The unique challenges and coping strategies in pediatric emergency care: a narrative review
Review Article

The unique challenges and coping strategies in pediatric emergency care: a narrative review

Feng Chen, Weiheng Gao, Yujun Xiang ORCID logo

Department of Emergency, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children and Adolescents’ Health and Diseases, Hangzhou, China

Contributions: (I) Conception and design: All authors; (II) Administrative support: F Chen, Y Xiang; (III) Provision of study materials or patients: F Chen, W Gao; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Yujun Xiang, Master of Medicine. Charge Nurse, Department of Emergency, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children and Adolescents’ Health and Diseases, No. 3333 Binsheng Rd., Hangzhou 310052, China. Email: 6512230@zju.edu.cn.

Background and Objective: Pediatric emergency care (PEC) is a specialized field that addresses the unique physiological, psychological, and social needs of children, presenting distinct challenges compared to adult emergency medicine. These differences influence disease presentation, treatment response, and communication, necessitating tailored care strategies and robust parental involvement. This narrative review aimed to systematically synthesize current evidence and clinical practices to identify and discuss the primary challenges in PEC and an effective strategy for improving the quality of care.

Methods: We adopted a narrative review methodology to explore the unique challenges and coping strategies in PEC. A comprehensive literature search was conducted using the PubMed database with combinations of keywords “pediatric emergency”, “child health”, “coping strategies”, “multidisciplinary care team”, and “best practices”, focusing on studies published between 2010 and 2024.

Key Content and Findings: This review highlights that the physiological peculiarities of children, such as differences in airway anatomy and drug metabolism, often lead to diagnostic complexities. Psychological factors, including anxiety and fear in both children and their parents, significantly impact clinical outcomes. Key findings show that a comprehensive approach integrating multidisciplinary teamwork, standardized protocols, continuous training, and leveraging appropriate technologies like simulation and digital tools is essential. Furthermore, family-centered care emerged as a critical component, enhancing patient cooperation and reducing distress.

Conclusions: A multifaceted strategy that combines clinical expertise with family engagement and systemic-level improvements is needed to improve PEC and ensure patient safety and optimize outcomes.

Keywords: Pediatric emergency; coping strategies; review; child health; multidisciplinary care team

Submitted Oct 11, 2025. Accepted for publication Dec 26, 2025. Published online Feb 05, 2026.

doi: 10.21037/tp-2025-aw-705

Introduction

Background

Pediatric emergency care (PEC) is a critical and specialized component of the healthcare system, providing life-saving interventions for a vulnerable patient population. Unlike adult emergency medicine, PEC addresses the unique physiological, psychological, and developmental needs of children, from neonates to adolescents. The unique physiology of a child, including differences in airway anatomy, metabolic rate, and immune system maturity, necessitates specialized clinical knowledge and equipment to ensure safe and effective care (1,2). Furthermore, children’s limited ability to verbally communicate symptoms, coupled with the emotional distress and anxiety experienced by patients and their parents, adds significant layers of complexity to the diagnostic and treatment process (3). The reliance on parental input for a child’s history and the need for family-centered care (FCC) models are therefore paramount in this setting (4).

The global landscape of emergency medicine has seen a growing emphasis on optimizing care for children; however, significant challenges persist. Studies have consistently highlighted issues such as diagnostic errors, suboptimal resource allocation, and a lack of standardized protocols tailored to pediatric patients (5,6). Crowding in general emergency departments (EDs), which often lack dedicated pediatric expertise, further compounds these challenges, potentially leading to delays in care and increased risk of adverse outcomes (7). The ethical considerations surrounding the use of advanced technologies, such as artificial intelligence (AI) to predict mortality risk, also add a new dimension to the complexities of clinical decision-making in PEC (8). These systemic and clinical vulnerabilities underscore the urgent need for a more comprehensive and systematic approach to improve the quality and safety of PEC.

Rationale and knowledge gap

Despite the wealth of literature addressing various aspects of PEC, consolidated reviews that synthesize the diverse challenges, offering a structured overview of effective coping and improvement strategies, are lacking.

