204 - HEALTH PROBLEMS

• 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°C)
• Burns are the 2nd greatest cause of unintentional injury in 1- 4 y.o and the 3rd most common cause of unintentional injury in children 5 - 14 y.o.
• 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
  • 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


  • Airway
  • Breathing: beware of inhalation and rapid airway compromise
  • Circulation: fluid replacement
  • Disability: compartment syndrome
  • Exposure: percentage area of burn
• Rule of Nines (Wallace)


  The way medical professionals calculate the TBSA (total body surface area)
• Burn degrees


  • First Degree / Superficial thickness - affects only the epidermis, appears red, dry, and with no blisters
  • Second Degree / Partial thickness - involves the epidermis and part of the dermis layer, appears red, blistered, and may be swollen
  • Third Degree / Full thickness - involves the epidermis and full extent of dermis and may go into the subcutaneous tissue, appears white or charred and lacks sensation
  • Fourth Degree - full thickness burn extending into muscle and bone
• Emergency management of burns

  • Minor Burns - Apply cool water, Analgesic-antibiotic ointment and a gauze bandage
  • Moderate Burns - Don't rupture blisters, Apply topical antibiotic, Debridement
  • Severe Burns - Fluid Therapy, Systemic antibiotic therapy, Pain management, Physical Therapy
  • Electrical Burns - Clean with antiseptic solution, Monitor for airway obstruction, Provide bland liquid diet
• Burn injury leads to increased capillary permeability, resulting in hypoproteinemia, hyponatremia, hyperkalemia, and hypovolemia
• Therapeutic management of burns


  • Topical Therapy - Silver sulfadiazine, Furacin
  • Escharotomy - cut into the eschar
  • Debridement - removal of necrotic tissue
  • Grafting - Allografting, Xenograft, Autografting
• Unintentional injury prevention measures for toddlers

  • Cook on the back burners of the stove
  • Use a cool-mist type vaporizer
  • Keep the screen in front of the fireplace or heater
  • Monitor toddlers carefully near lit candles
  • Check the temperature setting for the hot-water heater
  • Do not leave coffee/tea pots on a table where children can reach them
  • Buy flame-retardant clothing
  • Keep electric wires and cords out of toddlers' reach
• 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 it occurs in the child's home. 9,500 children will be hospitalized yearly for unsupervised ingestion of prescription medication.
• Poison


  Any substance that is harmful to your body (swallow it, inhale it, inject it, or absorb it through your skin)
• Poison prevention tips for parents

  • Keep medicines and toxic products locked and away from children
  • Add the poison control number (1-800-222-1222) in your cell phone
  • Call the poison control center if you think your child has ingested anything that may be poisonous
  • If your child has ingested a poisonous product and collapses or stops breathing, call 911
  • Read labels carefully to administer the appropriate amount of medications
  • Safely dispose of unused, unneeded, or expired medications and vitamins
• Emergency management of poisoning

  • At home - Call National Poison Control Center, provide details about the poisoning
  • At health care facility - Administer Activated Charcoal
• Acetaminophen poisoning


  Causes extreme permanent liver destruction, child develops anorexia, nausea and vomiting, high Sgpt, Sgot. Antidote is 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, and hypotension
• Therapeutic management of caustic poisoning


  • Bring child to nearest hospital
  • Don't administer Activated charcoal
  • IV morphine for pain
  • X-ray
  • Laryngoscopy and Esophagoscopy
  • Intubation or tracheostomy
• Iron poisoning


  Large amount of iron is corrosive to the gastric mucosa and leads to severe gastric irritation in the child. Immediate effects are nausea, 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

  • Don't give Activated charcoal
  • Stomach lavage
  • Administer Cathartics
  • Administer Maalox or Mylanta
  • Administer IV or IM Deferoxamine
  • GI X Ray
  • 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, and leads to Encephalitis or inflammation of brain cells (toxic level).
• Assessment of lead poisoning

  • Lethargy
  • Impulsiveness
  • Learning difficulties
  • Blood level of lead >5μg/dl [unsafe for children]
• Therapeutic management of lead poisoning

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


  Willful injury by one person to another. It 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 - Stress
• Reporting of suspected child maltreatment

  • 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 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


  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

  • 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 with the multidisciplinary team concerning immediate and long term therapies to prevent further abuse
• Nursing care of a family when a child has a malignancy includes leukemias and Wilms tumor (nephroblastoma)
• Malignant and cancerous


  Describe cells that are growing and proliferating in a disorderly, chaotic fashion
• Types of child maltreatment

  • Hitting, threatening, rejecting, isolating, or exploiting a child
• Indicators of sexual maltreatment

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