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Promotion of Pediatric Safety
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• Injuries are a major cause of death in children.
  
• All children are at risk for injury because of
  their normal curiosity, impulsiveness, and desire
  to master new skills.

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Safety Risks in terms of Developmental Stage
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INFANT

• SIDS
• Motor Vehicle
• Infections
• Dehydration
• Respiratory Problems
• Child abuse

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TODDLER

• Injuries MVA
• Toddler fracture
• Poisoning
• Foreign Body airway obstruction
• Asthma, Croup, Respiratory problems
• Vomiting, Dehydration
• Child Abuse

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PRESCHOOL

• Motor Vehicle -- Bicycle
• Trauma
• Poisoning
• Asthma, Respiratory inf
• Drowning
• Child Abuse

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SCHOOL AGE

• Motor vehicle pedestrian - vehicle bike -
  vehicle
• Sports injuries

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ADOLESCENT

• Trauma
• Motor Vehicle
• Knife and gunshot wounds
• Pregnancy complications
• Suicide
• Poisoning
• Drowning

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Common Safety Problems
and Injury Prevention Measures
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Aspiration

• Asphyxiation by foreign material in respiratory
  tract is leading cause of fatal injury in
  children under 1 year of age.
• Puts everything in mouth
• Very interested in body and newly found openings

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AspirationPreventive Measures

• Carefully inspect toys for potential danger /
  removable parts.
• Keep small objects out of reach, floors free of
  objects
• Do NOT feed hard candy, nuts, food with pits or
  seeds, circular pieces of hot dogs
• Hold infant for feeding, do NOT prop bottle
• Use pacifier with one-piece construction and loop
  handle.

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Motor Vehicle Accidents

• Vehicle children improperly restrained
• Pedestrian
• Walking, running, especially after objects thrown
  into street
• Poor perception of speed, lack of experience to
  foresee danger
• Able to open doors and gates and get outside
• Children often unseen because of small size, can
  be run over by car backing out of driveway.
• Ride toys, bikes in path of danger

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Motor Vehicle AccidentsPreventive Measures

• Use federally approved car restraints
• Supervise child while playing outside.
• Do not allow playing behind cars.
• Supervise riding of toys, bikes.
• Lock fences, gates, doors
• Teach to obey pedestrian safety rules

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Burns

• Children are inquisitive and will pull pots off
  stove, plays with matches, inserts objects into
  wall sockets
• They can climb - reaches stove, oven, ironing
  board and iron, cigarettes on table
• Unaware of sources of heat or fire

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BurnsPreventive Measures

• Turn pot handles toward back of
• stove, place guardrails in front of
• radiators, fireplaces, stoves.
• Store lighters and matches in locked container
• Cover electrical outlets with protective covers.
  Keep electrical cords hidden
• Check bath water. Do not allow child to play
  with faucet

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Drowning
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Drowning

• Child and parents do not recognize the danger of
  water
• Child is unaware of inability to breathe under
  water
• Has curiosity about water
• Unaware of danger of depth

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DrowningPreventive Measures

• Fence around pools , have self-locking gate
• Supervise when near water sources
• Keep bathroom doors closed and toilet seat down
• Teaching swimming and water safety

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Bodily Injury Fractures

• Like to climb, run, jump
• Still developing sense of balance
• Easily distracted from tasks and hurt self
• Able to open doors and windows
• Poor depth perception

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Bodily Injury / Fracture
Preventive Measures

• Keep screens in the windows and locked
• Place gates at top and bottom of stairs
• Apply non-skid decals in bathtub or shower
• Remove unsecured rugs, scatter rugs
• Never leave unattended in shopping cart
• Avoid giving sharp or pointed objects.
• Do not allow lollipops in mouth when running

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Poisons

• Ingestion of toxic agents is common during early
  childhood. Most common in 2 year olds.
• 75 of poisons are ingested, others are by
  dermal, inhalation, and ocular
• Reasons for poisoning
• Improper storage
• Learning new tastes /textures, loves to put
  things in mouth
• Developing fine motor skills able to open
  bottles, jars, cabinets. Climbs onto shelves
• Cannot read labels

