Disaster Med Public Health Prep. 2025 Dec 1;19:e333. doi: 10.1017/dmp.2025.10260.
ABSTRACT
INTRODUCTION: Children are uniquely vulnerable to chemical, biological, radiological, and nuclear (CBRN) events due to anatomical, physiological, and psychological differences. Current decontamination practices are adapted from adult protocols.
OBJECTIVE: To evaluate current practices, challenges, and special considerations in pediatric decontamination during CBRN events.
METHOD: A scoping review was conducted using six databases in accordance with PRISMA-ScR framework. Studies were eligible if they evaluated decontamination methods involving children (0-18 years) in real or simulated CBRN scenarios. Fourteen studies met the inclusion criteria, and data were thematically analyzed into four domains.
RESULTS: Disrobing is widely recognized as a critical first step in the decontamination process, and 43% of the studies reviewed identified it as such. When done immediately and appropriately, it can remove a significant amount of contaminants. Although its effectiveness varies based on how much of the body is covered and the nature of the exposure. Dry decontamination was discussed in 21% of studies, and wet decontamination was the most commonly reported approach, appearing in 93%. Key pediatric challenges included hypothermia, psychological distress, separation from caregivers, and difficulties managing non-ambulatory or special needs populations. Few studies addressed age-specific protocols or long-term psychological impacts. The results are presented in procedural order to reflect the typical sequence of decontamination in CBRN response.
CONCLUSIONS: Current decontamination guidelines inadequately address pediatric-specific needs. There is a critical need for standardized, age-appropriate guidelines that integrate caregiver support and psychosocial considerations. A pediatric decontamination algorithm was developed to consolidate current evidence into a practical framework for CBRN mass casualty incidents.
PMID:41321230 | DOI:10.1017/dmp.2025.10260
