This article has been written in Norwegian. Here you can read a machine translated version:

About the wonder of "children", a discourse about growing up, measures in certain acute cases and psychological changes along the way.

For many, becoming parents is one of the greatest things they are allowed to experience in their lives. That a being develops from closeness between two people, bodily changes in the mother during pregnancy, first a feeling of a butterfly moving its wings in the stomach, then later small kicks to full blast eventually. Fathers are also affected by changes in this time and many ask themselves the question, at least at some point, whether they are really ready to become parents.

Now how is it actually to hold this child so that the neck is taken care of? And how do you change diapers? Breastfeeding? How much clothes should the prince or princess wear?

Midwives, own parents and friends with children suddenly have a completely different status. There is a lot of new things to learn and it can sometimes seem overwhelming. Having children is a complex but very natural process that has repeated itself countless times since the dawn of man. Still, it's the same every time.

If we look at it from a medical perspective, many "miracles" happen from conception to the "finished" child. For example, the complex process during chromosome segregation (also known as cell division ) which determines whether the child will be a girl or a boy. Incidentally, this process – if there are unexpected changes along the way – also determines, for example, whether the child has a set of genitals, but otherwise develops as a different sex.

Or the fact that the fetus receives blood and oxygen from the mother through the umbilical cord and has lungs full of amniotic fluid in the mother's abdomen. So when we talk about the large and small circuit (large = between the heart and the organs, small = between the heart and the lungs) that supplies the body with blood and oxygen, there must naturally be a "bypass", a hole, in the heart until birth. This hole in the heart wall closes the moment the baby takes its first breath after birth. And if this process does not work, the child must be operated on.

There are many things that can go differently than expected. This does not mean that a fetus cannot develop into a full-fledged child and adult. On the contrary, some people just have a slightly tougher start to life.
 

Some choose to take a first aid course in addition to the guidance they are given by the midwife and community nurse. Here the expectant parents learn all about free airways - which are free in infants in a neutral position, NOT when the head is bent backwards, for handling foreign objects, poisoning, illness and injury.

Sometimes I meet people who are genuinely afraid that something will happen to their children. The process through pregnancy and the bond that forms between parents and children are very big. I hear that the little ones are so fragile and vulnerable... Well, I try to focus on the opposite. At birth, the vast majority of children are pushed through the birth canal with great force. For most people head first, then the neck (!) and then the rest of the body. A rather tough event that prepares the child for a hopefully long and not too tough life. This child is born virtually "sterile" and after birth is infected with a sea of ​​bacteria that will form the normal flora of the child for life, and will lay the foundation for a good immune system. Just think about gut bacteria that MUST be there for everything to work properly.

I would rather say that children are very robust. We see that when they injure themselves, how quickly the healing process is initiated and how quickly wounds disappear. They are also much stronger than adults in relation. Have you ever seen a paw drag something as heavy as him, or even lift his mom? Children are developing and have enormous capacity, both physically and mentally. They are simply strong. BUT they have a small body, and thus do not have the same reserves as adults when an accident should happen. If you work with children in the medical world, you have therefore heard it many times:

" Children are not small adults ". Yes, we are aware that they communicate differently, have a different perception of the world, but from an emergency medical perspective they can be scary: Children are good at compensating, i.e. maintaining normal functions in the body. To a certain point. Since they have no reserves in the form of volume, blood, lung capacity, nutrition and fluid, they will therefore become very poor much faster when accidents first occur. And this is scary.

So if you have your suspicions that something has happened, take it seriously. I personally think that things I can't see are scary in this context, and I have experienced this all too often. E.g. The child who crashed his bike on the road and got the handlebars in his stomach. A blunt trauma that led to internal bleeding. Or children with breathing difficulties who have become too tired and exhausted to draw in air properly. Or dehydrated children, because they have vomited or had diarrhea for too long and do not get enough fluid back into their bodies to maintain the vital fluid balance.

As a healthcare professional, I think that children are a very grateful and interesting patient group. They are honest. If you ask a child where he has fallen, he will point to the stairs. That's where it happened. And very much is a pain in the stomach. No wonder when you have to learn to know so much in the world. First with the mouth (which has lots of sensory nerves), then with the hands, and finally with the whole body. The nerve cords gather in paths along the spinal cord in the stomach and chest region, so it is natural that things hurt the stomach.

