Pediatric Trauma: Injury Patterns, Head Injury, Spinal Motion Restriction, Burns, Drowning, and Field Triage Practice Questions

25 multiple-choice questions on Pediatric trauma: injury patterns, head injury, spinal motion restriction, burns, drowning, and field triage for paramedic and EMT students, from Chapter 44 (Pediatric Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. The most effective way to prevent toddler drownings in home swimming pools is:

   1. A. Early swimming lessons
   2. B. Four-sided pool fencing
   3. C. Inflatable arm floats
   4. D. Floating pool alarms in use
   Show answer

   Answer: B. Four-sided pool fencing

   Isolation fencing on all four sides with a self-latching gate markedly reduces pool drownings, along with constant, attentive supervision. Swimming lessons help but do not make toddlers drown-proof. Arm floats are not safety devices. Floating alarms sound after a child is already in the water. (AAP Prevention of Drowning 2019.)

2. A 2-year-old bit an electrical cord and has a burn at the corner of his mouth. Parents should be warned that:

   1. A. Severe bleeding can occur days later
   2. B. Infection is the main danger later
   3. C. The burn will scar but not bleed
   4. D. Heart problems will appear weeks later
   Show answer

   Answer: A. Severe bleeding can occur days later

   Oral commissure burns from biting a cord are deeper than they look; when the eschar separates, usually 5 to 14 days later, the labial artery can bleed briskly, so parents need to know how to apply pressure and seek care. Infection can occur, but the delayed bleed is the danger parents must be told about, and the injury extends into deeper tissue rather than simply scarring. Low-voltage dysrhythmias appear at the time of injury, not weeks later. (ABA ABLS electrical injury.)

3. A child can move from a booster seat to an adult seat belt when the belt fits properly, which usually happens at a height of about:

   1. A. 3 feet 6 inches (107 cm)
   2. B. 4 feet 0 inches (122 cm)
   3. C. 5 feet 6 inches (168 cm)
   4. D. 4 feet 9 inches (145 cm)
   Show answer

   Answer: D. 4 feet 9 inches (145 cm)

   The AAP and NHTSA advise a booster until the lap belt lies low across the upper thighs and the shoulder belt crosses the chest and shoulder, typically at about 4 feet 9 inches, between 8 and 12 years; a poorly fitting belt rides up onto the abdomen and causes seat belt injuries. At 3 feet 6 inches or 4 feet the belt does not fit. Waiting until 5 feet 6 inches is not necessary. (AAP Child Passenger Safety 2018.)

4. Children younger than 13 years should ride in the back seat mainly because:

   1. A. Rear seats have stronger, wider seat belts
   2. B. Front seats have weaker shoulder belts
   3. C. Front air bags can seriously injure them
   4. D. Rear-end crashes are less common
   Show answer

   Answer: C. Front air bags can seriously injure them

   A deploying front air bag can cause severe head and neck injuries to a small child, especially in a rear-facing seat. The protection comes from distance from the air bag, not from stronger or wider rear belts. Front shoulder belts are not weaker. Crash type frequency is not the reason. (AAP Child Passenger Safety 2018.)

5. Children are more likely than adults to sustain head injuries in falls mainly because they have:

   1. A. A large head relative to the body
   2. B. Thicker and stiffer skull bones
   3. C. Weaker leg muscles for walking
   4. D. Less cerebrospinal fluid volume
   Show answer

   Answer: A. A large head relative to the body

   A child's proportionally large, heavy head leads the way in falls and acts as the point of impact. The skull is actually thinner and more pliable, not thicker.

6. Unlike in adults, an isolated head injury may cause hypovolemic shock in an infant because:

   1. A. Infants cannot vasoconstrict
   2. B. Open sutures allow large blood loss
   3. C. The infant skull is rigid and closed
   4. D. Infant scalps have a poor blood supply
   Show answer

   Answer: B. Open sutures allow large blood loss

   Open fontanelles and sutures let the skull expand, so an infant can lose a significant share of blood volume into the head or scalp. Infants vasoconstrict strongly to compensate. The infant skull is open and pliable, not rigid. The scalp is very vascular, which is why scalp wounds bleed heavily. In older children and adults the closed skull limits this, so look for another bleeding source. (Caroline 9th ed.)

