What to Expect the Toddler Years (248 page)

53. Massive bleeding.
If a limb is severed (#47) and/or blood is gushing or pumping out of a wound, get
immediate
emergency medical assistance by
calling 911
or rushing to the nearest ER. In the meantime, apply pressure to the wound with sterile gauze pads, a fresh diaper or sanitary napkin, or a clean washcloth or towel. Increase the packing and pressure if bleeding doesn’t stop. Do not resort to a tourniquet without medical advice as it can sometimes do more harm than good. Maintain pressure until help arrives.

54. Puncture wounds.
Soak a small puncture wound (one caused by a thumb-tack, needle, pen, pencil, or nail) in comfortably hot, soapy water for 15 minutes. Then consult the doctor for what to do next. For deeper, larger punctures—from a knife or a stick, for example—take your child to the doctor or ER immediately. (If there is extensive bleeding, see #53.) If the object still protrudes from the wound, do not remove it; this could lead to increased bleeding or other damage. Pad or otherwise stabilize the object, if necessary, to keep it from moving around. Keep your child as calm and still as possible to avoid movement that might make the injury worse.

55. Splinters or slivers.
Wash the area with clean water and soap, then numb it with an ice pack or ice cube (see page 837) or a commercial teething-pain ointment. If the sliver is completely embedded, try to work it loose with a sewing needle that has been sterilized with alcohol or in the flame of a match or a gas burner. If one end of the sliver is clearly visible, try to remove it with tweezers (also sterilized by alcohol or flame). Don’t try to remove it with your fingernails, which might be dirty. Wash the site again after you have removed the
splinter. If the splinter is not easily removed, try soaking in warm, soapy water (or Epsom salts dissolved in warm water) for 15 to 30 minutes, three times a day for a couple of days, which may help it work its way out or make it easier to remove. Consult the doctor if the splinter remains embedded or if the area becomes infected (indicated by redness, heat, swelling). Also call the doctor if the splinter is deeply embedded or very large and your toddler’s tetanus shots are not up-to-date, or if the splinter is metal or glass.

see #6

56.
A sprain is an injury to the ligaments, which are the tough, fibrous tissues that connect bones to other bones. Because, during childhood, the ligaments are strong in comparison to bones and cartilage, injury to them is less likely than it is in adulthood, when bones become stronger. Still, a child may occasionally sprain an ankle or, less often, a wrist or knee. The symptoms (pain, swelling, inability to use the affected joint or, if it’s an ankle or knee that’s injured, to walk on it) are similar to those for a broken bone, so a sprain often requires medical expertise, and sometimes an x-ray, to differentiate it from a fracture. Call the doctor if your child develops such symptoms. If there is a possibility of a fracture, see #8. To treat a sprain initially, use the traditional
RICE
treatment:
R
est.
Rest the injured limb. If the sprain involves a leg, keep the child off it as much as possible for the first couple of days, or until the child seems able to walk without pain.
I
ce.
Apply an ice pack to the injured joint.
C
ompression.
Wrap it snugly (but not so tightly that you restrict circulation) in an elastic bandage.
E
levation.
Elevate the injured limb as much as possible. Your toddler may enjoy resting the limb on a plump pillow or a large stuffed animal friend.

Depending on the severity of the injury, the doctor may recommend continuing to use the elastic bandage until the sprain heals or may immobilize the joint with a splint (or even a cast). Check back with the doctor if a sprain hasn’t healed after 2 weeks or if it has gotten worse. Ignoring a serious sprain can occasionally lead to permanent damage.

see #15

57. Coins, marbles, and similar small objects.
When a child has swallowed such an object and doesn’t seem to be in any distress, it’s best to wait for the object to travel through the digestive tract. You can, however, give your child carbonated water or soda, which may help dislodge an object that’s stuck in the esophagus. Most children will pass a small swallowed object within 2 or 3 days (see page 216). Check the stool for the object until it’s passed. If, after ingesting such an object, however, a child has difficulty swallowing or complains about chest pain, or if chest or throat pain, wheezing, drooling, gagging, vomiting, or difficulty in swallowing develop later, the object may have lodged in the esophagus. Call the doctor or take the child to the emergency room immediately. In such a case, it is often possible to remove the object with a special instrument or via balloon extraction; if not, surgery may be necessary.

If there is coughing or there seems to be difficulty breathing, the object may have been inhaled rather than swallowed; treat as a choking incident (see page 689). The swallowing of a button battery requires special attention (see #58).

58. Button batteries.
If your child swallows a button battery of any kind, call the doctor. The most dangerous to swallow are larger batteries and those that have lithium cells; less hazardous are the very smallest batteries, zinc/air batteries, and batteries containing silver oxide cells. An x-ray to assure that the battery is not lodged in the esophagus may be recommended or a wait-and-see approach suggested. Most children pass a swallowed battery through their digestive systems without problems (61% pass it within 2 days, 86% within 4 days). If there are any related symptoms, they are usually digestive, though occasionally a rash may develop. Concern arises when the battery lodges in the esophagus (see #57).

