Let's face it: Pediatric patients can be intimidating. They're small, they cry a lot, they require different medication dosages, and, fortunately, we don't run into them with great frequency.
But infrequency has its drawbacks. As with any skill, the more often we apply it, the greater our proficiency. Likewise, the opposite is true: If we go long periods between certain types of patients, we tend to lose our edge when caring for such patients. (How many of us can calculate a dopamine drip in under five seconds—without using the street rule?)
When it comes to pediatric patients, the key to effective patient care is to be prepared: Know your pediatric protocols, practice airway and assessment skills regularly, and be sure to have the right equipment on hand. One of the most important pieces of equipment is your portable suction pump, which is why it should be a mainstay of your pediatric bag.
Assessing the Pediatric Patient? Include the Adult
Children are not simply smaller adults. They require a specific approach before, during, and after treatment. Because young children may not be able to relay specific information concerning their chief complaint, it is imperative to include the parent or guardian during the initial assessment. Here are a few key questions to ask during the assessment:
- Has your child experienced this kind of problem before?
- Is this the first time your child has experienced respiratory distress?
- Does the child currently take medication?
- Has the child been running a fever? If so, what is their temperature?
- Did the symptoms (coughing, choking, gagging) begin suddenly?
- Has your child sustained a traumatic injury to the chest?
The parent or guardian’s responses to these questions will help clarify the nature of the child’s complaint and condition.
Causes of Poor Air Movement in Children
Because children have trouble relaying information, it will behoove you to maintain a high index of suspicion concerning airway patency. Here are some of the functional problems associated with poor air movement in children, along with their possible causes:
- Airway obstruction – asthma, bronchiolitis, croup, or a foreign body
- Restriction of chest wall movement – traumatic injury, severe scoliosis, or kyphosis
- Chest wall muscle fatigue – prolonged increased work of breathing or muscular dystrophy
- Decreased central respiratory drive – head injury or intoxication
- Chest injury – rib fractures, pulmonary contusion, or pneumothorax
Suction Considerations in Infants and Children
The first step in suctioning a pediatric patient is determining which technique suits his or her size/age. Here are the guidelines:
- Newborns – use a bulb syringe or suction catheter (dial back the pressure of your portable suction machine)
- Infants and children with thin secretions – bulb syringe or suction catheter (ditto, concerning pressure)
- Newborns, infants, and children with an endotracheal tube in place – suction catheter (small-bore, flexible)
- Infants and children with thick secretions or particulate matter – large-bore suction catheter
Suctioning the Pediatric Patient
Once you’ve determined your patient needs suction, here are the steps to take:
- Select the appropriate suction device based on size and age.
- Ensure the suction pump is operational.
- Select the proper size of suction catheter (using pediatric resuscitation tape guidelines or selecting a catheter that is smaller than the patient’s nostril).
- Connect the catheter to the tubing and connect the tubing to the suction pump.
- Set the suction pressure (maximum of 120 mm Hg).
- Use a cautious technique when suctioning to avoid traumatizing oral or nasal tissues.
- Maintain sterile technique, especially when suctioning an advanced airway.
As with any treatment, suctioning can pose a threat if not applied appropriately. Possible complications when suctioning the pediatric patient include:
- Traumatic injury to the mouth, airway, or lung
- Gagging or vomiting
- Aspiration of stomach contents
- Hypoxia from prolonged suctioning (never suction for more than 10 seconds)
- Pushing the foreign body farther into the trachea with the suction device
- Increased intracranial pressure
- Suctioning beyond your direct vision can lead to gagging, vomiting, and aspiration
Suction can save the life of your patient. And because most cardiac arrests in children result from primary respiratory causes, correcting respiratory insufficiency through effective oral or nasal suctioning can prevent further complications, even death.
This is why it’s crucial to always have your portable suction pump with you on every pediatric call. Include the suction unit in your pediatric bag. That way, whenever one of your small patients needs suction, the pump will be right at your side.
Editor's Note: This blog was originally published in December, 2017. It has been re-published with additional up to date content.
Pediatric Education for Prehospital Professionals, American Academy of Pediatrics, Jones & Bartlett.