Differences Between Children and Adults

Anatomical and Physiological Differences and the Effect on Children’s Responses to CBRNE Incidents

Children have a proportionately larger body surface area (BSA) than adults do. The smaller the patient, the greater the ratio of surface area (skin) to size. BSA also parallels certain body functions, including basal metabolic rate (BMR) and minute volume.

As a result, children may be more susceptible to agents that affect the integrity of the skin or are absorbed through the skin.

Incidents:
Chemical
Biological
Radiological and Nuclear
Explosive
 

Children have thinner skin than adults. Their epidermis is thinner and under-keratinized, compared with adults.

As a result, children are at risk for increased absorption of agents that can be absorbed through the skin.

Incidents:
Chemical
Biological
Radiological and Nuclear
Explosive
 

Children have higher respiratory rates than adults. Higher respirator rates lead to proportionately higher minute volumes.

As a result, children may be more susceptible to agents absorbed through the pulmonary route than adults with the same exposure. Children may also respond more rapidly to such agents. Signs and symptoms in children may be an “early warning” of a chemical, biological, or radiological incident.

Incidents:
Chemical
Biological
Radiological and Nuclear
Explosive
 

Since children are generally shorter than adults, their breathing zone is lower to the ground. At the same time, many agents that are aerosolized are heavier than air.

As a result, children may be more susceptible to agents absorbed through the pulmonary route than adults with the same exposure. Children may also respond more rapidly to such agents. Signs and symptoms in children may be an “early warning” of a chemical, biological, or radiological incident.

Incidents:
Chemical
Biological
Radiological and Nuclear
Explosive
 

Children have immature blood-brain barriers and enhanced central nervous system (CNS) receptivity.

As a result, children may exhibit a prevalence of neurological symptoms. Nerve agents may produce more symptoms in pediatric patients, requiring levels of treatment for children that are not indicated for adults with the same level of exposure.

Incidents:
Chemical
Biological
Radiological and Nuclear
Explosive
 

Children are more prone to dehydration than adults. At the same time, exposure to many chemical agents and some biological agents leads to vomiting and diarrhea.

As a result, children may be more symptomatic and show symptoms earlier than adults.

Incidents:
Chemical
Biological
Radiological and Nuclear
Explosive
 

Children have a higher proportion of rapidly growing tissues than adults, and some agents, including ionizing radiation and mustard gas, significantly affect rapidly growing tissues.

As a result, children are more prone to ionizing radiation and other agents that affect rapidly growing tissue than adults are. Children may be more symptomatic and show symptoms earlier than adults. Exposure can have a significant impact on children’s bone marrow and developing CNS, especially in children under two years of age.

Incidents:
Chemical
Biological
Radiological and Nuclear
Explosive
 

Children have relatively small airways compared with adults. The smaller the caliber of the airway, the greater the reduction in airflow as a result of increased pulmonary secretions that occur following exposure to chemicals or edema from inhalation of hot gases, for example.

As a result, children suffer more pulmonary pathology than adults at the same level of exposure.

Incidents:
Chemical
Biological
Radiological and Nuclear
Explosive
 

While IV medications may be the recommended prescription, vascular access in children can be difficult. The smaller the child, the more difficult vascular access becomes. Managing the many size-related issues that arise in acute emergencies presents problems; the variation in children’s sizes further complicates the issue.

As a result, errors and delays in treatment, and discomfort in drug dosing, may occur. The use of intramuscular (IM) and intraosseous (IO) medications may be of practical value in a mass-casualty situation.

Incidents:
Chemical
Biological
Radiological and Nuclear
Explosive
 

 

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