Baby's Guide – Emergency Room

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Category: Cuts, Scrapes, Bruises, Jul 19, 2011

All children have falls and minor accidents from time to time. Many of the injuries caused by these minor accidents can be handled at home and do not require professional medical attention.

Treatment

Remain calm—your child will pick up cues from your behavior. The more upset you act, the more frightened he will become. Often, the louder your child cries, the less severe the injury! The wound often looks worse than it is, especially if there is brisk bleeding. Sometimes, relatively minor injuries are associated with a lot of bleeding. This is likely to happen if the injury is on the scalp, where there is a large supply of blood vessels close to the surface. Abrasions or superficial (first-degree) burns are very painful but usually not very serious.
Clean the wound properly. If possible, hold the affected area under running water and clean the wound thoroughly. If this is not possible, clean the area with soap and water. In the case of animal or human bites, hold the affected area under running water for at least 5 to 10 minutes. A small amount of bleeding will do no harm.
When the wound is thoroughly cleaned, apply an antiseptic or antibacterial ointment and cover it with clean gauze and fasten it with tape. At times, all that is needed is a bandage.
If the wound is still bleeding after you have cleaned it, place clean gauze directly over the area and apply firm pressure to the wound. If you do not have clean gauze, use a clean handkerchief or clean cloth. Elevating the affected part, for example, the foot or the hand, will also help to control the bleeding. If the bleeding continues, medical care should be sought.
If the wound is deep and gaping, your child will probably need stitches—seek medical attention. If you are traveling and away from home and medical help is not easily accessible, you can try to pull the edges of the wound together using Steri-strip or a butterfly bandage.
You can make your own butterfly bandage from adhesive tape. Your child may need a tetanus shot, especially if he is not fully immunized or the wound is contaminated with debris. Most children get tetanus immunizations as part of their routine childhood immunizations.
In the case of an animal bite, your child might need protection against rabies. Contact your physician for guidance. In certain parts of the world, especially Asia, animal bites have a much higher risk of rabies
It is important to keep the wound clean and dry as it heals. Many wounds will become infected if a bandage or other dressing is left on for too long. Replace the bandage or dressing on a daily basis. Clean the wound every day and allow it to aerate and dry.
Watch out for signs of infection, which include redness and swelling that spreads outward from the wound, red streaks spreading up the limb from the wound site, worsening pain, or a fever. Wounds of the hands and feet may be deeper than they appear, and infection can spread rapidly in these sites. Many puncture wounds are deep and often become infected. Puncture wounds of the hands or feet should be assessed by a medical professional.

When to Seek Medical Attention

If a wound continues to bleed.
If the wound is deep and gaping.
If your child has a puncture wound of the hands or feet.
If a wound appears to be infected.
If your child is not fully immunized against tetanus or the wound is contaminated with debris.
If your child is bitten by an animal that may have rabies (contact your physician for guidance).

Burns

Category: Burns, Jul 19, 2011

The most common burn encountered is a scald caused by hot liquids or steam. Scalds usually occur in the kitchen or bathroom. Burns may also be caused by flames, chemicals, electricity, or radiation. Sunburn is the most frequent cause of a radiation burn. If your child has been sunburned.

The skin is the largest organ in the body, and its thickness varies greatly according to the location. The skin of the palms and soles may be up to 10 times thicker than that of the eyelids. The thinner the skin, the greater the sensitivity to heat. Burns may also be associated with other injuries, including smoke inhalation damage to the lungs.

CAUTION

If your child has suffered a severe burn injury, seek medical care immediately.

CLASSIFICATION

The severity of a burn—and its consequences—depend on its size, depth, and location.

Size

The larger the burned area, the more severe the consequences. Even a superficial (first-degree) burn covering 10 percent of a child’s body can have serious consequences. (The palm of a person’s hand is equal to about 1 percent of his or her entire skin surface area.)

Depth

Heat burns can be classified into three degrees according to the depth of the burn. The degree of a burn is not always easy to determine, and the classification often has to be revised a day or two after the burn occurred.