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Sources of Poisoning

• Cosmetics, personal care products
• Household cleaners Soaps, detergents, polishes
• Plants
• Drugs
• Insecticides
• Hydrocarbons -- gasoline

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Therapeutic Interventions

• A poisoning may or may not require emergency
  intervention, but all should have medical
  attention
• Parents are advised to call the Poison Control
  Center BEFORE initiating any interventions

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Therapeutic Interventions

• Assess the child treat the child first, not the
  poison
• Take vital signs assess ABCs
• Maintain respiratory function provide
  ventilatory and oxygen support
• Start IV infusion
• Draw blood for toxicology screen
• Apply cardiac monitor
• Initiate measure to reduce effects of shock if
  applicable.

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Therapeutic Intervention

• Remove the child from exposure
• Empty out mouth of any pills, plants, or other
  material
• Flush eyes with tap water
• Flush skin and wash with soap
• Bring child of inhalation poison into fresh air

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Therapeutic Intervention

• Identify the Poison
• Question the child and witnesses. Try to find
  out if only single product ingested.
• Look around environment for clues
• Do the products ingested breakdown to other
  substances?
• Find out amount ingested? Amounts that cause
  concern
• 1 ½ - 3 year old 4.5 ml
• Adult 15 ml

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Therapeutic Intervention

• Remove the Poison and Prevent absorption
• Induce Vomiting and administer syrup of ipecac
• Dose
• 6-12 months - 10 ml. Do not repeat dose
• 1-12 years - 15 ml. Repeat X 1 if not
• vomiting in 20
  minutes
• Over 12 years 30 ml Repeat X 1 if not
• vomiting in 20
  minutes
• Administer clear liquids after giving ipecac
• Emesis should occur in 15-20 minutes

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Therapeutic Intervention

• Give activated charcoal
• Give orally
• Available in ready to drink solution
• Give in covered cup with a straw so child does
  not see the black liquid
• Give through a gastric tube
• Give only after vomiting stops

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Therapeutic Intervention

• Do NOT induce vomiting if
• Patient is lethargic, comatose, seizuring, has an
  absent gag reflex
• Patient ingested an unidentified material, a
  corrosive substance or petroleum product
• Insert gastric tube and perform gastric lavage
  with normal saline once airway is protected with
  a cuffed endotracheal tube
• Place child in side-lying position to decrease
  chance of aspiration.

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Lead Poisoning

• Also called Plumbism
• An environmental
• disease caused by
• the ingestion of
• lead-based materials.

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Lead PoisoningCauses

• Lead based paint
• Lead solder
• Battery casings
• Lead fishing sinkers, curtain weighs
• Bullets
• Some ceramic ware, pottery, pewter

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Lead PoisoningPathophysiology

• Lead in the body moves in the blood to soft
  tissues and organs, teeth, and bones.
• Competes with calcium interfering with the
  regulation of calcium
• Interferes with neurotransmission in the brain
  causing encephalopathy and mental retardation
• Interferes with synthesis of heme causing anemia
• Damages tubules in the renal system

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Assessment

• Gastrointestinal symptoms
• Unexplained, repeated vomiting
• Vague chronic abdominal pain, colic
• Anorexia, anemia
• Central Nervous System symptoms
• Irritability, difficulty concentrating
• Drowsiness
• Ataxia, loss of skills, paresis or paralysis
• Convulsive seizures from encephalopathy
• Arthralgia

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Diagnostic Tests
Blood tests that indicate presence
of lead in the blood Levels of 10 u
is harmful to the body
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Therapeutic Intervention

• Criteria for treatment
• lt 9 units not lead poisoning
• 10-14 units trigger prevention activities,
  rescreen
• 15-19 units nutritional and educational
• interventions and rescreening
• 20-44 units environmental evaluation and
• medications.
• 45-69 units medical and environmental
• interventions.
  Chelation therapy
• gt 70 units medical emergency

