MCN

• 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
• Other 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 years old
  • 3rd most common cause of unintentional injury in children 5 to 14 years old
  • 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, 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

  • Airway
  • Breathing: beware of inhalation and rapid airway compromise
  • Circulation: Fluid replacement
  • Disability: Compartment syndrome
  • Exposure: Percentage of area of burn
• Methods to calculate total body surface area affected by a burn injury

  • Wallace The Rule of Nines
  • Lund and Browder Chart
• Classification and description of burns

  • First degree / Superficial thickness - affects only the epidermis, appears red, dry, and with no blisters, feels mildly painful, heals 1-10 days
  • Second degree / Partial thickness - 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
  • 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, skin grafting is usually necessary, healing takes months
  • Fourth degree - full thickness burn extending into muscle and bone, skin grafting is necessary, muscle and bone may be permanently damaged
• Emergency management of burns

  • Minor Burns - don't rupture blisters, apply topical antibiotic and dressing
  • 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
• Fluid shifts after burn injury

  1. Increased vascular permeability

  2. Hypoproteinemia

  3. Hyponatremia

  4. Hyperkalemia

  5. 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 back burners, use cool-mist vaporizer, keep screen in front of fireplace/heater, monitor toddlers near lit candles, set hot-water heater thermostat below 125°F, don't leave hot beverages within reach, buy flame-retardant clothing, don't allow toddlers to blow out matches, keep electric wires/cords out of reach
• Poisoning


  Any substance that is harmful to your body, can be swallowed, inhaled, injected, or absorbed through skin
• Poisoning in toddlers

  • 90% occur in the child's home
  • 9,500 children will be hospitalized yearly for unsupervised ingestion of prescription medications
  • Usual agents ingested are soap, cosmetics, detergents or cleaners, plants, OTC drugs, vitamins, aspirin, acetaminophen and prescription drugs
• Poison prevention tips for parents

  • Keep medicines and toxic products locked and away from children
  • Add poison control number in cell phone
  • Call poison control if child may have ingested something poisonous
  • Call 911 if child has ingested poison and collapses or stops breathing
  • Read medication labels carefully and administer appropriate amount
  • Safely dispose of unused, unneeded, or expired medications and vitamins
• Emergency management of poisoning at home

  1. Call National Poison Control Center - get details on what was swallowed, child's weight/age, route, amount, and condition

  2. Administer Activated Charcoal - to conscious victims only, mixed with water and sweet syrup
• Types of poisoning

  • Acetaminophen Poisoning
  • Caustic Poisoning
  • Iron Poisoning
  • Lead Poisoning
• Child abuse / maltreatment


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

  • Special Parent - parent has potential to maltreat child
  • Special Child - children who are maltreated
  • Special Circumstance - stress
• Levels of reporting suspected child maltreatment

  • Mandatory reporters - professionals mandated by law
  • Permissive reporters - encouraged but not required by law
• Types of child maltreatment

  • Physical Abuse
  • Shaken Baby Syndrome
  • Physical Neglect
  • Physiological Maltreatment
  • Munchausen Syndrome by Proxy
  • Sexual Maltreatment
• Implementation for child maltreatment

  • Protect the child from further injury or neglect
  • 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
• Home school


  A school that is run by parents in their own home, rather than by a local authority or private institution
• Physiological 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

  1. Protect the child from further injury or neglect

  2. Make sure that the child is free from further harm

  3. Remove the child from the abusive environment

  4. Report the incident(s) to the proper authorities

  5. Document assessment findings carefully and objectively

  6. Collaborate w/ the multidisciplinary team concerning immediate and long term therapies to prevent further abuse
• Leukemias and Wilm's tumor (nephroblastoma) are common health problems in preschoolers
• Malignant and Cancerous


  Describe cells that are growing and proliferating in a disorderly, chaotic fashion
• In adults, cancer usually occurs in the form of a solid tumor, while in children the most frequent type of cancer is that of immature white blood cell (WBC) overgrowth, or leukemia
• Health Promotion and Risk Management

  1. Reduce children's exposure to secondary cigarette smoke and urging adolescents not to begin smoking

  2. Applying sunscreen, reducing the overall time of sun exposure

  3. Children who receive chemotherapy or radiation for one cancer have a higher incidence of developing another cancer later in life

  4. Both boys and girls should receive the vaccine against human papillomavirus (HPV)

  5. Seek health maintenance care or evaluation for their other children
• Neoplasia


  • All body tissue undergoes continuing growth to develop into and maintain that specific type of tissue
  • Normally, the body is able to balance the proliferation necessary to replace old cells that die plus produce new cells for physical growth needs
  • Cancerous, or malignant, tissue, however, is unable to maintain this balance and begins to proliferate in disorderly, chaotic ways
  • NEOPLASM means "new growth"; typically used to refer to a new abnormal growth that does not respond to normal growth-control mechanisms
• Cell Growth


  • Normal cells appear to be able to recognize when they are being crowded for the space they must occupy, and they apparently communicate with one another to stop growth when they touch or become crowded
  • Neoplastic cells do not respond to this communication or cannot receive it, so, despite how crowded they are, they continue to grow
  • By the time a tumor mass is detected by palpation, it is probably about 30 times the size of its original aberrant cell
• Neoplastic Growth

  • Neoplasms can be either benign (growth is limited) or malignant (cancerous or with unlimited growth)
  • Even when a tumor is benign, it may not be completely harmless as it can cause damage by pressing on adjacent tissue
• Causes of Neoplastic Growth

  • In adults: Tumors may grow because normal cell growth has been altered by environmental exposures, such as chronic exposure to chemical irritants or cigarette smoke
  • In children: Tumors most frequently occur in organs unexposed to the environment such as leukemia of the bone marrow, nephroblastoma of the kidney (Wilm tumor), brain tumors, and neuroblastoma in the abdomen
• Somatic Mutation Theory

  Postulates that an accumulation of mutations in the cell is what ultimately results in the transformation to a neoplastic state
• Oncogenic Viruses


  Cancer-causing viruses such as HPV may be directly responsible for tumor growth
• Examples of Oncogenic Viruses

  • C-type RNA viruses have been implicated in leukemia
  • Epstein–Barr virus (EBV) is associated with Burkitt lymphoma
• Assessing Children with Cancer


  • Many cancers in children have been developing for some time before a child is brought for care because the symptoms are not perceived as important by the parents
  • Cachexia (loss of weight, anorexia) occurs if the tumor is growing so rapidly that it takes nutrients from normal cells
  • Thorough history taking at health care visits can help reveal these symptoms, so that a child can be further evaluated and a cancer discovered early in its growth
  • As malignant tumors grow, they tend to cause systemic effects in the child
• General Signs and Symptoms of Cancer

  • Unexplained fever
  • Bleeding / bruising
  • Morning headaches and neurological changes
  • Palpable abdominal mass
  • Swollen lymph nodes
  • Bone and joint pain
  • Fatigue