(iv) The response of children to trauma

Children differ markedly from adults in their response to trauma. They sustain predictable injuries from typical mechanisms based upon their age and activity profile. They have been shown to have different patterns of injury when sustaining single bone trauma, pelvic fractures and spinal injuries. The microscopic structure of a child's bone is different creating an environment for unique fracture types including those of the physis. The biological healing response differs and children often have the capacity for significant remodelling. Due to the unique anatomy and physiology of a child, the management of severe trauma and multiple injuries is different to that of an adult. Continuing growth and development always needs to be taken into account and will have a bearing on the management plan. The long-term outcome, from both a functional and psychological standpoint, is of great concern as these patients have potentially so much time ahead of them. It is important to be aware of all these differences to ensure that assessment, diagnosis, initial and definitive management, rehabilitation and follow up are optimal for each injured child.