Trauma (peds)


  • Key is to recognize and treat shock early (before blood pressure decreases),
    • once child has signsigns and symptomsymptoms of shock, may have lost 25% of blood volume
  • BP not usually helpful sign of blood loss in pediatric patients
    • Kids more effective at increasing HR and stroke volume, so can have high, low, or normal BP in shock
    • pulse pressure is helpful
  • 80% of pediatric trauma deaths associated with neurological injury (see pediatric head trauma)

Pediatric car seat rules[1]

Age Type of Car Seat Position Comments
<2 years old Infant-only or convertible car seat Back seat, rear-facing If child height or weight > seat limit (usually ~40-65lbs), go to next age up
2-8 years old Convertible or combination car seat Back seat, forward-facing If child height or weight > seat limit, go to next age up
8-12 years old Booster seat Back seat, forward-facing If child height or weight > seat limit (usually 4' 9"), go to next age up
12-13 years old Lap and shoulder seat belt Front or back seat, forward-facing

Clinical Features

  • Peds assessment triad: appearance, work of breathing & circulation (skin color)
  • Child's size allows for distribution of injuries
    • multi-system trauma is common
    • internal organs more susceptible to injury due to anterior placement of liver and spleen (as well as less protective muscle & fat)
    • Kidneys also less well protected and more mobile, prone to decelleration injury
  • Wadell Triad in auto vs. pedestrian child= femoral shaft fracture, intraabdominal/intrathoracic injury, and contralateral head injury

Differential Diagnosis


  • Consider:

CT abdomen/pelvis[2]

Significant intra-abdominal injury after blunt torso trauma highly unlikely (0.1%) if all of the following are true:

  • Glasgow coma scale ≥14
  • No evidence of abdominal wall trauma or seat belt sign
  • No abdominal tenderness
  • No complaints of abdominal pain
  • No vomiting
  • No thoracic wall trauma
  • No decreased breath sounds


  • ATLS
  • In ED give IVF at 20cc/kg, if unresponsive after 40cc/kg give PRBC at 10cc/kg (can start with PRBC if presents in decompensated shock & multip injuries suspected)


  • Depends on underlying injury

See Also

External Links


  1. AAP 2011.
  2. Holmes JF et al. Identifying Children at Very Low Risk of Clinically Important Blunt Abdominal Injuries. Ann Emerg Med. 2013