TODDLERS

• Toddler development areas

  • 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
• 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 years old
  • 3rd most common cause of unintentional injury in children 5 to 14 years old
  • More than 300 children treated in emergency rooms for burn-related injuries every day
• Types of burns

  • Thermal Burns
  • Radiation Burns
  • Chemical Burns
  • Electrical Burns
  • Friction Burns
• Thermal burns


  Due to external heat sources, e.g. hot meals, scalding liquids, steam and flames
• 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, e.g. lightning, stun guns, and contact with job site or household current
• Friction burns


  From direct damage to the cells and from the heat generated by friction, e.g. falling on or touching a treadmill in motion, rope burn from a rope sliding through the hands
• Assessment of burns


  • Airway
  • Breathing: beware of inhalation and rapid airway compromise
  • Circulation: Fluid replacement
  • Disability: Compartment syndrome
  • Exposure: Percentage of area of burn
• Wallace The Rule of Nines


  The way medical professionals calculate the TBSA (total body surface area)
• Lund and Browder Chart


  The most accurate and widely used chart to calculate total body surface area affected by a burn injury
• Classification and description of burns

  • First degree / Superficial thickness
  • Second degree / Partial thickness
  • Third degree / Full thickness
  • Fourth degree
• First degree / Superficial thickness burns


  Affects only the epidermis, or outer layer of skin. Appears red, dry, and with no blisters. Feels mildly painful. Heals 1-10 days by simple regeneration. Common cause: Sunburn
• Second degree / Partial thickness burns


  Involves the epidermis and part of the dermis layer of skin. Appears red, blistered, and may be swollen. Very painful. Heals over 2-6 weeks by tissue regeneration. Common cause: Scalding
• Third degree / Full thickness burns


  Involves the epidermis and full extent of dermis and may go into the subcutaneous tissue. Appears white or charred and lacks sensation because the nerve endings are destroyed. Skin grafting is usually necessary, healing takes months. Scar tissue will cover the final healed site. Common cause: Flames
• Fourth degree burns


  Full thickness burn extending into muscle and bone. Skin grafting is necessary. Muscle and bone may be permanently damaged. Scarring will cover the healed site. Common cause: High voltage electric or severe fire
• 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

  • Don't rupture blisters
  • Apply topical antibiotic (Silver sulfadiazine-Silvadene) and dressing to prevent damage and infection
  • Broken blisters may be debrided
  • Debridement - the removal of dead (necrotic) or infected skin tissue to help a wound heal, also done to remove foreign material from tissue
• Emergency management of severe burns

  • Fluid therapy - LR or PNSS
  • Systemic antibiotic therapy
  • Pain management - Morphine sulfate IV
  • Physical therapy - Prevent contractures
• Electrical burns


  Clean with antiseptic solution (Half strength Hydrogen peroxide) 1:1, monitor for airway obstruction, provide bland liquid diet
• Therapeutic management of burns


  • Topical therapy - Silver sulfadiazine, Furacin (if w/ 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
• Unintentional injury prevention measures for toddlers

  • Cook on the back burners of stove if possible; turn handles of pots toward back of stove to prevent toddler from reaching up and pulling them down
  • If a vaporizer is used, use a cool-mist type rather than a steam vaporizer so child cannot be scalded
  • Keep screen in front of fireplace or heater
  • Monitor toddlers carefully when they are near lit candles
  • Do not leave toddlers unsupervised near a hot-water heater so thermostat is not over 125°F
  • Do not leave coffee-tea pots on a table where children can reach them
  • Never drink hot beverages when a child is sitting on your lap or playing within reach
  • Buy flame-retardant clothing
  • Do not allow toddlers to blow out matches (teach fire is not fun); store matches out of reach
  • Keep electric wires and cords out of toddlers' reach; cover electrical outlets with safety plug
• 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, can be swallowed, inhaled, injected, or absorbed through the 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
• Poison prevention tips for parents

  • Keep medicines and toxic products locked and away from children
  • Add the poison control number in your cell phone and make sure all caretakers do the same
  • 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
  • When administering medications, be sure to read labels carefully and to administer the appropriate amount
  • Safely dispose of unused, unneeded, or expired medications and vitamins
• Emergency management of poisoning at home


  1. Call National Poison Control Center

  2. Provide information: what was swallowed, child's weight and age, how long ago the poisoning occurred, route of poisoning, estimation of how much poison was taken, child's present condition

  3. Administer Activated Charcoal
• Activated Charcoal


  Administered to conscious victims only, given ASAP, mixed with water, adding a sweet syrup is suggested, stools will appear black
• Types of poisoning

  • Acetaminophen Poisoning
  • Caustic Poisoning
  • Iron Poisoning
  • Lead Poisoning
• Acetaminophen poisoning


  Causes extreme permanent liver destruction, symptoms include anorexia, nausea and vomiting, increased SGPT and 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. Symptoms include pain in mouth and throat, drooling saliva, mouth turns white, vomits blood, mucus and necrotic tissue, tachycardia, tachypnea, pallor, hypotension. Therapeutic management includes bringing child to nearest hospital, no 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 include nausea and vomiting, diarrhea, abdominal pain. After 6-12 hours: melena, hematemesis, cyanosis, vasomotor collapse, coagulation defects, hepatic injury, lethargy and coma. Therapeutic management includes no activated charcoal, stomach lavage, cathartics, Maalox or Mylanta, 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 and kidney destruction. Encephalitis or inflammation of brain cells at toxic level. Symptoms include lethargy, impulsiveness, learning difficulties. Blood level of lead >5µg/dl is unsafe for children. Therapeutic management includes DMSA or succimer for lead levels >10-20 µg/100ml, BAL or CaEDTA for levels >45µg/100ml