| Realm | Potential Vulnerability | Potential Response |
|---|---|---|
| Physiologic | Increased respiratory exposure (higher minute ventilation, live closer to the ground) | Early warning, shelteringa (gas masks not advised because of risk of poor fit, suffocation) |
| Increased dermal exposure (thinner, more permeable skin; larger body surface area/mass ratio) | Protective clothing, early decontamination1 | |
| Increased risk of dehydration, shock with illness-induced vomiting, diarrhea (decreased fluid reserves, larger body surface area/mass ratio) | Recognition, aggressive fluid therapy | |
| Increased risk of hypothermia during decontamination (larger body surface area/mass ratio) | Warm water decontamination | |
| More fulminant disease; (possible) physiologic detoxification immaturity; more permeable blood-brain barrier | Pediatric-specific research for early diagnosis and treatment of chemical weapons victims1 | |
| Developmental | Less ability to escape attack site, take appropriate evasive actions (developmental immaturity, normal dependence on adult caregivers who might be injured or dead) | ? |
| Psychological | Less coping skill of children who suffer injury or witness
parental, sibling death (psychological immaturity) |
Child psychiatry involvement, research for preventing pediatric post-traumatic stress disorder1 |
| Greater anxiety over reported incidents, hoaxes, media coverage, etc | Pediatric counseling of parents and childrenb | |
| EMS | Less capacity to cope with infux of critical pediatric patients | Community and regional planning with significant pediatric input |
| Loss of routine hospital transfer protocols | ||
| Limited ability to expand pediatric hospital bed capacity through NDMS |
a Plausible, but unproved or unstudied, and/or not
intuitively obvious.
b For American Academy of Pediatrics (AAP) and American Academy of Child and Adolescent Psychiatrists (AACAP) resources for parents and pediatricians, go to http://www.aap.org/advocacy/releases/disastercomm.htm and http://www.aacap.org/publications/factsfam/disaster.htm.
1 Adapted from Rotenberg JS, Newmark J. Nerve agent attacks on children: diagnosis and management. Pediatrics 2003; 112:648-58.
Note: EMS = emergency medical services; NDMS = National Disaster Medical System.
Source: Adapted from Henretig FM, Cieslak TJ, Eitzen EM Jr. Biological and chemical terrorism. J Pediatr 141:311-326, © 2002, with permission from Elsevier.