7. A 6-year-old bitten by a rattlesnake will need antivenom. Compared with an adult, the child's antivenom dose is:

   1. A. Calculated strictly per kilogram
   2. B. One-quarter of the adult dose
   3. C. Withheld until age 12 for safety
   4. D. The same dose an adult would get
   Show answer

   Answer: D. The same dose an adult would get

   Crotalid antivenom is dosed to neutralize the venom, not the body weight, so children get the same number of vials as adults, and they may be sicker because the venom dose is larger for their size. A per-kilogram calculation would underdose. A quarter dose would underdose. Antivenom is not withheld from children. In the field: keep the child calm, immobilize the limb, mark the swelling and transport. (CroFab prescribing information; Lavonas et al. 2011.)

8. Dog bites in children younger than about 5 years most often involve the:

   1. A. Hands and both forearms
   2. B. Lower legs and feet
   3. C. Head, face, and neck
   4. D. Buttocks and back
   Show answer

   Answer: C. Head, face, and neck

   A small child's face is at the level of a dog's mouth, so most bites in young children are to the head, face and neck, usually by a familiar dog; these bites can involve the eyes or airway and need hospital care. Hand and forearm bites are more typical of older children and adults. Leg and buttock bites are less common in this age group. (CDC dog bite prevention; Golinko et al. 2016.)

9. On an 80°F (27°C) day, the inside of a closed car can warm by about how much in the first 10 minutes?

   1. A. About 2°F (1°C)
   2. B. About 19°F (10°C)
   3. C. About 5°F (3°C)
   4. D. About 60°F (33°C)
   Show answer

   Answer: B. About 19°F (10°C)

   Most of the temperature rise in a closed car occurs in the first 15 to 30 minutes, about 19°F in the first 10 minutes even on a mild day, and a child's body heats faster than an adult's, so heatstroke can develop quickly; treat with rapid cooling and transport. 2°F and 5°F understate the rise. 60°F in 10 minutes overstates it. (McLaren et al., Pediatrics 2005; NHTSA.)

10. Which measure most reduces the risk of drowning for teenagers boating on a lake?

    1. A. Wearing a well-fitted life jacket
    2. B. Swimming lessons taken years ago
    3. C. Not eating for an hour beforehand
    4. D. Inflatable pool toys kept on board
    Show answer

    Answer: A. Wearing a well-fitted life jacket

    Most people who drown in boating incidents were not wearing a life jacket, so a properly fitted, approved life jacket is the most effective measure, along with avoiding alcohol. Past swimming lessons do not protect against cold shock or exhaustion. Waiting an hour after eating is a myth. Pool toys are not flotation devices. (AAP Prevention of Drowning 2019.)

11. No cervical collar fits a 2-year-old who needs spinal motion restriction. You should:

    1. A. Apply the smallest adult collar anyway
    2. B. Skip SMR because no collar fits
    3. C. Have her sit up in her mother's lap
    4. D. Use towel rolls and tape instead
    Show answer

    Answer: D. Use towel rolls and tape instead

    If no collar fits, improvise with towel or blanket rolls on each side of the head, secured with tape, plus padding under the torso to keep the neck neutral. An oversized collar can hyperextend the neck or press on the airway. Motion restriction does not depend on a collar. A lap gives no restriction and no crash protection. (Caroline 9th ed.)

12. Compared with an adult, a toddler exposed to the same hot tap water for the same time is likely to have a burn that is:

    1. A. Deeper, because the skin is thinner
    2. B. Shallower, because skin heals faster
    3. C. Shallower, because of more body fat
    4. D. Equal, since water temperature decides
    Show answer

    Answer: A. Deeper, because the skin is thinner

    Young children have thinner skin, so a given temperature and contact time produces a deeper burn than in an adult; this is why water heaters should be set at or below 49°C (120°F). Faster healing does not make the initial burn shallower. Body fat does not protect the dermis. Temperature matters, but skin thickness changes the depth. (ABA ABLS.)

13. Removing a child from a car seat for spinal motion restriction is necessary when the child:

    1. A. Is crying loudly
    2. B. Needs airway management
    3. C. Is in a rear-facing seat
    4. D. Has a parent who asks
    Show answer

    Answer: B. Needs airway management

    Remove the child if the seat is damaged, the child is unstable, or the airway cannot be assessed and managed in the seat. Crying alone suggests an open airway.

