Important Tips for Pediatricians and Other Health Professionals
Mitigating the effects of radiologic injury is a high priority for those who care for children. The amount of radiation absorbed by the body determines how sick a person will be. Although decontamination should not delay the stabilization of a patient, removal of all clothing and decontamination by washing with mild soap and lukewarm water can dramatically reduce the negative effects of radiation. The US Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response offers a Radiation Event Medical Management Web site that includes patient management algorithms and detailed information on decontamination procedures. The article Preparation for Terrorist Threats: Radiation Injury provides specific information for health professionals.
Affected children will need to be followed closely during the hours, days, and weeks following an incident, including monitoring for long-term effects such as cancer. This potential for long-term effects can cause ongoing psychological trauma and stress that will need to be specifically monitored and addressed.
Radiologic/Nuclear Terrorism and Its Effect on Children
The clinical manifestations of radiation injury in children are generally similar to those in adults. However, there are a number of characteristics that render the pediatric patient uniquely sensitive to the effects of radiation exposure. For example, children have a greater body surface area to weight ratio than adults and skin that is more permeable and less keratinized, which renders them more vulnerable to both thermal and radiation burns. The inability of young children to shield their eyes also makes them more susceptible to ocular injury from blast, radiation, and thermal effects. This latter problem is compounded by the increased sensitivity of a child's lens to radiation damage.
Children have a higher baseline respiratory rate than adults and also exist in a lower breathing zone, which makes them more vulnerable to both generalized inhalation exposure and particulate exposure from radioactive fallout. Children also have a lower intravascular volume reserve, rendering them more susceptible to dehydration from the gastrointestinal losses encountered in acute radiation syndrome.
The well-documented long-term effects of radiation exposure to the fetus and child are potentially of even greater concern for the more broadly exposed pediatric population. These effects can occur anywhere from months to years after initial exposure. A number of effects have also been documented from fetal exposure to radiation throughout gestation.
Children involved in a radiation-related incident will be particularly vulnerable to psychological trauma, as in any disaster or terrorist event. Depending on the child's stage of development, this increased vulnerability can manifest as generalized fear and anxiety, developmentally regressive behavior, sleep and appetite problems, altered play, school problems, or greater dependence on caregivers. Children also experience stress by witnessing the reactions of their parents. Any treatment plan regarding children exposed to radiation should take these unique vulnerabilities and parental reactions into consideration.
Text adapted from the Pediatric Terrorism and Disaster Preparedness: A Resource for Pediatricians manual.