Trauma (peds)

This page is for pediatric patients. For adult patients, see: Trauma (main).


  • Key is to recognize and treat shock early (before blood pressure decreases),
    • once child has signs and symptoms of shock, may have lost 25% of blood volume
  • BP not usually helpful sign of blood loss in pediatric patients
    • Can have high, low, or normal BP in shock
    • pulse pressure is helpful
  • 80% of pediatric trauma deaths associated with neurological injury (see pediatric head trauma)

Locations of Possible Life-Threatening Bleeding

Pediatric car seat rules[1]

Age Type of Car Seat Position Comments
<2 years old Infant-only or convertible car seat Back seat, rear-facing If child height or weight > seat limit (usually ~40-65lbs), go to next age up
2-8 years old Convertible or combination car seat Back seat, forward-facing If child height or weight > seat limit, go to next age up
8-12 years old Booster seat Back seat, forward-facing If child height or weight > seat limit (usually 4' 9"), go to next age up
12-13 years old Lap and shoulder seat belt Front or back seat, forward-facing

Clinical Features

  • Peds assessment triad: appearance, work of breathing & circulation (skin color)
  • Child's size allows for distribution of injuries
    • multi-system trauma is common
    • internal organs more susceptible to injury due to anterior placement of liver and spleen (as well as less protective muscle & fat)
    • Kidneys also less well protected and more mobile, prone to decelleration injury
  • Wadell Triad in auto vs. pedestrian child= femoral shaft fracture, intraabdominal/intrathoracic injury, and contralateral head injury

Differential Diagnosis


  • FAST exam
  • Consider as indicated:
    • CBC, coags, T&S, LFTs for abdominal trauma[2]
    • Plain films
    • CT head, cervical spine clearance clinically or with imaging
    • CT abdomen/pelvis[3]
      • Significant intra-abdominal injury after blunt torso trauma highly unlikely (0.1%) if all of the following are true:
        • Glasgow coma scale ≥14
        • No evidence of abdominal wall trauma or seat belt sign
        • No abdominal tenderness, abdominal pain, or vomiting
        • No thoracic wall trauma or decreased breath sounds


  • ATLS
  • In ED give IVF at 20cc/kg, if unresponsive after 40cc/kg give PRBCs at 10cc/kg (can start with PRBC if presents in decompensated shock & multiple injuries suspected)


  • Depends on underlying injury

See Also

External Links


  1. AAP 2011.
  2. The Utility of Laboratory Testing in Pediatric Trauma: A Primer from TAMING OF THE SRU Dec 13, 2019 available at
  3. Holmes JF et al. Identifying Children at Very Low Risk of Clinically Important Blunt Abdominal Injuries. Ann Emerg Med. 2013