Infants Part I (1 Hour)

Anatomical Differences between Adults and Infants

It goes without saying that infants are different than adults in their anatomy.  Some courses on pediatrics would tend to paint the picture that infants are like aliens from another universe with a completely different anatomy than that of an adult.  We prefer to think of infants as ‘little people’ with their own thoughts and imaginations.  The picture that comes to mind is the character of ‘Stewey’ on the family guy.  Stewey is an infant with his own thoughts, deeds, motivations, and of course military equipment to carry out his plans to rule the world.   When you are assessing and treating an infant, remember that the infant is a small human and treat accordingly. The biggest difference between infants and adults is their inability to communicate.  Developmentally, the infant exists in a non-verbal state.  The lack of communication and sheer emotional volatility of the infant is probably what scares us the most.  The good news is that infants do not live alone in this communication vacuum.  At the beck and call of the infant is a mother or mother figure (care giver) that should be able to console, communicate, and assist you in your endeavors to make the situation less volatile.  Since all children develop at different rates, many infants will not have developed stranger anxiety.  This makes things a little more possible to perform a physical examination.  If the infant has developed stranger anxiety, you’ll have to enlist the support of the care giver to perform the assessment.   When confronted with an infant or small child with stranger anxiety, we recommend the following:

• If possible conduct the assessment while the care giver holds the child.   The act of the care giver holding the child results in a consistent consolation.
• If possible conduct the assessment from behind the patient (this is assuming of course that the child is inconsolable, therefore the airway and breathing are obviously good).   We like to refer to this style of assessment as the “sneak attack”, exploiting a known developmental weakness of the infant which prevents the infant from being able to perceive that you are there because they can’t see you (object permanence). 
• Restrain the patient in a car seat.  The best piece of equipment for consoling, treating, and assessing your patient is one you probably don’t carry.  The good news is that Georgia Car Seat laws are so strict that parents are forced to keep them around pretty much everywhere you go.  The car seat is great for a variety of reasons
  • The infant feels enclosed and very safe.
  • The infant is placed in a desirable position which will allow them to maintain their own airway
  • The infant suddenly finds themselves in a familiar setting.