14. The most common cause of burns in children younger than 5 years is:

    1. A. Flames from house fires
    2. B. Electrical outlets and cords
    3. C. Scalds from hot liquids
    4. D. Household chemical spills
    Show answer

    Answer: C. Scalds from hot liquids

    Scalds from hot drinks, bathwater and cooking liquids cause most burns in young children, which is why prevention focuses on hot liquids and water heater settings. Flame burns are more common in older children and adults. Electrical and chemical burns occur but are much less common. (ABA ABLS.)

15. Under the 2021 field triage guideline, the red criterion of a heart rate greater than the systolic BP applies to patients aged:

    1. A. Birth to 9 years
    2. B. 10 years and older
    3. C. Infants under 1 year
    4. D. Toddlers aged 1 to 3
    Show answer

    Answer: B. 10 years and older

    The 2021 guideline uses SBP below 70 + (2 x age) as the hemodynamic red criterion for ages 0 to 9 and adds heart rate greater than systolic pressure for patients 10 and older (with SBP below 90 for ages 10 to 64 and below 110 for 65 and older). Young children normally have heart rates above their systolic pressure, so applying that rule to infants and toddlers would label healthy children as unstable. (Newgard et al., 2021 field triage guideline.)

16. Per American Burn Association guidance, the initial prehospital fluid rate for a 4-year-old with large burns is:

    1. A. 125 mL/h
    2. B. 500 mL/h
    3. C. 1,000 mL/h
    4. D. 2,000 mL/h
    Show answer

    Answer: A. 125 mL/h

    ABA prehospital rates are 125 mL/h for children 5 and younger, 250 mL/h for ages 6 to 13, and 500 mL/h for 14 and older, until a formula-based rate is calculated. A rate of 500 mL/h is the adult starting rate.

17. A 4-year-old pulled from under a collapsed wall is pulseless. Compared with adult traumatic arrest, the step to emphasize early in a child is:

    1. A. Epinephrine as the first priority
    2. B. Compressions as the first step
    3. C. A pelvic binder as the first step
    4. D. Airway control and ventilation
    Show answer

    Answer: D. Airway control and ventilation

    Children in traumatic arrest often arrest from hypoxia caused by head injury or airway obstruction, so early airway control and ventilation is stressed along with bleeding control, volume and chest decompression. Epinephrine is secondary to fixing reversible causes. Compressions alone cannot restore flow in a hypoxic or empty circulation, so reversing hypoxia and bleeding takes priority over starting with compressions. A pelvic binder addresses one bleeding source but does not come before the airway in a hypoxic child. (ACEP/AAP/NAEMSP/ACS-COT pediatric traumatic arrest policy; ATLS 10th ed.)

18. The safest way to store a firearm in a home with children is:

    1. A. Loaded but hidden on a closet's top shelf
    2. B. Unloaded in an unlocked nightstand
    3. C. Locked, unloaded, ammo kept separately
    4. D. Loaded with the safety switch on
    Show answer

    Answer: C. Locked, unloaded, ammo kept separately

    The AAP advises that the safest home has no firearm; if one is kept, it should be stored unloaded and locked, with ammunition locked separately, which lowers child injury and suicide risk. Children find hidden guns, so hiding a loaded gun is not safe. An unlocked drawer gives a child access. A safety switch can fail or be released by a child. (AAP firearm policy statement 2022.)

19. After a moderate or severe crash, a child's car seat should be:

    1. A. Replaced, even if it looks undamaged
    2. B. Reused if there is no visible crack in it
    3. C. Washed and checked by the parent
    4. D. Kept for use in a second car
    Show answer

    Answer: A. Replaced, even if it looks undamaged

    NHTSA advises replacing a car seat after a moderate or severe crash because its structure can be weakened without visible damage; only seats in minor crashes that meet strict criteria can be reused. A seat without a visible crack may still fail. Washing does not reveal hidden damage. Moving it to another car keeps a weakened seat in use. (NHTSA car seat recommendations.)

