When it comes to disaster response planning, according to the nation's largest group of pediatricians, one size does not fit all.
A new policy statement by the American Academy of Pediatrics (AAP) says any planning efforts to respond to natural disasters, terrorist attacks, industrial accidents or disease outbreaks must consider the unique physical, mental, behavioral, developmental, communication, therapeutic and social needs of its smallest and most vulnerable citizens: children.
The statement, "Ensuring the Health of Children in Disasters," to be published in the November 2015 issue of Pediatrics (published online Oct. 19) emphasizes that the impact of disasters on children can be especially harmful for many reasons. For example:
- Children take more breaths per minute, are closer to the ground, have a larger surface area relative to their body mass and more permeable skin than adults. This means that debris, smoke or other
environmental hazards will affect them more quickly.
- Young children are in a critical period of development, when toxic exposures can have profound negative effects. Exposure to carcinogens and radiation can damage DNA and increase children's lifetime
- Children may not know to run away from dangers or may even approach them out of curiosity, and limited ability to understand the nature of the event can have profound psychological effects.
- Infants and younger children require properly sized medical equipment and
medication dosages that are not always readily available.
"It is critical that medical service facilities develop plans for how they will continue providing care for children during and after disasters," said Joseph L. Wright, MD, MPH, FAAP, chair of the Department of Pediatrics and Child Health at Howard University College of Medicine and one of the statement's authors.
"As a hospital-based provider, I'm particularly intrigued by the fact that in the intervening years since 9/11, a national assessment shows that hospital emergency departments are less likely to have included explicit pediatric elements in their institutional disaster planning than compared to a similar assessment done in the early 2000s," Dr. Wright said. In 2003, he said, 76 percent of emergency departments reported addressing the specific needs of children in disaster planning, but in 2014 only 47 percent did.
Scott Needle, MD, FAAP, chief medical officer of the Healthcare Network of Southwest Florida and the statement's co-author, said pediatric primary care practices also need to be ready to care for children during and after disaster.
"Fewer than half of pediatric offices have
preparedness plans. This is particularly concerning because office pediatricians are a key source of health care, including immunizations and mental health care, for families in the community," Dr. Needle said. In addition, he said, primary care providers should be part of broad community coalitions that address children's needs.
The AAP policy statement also recommends disaster exercises and drills that include children as both victims and responders.
"Disaster response plans are especially important in settings where children are separated from their families, such as
schools and child care centers," said David Schonfeld, MD, FAAP, a member of the AAP Disaster Preparedness Advisory Council. "Care must be taken that the drills themselves do not inflict psychological trauma on children, however," he said. "Staff and students should be informed before an exercise is conducted, especially if it includes scenarios (such as armed assailants) that are sure to be frightening to many children and staff.''
The clinical report is the latest in a series of resources developed by the AAP to prepare pediatricians addressing the needs of children during times of crisis.
Additional AAP resources are available at
www.aap.org/disasters, including a
Family Readiness Kit and a
Pediatric Preparedness Resource Kit. A disaster readiness infographic is available