Table 1

Key issues in pediatric blast injury: epidemiology, clinical considerations, recommendations to mitigate the impact of explosive weapons on children

Domain	Key issue	Recommendations
Injury epidemiology	A higher proportion of conflict-related injury is caused by blast mechanisms in children than adults. Children are more likely to be handling/playing with explosives at time of detonation.	Strengthen injury prevention: build ties between medical personnel and explosive ordnance risk education programming (eg, UNICEF’s International Mine Risk Education Working Group).
	Gaps in data collection limits understanding of epidemiology of explosive weapon-related injury in children.	Establish a uniform minimum dataset among actors caring for children with explosive weapon-related injuries.
	Specific patient subsets have disproportionately high mortality, including children <5 years, and those with burns or traumatic brain injury.	Target research efforts on high-mortality subsets to generate clinical care guidelines and quality improvement toolkits.
Clinical considerations	Although guidelines on the care of children with explosive weapon-related injuries exist, pediatric knowledge is still limited among most medical personnel in conflict settings (including age-specific normal physiological ranges for vital signs, equipment sizing, and medication dosing).	Promote the integration of pediatric modules into standardized trauma training programs. Disseminate references such as the Pediatric Blast Injury Field Manual as well as pediatric vital sign charts, triage (eg, Broselow) tapes; ensure sustainability provision of pediatric equipment in conflict-affected settings.
	Several anatomic and physiological differences exist in children that warrant special consideration during acute trauma resuscitation (eg, narrower airways, less functional residual capacity, less adipose reserves).	Provide padding on backboard to prevent airway occlusion. Ensure frequent reassessment of endotracheal tube positioning given propensity for displacement. Avoid cricothyroidotomy in children <12 years of age. Prioritize external warming and hyperthermia prevention. Ensure adequate source of dextrose to prevent hypoglycemia.
	The long-term sequelae of explosive weapon-related injury are profound, requiring a broad range of rehabilitation services from physiotherapy to mental health and vocational services.	Improve coordination between acute trauma care and disability services, strengthen referral pathways to rehabilitation services.
Policy and advocacy	Wide variation exists in the types and quality of assistance available to child victims of blast injury.	Support the implementation of United Nations International Mine Action Standard 13.1072 on Victim Assistance.
	Few research and advocacy initiatives focus specifically on the impact of explosive weapons on children.	Support the work of Save the Children’s Pediatric Blast Injury Partnership; expand collaborations with local mine action authorities and national ministries of health in heavily affected countries.
	Inadequate legislation and policy exists to protect children from the impact of explosive weapons.	Support: International Network on Explosive Weapons Political Declaration on the use of Explosive Weapons in Populated Areas.65 International Campaign to Ban Landmines treaty promulgation, disarmament, and clearance efforts. Human Rights Watch efforts to pass legislation banning the use of incendiary weapons.

UNICEF, United Nations Children's Fund.