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Children are not just small adults. This standard mantra is heard in EDs around the world. About one third of all ED visits are by children. Anatomic, physiologic, and developmental differences between children and adults give rise to a unique epidemiology, pathophysiology, and differential diagnosis. Key elements of the medical history must often be elicited from caretakers, not from the child, and symptoms are often inferred from observation. It may be difficult to perform a physical examination on a child, and cardinal signs of disease are different in children compared to adults. Diagnostic testing can cause pain or potentially long-term harm. Drugs require weight-based dosing, and equipment selection must be tailored to the child’s size. Disposition may require transfer to a specialized children’s hospital. Finally, even though the child is the primary patient, management must be family centered and often involves addressing the fears and stresses of family members.


Pediatric age groups are divided into neonates (birth to 1 month), infants (1 month to 1 year), toddlers (1 to 3 years), school-aged children (3 to 12 years), and adolescents (12 to 18 years). Significant developmental and physiologic changes occur across these age groups; Table 106-1 summarizes the developmental milestones as they relate to the ED evaluation and approach, and Table 106-2 lists the age-dependent vital signs.

TABLE 106-1Pediatric Developmental Stages and ED Assessment
TABLE 106-2Pediatric Vital Signs by Age (Awake and Resting)

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