First-Degree Burns

These are fortunately the most common and are characterized by superficial redness and pain. The skin will turn white when you press on it. The skin often peels within the next two to three days and is totally healed by one week. Sunburn is usually a first-degree burn.

Second-Degree, or Partial-Thickness, Burns

Second-degree burns are characterized by deeper redness, more severe pain, and swelling and blistering. Depending on their depth, these burns may take up to four weeks to heal. If these burns become infected, their classification may be revised to a third-degree, or full thickness, injury. Less severe scalds are usually second-degree burns and usually take 7 to 14 days to heal.

Third-Degree Burns

In third-degree burns, the burned area is leathery and either white or charred. The burned skin itself is not painful, but the surrounding area may be. These burns will require skin grafting.

Location

Burns of the face, hands, feet, and genital area have complications out of proportion to their size and should always be assessed by a medical professional.

Prevention

Most burns can be prevented by taking appropriate precautions, including the following :

For the prevention of sunburn, refer to Chapter 38.
Make sure your home has a number of functioning smoke detectors and use them. Newer photoelectric models cause fewer false alarms than the older smoke detectors, so consider switching to these newer models if you are tempted to disconnect your smoke detectors because of frequent false alarms. Replace the batteries in your smoke detectors every six months (some people do this in the spring and in the fall at the same time they adjust their clocks for the beginning and the end of daylight saving time).
Keep matches and cigarette lighters in a safe place. Do not leave lighted cigarettes and pipes around. Better still, give up smoking!
Be careful in the kitchen. Turn pot handles to the side or back of the stove. Preferably use the back burners of the stove.
Do not hold your child on your lap when drinking hot beverages.
Keep your hot water temperature between 120°and 125°F. Check the water temperature before putting your child in the bath.
Be especially careful when using curling irons. These are extremely hot and cause deep burns very quickly.
Don’t leave a hot iron on the ironing board. Both the iron and the board are too unstable.
Don’t leave burning candles within your toddler’s reach.
Keep caustic chemicals (strong alkalis and acids) in a safe place and in secure containers.
Put covers on electrical outlets.
If your car has been standing in the sun, check the temperature of your child’s car seat before putting her in it. Hot buckles can burn an infant’s sensitive skin.
Do not purchase your own fireworks. Attend public displays instead. Fireworks not only result in serious burns but are also a frequent cause of blindness

Treatment

The following treatment measures apply only to minor burns.

Remove your child from the heat source.
Remain calm.
Immerse the area in cold water. If this is not possible, cover the area with a cloth soaked in cold water. This will not only limit the burn size but also provide some pain relief.
Do not apply butter, oil, salves, or sprays to the burn. Benzocaine and other local anesthetic sprays may lead to sensitization, leading to allergic or irritant reactions.
Give your child an analgesic such as ibuprofen (Advil or Motrin) or acetaminophen (Tylenol).
After the initial cool water soaks, for fi rst-degree burns apply a skin care product such as aloe vera cream. For second-degree burns apply either aloe vera or an antibiotic ointment, and cover the burn with a nonstick dressing such as Telfa if you have it. Keep it in place with gauze and tape. An ideal cream for preventing infection is Silvadene, which is available only by prescription.
Do not pop the blisters.

When to Seek Medical Attention

If the burn covers an area larger than the palm of your child’s hand.
For any burn of the face, hands, feet, or genital area.
If the burn is anything other than a first-degree burn. The degree of the burn may be difficult to assess. If you are unsure, seek medical care.
If the burn becomes infected. Signs of infection include the following :

- Wound discharge that is green or yellow

- Increasing pain at the burn site after a day or two

- Increased swelling or redness of the skin surrounding the burn

- A fever

If your child gets an electrical burn.
If your child has a second- or third-degree burn, he may require a tetanus shot.

FOLLOW-UP CARE

Burns other than fi rst-degree burns will require dressing changes once a day. Soak the burned area in cool water for 15 minutes, allow to air dry, and then apply an antibiotic ointment. Cover with a nonstick dressing such as Telfa, and keep it in place with gauze and tape. It is a good idea to give your child a suitable analgesic one hour before you change the dressing.
Be on the lookout for secondary infection (described above).
Once the burn has healed, soften the area by rubbing in vitamin E cream.
Be extra careful to avoid sunburn to the area for at least one year.