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Lead Poisoning Therapeutic Intervention

• Acute care
• Gastric lavage followed my magnesium sulfate.
  Enema. Just want to rid body of lead.
• Chronic Care / Chelation therapy
• Administer meds that bind with the lead
• Calcium disodium edentate (EDTA) -- IV
• Dimercaprol (BAL) or D-Penicillamine -- IM
• Succimer -- orally
• Assess I O must have adequate urinary output.
  Force fluids.
• Monitor mineral levels

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Lead PoisoningPrevention

• Make environment lead-free
• Inspection of building 25 years or older
• Areas painted with lead paint cover with
  plywood or linoleum
• Education of parents
• Be sure parents know importance of follow-up
  testing of lead levels.

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Immunizations
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Immunizations

• Introduction of an antigen into the body,
  allowing immunity against a disease to develop
  naturally
• Person produces antibodies, proteins capable of
  responding to specific antigens.

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p
Immunizations

• The introduction of vaccines against childhood
  diseases has greatly improved the quality of life
  for children and adults.
• American Academy of Pediatrics on Immunizations
  recommends all children receive immunizations
  risks are outweighed by the life-saving effects
  of immunizations.

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Recommendations by American Academy
of Pediatrics on Immunizations

• Minor infections without fever is not a
  contraindication.
• If a reaction to the immunization occurs consult
  pediatrician before the next administration.
• If appointment is missed, resume the schedule
• Pertussis vaccination if not given to children
  over 6 years of age
• Consult pediatrician if a child has any of the
  following disorders
• Neurological
• Altered immune system
• Allergies to substances in vaccine, recent dose
  of immune serum

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Immunizations

• American Academy of Pediatrics on Immunizations
  has a Recommended Immunization Schedule

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Immunizations and Side Effects

• Diphtheria (D)
• Fever up to 1010F within 24-48 hours
• Soreness, redness and swelling at injection site
• Drowsiness, fussiness
• Reactions may be more severe on the 4th and 5th
  doses.

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Immunizations and Side Effects

• Tetanus (T)
• Same as diphtheria with urticaria and malaise.
• All may have delayed onset and last several
  days.
• Lump at injection site.

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Immunizations and Side Effects

• Pertussis (P)
• same as tetanus.
• May also include convulsions and loss of
  consciousness.

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Immunizations and Side Effects

• Polio virus (TOPV)
• Live virus
• Essentially no side effects.
• May have swelling at injection site,
  irritability, tiredness
• Vaccine associated paralysis occurs within two
  months.
• Live virus shed for 4-6 weeks in feces

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Immunizations and Side Effects

• Measles, Mumps, Rubella (MMR)
• live
• Anorexia, malaise,
• Rash and fever may occur 7 to 10 days after
  immunizations.
• Redness or pain at injection site
• Joint pain

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Immunizations and Side Effects

• Hepatitis B (HBV, HepB)
• Pain or redness at injection site
• Headache
• Photophobia
• Prior to immunization, check status of mothers
  hepatitis B test. If mother is HepB, vaccine
  should be given to the newborn within 12 hours of
  birth.

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Immunizations and Side Effects

• Haemophilus influenza Type B
• Prior to injection, ask if child is
  immunosuppressed
• Pain, redness or swelling at injection site

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Immunizations and Side Effects

• Varicella
• Prior to injection, ask if child is
  immunosuppressed, or allergic to neomycin or
  gelatin.
• Pain, redness or rash at injection site
• Fever up to 1020F
• Long term immunity under study

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TEACHING

• Prior to administration, assess if
  immunocompromised people are in the household
  (discuss with M.D. alternatives to live virus)
• Children should have their immunization status
  assessed during all health care visits,
  hospitalizations, and in school. If
  immunizations are not current, arrange to update
  them
• Assess if any reactions to past vaccines
• Advise parents of side-effects
• Have parents sign permit with educational
  instructions. Record lot and manufacturer of
  vaccine
• Teach use of antipyretics for fever. If fever
  persists for gtthan 24 hours, or has other
  concerns call M.D.