Objective

In this narrative review, we aimed to fill this gap by systematically examining the multifaceted challenges inherent in pediatric emergency medicine. By synthesizing recent evidence and clinical best practices, we explored physiological, psychological, and social factors that define PEC’s uniqueness. The review also presents a range of proven strategies, from multidisciplinary teamwork and standardized protocols to the implementation of FCC and the adoption of adaptive technologies. Ultimately, we sought to provide a foundational understanding for clinicians, researchers, and policymakers, guiding the development of more effective and robust PEC systems to ensure optimal outcomes for children (Figure 1). We present this article in accordance with the Narrative Review reporting checklist (available at https://tp.amegroups.com/article/view/10.21037/tp-2025-aw-705/rc).

Figure 1 Key challenges and their interrelationships in pediatric emergency care. ED, emergency department.

Methods

A literature review was conducted using the PubMed database with the keywords “Pediatric emergency”, “Child health”, “Coping strategies”, “Multidisciplinary care team”, and “Best practices”, focusing on studies published between 2010 and 2024. Eligible studies were identified based on predefined inclusion and exclusion criteria. Table 1 summarizes our search strategy, which aimed to identify previously published journal articles that have conducted research, analysis, and discussion on PEC.

Table 1

The search strategy summary

Items Specification
Date of search January 15, 2025
Database searched PubMed
Search terms used “Pediatric emergency”, “Child health”, “Coping strategies”, “Multidisciplinary care team”, and “Best practices”
Timeframe From January 1, 2010 through December 31, 2024
Inclusion and exclusion criteria Inclusion criteria: (I) participants: children aged 0–18 years who presented to pediatric emergency departments; studies including both patients and their caregivers or healthcare providers involved in pediatric emergency care; no restrictions on gender, ethnicity, or underlying health conditions; (II) interventions: any coping strategies or interventions aimed at managing the unique challenges faced in pediatric emergency care, including but not limited to psychological support, communication techniques, pain management strategies, and family-centered care approaches; (III) comparator: studies may include comparisons between different coping strategies, standard care practices, or no intervention; qualitative studies may compare experiences of caregivers or healthcare providers in different settings; (IV) outcomes: at least one of the following outcomes must be reported: caregiver or patient satisfaction, perceived effectiveness of coping strategies, psychological impact on patients and families, length of stay in the emergency department, and incidence of adverse events related to care; qualitative outcomes such as themes or patterns in coping experiences are also acceptable; (V) study design: qualitative studies, observational studies, and narrative reviews that provide insights into the challenges and coping strategies in pediatric emergency care; RCTs were not required but were included if relevant
Exclusion criteria: (I) non-English literature; (II) studies focusing solely on adult populations or those outside the pediatric age range (0–18 years); (III) research not involving pediatric emergency departments or lacks a focus on coping strategies in this context; (IV) studies that did not include both patients and their caregivers or healthcare providers; (V) literature that did not report any of the specified outcomes or lacks relevant data; (VI) animal studies, cell studies, case reports, letters, or duplicates; (VII) reviews or meta-analyses that did not present original data or insights into coping strategies in pediatric emergency care
Selection process The search outcomes were meticulously scrutinized by two distinct authors (F.C., and W.G.), adhering strictly to the predefined inclusion and exclusion criteria. In instances where discrepancies arose, a fourth reviewer (Y.X.) was involved to provide an impartial decision. All authors approved the final list of references

RCTs, randomized controlled trials.

Key findings

Physiological peculiarities in PEC

The physiological distinctiveness of children is a cornerstone of PEC, profoundly influencing clinical assessment, diagnosis, and management. Pediatric patients possess distinct physiological and anatomical characteristics that differentiate them from adults, with their specific developmental trajectories significantly influencing the function and pathology of nearly every organ system (9,10). Understanding these differences is paramount to preventing diagnostic errors and ensuring patient safety (Table 2).

Table 2

Key physiological differences between pediatric and adult emergency patients

Physiological feature Pediatric patients Adult patients
Airway anatomy Smaller diameter, more anterior larynx, larger tongue relative to the oral cavity Larger, more stable airway, posterior larynx
Respiratory rate Higher baseline rate, prone to rapid decompensation Lower baseline rate, generally more stable respiratory function
Metabolic rate Higher, requiring more oxygen and glucose Lower, less susceptible to hypoglycemia
Body surface area Larger ratio of body surface area to mass, leading to rapid heat loss Smaller ratio of body surface area to mass, better thermoregulation
Cardiovascular response Initial compensation via tachycardia, less able to increase stroke volume Can increase both heart rate and stroke volume to compensate

Firstly, the anatomical differences in a child’s airway present a critical challenge. A child’s smaller and more pliable trachea, along with a larger occiput, makes them more susceptible to obstruction and difficult intubations. The smaller reserve capacity of the lungs means that respiratory distress can quickly escalate to respiratory failure (11). The compensatory mechanisms also differ; while adults can increase both heart rate and stroke volume in response to shock, children primarily compensate through an increase in heart rate. Therefore, tachycardia is often the earliest and most critical sign of shock in a pediatric patient, making timely recognition crucial (12).