59. Sharp objects.
Get prompt medical attention if a swallowed object is sharp (a pin or needle, a fish bone, a toy with sharp edges). It may have to be removed (see #57).

see #38, #39

see #27, #28, #29, #30

see #37

The instructions that follow should serve only to reinforce what you learn in a first aid and CPR course for young children. (The training you receive may vary somewhat from the protocol described here, and should be the basis for your actions). For your child’s sake, you should take such a course. Participating in a formal course is the best way to ensure you’ll be able to carry out these life support procedures correctly. Periodically review the guidelines below, and/or the materials you receive from course instructors.

Resuscitation efforts should be attempted when a child has stopped breathing or is struggling to breathe (gasping, wheezing, flushed or bluish skin color). If your child is struggling to breathe, have someone call 911 or the local emergency number immediately. Meanwhile, keep your child’s body temperature normal (cool or warm him as needed). Keep him calm and have him rest in the position that seems most comfortable and easiest to breathe in.

To determine whether resuscitation is necessary, survey your toddler’s condition with the Check, Call, Care method recommended by the American Red Cross.

1. Check the scene, then the toddler

Try to rouse a toddler who appears to be unconscious by tapping his shoulder and shouting his name: “Matthew, Matthew! Are you okay, Matthew?”

2. Call

If you get no response, have anyone else present call 911 for emergency medical assistance while you continue to Step 3 without delay. If you are alone, give about 2 minutes of care, then call 911. If you can, periodically call out to try to attract help from neighbors or passersby. If, however, you are unfamiliar with CPR or feel overwhelmed and panicked, go to the nearest phone immediately—with your child, if there are no signs of head, neck, or back injury. Better still, if a cordless or cell phone is available, bring it to your child’s side and call 911. The dispatcher will be able to guide you as to the best course of action.

Important:
The person calling for emergency assistance should stay on the phone as long as necessary to give complete information to the dispatcher. This should include: name, age, and approximate weight of the child; any allergies, chronic illnesses, or medications taken; present location (address, cross streets, apartment number, best route if there is more than one). Ideally this information should be kept ready at your home phone; duplicate lists of information should also be carried in your bag (and that of any caregivers). Also tell them the condition (Is the child conscious? breathing? bleeding? in shock? Is there a pulse?); cause of condition (fall, poison, drowning, etc.), if known; phone (or cell) number. Tell the person calling for help not to hang up until the EMS dispatcher has concluded questioning and to report back to you after completing the call.

3. Care

Move the child, if necessary, to a firm, flat surface. Quickly position the child face-up, head level with heart, and proceed with the A-B-C survey below.

If there is a possibility of a head, neck, or back injury—as there may be following a fall or car accident—go to Step B to look, listen, and feel for breathing before moving the child. If breathing is present, leave the child where he or she is unless there is immediate danger (from traffic, fire, an imminent explosion) at the present site. If breathing is absent and rescue breathing cannot be accomplished in the child’s present position, roll the child as a unit to a face-up position, so that head, neck, and body are moved as one, without twisting, rolling, or tilting the head.

A. Open the Airway

Use the head-tilt/chin-lift technique described below to try to open the airway, unless there is a possibility of a head, neck, or back injury—in which case, try to minimize movement of the head and neck when opening the airway.

Important:
The airway of an unconscious child may be blocked by a relaxed tongue or by a foreign object. It must be cleared before the child can resume breathing.

Head-tilt/chin-lift technique.
Push down on your toddler’s forehead while pulling up on the bony part of the jaw with two or three fingers of your hand to lift the chin. See the illustration on page 686. (The American Red Cross no longer recommends using the jaw-thrust technique.)

HEAD TILT/CHIN LIFT
Tilt the child’s head back by pushing on the forehead and pulling up on the jaw with your fingers.

Important:
Even if the child resumes breathing immediately, get medical help. Any child who has stopped breathing (even briefly), has been unconscious, or has nearly drowned requires prompt medical evaluation.

B. Check for Breathing

B-1.
After performing the head-tilt/chin-lift technique, look, listen, and feel for no more than 10 seconds to see if the child is breathing. Can you see the chest and abdomen rising and falling? Can you hear or feel the passage of air when you place your ear near the child’s nose and mouth?

If normal breathing has resumed, maintain an open airway with the head-tilt/chin-lift technique as you continue to look for other life-threatening conditions.

Activate emergency medical system.

If breathing has resumed, and no one has yet called for help, call 911 now.

If the child regains consciousness as well (and has no injuries that make moving inadvisable), turn him or her on one side. A spate of coughing when the child starts to breathe independently may be an attempt to expel an obstruction.
Do not attempt to interfere with the coughing.