Management of paediatric trauma will follow the same pathways as adults (section 3). This chapter details the variations in care where expected. This guideline is applicable to children involved in trauma from the neonatal age group up to their 16th birthday.

The paediatric section of TEMPO provides a template for the management of major trauma in children. The paediatric emergency folder should be used in conjunction with TEMPO to help clinicians guide management and should be available in all resuscitation departments.

Children account for nearly 25% of the UK population. Major trauma remains the leading cause of death in children over one year of age, and the Confidential Enquiry into Maternal and Child Health found that 47% of all non-natural deaths in children were due to road traffic collisions. Approximately 300–500 children are involved in major trauma per annum in the UK. In the east of England, Cambridge University Hospitals (CUH) has the only paediatric major trauma centre (MTC).

Children have a higher proportion of head injuries and burns. Traumatic brain injury is the leading cause of morbidity and mortality. The need for urgent neurosurgical decompression is less common than in adults, however there is an equivalent urgency to access intracranial pressure monitoring.

At every stage of the trauma pathway, the importance of safeguarding children is paramount. Vulnerable children or those from an area of high social deprivation are over-represented as a group.

Children and young people are usually part of a family unit and they need their families to be involved in their care. Families should have information, encouragement and support to enable them to share in decisions about the child’s care and to remain informed about their condition and management. Children must be informed about, and have active involvement in decisions related to their own ongoing care.

Particular attention needs to be paid to full documentation of decisions, interventions and times. The role of the scribe as part of the trauma team is pivotal to good documentation and their importance is often underestimated. Following admission, the requirement for accurate, concise and legible documentation of ongoing care does not diminish.