Background of Study

In 2002, children under age 19 made more than 29
million visits to emergency departments (EDs) in the United States (2002
National Hospital Ambulatory Medical Care Survey [NHAMCS] data, calculations by
Institute of Medicine [IOM] staff). Approximately 20 percent of children make
one or more visits to an ED each year; 7 percent make two or more visits
(National Center for Health Statistics, 2005). Despite this heavy reliance on
the emergency care system, the public typically gives little thought to the
adequacy of the system for children. Yet they have lofty expectations.

Parents and caregivers expect emergency and trauma
care providers to deliver high quality care to their children when it is
needed. They expect the system to be agile, able to respond quickly at any hour
of the day or night and handle any type of pediatric emergency appropriately
(Harris Interactive, 2004). In reality, however, the public knows little about
how well local emergency care and trauma systems perform, both absolutely and
in comparison with other systems.

Emergency care systems are largely local in nature,
and they vary accordingly. State and local prevention laws, the training of
prehospital emergency medical technicians (EMTs), and the availability of
hospitals and pediatric emergency medicine physicians are but a few examples of
such variations – key elements that have an important impact on the functioning
of the emergency care system. Some areas of the country, particularly urban
settings, have children’s hospitals and hospitals with pediatric EDs staffed by
pediatric emergency specialists and equipped with the latest technologies for
the care and treatment of children. In other areas, however, pediatric-
specific resources are highly limited. Dedicated, well-intentioned prehospital
emergency medical services (EMS) and ED providers make do without the resources
that most would expect to be available for the care of children.

For example:

Only
about 6 percent of hospitals have available all the pediatric supplies
deemed essential by the American Academy of Pediatrics and American
College of Emergency Physicians for managing pediatric emergencies,
although about half of hospitals have at least 85 percent of those
supplies (Middleton and Burt, 2006).
Of
hospitals that do not have a separate pediatric inpatient ward, only about
half have written transfer agreements with other hospitals (Middleton and
Burt, 2006), which are necessary in case a critically ill or injured child
arrives at a hospital that lacks pediatric expertise.
Although
research shows that pediatric skills deteriorate after a short time
without practice (Su et al., 2000; Wolfram et al., 2003), pediatric
continuing education is not required or is extremely limited for many
prehospital providers (Glaeser et al., 2000).
Many
medications prescribed and administered to children in the ED are “off
label,” meaning they have not been adequately tested in pediatric
populations and therefore are not approved for use in children by the U.S.
Food and Drug Administration (FDA).
Disaster
preparedness plans largely overlook the needs of children, even though
children’s needs in the event of a disaster often differ from those of
adults (Dick et al., 2004; NASEMSD, 2004).

The lack of preparedness carries a cost: many
children with an emergency medical condition do not receive appropriate care
under the current system. This conclusion is clear from a recent mock drill
conducted in 35 of North Carolina’s EDs, including 5 trauma centers. Nearly all
of the EDs in the study failed to stabilize seriously injured children properly
during trauma simulations. Almost all failed to administer dextrose properly to
a child in hypoglycemic shock (a life-threatening drop in blood sugar),
correctly warm a hypothermic child, or order proper administration of
intravenous (IV) fluids (Hunt et al., 2006).

Ongoing research suggests that these problems are
not unique to North Carolina EDs. While data on pediatric emergency care
outcomes are largely unavailable, data on practice patterns indicate
shortcomings in the treatment and care of pediatric patients. Providing quality
pediatric emergency and trauma care is not just about having the right training
and equipment. Indeed, the delivery of care should be built on a strong foundation
in which emergency care is well planned and coordinated, care is based on
scientific evidence, data are collected so providers can learn from past
experience, and system performance is monitored to ensure quality. Moreover,
since preventing an injury or illness is almost always better and more
cost-effective than even the best emergency care, the emergency care system
should promote prevention through surveillance, research, and patient
education. Unfortunately, today’s emergency care system generally does not
function in this way.

Control the spread of infectious
disease, promote healthy life styles for a long disease free life and help ease
the problems of children and adolescent with chronic conditions. Paediatricians diagnose and treat several conditions
among children including:

i.
Injuries

ii.
Infection

iii.
Genetic

iv. Congential condition

v.
Cancer

vi. Organ diseases

vii. Dysfunction

Paediatrics is concerned
not only about immediate management of the ill child but also long term effect
on quality of life disability and survival. Paediatricians are involved with
prevention of early detection and management of problem including:

i. Behavioural Problem

ii. Functional disabilities

iii. Social stress

(Zonetwork, 2016)