20. A parent says she can step away briefly because her 9-month-old sits in a bath seat in the tub. You should explain that bath seats:

    1. A. Are federally certified to prevent drowning
    2. B. Do not prevent drowning if unwatched
    3. C. Are safe if the water is shallow
    4. D. Make short absences reasonably safe
    Show answer

    Answer: B. Do not prevent drowning if unwatched

    Bath seats and rings can tip over or let an infant slip through, and infants have drowned in them during brief absences; they are bathing aids, not safety devices, so an adult must stay within arm's reach. They are not certified to prevent drowning. An infant can drown in a few inches of water. No absence is safe. (AAP Prevention of Drowning 2019; CPSC.)

21. Under the 2021 field triage guideline, which finding in a 6-year-old crash victim with normal vital signs is a yellow mechanism criterion?

    1. A. She was in a rear-facing car seat
    2. B. Another passenger had minor injuries
    3. C. The car's air bags deployed
    4. D. She was in an unsecured car seat
    Show answer

    Answer: D. She was in an unsecured car seat

    The 2021 guideline lists a child aged 0 to 9 who was unrestrained or in an unsecured child safety seat as a yellow (moderate-risk) mechanism criterion, favoring a trauma center. A properly secured rear-facing seat is not a criterion, and a passenger's minor injuries do not count; a death in the same passenger compartment does. Air bag deployment alone is not a 2021 criterion. (Newgard et al., 2021 field triage guideline.)

22. A 3-year-old has a minor-looking head injury, but the story does not fit and you suspect abuse. Under the 2021 field triage guideline, this suspicion:

    1. A. Has no bearing on the destination
    2. B. Requires police transport instead
    3. C. Favors transport to a trauma center
    4. D. Means he should go to his own pediatrician
    Show answer

    Answer: C. Favors transport to a trauma center

    The 2021 guideline lists suspicion of child abuse among the EMS-judgment risk factors that favor a trauma center, ideally one with pediatric capability, because abused children often have hidden injuries. It does affect destination. Police do not transport injured children in place of EMS. A pediatrician's office cannot evaluate occult trauma. Report your concern as required. (Newgard et al., 2021 field triage guideline.)

23. A 6-year-old has a tension pneumothorax and needs needle decompression. Per ATLS, the pediatric site taught is the:

    1. A. 7th intercostal space, posterior line
    2. B. Xiphoid notch, angled to the left shoulder
    3. C. Suprasternal notch, angled downward
    4. D. 2nd intercostal space, midclavicular line
    Show answer

    Answer: D. 2nd intercostal space, midclavicular line

    ATLS 10th edition keeps the 2nd intercostal space in the midclavicular line for children (adults moved to the 4th or 5th space just anterior to the midaxillary line, which some pediatric protocols also allow), using a catheter sized for the child. The 7th posterior space risks the liver, spleen and diaphragm. The subxiphoid approach is for pericardiocentesis. The suprasternal notch overlies the trachea and great vessels. (ATLS 10th ed.)

24. A 2-year-old fell 4 feet from a kitchen counter and struck his head on tile. Under the 2021 field triage guideline, this fall:

    1. A. Meets a red criterion by itself
    2. B. Is ignored because it is under 10 feet
    3. C. Counts as an EMS-judgment risk factor
    4. D. Matters for older adults, not children
    Show answer

    Answer: C. Counts as an EMS-judgment risk factor

    The 2021 guideline lists low-level falls with significant head impact in young children (5 years and younger) and in older adults (65 and older) as EMS-judgment risk factors to weigh when choosing a destination. It is not a red criterion on its own. The 10-foot rule is a separate mechanism criterion and does not cancel this risk factor. Young children are named along with older adults. (Newgard et al., 2021 field triage guideline.)

25. On the pediatric Glasgow Coma Scale, an infant who moves spontaneously and purposefully earns a motor score of:

    1. A. 6
    2. B. 5
    3. C. 4
    4. D. 3
    Show answer

    Answer: A. 6

    In the infant motor scale, normal spontaneous movement scores 6, withdrawal from touch 5, withdrawal from pain 4, abnormal flexion 3, extension 2 and none 1. A 5 means the infant only withdraws from touch. A 4 means withdrawal from pain. A 3 is abnormal (decorticate) flexion. (Caroline 9th ed.; AHA PALS provider manual.)