Pediatric blast injuries: Distinguishing features and unique challenges

Abstract: Blast injuries are a major cause of morbidity and mortality in modern conflicts and terrorist incidents, placing children in particular danger in both combat and civilian settings. Pediatric blast trauma differs notably from adult presentations due to unique anatomical, physiological, and developmental factors. This review highlights the etiology, demographic distribution, and injury patterns in pediatric blast victims, emphasizing distinctions from adults and the implications for clinical management. Children are frequently injured in terrorism-related explosions, explosive remnants of war, and accidental incidents such as fireworks, with a consistent male predominance. Head injuries are more common and severe in children, reflecting larger head-to-body ratios, thinner skulls, and a lack of protective equipment. Ocular trauma, tympanic membrane rupture, and primary blast lung injury occur at higher rates than in adults. Abdominal trauma, though less frequent, contributes disproportionately to mortality due to thinner abdominal walls and larger solid organs. Extremity injuries are the most common overall, particularly upper limb amputations from unexploded ordnance and lower limb amputations from landmines. Burn and inhalation injuries, although less prevalent, are associated with markedly higher mortality in children compared to adults. Management poses unique challenges: pediatric airway anatomy predisposes to obstruction; permissive hypotension strategies used in adults are inappropriate; and surgical needs, including laparotomy and orthopedic interventions, are more frequent. Beyond the physical trauma, psychosocial consequences are profound and require early, age-appropriate support. Pediatric blast injuries, therefore, demand customized guidelines that address their distinctive injury patterns and management requirements, highlighting the need for pediatric-specific protocols in emergency medicine.