Pediatric Resources

Children are not simply “small adults” in a disaster. Their physiology, developmental stage, dependency on caregivers, and the systems that serve them all interact in ways that make pediatric preparedness a distinct discipline.

A dose of medication, a triage decision, a shelter layout, or a reunification protocol that works for an adult population can fail — or actively harm — a child. This page collects resources and guidance for public health professionals, emergency managers, hospital and healthcare preparedness coordinators, first responders, and students who need to plan for children across the full spectrum of hazards.

Key Takeaways

• Pediatric disaster planning must address four distinct domains: clinical care, equipment and supplies, psychosocial support, and family reunification — none of which is fully covered by general all-hazards planning.
• Children have unique physiological vulnerabilities (higher respiratory rates, greater surface-area-to-mass ratio, immature thermoregulation) that change how they are triaged, decontaminated, dosed, and sheltered.
• Reunification is a preparedness function, not just a response function. Plans, forms, and accountability systems should be built and exercised before an incident.
• Psychosocial and mental health support for children is a core capability, not an afterthought, and should be integrated into exercise design and post-incident planning.
• The resources below — from hospital toolkits to checklists for pediatric practices — are meant to be adapted to your local plans, not adopted verbatim.

Why Pediatric Preparedness Is a Separate Discipline

The case for treating children as a distinct planning population rests on several well-established facts.

Physiological differences. Children breathe faster and have smaller airways, making them more vulnerable to aerosolized chemical, biological, and radiological agents and to respiratory compromise. Their skin is thinner and more permeable, and their larger surface-area-to-mass ratio means they absorb more of a contaminant and lose heat faster. Immature thermoregulation makes them prone to hypothermia during decontamination, especially when water is used in cold conditions.

Dependency and communication. Young children cannot self-evacuate, self-report symptoms accurately, or identify themselves to responders. A preverbal or frightened child may be unable to give a name, a medication list, or an allergy history — which is why identification and tracking systems matter so much.

System gaps. Pediatric-sized equipment, pediatric-trained providers, and pediatric-capable surge capacity are unevenly distributed. Many communities have limited pediatric inpatient beds, and a mass-casualty event can overwhelm them quickly. Planning must account for this scarcity rather than assume it away.

Legal and ethical dimensions. Children are a protected population with specific consent, custody, and reporting considerations. Reunification and custody questions intersect with law enforcement, child welfare, and school systems in ways that adult planning does not.

Core Planning Domains

A useful way to organize pediatric preparedness is around four domains. Each has its own resources, metrics, and exercise objectives.

1. Clinical Care and Surge

• Pediatric triage tools and age-appropriate vital sign parameters.
• Weight-based dosing and the availability of pediatric-specific medications and formulations.
• Pediatric-capable ventilators, airway equipment, and vascular access supplies in sizes that match your likely patient mix.
• Transfer agreements and regional pediatric referral patterns, including which facilities can accept pediatric critical care.

2. Equipment, Supplies, and Decontamination

• Pediatric-sized personal protective equipment, including for children themselves in some scenarios.
• Warming capability for decontamination, since cold water and prolonged exposure are dangerous for children.
• Pediatric-safe sheltering supplies: cribs, cots, diapers, formula, and safe sleep arrangements.

3. Psychosocial and Behavioral Health

• Psychological first aid appropriate to developmental stages.
• Screening and referral pathways for trauma, grief, and adjustment reactions.
• Support for caregivers, since a child’s recovery is closely tied to the stability of the adults around them.

4. Family Reunification and Accountability

• Intake and tracking systems that capture identifying information and custody status.
• Designated reunification sites with security, privacy, and child-friendly space.
• Coordination with schools, childcare providers, and child welfare agencies.

Hospital and Healthcare Facility Resources

Hospitals and healthcare coalitions carry much of the pediatric preparedness burden. The resources below support planning, training, and exercise design.

• Hospital Guidelines for Pediatric Preparedness — foundational guidance for building a facility-level pediatric plan.
• Pediatric Hospital Simulation Toolkit — scenario-based tools for exercising pediatric surge, triage, and treatment.
• Hospital Pediatric Preparedness Toolkit — a structured set of tools for assessing and improving readiness.
• Emergency Department Pediatric Preparedness Checklist — a practical checklist for ED-level readiness.
• Pediatric Preparedness Resource Kit — a broader collection of planning and reference materials.
• Preparedness Checklist for Pediatric Practices — aimed at ambulatory and primary care settings, which are often overlooked in hospital-centric planning.

A recurring theme across these tools is that readiness is not a single document. It is a set of capabilities — trained staff, available equipment, tested protocols, and exercised plans — that must be maintained over time. A checklist that is completed once and filed away provides little protection.

Community, School, and Childcare Planning

Children spend much of their day outside the healthcare system, in schools, childcare centers, and community programs. These settings are frequently the first point of contact in a disaster and are often the last to be integrated into formal preparedness planning.

Practical priorities for these settings include:

• Emergency operations plans that address lockdown, shelter-in-place, evacuation, and reunification.
• Drills and exercises appropriate to the age and developmental stage of the children involved.
• Communication plans that reach caregivers through multiple channels and account for language and accessibility needs.
• Supply caches that include water, food, medications, and comfort items for the duration of a likely sheltering period.
• Staff training on pediatric first aid, psychological first aid, and reunification procedures.

The National Commission on Children and Disasters produced recommendations that remain a useful reference for aligning community, school, and healthcare planning around children’s needs. The Children & Disasters resource and the Learning Center for Child and Adolescent Trauma provide additional background and training material.

Psychosocial Support and Mental Health

Disasters affect children’s mental health in ways that can persist long after physical recovery. Reactions vary by age and developmental stage — from regressive behavior in young children to risk-taking or withdrawal in adolescents — and are strongly influenced by the stability and support of caregivers.

Key practices include:

• Psychological first aid as an early, evidence-informed approach that focuses on safety, calm, connection, efficacy, and hope.
• Developmental screening and referral for children showing persistent distress.
• Support for caregivers and families, since caregiver functioning is one of the strongest predictors of child outcomes.
• Integration into exercise design, so that psychosocial support is practiced rather than assumed.

The resources Providing Psychosocial Support to Children and Families in the Aftermath of Disasters and Crises and Addressing Disaster Mental Health Needs of Children: Practical Guidance for Pediatric Emergency Healthcare Providers are directly relevant to both planners and clinicians. The Learning Center for Child and Adolescent Trauma offers training and reference material on trauma-informed care.

Infant Feeding and Nutrition in Emergencies

Infant and young child feeding is a frequently neglected element of disaster planning, yet it is critical to survival and health. Breastfeeding in Emergencies addresses the protection and support of breastfeeding during disasters, including the risks of uncontrolled distribution of infant formula, which can undermine breastfeeding, introduce contamination risks where clean water is scarce, and create dependency on supplies that may not be sustainable.

Planning considerations include:

• Protecting and supporting breastfeeding mothers, including privacy and lactation support in shelters.
• Safe preparation of formula where it is needed, with attention to water quality and sterilization.
• Age-appropriate complementary foods for older infants and young children.
• Coordination with nutrition and public health partners.

Reunification: A Preparedness Function

Reunification is one of the most complex and emotionally charged aspects of pediatric disaster response. It involves identifying unaccompanied children, verifying custody and identity, and returning children to caregivers safely — all under conditions of uncertainty and stress.

The resource Post-Disaster Reunification of Children provides guidance on this process. Effective reunification planning typically includes:

• Intake and tracking systems that record identifying information, photographs where appropriate, and custody status.
• Verification procedures that balance speed with the need to prevent a child from being released to the wrong person.
• Designated reunification sites with security, privacy, and child-friendly space.
• Coordination with schools, childcare providers, law enforcement, and child welfare agencies.
• Exercises that test the full reunification process, not just the intake step.

A useful decision rule: if your plan cannot answer “who is authorized to release this child, and how do we verify it?” within minutes, the plan is not yet ready.

Choosing and Using These Resources

With this many resources, the practical question is where to start. The table below offers a rough guide by role and setting.

