What to Expect the Toddler Years (246 page)

42. Foreign object in the nose.
Difficulty breathing through the nose and/or a foul-smelling, sometimes bloody, nasal discharge may be a sign that something has been pushed up the nose. Keep the child calm and encourage mouth breathing. If the object protrudes, remove it with your fingers, but don’t probe or use tweezers (or anything else) that could injure the nose if the child were to move unexpectedly, or that could push the object farther into the nasal canal. If you can’t remove the object, try to get your child to blow through the nose (have him or her try to move a feather or tiny piece of paper on your hand with the blows). If this fails, take the child to the doctor or emergency room.

43. A blow to the nose.
If there is bleeding, keep the child upright and leaning forward to reduce the swallowing of blood and the risk of choking on it. Use an ice pack or cold compresses (page 836) to reduce swelling. If swelling persists, check with the doctor to be sure there is no break.

44. Swallowed poisons.
Any nonfood substance is a potential poison. The more common symptoms of poisoning include: lethargy, agitation, or other behavior that deviates from your child’s norm; racing, irregular pulse and/or rapid breathing; difficulty breathing (after inhaling laundry detergent, for example); diarrhea or vomiting; excessive watering of the eyes, sweating, or drooling; hot, dry skin and mouth; dilated (wide open) or constricted (pinpoint) pupils; flickering, sideways eye movements; tremors or convulsions.

If your toddler has some of these symptoms (and their presence cannot be explained in another way), or if you have evidence that your toddler has
definitely
ingested a questionable substance (you saw it happen) or
possibly
has (you found your child with an open bottle of pills or hazardous liquid; found spilled liquid on clothing or loose pills on the floor; smelled a toxic chemical on his or her breath), call (or have someone else call) the Poison Control Center (800-222-1222) or the ER
immediately
for instructions. Call promptly for suspected poisoning even if there are no symptoms—they may not appear for hours.

If your child has severe throat pain, excessive drooling, breathing difficulty, convulsions, or excessive drowsiness after the ingestion (or suspected ingestion) of a dangerous substance,
call 911
for emergency medical assistance. Begin emergency treatment
immediately
if the child is unconscious. Place your toddler face up on a table or another firm surface and check for breathing (see page 684). If there is no sign of breathing, begin CPR promptly.
Call 911
for emergency medical assistance after 2 minutes, then continue CPR until the child revives or until help arrives.

Do not
try to treat a poisoning on your own.
Do not
follow the directions on a product label—they are often inaccurate, out-of-date, or even outright dangerous.
Do not
give your toddler anything by mouth (including food or drink, the activated-charcoal blend known as universal antidote, or anything to induce vomiting, such as syrup of ipecac, salt water, or raw egg whites) without explicit medical advice.

If you are alone, safely position the child before calling. Set a child who is vomiting on his or her side to reduce the risk of inhaling the vomit; a child who is convulsing should be put in a safe spot, with clothing loosened (see #16).

When calling, have ready your child’s illness record (page 872), as well as the name of the product ingested, along with the ingredients and package information, if available (if part of a plant was eaten, supply the name, or at least a description, of the plant); the time the poisoning is believed to have occurred; how much of the substance was ingested (give an estimate if you don’t know for sure); any symptoms that have appeared; and any treatment already tried. Have a paper and pen handy for writing down exact instructions.

Follow the instructions from the Poison Control Center or 911 dispatcher precisely. Giving syrup of ipecac or activated charcoal isn’t recommended (see box above). Vomiting should not be induced at any age when a corrosive substance such as bleach, ammonia, or drain cleaner or anything with a kerosene, benzene, or gasoline base (furniture polish, cleaning fluid, turpentine) has been ingested. Nor should it be induced when the victim is unconscious, drowsy, or having convulsions or tremors.

Of course, it’s best to prevent your child from being poisoned in the first place. According to the AAP most poisonings occur when parents or caregivers are home but not paying attention. The most common culprits are medicines, cleaning products, antifreeze, windshield wiper fluid, pesticides, furniture polish, gasoline, kerosene, and lamp oil. There are plenty of ways to keep your child safe from poisons while at home. See page 636 for tips on poison prevention.

You can also get more information about poisoning prevention, updates on poisoning rumors and recalls, as well as a database of poison control centers on the American Association
of Poison Control Centers website (aapcc.org).

45. Noxious fumes or gases.
Fumes from gasoline, auto exhaust, some poisonous chemicals, and dense smoke from fires can all be toxic. Symptoms of carbon monoxide poisoning include: headache, dizziness, coughing, nausea, drowsiness, irregular breathing, and unconsciousness. Get a child who has been exposed to hazardous fumes to fresh air (open the windows or take the child outside) promptly. If the child is not breathing, begin CPR (see page 688)
at once.
If possible,
have someone else call 911
(and the Poison Control Center 800-222-1222), while you proceed. If no one else is around, call 911 yourself after 2 minutes of resuscitation efforts—then return immediately to CPR, and continue until breathing is established or help arrives. Unless an emergency vehicle is on its way, transport the child to a medical facility promptly. Have someone else drive if you must continue CPR or if you were also exposed to the fumes and your judgment and reflexes may be impaired. Even if you should succeed in reestablishing breathing,
immediate medical attention
will be necessary.

46.
Most children who come in contact with poison ivy, poison oak, or poison sumac will have an allergic reaction (usually a red itchy rash, with possible swelling, blistering, and oozing) that develops within 12 to 48 hours and can last from 10 days to 4 weeks. If you know your child has had such contact, remove his or her clothing. Protect your own hands from the sap (which contains urushiol, the resin that triggers the reaction) with gloves, paper towels, or a clean diaper. To prevent the resin from “fixing” to the child’s skin, immediately wash the skin with soap and cool water (for at least 10 minutes) and rinse thoroughly. In a pinch, use a wipe. (The rash itself isn’t contagious and won’t spread from person to person or from one part of the body to another. It may appear to do this, because the sap was spread originally from the clothing or hands, and because the rash takes longer to appear where the dose of urushiol is smaller.)

Also wash anything else that may have come in contact with the plants (including clothing, pets, stroller, and so on); urushiol can remain active for up to a year on such objects. Shoes can be swabbed with cleaning fluid if they aren’t washable.

Should a reaction occur, calamine or another anti-itch lotion will help relieve the itching. Acetaminophen, cool compresses (see page 836), and/or a colloidal oatmeal bath may also offer relief. Cut your toddler’s nails to minimize scratching. Contact the doctor if the rash is severe or involves the eyes, face, or genitalia. An antihistamine or oral steroid medication may be prescribed to reduce discomfort.

see #54

see #11, #12, #13

see #50

see #16

47.
Such serious accidents are rare, but knowing what to do should one occur can mean the difference between saving and losing a limb or digit. Take these steps, as needed, immediately: