Children are uniquely sensitive to chemical exposures. The child's thinner stratum corneum results in increased skin permeability. A relatively greater surface area (approximately 2.5 times larger than that of adults on a pound-per-pound basis), greater fluid intake per body weight, and increased minute volume provide greater dermal, oral, and respiratory uptake of chemicals. Children are at greater risk than adults to develop methemoglobinemia when exposed to oxidant stresses based on low NADH methemoglobin reductase activity. Other factors rendering them more susceptible to toxins include lower oxygen-carrying capacity, owing to lower baseline hematocrits, and greater susceptibility to bronchospasm following exposure to inhaled toxins.20 When wet, infants develop rapid hypothermia; therefore, special consideration for decontamination will need to be made with use of warm liquids and control of ambient temperature. Finally, ocular irrigation is difficult in children. One method involves the use of a "papoose" followed by flooding the bridge of the nose with normal saline rather than the eyes directly.
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