I don't hold back at all as a GM. I wouldn't role play WWIII and a semi-apocalypse as some sort of happy boys' own adventure. Total war is a nightmare. A game in that sort of realistic setting should be realistic. There were parts of my last campaign that were quite distressing to run. Frankly if I hadn't found them distressing, I think there'd be something wrong with me.
I think I'd try to stop child soldiers from being a threat by non-lethal means if I could, but if someone is pointing a rifle at you, Big Boys' Rules apply. It would probably haunt me for life, but what are you supposed to do, stand there and get shot?
In-game most PCs are human wreckage anyway. Some might shoot a child solider, feel devastated and be non-functional as a combat asset for some period. Some might just have yet another piece of their soul chipped off and just carry on. I think that anyone who is able to shoot kids and not have it affect them in a negative way is probably clinically insane.
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 "It is better to be feared than loved" - Nicolo Machiavelli
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