Toddlers

• Health problems common in toddlers

  • Gross motor - walking, running, climbing
  • Fine motor - feeding themselves, drawing
  • Sensory/Cognitive - seeing, hearing, tasting, touching, and smelling
  • Language/communication (speech) - saying single words, then sentences
  • Social/Emotional - playing with others, taking turns, doing fantasy play
• Toddler development issues


  • Burns
  • Poisoning
  • Child Abuse
  • Cerebral Palsy
  • Common injuries - Drowning, Aspiration
• Burns


  Injuries to body tissue caused by excessive heat (greater than 40°C or 104°F)
• Burns


  • 2nd greatest cause of unintentional injury in 1-4 y.o.
  • 3rd most common cause of unintentional injury in children 5 to 14 yo
  • Every day, there are more than 300 children treated in emergency rooms for burn-related injuries
• Types of burns


  • Thermal burns - due to external heat sources
  • Radiation burns - caused by prolonged exposure to ultraviolet rays of the sun, therapeutic cancer treatments or nuclear power plant leaks
  • Chemical burns - caused by strong acids, alkalis, detergents, or solvents
  • Electrical burns - from electrical current
  • Friction burns - from direct damage to the cells and from the heat generated by friction
• Rule of 9s (adults)


  Wallace The Rule of Nines - is the way medical professionals calculate the TBSA (total body surface area)
• Lund and Browder chart
• Be certain to ask what caused the burn because different materials cause different degrees of burn
• Ask where the fire happened because fires in closed spaces are apt to cause more respiratory involvement than those in open areas
• Emergency management of minor burns

  1. Immediately apply cool water to cool the skin - prevent further burning

  2. Application of Analgesic-antibiotic ointment and a gauze bandage to prevent infection

  3. Keep dressing dry and changed every 2 days
• Emergency management of moderate burns

  1. Don't rupture blisters

  2. Apply topical antibiotic (Silver sulfadiazine-Silvadene) and dressing to prevent damage and infection

  3. Broken blisters may be debrided
• Debridement


  the removal of dead (necrotic) or infected skin tissue to help a wound heal
• Emergency management of severe burns

  1. Fluid therapy- LR or PNSS

  2. Systemic antibiotic therapy

  3. Pain mgt – Morphine sulfate IV

  4. Physical therapy- prevent contractures
• Emergency management of electrical burns

  1. Clean with antiseptic solution (Half strength Hydrogen peroxide) 1:1

  2. Monitor for airway obstruction

  3. Provide bland liquid diet
• Burn


  • Increased capillary permeability
  • Hypoproteinemia
  • Hyponatremia
  • Hyperkalemia
  • Hypovolemia

  
• Therapeutic management of burns


  • Topical therapy – Silver sulfadiazene, Furacin (If with Pseudomonas)
  • Escharotomy – Cut into the eschar
  • Debridement – Removal of necrotic tissue
  • Grafting- Reduce fluid and electrolyte loss, pain, and infection
• Types of grafting


  • Allografting – the placement of sterilized and frozen skin (from donor or cadaver) on the cleaned burn site
  • Xenograft – Skin from other sources like pigs, done in small children
  • Autografting- Layer of OWN unburned skin placed over the burned site

  
• According to the American Association of Poison Control Centers (AAPCC), there are more than 1 million reported poison exposures among children younger than 6 years of age yearly
• 90% of the time poisoning occurs in the child's home
• 9,500 children will be hospitalized yearly for unsupervised ingestion of prescription medications
• Poison


  Any substance that is harmful to your body - swallow it, inhale it, inject it, or absorb it through your skin
• Poisoning tends to occur when parents are preoccupied or highly stressed
• Usual agents ingested


  • Soap
  • Cosmetics
  • Detergents or cleaners
  • Plants
  • OTC drugs
  • Vitamins
  • Aspirin
  • Acetaminophen
  • Prescription drugs
• Emergency management of poisoning at home


