Are Kids Just Small Adults?

I started in adult nursing. For three years, I worked adult ICU and a community centered ED which primarily saw adult patients with a few kids mixed in.

I thought I knew everything I needed to know about treating pediatric patients. Needless to say, my eyes were opened when I took a class called Pediatric Advanced Life Support (PALS). That was just a taste of discovering I knew very little about the uniqueness of a pediatric patient.

During my time in the adult world, I discovered my joy of working with kids. In fact, I would bargain with my co-workers to take all of their patients eighteen-years-old and younger if they took everyone over the age of seventy-five. Surprisingly, this was an easy trade and I began to learn most adult centered nurses were very uncomfortable working with a child-- particularly a young child.

Then, an epiphany happened. There are places . . . whole big hospitals . . . where there are only kids. I need to go there. That began my career in pediatric nursing and I've never regretted choosing kids over adults.

What irks me about some of my adult counterparts is that they're very unwilling to admit that pediatric hospitals are the best places for kids to go. They think they can do it the same or better. Trust me, I'll be the first to admit that if you have crushing chest pain, I can do the basics to save your life, but I'll also be the first one to drag you by the shoulders across the threshold to the adult ED because I know you'll fair better there.




Why? Because they do adults every day and you get very good at what you practice.

I found this article very interesting. Confessions of a Preemie: How I Am Different than a Full-Term Baby. Isn't that amazing to think about? The difference four months can make in development?

In a humorous way . . . it got me thinking about things pediatric nurses have to consider that would be very odd for an adult ER nurse to have to think of or deal with.

1. When stripping for the scale-- kids are handing off favored stuffed animals, blankets and toy cars.
2.  The size difference. We have at least eight different sizes of BP cuffs (probably more when you get into preemie sizes.) In fact, we have multiple sizes of everything where as an adult focused ED might have a very small supply of pediatric equipment.
3. Vital signs are different according to age group. A newborn's resting heart rate can be 160 where as this would be considered abnormal for a teen. We have to memorize a large range of "normal" vital signs for about five different age groups. The only vital signs consistent across age groups is temperature and oxygen level. Heart rate, respiratory rate, and BP all change with age.
4. Does your child suck their thumb? If so, which one? Hopefully, my adult counterparts are not asking this question (and if they are, maybe adding a psych consult) but in pediatrics, it's very important when it comes to IV placement. We don't want to put an IV in the hand that contains their favorite thumb for soothing. Ultimately, everyone gets cranky because the child will be cranky.

That's just a very small sampling of some of the things that pediatric nurses have to deal with every day. Do you think you could do pediatric nursing?