If you are…	Start with…	Because…
A hospital preparedness coordinator	Hospital Guidelines for Pediatric Preparedness; Hospital Pediatric Preparedness Toolkit	These provide facility-level structure and assessment tools.
An emergency department leader	Emergency Department Pediatric Preparedness Checklist	It targets ED-specific readiness gaps.
A pediatric practice or clinic	Preparedness Checklist for Pediatric Practices	It addresses ambulatory settings often left out of hospital planning.
An emergency manager or public health planner	National Commission on Children and Disasters recommendations; Post-Disaster Reunification of Children	These frame community-level and reunification planning.
A behavioral health or social services provider	Providing Psychosocial Support…; Addressing Disaster Mental Health Needs of Children	These focus on child and family mental health.
A trainer or exercise designer	Pediatric Hospital Simulation Toolkit	It supports scenario-based pediatric exercises.

Two caveats apply across all of these. First, resources are starting points, not finished plans — they must be adapted to local hazards, populations, and capabilities. Second, a resource that is not exercised is not a capability. Build pediatric objectives into your regular exercise cycle so that plans are tested under realistic conditions.

Upcoming Events

The Center for Preparedness Education offers training and exercise opportunities relevant to pediatric and all-hazards preparedness. Current listings include:

• Cancelled — FEMA Certified MGT 433 Isolation and Quarantine for Rural Communities AND MGT 432 Isolation and Quarantine for Rural Public Safety Personnel — May 19, 2016.
• Preparedness Symposia and Nebraska Medicine Biocontainment Unit Training: Norfolk — May 24–25.
• Preparedness Symposia and Nebraska Biocontainment Unit Training: Omaha — June 14–15.

View all events for the most current schedule.

Frequently Asked Questions

Why do children need separate disaster planning rather than being folded into general plans?

Children differ from adults physiologically, developmentally, and legally. They breathe faster, absorb contaminants more readily, lose heat faster, and depend on caregivers for evacuation, identification, and consent. General all-hazards plans rarely address pediatric-sized equipment, weight-based dosing, reunification, or developmental mental health needs, so children’s requirements tend to fall through the gaps unless they are planned for explicitly.

What is the single most overlooked element of pediatric preparedness?

Reunification is frequently the weakest link. Many plans address clinical care and sheltering but do not specify how unaccompanied children are identified, tracked, and safely returned to caregivers. Because reunification involves schools, childcare, law enforcement, and child welfare, it requires coordination and practice well before an incident occurs.

How should a hospital begin improving pediatric readiness?

Start with a structured assessment using a recognized toolkit or checklist, then close the gaps it reveals in priority order: trained staff, available pediatric equipment and supplies, tested protocols, and exercised plans. Build pediatric scenarios into your existing exercise cycle rather than treating pediatric readiness as a separate, one-time project.

Is breastfeeding support really a preparedness issue?

Yes. Infant and young child feeding is a survival issue in disasters. Uncontrolled distribution of infant formula can undermine breastfeeding, introduce contamination risks where clean water is scarce, and create dependency on supplies that may not be sustainable. Protecting and supporting breastfeeding, and ensuring safe formula preparation where needed, should be part of shelter and nutrition planning.

How do we verify who is authorized to take a child after a disaster?

Verification procedures should be defined in advance and tested in exercises. They typically combine identity documentation, custody information, and cross-checks with schools, childcare providers, and child welfare or law enforcement partners. The goal is to balance speed with the need to prevent release of a child to an unauthorized person.

Where can I find training on pediatric disaster mental health?

Several of the resources on this page address child and family mental health directly, including guidance on psychosocial support in the aftermath of disasters and practical guidance for pediatric emergency healthcare providers. The Learning Center for Child and Adolescent Trauma also offers training and reference material on trauma-informed care for children and adolescents.

Additional Authoritative Sources

For broader context and standards, the following external sources are useful:

• The American Academy of Pediatrics publishes policy statements and clinical guidance on pediatric disaster preparedness and children’s needs in emergencies.
• The Centers for Disease Control and Prevention maintains resources on children’s health, emergency preparedness, and crisis communication.
• FEMA provides planning guidance and training relevant to schools, childcare, and community preparedness.
• The World Health Organization offers international guidance on infant and young child feeding in emergencies and on child health in disasters.

These complement the Center’s own resources and can help you align local plans with national and international standards.