Children also expect the same honesty in return. If someone tells you that the sting that immediately comes with the huge needle does not hurt, then it is a lie. It will hurt and you have now broken the relationship of trust that you first built up. If you then have a despairing mum and dad, or very resolute parents who hold the child by force - we MUST have that blood test - then it does not help to create trust either. My experience is that you get the furthest with honesty. Both as a parent and healthcare professional. Explain things in a simple way, maybe you even have time to show it to the teddy bear first?

Interventions are also not always the way we are used to with adult patients: I have experienced this both with 5-year-olds with ugly forearm fractures (which were completely loose) and severe allergic reactions after wasp stings where the tongue swelled up so much that it stuck out the mouth. In both cases, the measures were of a purely supervisory function until arrival in the hospital and in the operating theatre. Both children compensated well and were more interested in their surroundings than what had actually happened. If you "just should" have inserted a needle (PVK*) to make sure, and then have a howling, crying child with a partially closed airway in front of you, it would not be appropriate. What if the needle doesn't fit on the first try? Maximum invasive approach with IO (intraosseous access in the bone marrow)? Adrenaline, which is the main preparation for anaphylaxis, is given IM (intramuscularly) anyway, we get this quickly in case the condition worsens...

When the children get bigger and reach school age, the challenges also change . They participate in organized sports, are given more responsibility and thus become more independent. It goes too far when a primary school pupil who comes from a disadvantaged home has to take responsibility for his daily dose of Ritalin himself. Ritalin is a common preparation in the treatment of attention deficit hyperactivity disorder (ADHD). The student, who is still a child, mismedicated himself and took a larger dose (several tablets) at once. When we arrived at our young patient, he had changes in his EKG picture. It is common to send these using telemetry to the hospital so that a heart specialist (cardiologist) can look at them. We followed the advice (also called medical delegation) and eventually delivered the patient to the hospital. Remember that a modern ambulance is so much more than a transport unit today, the ambulance service is the hospital's extended arm out with the patient.
 

Now this may be a strange example, but poisoning is something that can be experienced in all forms . For example, when the girl who wanted to look scary for Halloween opened a Cyalume light stick and put the chemicals on her teeth. It worked well and she seemed fine. Until father finds out about it and gets to read that it says "corrosive" on the package and "must not be eaten". Is this dangerous? Even as a healthcare professional, you will reach your limitations of knowing everything at all times. Being able to get help from professionals who are present around the clock, both for lay people and healthcare personnel, is extra useful:

22 59 13 00 is the number for the poison information center at Ullevål University Hospital and applies to the whole of Norway . If you save it on your mobile phone with +47 in front, you can also reach them from abroad. This number is no substitute for 113, but if you are in doubt as to whether the child has ingested something dangerous and you need an assessment, call.

But back to the ADHD story from instead. After the incident was over, the patient handed over and the shift finished, a letter (better said an email) suddenly arrived a few months after the incident.

Child protection had contacted the healthcare system and wanted comprehensive information. Once again, it was absolutely essential to write a proper journal during the mission, because after such a long time I remembered nothing more than rough outlines of the incident. Record keeping is also there for you as a (future) healthcare professional! It helps you look up details later. Now, in this article, I will not go into the duty of confidentiality and the duty to provide information, two important duties that healthcare personnel are bound to, but it is important to note that the protection of children comes first in the Norwegian legal system. Children's services, like the health care system, the ambulance service, AMK, paramedics, the police, you name it, have a long list of complaints against them. Some stories come to light in the media, but the worst (or best) stories are never heard about... precisely because of the duty of confidentiality.

And it does not end when the child approaches the age of 18 . Adolescence, the teenage years and becoming an adult go smoothly, and some people struggle with this transition. Psychosocial first aid is becoming more and more important. There are new challenges with getting bigger, a hormonal roller coaster with falling in love and heartbreak, tension with drugs such as alcohol and finding one's place in society. This is where it is so important to have stable and safe relationships at home, friends with good attitudes and services such as health nurses and mental health. Namely because "children are not small adults".

If you work with children and need a confidential conversation with healthcare personnel bound by confidentiality, a course aimed at children, or if you are a parent and want to discuss something, then do not hesitate to get in touch. I am here for you.
 

*Fun fact: PVK for " peripheral venous cannula ", also referred to as " needle ". In Norway, the product name Venflon is often used , but it could just as well be called Braunüle, Flexüle or Abbokath depending on the manufacturer. The essence of these is that they have a steel tip that is surrounded by a thin needle. This is introduced into a vein and after the steel tip is removed, the needle is left and fixed on, for example, the arm. If you have a little training, you can do this on the first try, and without spilling a lot of blood.