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DIFFERENCE BETWEEN AN ADULT AND CHILD.
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There are a many differences between children, adolescents and adults- physiological, anatomical, cognitive, social and emotional- which all impact on the way illness and disease present in children and young people, as well as the way healthcare is provided.
Anatomical/ physiological changes • Size- influences the methods and instruments used in caring children • Greater size and weight of head in comparison to body in newborn baby • Suture of the skull are not united; Braain is not protected by the skull at fontanelles. • When ICP increases head enlarges in infants. • Shape of the head and chest of the infant can alter by constant pressure by lying in one position.
Larger BSA- Children have a proportionately larger body surface area (BSA) than adults do. • The smaller the patient, the greater the ratio of surface area (skin) to size. • As a result, children are at greater risk of excessive loss of heat and fluids; children are affected by more quickly and easily toxins that are absorbed through the skin.
Thinner skin- Children have thinner skin than adults. Their epidermis is thinner and under-keratinized, compared with adults.As a result, children are at risk for increased absorption of agents that can be absorbed through the skin. • Rapidly dividing cells- Children's cells divide more rapidly than adults to assist in their rapid rate of growthAs a result, children are more susceptible to the effects of radiation than adults.
Higher RR- Children have higher respiratory rates than adults. Higher respirator rates lead to proportionately higher minute volumes.As a result, children may be more susceptible to agents absorbed through the pulmonary route than adults with the same exposure. Children may also respond more rapidly to such agents. Signs and symptoms in children may be an "early warning" of a chemical, biological, or radiological incident.
Fetal lung immature. • Alveolar surface and weight of adult lung is about 20 times that of neonate. • During infancy, respiratory tract is delicate and do not produce mucus as they do in childhood. • Infection travel quicker to other areas because of the proximity of the Eustachian tube to the throat.
Eustachian tube is shorter and straighter in infants than older child and adult- infection • Tonsils and adenoids are large in children and are involved in the production of immune bodies.
During infancy heart sounds are of higher pitch and greater intensity than adult life. • Pulse rate 140 in newborns then it decreases. • Normal systolic and diastolic BP reading of children increases with advancing age from newborn to adolescents. • Variations in BP occurs more frequently in infants. • During newborn period ECG is unique because of the many changes occurring in the heart.
RBC of the newborn infants are different from those of adult- macrocytic. • Life span of RBC in normal adult is app. 120days but in neonates 90 days. • Soon after the birth erythropoietic bone marrw becomes hypoactive- Physiologic anemia which is more common in premature babies than term babies. It becomes normal after two months.
Total body water in infants is about 750ml/kg body weight and in adult 550ml/kg body weight. • Proportion of total body water and total body fat is different in infants and young children from that in adults. • Newborns 75-80% of body weight is of body water where as 60% of body weight is water in adults.
Infants retain less body water within the cells than do adults. • Infant has a potentially greater water loss than the adults. They loose fluid more than adults. • Fasting infants develop ketosis more quickly than adults because of their relatively higher metabolic rates. • Higher metabolic rate- More susceptible to contaminants in food or water; greater risk for increased loss of water and when ill or stressed
Cardiac sphincter of stomach is fairly tight in the adult. In the infants more relaxed.Vomiting is so frequent, hence proper positioning of the child during feed is so important. • Gastric emptying time in infants 2-3 hours but in adults 3-6 hours. • Neonate and infant stool relatively loose as food passes rapidly. • Increase motility causes infection and trauma. • The liver is approximately 4% of body weight in the newborn, infant and occupies a much larger portion of the abdominal cavity than in adult life.
When the infants under stress, kidneys functional reserves are reduced compared with those of adults. • Young infants cannot concentrate their urine as well as older children and adults. • CRF usually does not follow ARF in child.
GLOMERULAR FILTRATION RATE: Concentration of urine in newborn is 800 mOsmol /L whereas in adults it is 1400 mOsmol /L. GFR and tubular functions are lower in neonates than adult because low blood supply to kidney, smaller pore size and less filtration power across nephrons . GFR- 38 ml/ min (neonate) GFR- 125 ml/min (adult)
The levels of growth hormone are greater in girls and women than in younger children and men. • Thyroid hormone levels vary in preterm, newborns, infants, children and adolescents. • Adrenal glands are small during infancy and have limited function, but their function increase until puberty.
REPRODUCTIVE SYSTEM FEMALE MALE
OVARY: In normal full term baby girl, the ovary is approximately 10mm in length and 2-4mm in width. 12-13 years ovulation starts. • TESTES: Genitalia is small. Begins to enlarge between 9-13 years of age. Development completes between 13-17years.
At puberty the male hormone androgen causes increase muscle size in boys. • Bone growth takes place after birth until the end of adolescents. • The length of the head is one quarter of total body length in the newborn infant, about 1/6th in 6year old and about 1/8th in the adult.
The weight of the brain in neonate 300-350gram. Doubles the size by 1 year, at which time its weight is two thirds that of the adult. • By 2 years of age, child can perform motor movement like an adult, but with less speed and coordination. • Neonatal eyes are not anatomically matured.
Immature blood brain barrier- Children have immature blood-brain barriers and enhanced central nervous system (CNS) receptivity.As a result, children may exhibit a prevalence of neurological symptoms. Nerve agents may produce more symptoms in paediatric patients, requiring levels of treatment for children that are not indicated for adults with the same level of exposure.
TEMPERATURE REGULATION:: • TEMPERATURE REGULATION: Poor thermo regulation is attributed to immaturity of the hypothalamus. Shivering and sweating mechanisms are absent in newborn.
An infant cannot complain about pain or localize the pain. Older child can successfully communicate. • Infants and little children are in general better patients than adults because they live in the present, easily forgetting the past, not concerned about future, and their attention span is poor.
Fear , escape and avoid strangers till 5 years of age. Explore the environment. • INFANCY- more bonding with parents. Separation anxiety is very common. • TODDLERS – Negativistic behavior • PRE SCHOOLER- short attention span, easily distractible . • ADOLESCENTS- Identity of peer, confusion.
. Medication doses must be carefully calculated based on the child's weight and body size • Immature immune systems- Greater risk of infection; less hard immunity from some infections.
Erythroblastosis fetalis only seen in neonates. • Nutritional disorders commonly seen in infancy and childhood. • Curiosity activities can cause accidents in children. • Less immunity make cause prone for infection in children than the adult. • Failure to thrive seen in children.
Emotional disturbances – conduct disorders, psychosomatic disturbances seen in children.
