As soon as their eye/hand coordination permits, children have a tendency to place anything and everything in their mouths. Any of you with children know this to be true. As a result, airway obstructions in children are very common. As with other patients, determining if the obstruction is partial or complete is your first step. Infants and small children are not likely to be able to answer questions, so be alert for sounds of respiration or coughing. Toys cause nearly 70% of choking deaths in children under 3, with 29% of those deaths resulting from balloons. Two thirds of choking deaths in children are under the age of 2 and nearly 75 children die each year from choking on food.

Hot dogs top the list of choking hazards, with peanut butter, chewing gum and grapes not far behind.

In addition to airway obstructions. respiratory problems in children are also quite common and they can result from illness or injury. Infections, asthma, drowning, near-drowning, allergic reactions and trauma are some possible causes of respiratory distress. Whichever situation you find, make certain you have activated the EMS system so that help is on the way.

Infants and children have their own special, onsiderations when it comes to breathing. Their lungs and trachea are smaller and therefore, more easily obstructed. An infant's tongue takes up proportionally more space in their mouth. As you would expect, because of their small physical size, infants and children have a smaller lung capacity. Their tracheas are also more flexible which makes an open airway more difficult to assess. Because their head is larger in proportion to their body, infants in particular, require different positioning of the head for airway management. Lastly, the main cause of cardiac arrest in infants and children is respiratory arrest. There are three specific childhood illnesses that deserve special mention; asthma, croup and epiglottises.

Treatment options available include inhalers, daily medications and nebulizer treatments. A large percentage of children will outgrow their asthma by the time they reach puberty.

Treatment for an asthma attack in a child is similar to that of an adult. You should always begin by calling 91 1, then check their ABC's. You may need to assist their breathing. The amount of air you blow into their lungs is described as a puff of air and the rate at which you deliver ventilations is more rapid.

Croup is an inflammation of the upper airway. Croup usually affects children between the ages of six months and four years. When the airway narrows, the child will experience increased breathing difficulties. Signs of croup include a sympathetic response and a loud "barking" cough. Some parents describe the sound like a seal making noise. A change in humidity often helps break the cough. This can be accomplished with steam from a hot shower or cool, moist air from the outdoors.

Epiglottitis, although very rare, can be much more serious than croup. It is a bacterial infection that usually strikes children up to the age of twelve. This infection causes the child's epiglottis to become in flamed and swell, which can eventually lead to a completely obstructed airway. Be alert for a sore throat that gets progressively worse followed by difficulty swallowing, high fever, noisy respirations and pronounced drooling. The best possible first aid treatment is to keep the child calm and call 91 1 immediately.

If a child stops breathing at any point during your care, you may need to relieve an airway obstruction, provide rescue breathing or even perform CPR- While these techniques are similar for infants, children and adults, there are subtle differences worth noting. An infant's airway is open when in a neutral position. Imagine a garden hose. When linked tightly, nothing gets through. Artificial ventilations are proportionally smaller in children and infants that in adults. A breath for an infant is described as the amount of air you can fit in your cheeks.

Compressions on infants are done with two fingers rather than two hands, and for a child, only use the pressure from one hand. Since infants really have no neck, it is necessary to check a brachial pulse. This is done by applying slight pressure to the inside of their upper arm, just under the biceps muscle. The last difference between infants, children and adults, is the timing of EMS activation. The first minute of care for an infant or child in respiratory or cardiac arrest may reverse the situation. With adults, we recommend calling 911 immediately to get defibrillators and cardiac drugs on the way. With infant and child care, perform the first minute of CPR, then call 911. In the following sections we will show you the techniques necessary to perform life-saving measures on infants and children.