can crash suddenly. Hypothermia and hypoglycemia are easily missed. Do not assume a quiet child is stable.
Rule of thumb
Use a length-based or weight-based system and double-check every dose. A useful fluid rule is 10–20 mL/kg boluses with reassessment, not a single large adult bolus.
Worked example
A 10-kg child with vomiting and diarrhea is lethargic with delayed cap refill. Obtain glucose, give a 10–20 mL/kg isotonic fluid bolus, reassess, and repeat as needed. Check weight-based medication doses and keep the child warm. The trap is treating the child like a small adult and missing hypoglycemia.