differences between children and adults

8/14/2019 Differences Between Children and Adults

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Differences between children andadults

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.

Overview of differences

Anatomical/physiological

Larger BSA- Children have aproportionately 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 theskin.

Thinner skin- Children havethinner 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 growth

As a result, children are more susceptible to the effects of radiation than adults.

Higher HR and RR- Children have higher respiratory rates than adults. Higherrespirator 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


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more rapidly to such agents. Signs and symptoms in children may be an "early

warning" of a chemical, biological, or radiological incident.

Immature blood brain barrier- Children have immature blood-brain barriers andenhanced central nervous system (CNS) receptivity.

As a result, children may exhibit a prevalence of neurological symptoms. Nerve agents

may produce more symptoms in pediatric patients, requiring levels of treatment for

children that are not indicated for adults with the same level of exposure.

Higher metabolic rate- More susceptible to contaminants in food or water; greater riskfor increased loss of water and when ill or stressed. 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 someinfections.

Psychosocial Differences

Although adults continue to develop psychosocially, their values/behaviour/social circles are

generally far more defined and stable, whereas children and adolescents are rapidly

developing and using the world around them and picking up cues from their environment to

aid in that development.

It is essential to be mindful of the way clinicians interact & communicate with children,

adolescents and their families as they play a role in this development, and to be well aware

of the broader context of a child or adolescent's life, as this has a much more significant

impact on the way they experience and recover from illness or injury.

Social

Unlike adult, children and adolescents

are still in a period of social

development which involves learning

the values, knowledge and skills that

enable them to relate to others. The

goal is for children and adolescents to

build a positive sense of their own

identity and their role in relationships

with people around them.

These social skills and lessons can be

learnt from those who care for them, as

well as indirectly through negotiating


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social relationships with family or with friends, and through participation in the world around

them e.g. coming to hospital. Not of these relationships and experiences are positive, and

the impact of negative influences also shapes social behaviours. Hospitals and their staff

can be part of a child/families social environment and therefore it is important for clinicians

to be mindful of how they conduct themselves in their social or professional relationships

with a child's family and toward the child and adolescent themselves, as this has an impact

on learning and development of their own social identity. It is also important to be mindful

of different circumstances which shape social skills during the developmental process and

influence behaviours and interactions with other people.

Children, and to a lesser extent adolescents, typically present more explicitly with their

immediate social circle shown to the clinician- with the presentation of parents,

grandparents, aunts & uncles etc at appointments.

Emotional

Children and adolescents are still developing their ability to recognize and manage their

emotions or feelings, and this can be influenced by many social and environmental factors.

For infants and young children, their emotional bond of affection or 'attachment' to their

caregivers is crucial to their emotional development.

Effects of Secure Attachment

More resilient, competent toddlers with high self esteem In pre-school display more persistence, curiosity, self reliance, leadership and have

better peer relations

After age 11- better social skills, > close friendsClinicians in a pediatric setting should be mindful of the disruption to this bond that may

result in separation anxiety which is emotional distress seen in many infants when they are

separated from people with whom they have formed an attachment.

They should also be mindful that not all children and adolescents will come from an

environment where they will have the consistency and stability in their everyday lives to

allow them to form secure attachments, and this may be reflected in their coping and

behavior.

Cognitive


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The growth of thought in children

More so that in an adult environment, a clinician must be mindful of how they communicate

with a patient, taking into account a child or adolescent's level of cognitive development.

Examples:

Example for a younger child-Four year old Susan was asked where she got her name.

- She answered, "My mummy named me",

- "What if your mother called you Jack?"

- "Then I'd be a boy"

Example for an older child:Concrete: "You said I'd get it if I missed my asthma inhalers, but I forgot them twice

and I stayed fine so I don't need them anymore"

Abstract: "I missed my inhalers a couple of times but I think I got away with it


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because I wasn't doing much exercise. I think I'll still need them in the future if I'm

doing lots of exercise or in cold weather"

AdolescenceIt is important to not only acknowledge the differences in a child vs adult population but

also adolescence and the specific developmental challenges that it presents.

Adolescents are generally more able to participate in decision-making about their own care,

and have opinions and views which can challenge those of their families and/or health care

providers so it is necessary to find the most appropriate way to work with each adolescent

on an individual basis. This is the case in a paediatric or adult setting, as adolescents can

often be seen in adult environments and can feel overwhelmed or insignificant without the

opportunity to participate in their own healthcare decisions.

Adolescents can be more inclined to be experimental and take part in high-risk behaviours

which impact on their health and their response to intervention. Adolescents and children

are also more vulnerable as a result of their reliance on others to meet their different needs,

and they can be more susceptible to the negative impacts of complex social situations and

exploitation as they are not yet fully developed or independent. These factors can have a

major impact on their presentation and behaviours, and are also a major factor in planning

for discharge/ future healthcare and wellness.

Adolescents will eventually transition to adult health-care environments, which can be a

vastly different environment with new challenges and staff. It is important to help

adolescents prepare for this transition by taking more responsibility for their own healthcare

and enable them to negotiate their way through this new environment.

Why is specialist paediatric training important?

Children, adolescents and adults

Present with illness differently, so people working with children need the skills andknowledge to identify and diagnose illness in a child or adolescent, and be aware of

illnesses specific to different age groups.

Often require different treatment or approaches to treatment, so require specific age-appropriate treatment approaches and environments (where possible).

Have different contexts.o Children and adolescents come with family, who generally have a greater role in

their wellbeing, so health professionals need to work with family as well as the

patient.


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o Activities are different for different ages- play becomes less important with age,but the need for stimulation and employment in other activities remains

important. School in older children and adolescents moving towards work for

older adolescents and adults.

o Children and adolescents are still developing, so their responses to similarsituations will be different and experiences they have will impact on their future

development.

Summary

As well as the more obvious physiological and cognitive differences between childrena dn

adults, working with children and adolescents requires the consideration of future

development- physical, social, emotional cognitive- as of primary importance. The need to

be aware of the context in which a child or adolescent lives and functions is crucial for both

the provision of appropriate management as well as planning for future healthcare.

differences between children and adults

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