week 11 - NRG 204

• HEALTH PROBLEMS COMMON IN TODDLERS
• 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
  • Drowning
  • Aspiration
• Burns


  Injuries to body tissue caused by excessive heat (greater than 40°C or 104°F)
• Burns are the 2nd greatest cause of unintentional injury in 1 to 4 year olds and the 3rd most common cause of unintentional injury in children 5 to 14 year olds
• 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


  • Airway
  • Breathing: beware of inhalation and rapid airway compromise
  • Circulation: fluid replacement
  • Disability: compartment syndrome
  • Exposure: percentage of area of burn
• Rule of 9s (ADULTS)

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

  • First degree / Superficial thickness - Affects only the epidermis, or outer layer of skin. Appears red, dry, and with no blisters. Feels mildly painful. Heals 1 to 10 days by simple regeneration.
  • 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 by tissue regeneration.
  • 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 bec. the nerve endings are destroyed. Skin grafting is usually necessary, healing takes months. Scar tissue will cover the final healed site.
  • Fourth degree - 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.
• 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

  • Immediately apply cool water to cool the skin. Prevent further burning
  • Application of Analgesic-antibiotic ointment and a gauze bandage. To prevent infection
  • Keep dressing dry and change every 2 days
• Emergency Management of Moderate Burns

  • Don't rupture blisters
  • Apply topical antibiotic (Silversulfadiazine-Silvadene) and dressing to prevent damage and infection
  • Broken blisters may be debrided
• Emergency Management of Severe Burns

  • Fluid therapy- LR or PNSS
  • Systemic antibiotic therapy
  • Pain mgt – Morphine sulfate IV
  • Physical therapy- prevent contractures
• Emergency Management of Electrical Burns

  • Clean with antiseptic solution (Half strength Hydrogen peroxide) 1:1
  • Monitor for airway obstruction
  • Provide a bland liquid diet
• Debridement


  The removal of dead (necrotic) or infected skin tissue to help a wound heal
• Debridement is also done to remove foreign material from tissue
• Fluid shifts after burn injury


  Increased capillary permeability leads to hypoproteinemia, hyponatremia, hyperkalemia, and hypovolemia
• Therapeutic Management of Burns

  • Topical therapy — Silver sulfadiazine, 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
• Unintentional Injury Prevention Measures for Toddlers

  • Cook on the back burners of the stove if possible; turn handles of pots towards the back of the stove to prevent the toddler from reaching up and pull 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 hot-water faucets; check the temperature setting for hot-water so the thermostat is not over 125°F
  • Do not leave coffee/tea pots on a table where child 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 plugs
• Poisoning


  A poison is 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
• Poison Prevention Tips (AAPCC.org)


  • Keep medicines and toxic products locked and away from children
  • Add the poison control number (1-800-222-1222) 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. Keep in mind that the child may be awake and alert
  • 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 unused, unneeded, or expired medications and vitamins
• Emergency Management of Poisoning at Home


  • 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 -(sleepy, hyperactive, comatose)
• Emergency Management of Poisoning at the Healthcare Facility

  • 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, child develops anorexia, nausea and vomiting, and increased 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
  • Vomits blood, mucus and necrotic tissue
  • Tachycardia, tachypnea, pallor, 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: 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

  • Don't give Activated charcoal
  • Stomach lavage
  • Administer Cathartics
  • Administer Maalox or Mylanta - help decrease gastric irritation and pain
  • 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 and kidney destruction. Can lead to encephalitis or inflammation of brain cells (toxic level).
• Assessment of Lead Poisoning

  • 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. History of mental illness (10%), maltreated as children, unfamiliar with Normal G&D, socially isolated, substance abuse.
  • Special Child — Children Who Are Maltreated. Parent view child as different, birth anomaly.
  • Special Circumstance — Stress, Reporting
• Reporting 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