Furthermore, children’s higher metabolic rates require a constant supply of oxygen and glucose, making them more vulnerable to hypoxia and hypoglycemia. This is particularly relevant in cases of critical illness or trauma, where a rapid decline in blood glucose levels can worsen neurological outcomes (13). Thermoregulation is another significant challenge; a child’s larger body surface area to mass ratio makes them prone to rapid heat loss, increasing the risk of hypothermia, which can negatively impact coagulation and cardiac function (14).

Finally, the nonspecific presentation of many common illnesses in children poses a significant diagnostic challenge. Unlike adults who can often articulate specific symptoms, children may only present with generalized signs such as irritability, lethargy, or poor feeding. This requires clinicians to have a high index of suspicion and rely on a combination of parental reports, subtle physical exam findings, and clinical experience to arrive at an accurate diagnosis (15) (Table 3).

Table 3

Common pediatric conditions and their non-specific clinical presentations

Condition Non-specific presentations in children Typical presentations in adults
Infection (e.g., sepsis) Irritability, lethargy, poor feeding, fever, decreased activity Specific symptoms like localized pain, cough, or urinary symptoms
Pain Crying, refusal to move a limb, altered behavior, guarding of an area Verbal description of pain location and quality
Trauma Refusal to bear weight, unexplained bruising, irritability Specific report of the mechanism of injury and pain location
Hypoglycemia Altered mental status, lethargy, poor feeding, jitteriness Dizziness, confusion, sweating, palpitations

Psychological and social factors in PEC

Beyond the physiological complexities, the ED environment presents significant psychological and social challenges for children and their families. The unfamiliar and often intimidating setting, coupled with the pain, fear, and uncertainty of a medical emergency, can trigger profound emotional distress in pediatric patients (16). This distress can manifest as uncooperative behavior, anxiety, and even long-term psychological trauma, which can complicate the clinical assessment and treatment process (17). A child’s fear and anxiety can significantly elevate heart rate and blood pressure, potentially masking or mimicking clinical signs of a serious condition. Furthermore, the limited cognitive and verbal abilities of younger children, particularly infants and toddlers under the age of five, make it difficult for them to express their fears or pain, placing a greater burden on healthcare providers to interpret non-verbal cues (18).

The psychological needs of the parents or guardians are equally important as they are often in a state of heightened anxiety and distress. Parents play a dual role as the child’s primary support system and a crucial source of information for the healthcare team. Their emotional state can directly influence their child’s behavior and coping mechanisms. Ineffective communication or a lack of clear information from the medical team can exacerbate parental anxiety, leading to a breakdown in trust and potentially hindering cooperation with the care plan (19). The social aspect of PEC, therefore, extends beyond the immediate patient to encompass the entire family unit. Establishing a supportive, communicative, and transparent environment is vital for mitigating the psychological impact of an ED visit on all those involved (20) (Table 4).

Table 4

Common psychological and social challenges in pediatric emergency care

Challenge Impact on patient and family Coping strategies in the emergency department
Fear and anxiety in
children		 Uncooperative behavior, physiological distress (tachycardia), and long-term psychological trauma Therapeutic play, child life specialists, and distraction techniques
Parental distress and anxiety Hindered communication, breakdown in trust, and difficulty cooperating with the care plan Clear and empathetic communication, active listening, and providing consistent updates
Communication barriers Diagnostic delays, misinterpretation of non-verbal cues, and patient dissatisfaction Use of age-appropriate communication tools, visual aids, and a translator if necessary
Impact of ED environment Sensory overload, heightened stress, and emotional distress Creating a child-friendly environment, reducing noise and visual clutter

ED, emergency department.