  1. Call National Poison Control Center

  2. What was swallowed

  3. Child's weight and age and how long ago the poisoning occurred

  4. Route of poisoning

  5. Estimation of how much of poison was taken

  6. Child's present condition -(sleepy, hyperactive, comatose)
• Emergency management of poisoning at the health care facility

  1. Administer Activated charcoal

  2. Administered to conscious victims only

  3. Give ASAP

  4. Mixed with water, adding a sweet syrup is suggested

  5. Stools will appear black
• Acetaminophen poisoning


  • Causes extreme permanent liver destruction
  • After ingestion, child develops: anorexia, nausea and vomiting, ↑ Sgpt, Sgot
  • Antidote- Acetylcysteine or Activated charcoal
• Caustic poisoning


  • Ingestion of strong alkali, such as lye, which is contained in certain toilet bowl cleaners and hair products
  • Causes burns and tissue necrosis in the mouth, esophagus, and stomach
  • Don't let the child vomit
• Assessment of caustic poisoning

  • Pain in mouth and throat
  • Drools saliva bec. of oral edema and inability to swallow
  • Mouth turns white
  • Vomits blood, mucus and necrotic tissue
  • Tachycardia, tachypnea, pallor, hypotension
• Therapeutic management of caustic poisoning

  1. Bring child to nearest Hospital

  2. Don't administer Activated charcoal

  3. IV Morphine for pain

  4. X-ray

  5. Laryngoscopy and Esophagoscopy

  6. Intubation or tracheotomy
• Iron poisoning


  • Large amount of iron is corrosive to the gastric mucosa and leads to severe gastric irritation in the child
  • Immediate effects: Nausea and vomiting, Diarrhea, Abdominal pain
  • After 6-12 hours: Melena, Hematemesis, Cyanosis, Vasomotor collapse, Coagulation defects, Hepatic injury, Lethargy and coma
• Therapeutic management of iron poisoning

  1. Don't give Activated charcoal

  2. Stomach lavage

  3. Administer Cathartics

  4. Administer Maalox or Mylanta - help decrease gastric irritation and pain

  5. Administer IV or IM Deferoxamine

  6. GI Xray

  7. Liver studies
• Lead poisoning


  • Also called Plumbism
  • From ingestion of contaminated water, paint chips or paint dust, home-glazed pottery, fumes from burning or swallowing batteries
  • Leads to Hypochromic, microcytic anemia
  • Kidney destruction occurs
  • Leads to Encephalitis or inflammation of brain cells (toxic level)
• Assessment of lead poisoning

  • Lethargy
  • Impulsiveness
  • Learning difficulties
  • Blood level of lead >5µg/dl
• Therapeutic management of lead poisoning

  1. Lead levels >10-20 µg/100ml will be prescribed dimercaptosuccinic acid (DMSA) or succimer

  2. Lead levels >45µg/100ml will be treated with Dimercaprol (BAL) or edetate calcium disodium (CaEDTA)

  3. Don't give BAL to patients with peanuts allergy or G6PD deficiency
• Child maltreatment


  • Willful injury by one person to another
  • May be physical, emotional or psychological , neglect, and sexual maltreatment
• Theories of child maltreatment

  • Special Parent - A parent has the potential to maltreat a child
  • Special Child - Children Who Are Maltreated
  • Special Circumstance
• Mandatory reporters


  Professionals who are mandated by law to report child maltreatment
• Permissive reporters


  Encouraged to report suspected child abuse but are not required by law
• Indicators of physical abuse

  • Bruises
  • Burns
  • Head injuries
  • Eye injuries
  • Mouth injuries
  • Human bites
  • Chunks of hair pulled off the scalp
  • Repetitive accidents
  • Multiple wound or fracture at different stages of healing

  
• Shaken baby syndrome


  Repetitive violent shaking of a small infant by the arms or shoulders, causing a whiplash injury to the neck, edema of brainstem or possibly subdural or retinal hemorrhage