What to Expect the Toddler Years (242 page)

Black widow spider bites are graded according to severity. Grade 1: local pain at the site with no other symptoms. Grade 2: muscular pain in the arm or leg bitten, which may spread to the abdomen if a leg is affected or to the chest if an arm is. Grade 3: local diaphoresis (profuse perspiration) at site or on the entire extremity. Grade 4: generalized muscle pain in back, abdomen, and chest; generalized sweating; nausea, vomiting, and headache.

Signs of the bite of a brown recluse spider may include: no initial pain; a round, red spot developing within minutes, which becomes a raised papule (or pimple) within a few hours and then progresses to a painful bruise-like lesion. Over the next few days, a hemorrhagic blister forms around the bite, which develops a white ring and a gray, blue, purple, or black area. An irregular area of redness may also develop around the entire lesion.

Watch for a serious reaction to the sting of a bee, wasp, or hornet. About 90% of children react to an insect sting with short-lived (under 24 hours) redness, swelling, and pain in a 2-inch area at the site of the sting. But the remainder have a much more severe local reaction—with extensive swelling and tenderness covering an area 4 inches or more in diameter that doesn’t peak until 3 to 7 days after the sting.

Between 1 and 10 in 200 have a true systemic anaphylactic reaction. Most systemic reactions begin several minutes to several hours after the sting with such
allergic symptoms as hives (urticaria; see page 707), reddened patches of skin (erythema), itching (pruritis), and swelling (angioedema) and are rarely life-threatening. Life-threatening anaphylactic reactions (which are uncommon) usually begin within 5 to 10 minutes of the sting. They may include swelling of the face and/or tongue; signs of swelling of the throat (laryngeal edema), such as tickling, gagging, difficulty swallowing, or voice change; bronchospasm (chest tightness, coughing, wheezing, or difficulty breathing); a drop in blood pressure, causing dizziness or fainting; and/or cardiovascular collapse. Fatal outcomes in children are extremely rare, but do report
any
systemic reaction to your child’s doctor
immediately
; emergency treatment may be needed. Should your child have a life-threatening systemic reaction,
call 911 immediately.

After a systemic reaction, a skin test, and possibly other testing, will probably be performed to determine sensitivity to insect venom. In the unlikely case that it’s determined your child is at risk of a life-threatening episode from an insect sting, it will probably be recommended that an Epi-Pen device (see page 707) accompany your child on outings during bee season.

6. Snake bites.
The four major types of poisonous snakes in the U.S.—rattlesnakes, copperheads, coral snakes, and cottonmouths (or water moccasins)—all have fangs, which usually leave identifying marks when they bite. It’s rare that a young child is bitten by a poisonous snake, but such a bite is very dangerous. Because of a toddler’s small size, even a tiny amount of venom can be fatal. Following a poisonous snake bite, it is important to keep the child and the affected part as still as possible. If the bite is on a limb, immobilize the limb with a splint if necessary, and keep it below the level of the heart. Use a cool compress if available to relieve pain, but
do not
apply ice or give any medication without medical advice. Sucking out the venom by mouth (and spitting it out) may be helpful if done immediately, but
do not
make an incision of any kind, unless you are 4 or 5 hours from help and severe symptoms develop. If the child is not breathing and/or the heart has stopped beating, give CPR (page 688). Treat for shock (#48) if symptoms (cold, clammy, pale skin; weak, rapid pulse; chills; confusion; and, possibly, nausea, vomiting, and/or shallow breathing) develop.
Get prompt medical help
, and be ready to identify or describe the snake, if you can. If you won’t be able to get medical help within an hour for bites to limbs, apply a loose constricting band or tourniquet (use a belt, tie, or hair ribbon), tied loosely enough for you to slip a finger under, 2 inches above the bite to slow circulation from the area. (Never tie a tourniquet around a finger or toe, or around the neck, head, or trunk.) Check the pulse (see page 574) on the limb frequently to be sure circulation is not cut off, and loosen the tourniquet if the limb begins to swell. Make a note of the time the tourniquet was tied.

Treat nonpoisonous snake bites as puncture wounds (#54), and notify the doctor.

7. Marine stings.
The stings of marine animals are usually not serious, but an occasional child will have a severe reaction. Medical treatment should be sought immediately as a precaution. First-aid treatment varies with the type of marine animal involved, but in general, any clinging fragments of the stinger should be carefully brushed away with a diaper or piece of clothing (to protect your own fingers). Heavy bleeding (#52), shock (#48), or cessation of breathing (see page 686) should be treated immediately. (Don’t worry about light bleeding; it may help to purge the toxins.) The site
of the sting of a stingray, lionfish, cat-fish, stone fish, or sea urchin should be soaked in hot water, when it’s available, for 30 minutes, or until medical professionals take over. The toxins from the sting of a jellyfish or Portuguese man-of-war can be counteracted by applying vinegar, alcohol, or diluted ammonia. (Pack a couple of alcohol pads in your beach bag, just in case.)

see #51, #52, #53

see #1

8. Possible broken arms, legs, collarbones, or fingers.
Though fractures in small children usually mend quickly, medical treatment is necessary to ensure proper healing. Take your child to the doctor or ER even if you only suspect a break. Signs of a break include: a snapping sound at the time of the accident; deformity (although this could also indicate a dislocation, #17); inability to move or bear weight on the part; severe pain (persistent crying could be a clue); numbness and/or tingling (neither of which a young child can be guaranteed to report); swelling and discoloration. If a fracture is suspected, don’t move the child before you’ve checked with the doctor—unless it’s necessary for safety. If you must move the child immediately, first try to immobilize the injured part by splinting it in the position it’s in with a ruler, a magazine, a book, or another firm object, padded with a soft cloth to protect the skin. Or use a small, firm pillow as a splint. Fasten the splint securely at, above, and below the possible break with bandages, strips of cloth, scarves, or neckties, but not so tightly that circulation is restricted. If no potential splint is handy, try to splint the injured limb with your arm. Check regularly while awaiting help to be sure the splint or its wrapping isn’t cutting off circulation. Apply an ice pack to reduce swelling.