ELECTRICAL BURNS

Electrical burns may appear to be very minor at the surface, but serious deep tissue injury may have occurred. Internal injuries may also be present.

Do not touch the victim until the current has been turned off or the source of the current has been removed with an implement that does not conduct electricity, such as a wooden broomstick.
If the victim is unconscious, call 911 and begin CPR if necessary.
If the victim is otherwise “OK,” treat the burn like other heat burns by immersing the burned part in cold water, if possible.
Use pain medicine as necessary.
Seek medical care.

Choking

Category: Choking, Jul 19, 2011

People of any age can choke, but children younger than four years of age are particularly prone to choking. As always, your goal should be prevention.

Prevention

Foods that easily lead to choking in young children include peanuts and other nuts, popcorn, hard candy, pieces of hot dog, and raw carrots. Do not give nuts and hard candy to young children. Cut food into small pieces before feeding it to young children.

Do not let your child eat while running around. Supervise eating and mealtimes.
Keep small toys and other small objects away from your children. Select toys appropriate for your child’s age. Latex balloons are particularly dangerous, as are eraser tips, buttons, and button batteries.
Instruct the older children in your house not to give infants and younger children pieces of food and small objects.
Learn CPR. Take a course at your local hospital, Red Cross, or similar organization. Update and practice your skills frequently. Renew your certification regularly, at least every two years.

First Aid

Most choking episodes in children occur while they are eating or playing and are often witnessed by adults who can intervene while the child is still conscious and responsive. If your child appears to be choking, assess the situation before you intervene :

Do not start first aid for choking if your child can cry or talk, has a strong cough, or is breathing adequately.
Do start first aid for choking if your child cannot cough, talk, or emit normal sounds; is changing color (turning blue or pale); or cannot breathe; or if an older child uses the universal sign for choking (hands clutching the neck). If a child is found unconscious, you should always suspect upper airway obstruction as a possible cause and initiate appropriate first aid. See below for appropriate first aid measures by age group.

Call 911 after starting rescue efforts.

Infants Younger Than One Year of Age

If your baby appears to be choking, his breathing is obstructed, or he is turning blue and trying to cry but just making weak sounds, you will need to intervene :

Lay your baby face down with his head low along your forearm. His legs will straddle your forearm. Give five sharp back blows between his shoulder blades.
If this fails to clear the blockage, turn your baby over and give five chest thrusts using two fingers on the lower half of the breastbone. Look in the mouth to see if this has dislodged anything.
If the blockage does not clear, call 911.
Repeat the above steps until the blockage has cleared or until help arrives.
If your child stops breathing or remains blue, start cardiopulmonary resuscitation (CPR).
See below for management of the unconscious infant.

Older Children

Conscious Child

If your child appears to be choking but is coughing or crying or is able to talk, encourage her to cough forcefully and try to expel the foreign body. If your child cannot breathe or make a sound, you need to intervene with the Heimlich maneuver. If this does not dislodge the object and she loses consciousness, try abdominal thrusts. If your child becomes blue or stops breathing, start CPR. Call 911.

Unconscious Child

If you come across an unconscious child, you should always consider a foreign body or upper airway obstruction as a reason for the unconsciousness. This is more likely to be the case if the child is not breathing normally or is blue.

Make sure the child is unresponsive.
Shout for help.
Open the airway and check for breathing. If the child is not breathing, attempt rescue breathing.
If the child’s chest does not rise, reposition the head and try the rescue breathing again. If you still are unable to give effective breaths (the chest does not rise), perform abdominal thrusts in a child or back blows in an infant.
After each set of five abdominal thrusts (child) or five back blows (infant), open the child’s mouth and look for a foreign body. If you see a foreign body, try to hook it out with your finger. If you cannot see a foreign body, do not put a finger in the mouth, as it may push an object in deeper. If you do not see a foreign body, repeat the cycle.
Call 911.
If the child is not breathing, give rescue breaths until help arrives. Assess the pulse/circulation and if necessary begin CPR.

