Approximately 10% of all EMS calls involve ill or injured children. Motor vehicle accidents pose the greatest safety issue for children. It is, in fact, the leading cause of death in children older than one year. Injuries remain the leading cause of death for people aged 1-18years.

Children represent special challenges when ill or injured. As a rescuer, it is important to understand that children are not just small adults.

They have unique characteristics, both physical and emotional. Infants and children have small airways that can easily become blocked by secretions, swelling or foreign bodies. Their tongues are proportionally large by comparison to their mouths and upper airways. Their cognitive skills are also lacking that of an adult. They don't understand why they are hurt and that you are trying to help. They can be fearful, emotional, combative or unwilling to communicate as a means of self-defense.

Children who experience respiratory problems quickly compensate by increasing their breathing and heart rate. Unfortunately, when these compensation methods fail, infants and children deteriorate rapidly. Children are also less able to compensate for blood loss, high or low temperature changes and infection. Avoid delays when requesting EMS whenever a child is involved.

Depending upon the age and cooperativeness, assessing a child can be fun and or a first aid nightmare. Children lack the negotiation skills, the strength or the money to get themselves out of scary situations. Their only method of fighting back is noise. Regardless of the age of the child, your main goal is not to make the situation worse by frightening or angering the child. When a parent or caregiver is involved, they may need as much reassurance as the child. If one becomes frightened, the other will too. This only makes your job more difficult.

The most important aspect when assessing a child is to stand back and evaluate their overall appearance. Assess their responsiveness, paying particular attention to their breathing. An anxious child who is working hard to breathe is not doing well. As you approach the child, consider the mechanism of injury, if any, and look at their environment. Be alert for signs of abuse or neglect such as bruises on the torso or head, unclean conditions or submissive behavior when you reach for the child.

Look at their skin color and check the temperature of their hands and feet.

Evaluate if the child is alert, attentive and appropriate for their age group. A listless infant or child represents a potentially dangerous situation. While it is true for all patients, the statement "noisy breathing is bad breathing" is especially true when dealing with infants and children.