The role of parents and FCC

The concept of FCC is a cornerstone of modern pediatric practice, and its importance is amplified within the high-stakes environment of the ED. FCC recognizes that the family is the constant in a child’s life and that their involvement is crucial for providing optimal care and ensuring patient safety (21). Parents are more than just visitors; they are integral partners in the care team, acting as historians who can provide critical information about the child’s baseline health, recent events, and behavioral patterns that may not be apparent to a clinical provider (22) (Table 5).

Table 5

Key roles and contributions of parents in pediatric emergency care

Parent’s role Description Benefit to patient and care team
Historian Providing a detailed and accurate medical history, including symptom onset, allergies, and past medical conditions Aids in rapid and accurate diagnosis, reducing diagnostic uncertainty
Comfort provider Offering emotional support, familiar presence, and calming techniques to the child Reduces child’s fear and anxiety, leading to better cooperation and more accurate physical exams
Information broker Facilitating communication between the medical team and the child, especially for younger patients Improves understanding of the care plan and enhances shared decision-making
Advocate Asking questions, clarifying information, and ensuring the child’s needs and preferences are met Promotes patient safety and satisfaction, leading to better long-term outcomes

The emotional state of a parent or guardian can have a direct and profound impact on their child’s psychological response to a medical emergency. Children often mirror their parents’ fear and anxiety; therefore, providing emotional support and clear, consistent communication to parents is a fundamental component of effective care (23). When parents feel informed and supported, they are better equipped to comfort their child, which in turn facilitates the medical team’s ability to perform necessary procedures and assessments. Empowering parents to be actively involved in their child’s care, from participating in decision-making to being present during procedures, can reduce psychological distress in the child and the parent (24). This collaborative approach transforms a potentially traumatic experience into a more manageable one, solidifying trust between the family and the healthcare system.

Application of medical resources and technology

The optimal use of medical resources and the integration of advanced technologies are essential for overcoming the unique challenges of PEC. Adequately equipped EDs, with appropriately sized and calibrated pediatric-specific equipment (e.g., smaller endotracheal tubes, defibrillator paddles, and medication dosages), are critical for ensuring patient safety and treatment efficacy (25). The lack of such resources in general EDs is a known contributor to suboptimal care and delayed interventions for critically ill children (26). Beyond physical equipment, technology plays a transformative role in enhancing PEC. Simulation training, for instance, provides a safe, low-stakes environment for healthcare professionals to practice high-acuity pediatric emergency scenarios, improving clinical skills, teamwork, and decision-making under pressure (27). Furthermore, digital tools, such as electronic health records (EHRs) with integrated clinical decision support systems, can help prevent medication errors by providing automated dosage calculations and flagging potential drug interactions, which is especially vital given the narrow therapeutic windows for many pediatric medications (28) (Table 6).

Table 6

Key technologies and medical resources in PEC

Technology/resource Application in PEC Benefits for patients and clinicians
Pediatric-specific equipment Appropriately sized airway devices, catheters, and monitoring tools Reduces procedural complications, ensures accurate physiological monitoring, and prevents iatrogenic injury
Simulation training High-fidelity mannequins and realistic scenarios for medical teams Improves team communication, clinical skills, and confidence in managing pediatric emergencies
Clinical decision support systems Electronic health record-integrated tools for medication dosage and diagnostic assistance Minimizes medication errors, enhances diagnostic accuracy, and supports evidence-based practice
Telemedicine and remote consultation Connecting general emergency departments with pediatric specialists in real-time Bridges geographical gaps in expertise, improves diagnostic accuracy, and facilitates appropriate patient transfers

PEC, pediatric emergency care.

Emerging technologies such as AI are also beginning to show promise in PEC. AI-powered algorithms can analyze large datasets to assist in triage decisions, predict patient deterioration, and optimize resource allocation, potentially improving efficiency and outcomes (29). However, the ethical implementation of such technologies requires careful consideration to ensure they are used to support, rather than replace, clinical judgment, and that data privacy and equity are maintained (30).

Strategies for improving the quality of PEC

Improving the quality of PEC is a multifaceted endeavor that requires a combination of systemic, educational, and procedural interventions. A primary strategy involves enhancing the multidisciplinary teamwork within the ED. Effective collaboration between physicians, nurses, child life specialists, and social workers ensures a holistic approach to patient care, addressing the physical, psychological, and social needs of the child and family (31). Standardized protocols and clinical practice guidelines for common pediatric emergencies, such as asthma exacerbations or fever without a source, are also crucial. These evidence-based guidelines streamline decision-making, reduce variability in care, and have been shown to improve clinical outcomes and patient safety (32) (Table 7).