Head Injuries

Category: Head Injuries, Jul 19, 2011

Head injuries are extremely common in childhood. Fortunately, most injuries are minor. Infants and toddlers have a relatively large head as well as limbs that don’t always do what they are supposed to do! Toddlers bump their head frequently as they learn to walk.

Usually these bumps are of no consequence, and the parent is often more upset by the episode than the child. Your child will probably cry for a short while after banging his head and may develop a bump (an “egg”). Most of these bruises will be on the forehead. Over the next day or two, the bruise will darken and a black eye may appear.

In fact, the injury often looks more impressive on day two or three than it did in the beginning! Bruises often take up to a week to fade. The crying will usually cease in 10 minutes or less. Some children are a little sleepy after a mild head injury and may even vomit once or twice. This is a common reaction and usually does not indicate a more serious problem.

Prevention

Most head injuries can be prevented by taking the appropriate precautions.

Motor Vehicles

• Always wear your seat belt. Younger children should be in their child safety seat or a booster seat.

• Never drive under the infl uence of drugs or alcohol.

Helmets

• Use helmets when riding a bike, a snowmobile, and an all-terrain vehicle and when skateboarding, snowboarding, skiing, or riding a horse.

• Wear a helmet when playing contact sports such as football and ice hockey and also when playing baseball, softball, and lacrosse.

• Set a good example for your children by wearing a helmet when you ride a bicycle or partake in activities that may lead to head injuries.

Playgrounds

Playgrounds should have shock-absorbing surfaces such as mulch, sand, or rubber.

Firearms

Keep firearms away from children!

Falls from Heights

• Never leave your infant unattended on a changing table.

• Do not put your child in a mobile walker—these walkers have a tendency to make their way to the nearest staircase and descend rapidly!

• Keep house and apartment windows fastened.

• Do not let children play on balconies.

CAUTION

Never shake your baby!

Treatment

• If the skin is broken, clean the abrasion gently with soap and warm water. If your child has a laceration that is bleeding, apply fi rm pressure with a handkerchief, tissue, or gauze until the bleeding has stopped. The scalp is very vascular, and it may take some minutes and fi rm pressure to control the bleeding. If he has a laceration with gaping wound edges, however, he needs medical attention.

• An older child with a swelling on his head may be willing to hold an ice pack against the swelling. Wrap a plastic bag of ice (or a bag of frozen vegetables) in a cloth or towel and apply this to the wound. It is probably not worth trying to do this if you are dealing with an uncooperative toddler!

• Do not give your child ibuprofen (Advil or Motrin) or aspirin. You may administer a dose of acetaminophen (Tylenol) if you feel this is necessary.

• If your child is sleepy, let him sleep. You don’t have to keep your child awake, but you do need to keep a close watch on him. If it is nighttime, wake him when you go to bed and then every four hours or so to determine whether he is behaving normally:

– Does he make good eye contact and appear to be totally “with it?”

– If he has learned to walk, can he walk normally?

– If he is an older child who has learned to talk, is he talking normally? Ask him a few simple questions and assess his response.

– Are his pupils (the dark spot in the center of the eyes) the same size? If you shine a fl ashlight into his eyes, do the pupils constrict equally?

If you are unsure or concerned about any of the answers to these questions, call your physician. Usually, by the following day, your child will have recovered, but you will have a few more gray hairs! Occasionally it may be necessary to watch your child more closely for another day or night.

When to Seek Medical Attention

• If your child has a laceration with gaping wound edges.

• If your child is two years of age or younger and has any detectable abnormality of his skull, even if it is just a bruise or a localize swelling (an “egg”).

• If your child vomits more than two times.

• If it is difficult to rouse your child, or if he becomes unconscious.

• If your child has a headache that lasts longer than just a few hours, or if he has a headache that is increasing in severity.

• If an older child is not behaving, walking, or talking normally. If she seems confused or has slurred speech, persisting dizziness, clumsiness, or difficulty walking, seek immediate medical care.

• If your child’s pupils are unequal in size.

• If your child has blurred vision, or if he sees double.

