- The recommendation for an initial fluid bolus of 30 mL/kg was downgraded from a strong recommendation to a weak recommendation, based on the low quality of evidence. However, resuscitation should start immediately.
- Balanced crystalloid solution (e.g., lactated Ringer’s solution) should be used (rather than normal saline) for resuscitation.
- Administration of vasopressors should be initiated via peripheral access, as opposed to waiting for placement of central venous access.
- Patients with ongoing vasopressor requirements should receive intravenous corticosteroids (this recommendation was strengthened); however, administration of intravenous vitamin C is explicitly not recommended.
Most infants transition from intrauterine to extrauterine life without any assistance. The term-infant with good tone, color, and respiratory effort requires no assistance and should be handed off to the mother after birth. However, approximately 10% of infants require some resuscitation and about 1% require extensive resuscitation. The main priority in neonatal resuscitation is establishment of effective ventilation and oxygenation.
- When there is concern for physical abuse, the physical examination should be completed with the child undressed (in a gown), with specific attention to the skin, scalp and fontanel, mouth and oral cavity (including frena), ears, genitalia, and growth chart.
- Any injury in a preambulatory child, including bruises, mouth injuries, fractures, and intracranial or abdominal injury, should raise concern for abuse.
- The “TEN 4” rule: bruising of the Torso, Ears, or Neck in children <4 years old and any bruising in children <4 months old should raise concern.
- Radiographic skeletal survey should be performed using proper technique for children <2 years old with concern for abuse. Repeating the skeletal survey 2–3 weeks later can identify additional fractures that were not seen initially.
- Young (<2 years old) siblings and household contacts of abused children should be examined for abusive injuries and undergo skeletal survey.
- Infants evaluated for physical abuse may benefit from neuroimaging even if they don’t have neurological symptoms.
- Retinal examination is indicated for children with concern for abusive head trauma but may not be indicated for children without intracranial injury.
- Health care providers with a reasonable suspicion of physical abuse have a legal mandate to report their concern to child protective services.
There is so much health information on the internet that it can be a challenge to know who to trust. TREKK provides resources about children’s emergency care that are created by experts and based on evidence. The information provided on TREKK.ca is not meant to replace the advice of a health professional. The information provided on TREKK.ca is designed to complement, not replace, the relationship between a patient and their own physician or healthcare provider.