Children 

Children

Children have unique characteristics which make them more vulnerable in an infectious, natural or man-made disaster.  These vulnerabilities apply to all children, although children with special health care needs may also have specific conditions which can place them more at risk.  Pediatric vulnerabilities have previously been well described by the Illinois Emergency Medical Services for Children’s project and are listed below: 

• Children are more vulnerable to agents that act on the skin because their skin is thinner and have a larger surface-to-mass ratio than adults.
• Children are particularly vulnerable to aerosolized biological or chemical agents because they breathe more times per minute than adults and would inhale larger doses of the substance in the same period of time.  Also, because some such agents (e.g. sarin and chlorine) are heavier than air, they accumulate close to the ground – right in the breathing zone of children.
• Children are more vulnerable to the effects of agents that produce vomiting and/or diarrhea because they have less fluid reserve than adults and can become dehydrated faster.
• Infants, toddlers and young children do not have the motor skills to escape from the site of a chemical, biological or other terrorist incident.  Children also lack cognitive decision-making skills to figure out how to flee danger or to follow directions from others.
• Children have smaller circulating blood volumes than adults so if treatment is not immediate, relatively small amounts of blood/fluid loss can lead to irreversible shock or death.
• A child’s condition can shift from stable to life-threatening quite rapidly because he/she has less blood and fluid reserves, is more sensitive to changes in body temperature, and has a faster metabolism.

Children and Youth with Special Health Care Needs

In addition to the vulnerabilities which all children may face during a disaster, children and youth with special health care needs (CYSHCN) may also have condition-specific risks or be more vulnerable because of the complexity of their conditions. Parents of CYSHCN are their caregivers, often providing complex care involving medications and medical devices such as insulin pumps, respiratory devices (nebulizers, oxygen, ventilators), and parenteral devices. In the event of separation from their parents, other trained personnel will be needed to provide this care. Children previously cared for in a home setting may need a higher level of care if separated from their parents/caregivers. Examples of CYSHCN at risk include, but are not limited to, those:

• with respiratory conditions (asthma, cystic fibrosis, bronchopulmonary dysplasia) when exposed to aerosolized biological or chemical agents or environmental contaminants (smoke, dust or other particulate matter);
• with endocrine disorders when exposed to agents that produce vomiting or diarrhea or in which dehydration would place them at very high risk (congenital adrenal hyperplasia);
• with metabolic disorders or with severe food allergies (phenylketonuria) requiring special formula or diet; 
• with neurological disorders whose baseline is difficult to assess without caregiver’s input;
• requiring medical devices, medical supplies or life-sustaining treatment (nebulizers, chest physiotherapy vests, oxygen, ventilators, dialysis);
• requiring medication (insulin, anti-epileptics, inhalers, Hemophilia factor) on a regular basis, without which increased morbidity and mortality could occur;
• with musculo-skeletal disorders (cerebral palsy, muscular dystrophy) who can not move independently or require assistance to ambulate;
• with cardiac conditions whose exercise tolerance limits the endurance required for walking/running during transport/evacuation;
• requiring tube or parenteral feedings by trained personnel;
• with behavioral, emotional or mental disorders whose condition may be exacerbated by separation, transition or anxiety;
• with communication disorders (hearing loss, non-verbal or severe speech articulation problems); and,
• with an immunocompromised state (cancer, HIV/AIDS) due to their medical condition or its treatment, when exposed to infectious agents.

The impact on children and families of disasters, terrorism, trauma, or violence presents many challenges to families and health professionals. This guide provides resources for helping children and adolescents cope with injury; loss of loved ones; destruction of homes and schools; and other trauma.