NRG204

• Toddler Development


  • 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
• Health Problems Common in Toddlers

  • 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
• ASSESSMENT of Burns


  1. Airway

  2. Breathing: beware of inhalation and rapid airway compromise

  3. Circulation: fluid replacement

  4. Disability: compartment syndrome

  5. Exposure: percentage area of burn

  
• Rule of 9s (ADULTS)


  Wallace's The Rule of Nines - is the way medical professionals calculate the TBSA (total body surface area)
• Classification and Description of Burns

  • Minor Burns
  • Moderate Burns
  • Severe Burns
  • Electrical Burns
• Emergency Management of Minor Burns

  1. Immediately apply cool water to cool the skin

  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
• 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 a bland liquid diet
• Fluid Shifts After Burn Injury
• 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 and prescription drugs
• Emergency Management of Poisoning at Home

  1. Call National Poison Control Center - What was swallowed, Child's weight and age and how long ago the poisoning occurred, Route of poisoning, Estimation of how much of poison was taken, Child's present condition

  2. Administer Activated charcoal - Administered to conscious victims only, Give ASAP, Mixed with water, adding a sweet syrup is suggested, Stools will appear black

  
• Acetaminophen Poisoning


  Causes extreme permanent liver destruction, After ingestion, the 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 because. 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

  Bring the child to nearest Hospital, Don't administer Activated charcoal, IV Morphine for pain, X-ray, Laryngoscopy and Esophagoscopy, 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 - passage of black stools containing digested blood, Hematemesis, Cyanosis, Vasomotor collapse, Coagulation defects, Hepatic injury, Lethargy and coma
• Therapeutic Management of Iron Poisoning


  Don't give Activated charcoal, Stomach lavage, Administer Cathartics, Administer Maalox or Mylanta - to help decrease gastric irritation and pain, Administer IV or IM Deferoxamine, GI Xray, 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: Lethargy, Impulsiveness, Learning difficulties, Blood level of lead >5μg/dl (unsafe level for children)
• Therapeutic Management of Lead Poisoning


  Lead levels >10-20 μg/100ml will be prescribed dimercaptosuccinic acid (DMSA) or succimer, Lead levels >45μg/100ml will be treated with Dimercaprol (BAL) or edetate calcium disodium (CaEDTA), 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
• Indicators of Physical Abuse

  • Bruises, Burns, Head injuries, Eye injuries, Mouth injuries, Human bites, Chunks of hair pulled off the scalp, Repetitive accidents, Multiple wounds or fractures 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
• Indicators of Physical Neglect

  • Child is unwashed, Thin and malnourished, Dressed inappropriately, Failure to bring child to seek early medical help, Not requiring a child to attend school without setting up a home school
• Psychological Maltreatment


  Constant belittling, threatening, rejecting, isolating or exploiting a child
• Munchausen Syndrome by Proxy


  Refers to a parent who repeatedly brings a child to a health care facility and reports symptoms and illness when the child is well
• Indicators of Sexual Maltreatment

  • Difficulty walking or sitting, Gross evidence of trauma in the genitalia, oral or anal regions, STI, Pregnancy, Weight loss
• Implementation of Child Maltreatment Management

  Protect the child from further injury or neglect, Make sure that the child is free from further harm. Remove the child from the abusive environment, Report the incident(s) to the proper authorities, Document assessment findings carefully and objectively, Collaborate w/ the multidisciplinary team concerning immediate and long-term therapies to prevent further abuse
• In adults, cancer usually occurs in the form of a solid tumor, In children, the most frequent type of cancer is that of immature white blood cell (WBC) overgrowth or leukemia