• If your child remains fussy, irritable, and inconsolable. These symptoms, as well as changes in eating or nursing, may be the only signs of a problem in a younger child. Most children do not cry for longer than 10 minutes after a minor head injury.

• If your child has blood or watery fl uid coming out of one or both ears or his nose.

• If your child has a seizure.

• If, over the following days, your child loses balance easily, seems to regress, or loses interest in favorite toys or activities, or if his schoolwork deteriorates.

• If your child has a preexisting brain condition.

• If your child has any bleeding disorder or is on blood thinners.

RISK FACTORS FOR BRAIN INJURY

• Children two years of age and younger, especially those in the fi rst year of life. The younger the child, the more vulnerable the brain.

• Falls from 3 feet and higher.

• The harder the surface, the more severe the injury. Falls onto a concrete fl oor are likely to be more traumatic than those onto a carpeted floor. Bumps over the temple or the back of the head have a higher chance of being associated with underlying damage. (Bumps on the forehead are the least likely to lead to underlying brain injury.)

• Children with blood clotting problems or who are on blood thinners.

• Children with preexisting neurological (brain) problems.

Remember, any child under two years of age who has had a fall and has signs of a

skull injury (an abrasion, a bruise, a swelling, or a laceration) should be discussed

with a physician.

Poisoning

Category: Poisoning, Jul 18, 2011

As children acquire new skills, they expose themselves to new dangers. By six months of age, most infants can reach out and grasp objects. The risk of accidental poisoning, as well as of choking, increases daily and persists throughout the toddler and early childhood years.

Children can ingest a variety of potentially toxic substances. These include both over-the-counter and prescription medications, household cleaning products, pesticides, plants, gasoline and kerosene, and paints and solvents, among many others.

When a parent discovers that his or her child has ingested a potentially dangerous substance, the parent’s natural reaction is to want the child to vomit it out, but this may not always be wise.

This is due to a combination of factors, the most important of which is the introduction of child-resistant containers and safer medications, as well as increasing public awareness of the dangers of poisoning.

Prevention :

Medications

Keep all medications, including vitamins, out of sight and out of reach. Store them high up and in a locked closet.
Always secure child-resistant caps in the locked position after use.
Never transfer a medication from its original container to another one.
Dispose of all unused or no-longer-needed medicines safely.
Never refer to medications as candy.

Household Products

• Store potentially dangerous products in locked cabinets, preferably high up. Be particularly careful with bleach, drain cleaners, and similar extremely toxic materials.

• Never transfer these substances from their original containers to other ones.

In the Garage, Basement, or Garden Shed

• Store gasoline, kerosene, paint thinners, and varnishes in secure containers, locked up and out of reach.

• Never pour these substances into cups, soda bottles, or other containers. Even you may forget what that soda bottle contains!

• Store pesticides and fertilizers safely.

When Visiting

Children are often poisoned in someone else’s home, so be especially vigilant when visiting relatives and friends. Grandmother’s sleeping pills or blood pressure medicine may look particularly colorful and appealing to young children. People who are not accustomed to having young children around may not be quite as careful about keeping potentially toxic substances in a safe place.

Treatment

Note: Keep the poison center phone number close to the telephone

Don’t panic!

• Take the substance away from your child. If there is still some poison in your child’s mouth, get her to spit it out or remove it with your fi ngers.

• Look for any obvious, immediate effects such as burns of the lips, redness around the mouth, or drooling.

• Contact the poison control center.

• Do not induce vomiting until you have discussed this with the poison control center.

• Watch out for side effects such as drowsiness, retching, stomach cramps, and behavior changes.

Call 911 if your child becomes excessively drowsy or unconscious or has

breathing difficulties, jerking movements, or seizures. If our child does become unconscious or has a seizure before medical help can be reached, position your child on his side with his head lower than the rest of his body so that should he vomit, he will not inhale what he threw up. Be alert for breathing difficulties.

• Take the poison, medicine container, or plant with you to the emergency room. If your child has vomited and you do not know what he ingested, take the vomited material with you to the hospital.

CAUTION

— the ingested substance is gasoline, kerosene, or similar volatile material;

— the victim is very drowsy or unconscious