9. Compound fractures.
If a bone is protruding through the skin, don’t touch it. Cover the injury, if possible, with sterile gauze or with a clean diaper; control bleeding, if necessary, with pressure (#52); and get emergency medical assistance (
call 911
).

10. Possible neck or back injury.
If any neck or back injury is suspected, don’t move the child
at all
.
Call 911
for emergency medical assistance. (If you must move the child away from a life-threatening situation, such as a fire, splint the back, neck, and head with a board, a chair cushion, or your arm. Move the child as a single unit, without bending or twisting the head, neck, or back.) Cover and keep the child comfortable while waiting for help, and if possible, put some heavy objects, such as books, around the head to help immobilize it. Don’t give any food or drink. Treat severe bleeding (#53), shock (#48), or absence of breathing (see page 686) immediately.

see #49

Important:
If a child’s clothing is on fire, use a coat, blanket, rug, bedspread, or even your own body (your clothing won’t catch fire) to smother the flames.
Teach a child who is old enough to understand never to run if his or her clothing catches on fire, but to
stop, drop, and roll
. Treat any burns as below.

11. Limited thermal (heat) burns.
Immerse burned fingers, hands, feet, toes, arms, or legs in cool water (50°F to 60°F); apply cool compresses (see page 836) to burns of the trunk or face. Continue until the child doesn’t seem to be in pain anymore—usually 15 minutes to half an hour. Do not apply: ice (which could compound skin damage), butter or burn ointments (which could trap the heat in the skin), or baking-soda preparations. And don’t attempt to break any blisters that form.

If the burned skin looks normal or only slightly red after soaking, covering it is not necessary. Repeat soaking if pain returns. Apply Bacitracin (or a similar antibiotic ointment) twice a day starting the second day. If redness and pain persist for more than a few hours, however, call the doctor.

Call the doctor immediately
for: burns that look raw, that blister (second degree burns), or are white or charred looking (third degree burns); burns on the face, hands, feet, or genitals; or burns that are the size of your child’s hand or larger.

If the burn looks raw, cover loosely with a material that won’t stick to the wound (such as a sterile nonstick bandage, or in a pinch, aluminum foil). If it’s oozing, cover only with sterile gauze; if that’s not available, leave the area uncovered. If there are blisters, ask the doctor for advice on how to cover the burn until your child gets medical attention.

If a burn you are treating at home doesn’t start to heal within a few hours, gets redder, starts to swell, or develops a discharge or bad odor, call the doctor. An infection may have developed.

12. Extensive thermal (heat) burns.
Call 911
for emergency medical assistance. Keep the child lying flat. Remove any clothing from the burn area that does not adhere to the wound (cut it away as necessary, but don’t pull). Keep the child comfortably warm by covering lightly with a clean sheet. If legs are burned, position them higher than the heart by propping them on pillows or bundled blankets. Apply cool, wet compresses to the injured area (but not to more than 25% of the body at one time). Do not apply pressure, ointments, butter or other fats, powder, or boric-acid soaks to burned areas. If the child is conscious and doesn’t have severe burns in the mouth, give water or another fluid (or nurse, if your child is not yet weaned).

13. Chemical burns.
Caustic substances (such as lye, drain cleaner, and other acids) can cause serious burns. Gently brush off dried chemical matter from the skin (wear rubber gloves or use a towel or clean diaper to protect your hands) and remove any contaminated clothing (again protecting your hands). Immediately wash the skin with large amounts of water and the antidote, if any, recommended on the product container, or soap. Call the Poison Control Center (800-222-1222), a physician, or the ER for further advice. Get
immediate
medical assistance if there is difficult or painful breathing, which could indicate lung injury from inhalation of caustic fumes. (If a chemical has been swallowed, see #44.)

14. Electrical burns.
Immediately disconnect the power source, if possible. Or pull the child away from the source using a dry, nonmetallic object—a broom, wooden ladder, rope, cushion, chair, or even a large book—but not with your bare hands. If the child is not breathing, initiate CPR (page 688) and
call 911
. All electrical burns should be evaluated by a physician, so call your toddler’s doctor or go to the ER at once even if your child seems okay.

15. Sunburn.
Treat by applying cool tap-water compresses (see page 836) for 10 to 15 minutes, three or four times a day, until redness subsides; the evaporating water helps to cool the skin. In between these treatments, apply a sunburn relief spray made just for kids or a moisturizing cream, or give a cool colloidal oatmeal bath. Don’t use petroleum jelly on a burn; it seals out air, which is needed for healing. And unless they are prescribed by the doctor, don’t give anti-histamines. A children’s pain reliever (acetaminophen) may reduce the discomfort, but, though there have been some claims to the contrary, giving aspirin won’t prevent sun damage to the skin (so don’t use it unless the doctor recommends otherwise). When sunburn is severe—there is blistering, pain, nausea, or chills—call the doctor immediately. Steroid ointments or creams may be prescribed, and large blisters may need to be drained and dressed. Calamine liniment may be recommended to help dry out blisters.

see #3