Differences between children and adults

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 a proportionately 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 the skin. Thinner skin- Children have thinner skin than adults. Their epidermis is thinner and underkeratinized, 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. Higher respirator 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

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 and enhanced 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 risk for 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 some infections.

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

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 friends Clinicians 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

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 childFour 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

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"

Adolescence
It 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 and knowledge 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 ageappropriate 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.

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.

Children and adolescents are still developing, so their responses to similar situations 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.