Table 7

Key strategies for improving pediatric emergency care

Strategy Description Expected outcome
Multidisciplinary teamwork Fostering effective communication and collaboration among all healthcare providers Improved clinical outcomes, enhanced patient and family satisfaction, and a more holistic approach to care
Standardized protocols (clinical practice guidelines) Implementing evidence-based guidelines for common pediatric conditions Reduced diagnostic and treatment errors, decreased variability in care, and improved patient safety
Continuous education and training Providing regular training, including simulation exercises, on pediatric emergency procedures and best practices Enhanced clinical skills, increased confidence in managing pediatric cases, and better preparedness for high-acuity situations
Optimizing triage systems Developing and using pediatric-specific triage tools to accurately prioritize patients Reduced wait times for critically ill children, improved patient flow, and more efficient resource utilization

Continuous education and specialized training are fundamental for maintaining a high standard of care. This includes providing dedicated training for general ED staff who may not be pediatric experts, as well as regular simulation-based drills to prepare teams for rare but critical events (33). Optimizing ED flow and triage systems is another vital component. Pediatric-specific triage protocols can accurately identify critically ill children who require immediate attention, reducing the risk of deterioration while they wait (34). Finally, the establishment of dedicated pediatric-readiness standards for all EDs, which address everything from equipment and staffing to policies and procedures, is associated with a significant decrease in pediatric mortality rates (35).

Conclusions

This narrative review systematically explored the unique and multifaceted challenges inherent in PEC and synthesized a range of practical strategies to address them. The review highlighted that a child’s physiological and psychological distinctiveness, coupled with the emotional dynamics of their family, creates a complex clinical environment. From the anatomical differences that heighten the risk of respiratory compromise to the nonspecific presentation of illness, pediatric patients require a specialized approach that goes beyond simply scaling down adult care protocols. The tables within this review underscored these differences, providing a clear comparison of physiological features and non-specific disease presentations.

Furthermore, this review highlights that the psychological and social factors within the ED, such as a child’s fear and parental anxiety, are not merely ancillary issues but are central to the quality of care. The adoption of FCC models is both an ethical imperative and a clinical necessity. In this context, parental empowerment is operationalized by integrating families as active partners through shared decision-making, providing transparent access to clinical information, and facilitating their presence and participation during medical procedures (22,24). This collaborative framework transforms the parental role from passive observers to essential contributors to the care team. The review also summarized the critical role of medical resources and technology, including pediatric-specific equipment, simulation training, and clinical decision support systems, in enhancing safety and efficiency.

Ultimately, this synthesis of current evidence reveals that improving PEC requires a comprehensive, integrated approach. It necessitates a commitment to multidisciplinary teamwork, the implementation of standardized, evidence-based protocols, and continuous education and training. By fostering a collaborative environment, leveraging technology thoughtfully, and, most importantly, centering the care around the unique needs of the child and family, we can mitigate the challenges and elevate the quality of care provided in the ED.

While significant progress has been made, several areas warrant further research and development. Future studies could focus on the following:

  • Long-term psychological impact: the long-term psychological effects of ED visits on children and interventions that minimize this trauma need to be explored.
  • Implementation science: effective methods for implementing pediatric-readiness standards and standardized protocols in diverse clinical settings, especially in resource-limited environments, need to be studied further.
  • Ethical technology integration: as AI and other technologies become more prevalent, future studies should address the ethical frameworks for their use, ensuring that they promote equity and not replace essential human-centric aspects of care.
  • Novel training modalities: the effectiveness of new training modalities, such as virtual reality (VR) simulation, for both clinical skills and communication techniques in PEC should be evaluated.

Acknowledgments

We thank Editage (www.editage.cn) for English language editing.

Footnote

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-aw-705/rc

Peer Review File: Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-aw-705/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-2025-aw-705/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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Cite this article as: Chen F, Gao W, Xiang Y. The unique challenges and coping strategies in pediatric emergency care: a narrative review. Transl Pediatr 2026;15(2):57. doi: 10.21037/tp-2025-aw-705

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