NRG 204

• 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


  • 2nd greatest cause of unintentional injury in 1 to 4 year olds
  • 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
• TSBA (total body surface area)


  The way medical professionals calculate the percentage of area of burn
• Degrees of Burns


  • First degree / Superficial thickness
  • Second degree / Partial thickness
  • Third degree / Full thickness
  • Fourth degree - Full thickness burn extending into muscle and bone
• 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 to 10 days by simple regeneration.
• 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.
• 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 bec. the nerve endings are destroyed. Skin grafting is usually necessary, healing takes months. Scar tissue will cover the final healed site.

  
• 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.

  
• Emergency Management of Minor Burns

  1. Immediately apply cool water to cool the skin

  2. Application of Analgesic-antibiotic ointment and a gauze bandage

  3. Keep dressing dry and change every 2 days
• Emergency Management of Moderate Burns

  1. Don't rupture blisters

  2. Apply topical antibiotic (Silversulfadiazine-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
• Debridement


  The removal of dead (necrotic) or infected skin tissue to help a wound heal
• Burn injury


  Increased capillary permeability leads to Hypoproteinemia, Hyponatremia, Hyperkalemia, 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.
• Common Agents Ingested by Toddlers


  • Soap, cosmetics, detergents or cleaners, plants, OTC drugs, vitamins, aspirin, acetaminophen and prescription drugs
• Poison Prevention Tips


  • 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


  1. Call National Poison Control Center

  2. Provide information about what was swallowed, child's weight and age, how long ago the poisoning occurred, route of poisoning, estimation of how much of poison was taken, child's present condition
• Emergency Management of Poisoning at the Healthcare Facility


  Administer activated charcoal
• Acetaminophen Poisoning


  Causes extreme permanent liver destruction. After ingestion, child develops anorexia, nausea and vomiting, increased SGPT and 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.
• Emergency Management of Caustic Poisoning

  1. Bring child to nearest Hospital

  2. Don't administer Activated charcoal

  3. IV Morphine for pain

  4. X-ray

  5. Laryngoscopy and Esophagoscopy

  6. 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.
• Emergency Management of Iron Poisoning

  1. Don't give Activated charcoal

  2. Stomach lavage

  3. Administer Cathartics

  4. Administer Maalox or Mylanta to help decrease gastric irritation and pain

  5. Administer IV or IM Deferoxamine

  6. GI X Ray

  7. 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. Leads to Encephalitis or inflammation of brain cells (toxic level).
• Lead Poisoning


  • Assessment: Lethargy, Impulsiveness, Learning difficulties. Blood level of lead >5μg/dl is unsafe level for children.
• Therapeutic Management of Lead Poisoning


  1. Lead levels >10-20 μg/100ml will be prescribed dimercaptosuccinic acid (DMSA) or succimer

  2. 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
• Special Parent


  • History of mental illness (10%), Maltreated as children, Unfamiliar with Normal G&D, Socially isolated, Substance abuse
• Special Child


  • Parent view child as different, Birth anomaly
• Special Circumstance


  • Stress, Reporting
• Levels of 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
• 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