Page 1


table of contents EMERGENCIES Biting Choking Burns Coma

37

Convulsion Drowning Poisoning Delirium

TRAUMA 85 Head Skin Teeth Genital

i

Bone and Joint Ear Eye Finger and Toe

NEW BABY 151 Hospital Behavior Breast-feeding Solid foods

Crying Baby (colic) Accident prevention Shoes Thumb sucking

BEHAVIOR 291 Over weight Poor Eaters Toilet Training Twitching

School Refusal Night Awakening Sibling problems Breath-holding spells

COMMON ILLNESSES Fever Brain Skin Burns

Eyes Ears Nose Lungs

GLOSSARY 431

371


symbol guide HANDS ON

(The situation is not severe and can be treated at home)

EMERGENCY

(Seek medical attention immediately, call 911, or head to the emergency room)

LEARN MORE

(Extra information or useful information to the topic)

A Pediatric Guide for Parents: This book is developed to make the parents life easier from conception through the childhood years. The design throughout the book will help create a book that is a quick reference guide that expands on your child’s health conditions of all scenarios. This book helps with many different situations from emergencies to scrapes and potty training with everything in-between. There is a symbol navigation system to help you guide your way through the book because of its many text parts.

Whenever you see a symbol that refers to a chapter: The chapter symbols that are placed at the end of text throughout the book

reference further information about the topic being discussed. They are relating to that chapter symbol along with a page number that is directly related to further information of the topic.

Whenever you see a symbol from the symbol guide: These symbols are quick solutions to the medical condition at hand. They

will guide you to the next response needed and help you with look quickly through the information and respond accordingly.

introduction

introduction

ii


how to navigate the book look for the symbols

why do children bite

LEARN MORE: symbol means their is extra information about the topic in this box

They’re in pain When babies bite, typically it’s because they’re teething. Their little gums and budding teeth aren’t discriminating -- they’ll just as soon aim for your hand as a teething ring

They’re exploring their world Very young children use their mouths to explore, just as they use their hands. Just about everything infants or toddlers pick up eventually winds up in their mouths.

iii

biting EMERGENCY: symbol means if this is the situation their is an emergency action needing to be performed

All can bites carry a big risk of infection, but by immediately cleaning the wound you greatly reduce this risk. If the wound is bleeding, you should stop that bleeding by putting pressure on the wound and then after the bleeding is stopped or greatly slowed, extensive cleaning is necessary. If bleeding resumes, reapply pressure on the wound. Get the patient to the doctor as soon as possible.

3

Snake Bites In the United States the poisonous snakes are rattlers, copperheads, cottonmouths (water moccasins), and coral snakes. Over 90 percent of snake bites occur on the let. In about 30 percent of poisonous snakebites, luckily, no venom is injected. If the venom was injected (envenomation), the fang marks will begin to burn, hurt, and swell within 5 minutes. Therefore, begin first aid.

Tamed Animal Bites, Most of these bites are from dogs

HANDS ON: symbol means that this situation calls for a home treatment.

or cats. Bites from domestic animals such as horses can be handled using these guidelines. Small indoor pets (such as gerbils, hamsters, guinea pigs, and white mice) are at no dish for rabies. Dogs and cats are free of rabies in many metropolitan areas. The main risk in pet bites is serious would infection, not rabies. Cat bites become infected five times more frequently than dog bites. Puncture would are more likely to become infected than cats claw wounds are treated the same as bit wounds, since they are contaminated with saliva

Human Bites Most of these bites occur during fights. Sometimes a fist is cute when it strikes a tooth. Human bites are more likely to become infected at increased risk of complications.


HANDS ON: this symbol with actions explains what needs to be done to treat at home.

They’re craving attention In older kids, biting is just one of several bad behaviors used to get attention. When a child feels ignored, discipline is at least one way of getting noticed -- even if the attention is negative rather than positive.

WASH HANDS: symbol means to wash the area thoroughly

They’re frustrated Biting, is a way for some children to assert themselves when they’re still too young to express feelings effectively through words. To your child, biting is a way to get back a favorite toy, tell you that he or she is unhappy, or let another child know that he or she wants to be left alone.

iiii

First Aid for Puncture Wound or Laceration

step one

Wash the area with mild dish washing detergent and running water for 10 minutes before going to the physician’s office.

step two

Also check your child’s immunization status for tetanus.

4

EMERGENCY: symbol means if this is the situation their is an emergency action needing to be performed

Scrapes and Superficial Cuts

step one

Wash the area with lost of water and mild dish washing detergent for 5 minutes. You can leave it exposed to the air,

step two

or put a bandage on it for 12 hours if it’s on an area that easily gets dirty. No antiseptic

CHAPTER SYMBOL: this symbol references the common illness chapter where more information can be given about the situation

is necessary. see page 320 for extra help.

BAND AID: this symbol means to cover the area with proper bandaging equipment

introduction

MEDICINE: know medical records or look up medical records, because medicine needs to be involved.

Home Car for Human Bites


Emergency telephone calls

Life threatening emergencies Dial “0” (operator or 911.)

EMERGENCIES

37

In larger cities, this call will dispatch an emergency vehicle staffed by a rescue squad. In smaller towns and counties, the operator will connect you with an emergency ambulance service. The direct number for this service is usually found on the inside of the front cover of your telephone directory. In areas that use 911, children and the elderly should be taught to dial this number for crises. Increasingly, 911 is being linked to a computer system (“enhanced 911”) that can determine the address of the incoming call even if the caller can’t speak.

Non-life-threatening emergencies Call your child’s physician. If you don’t have a physician call the nearest emergency room. Always call in first, rather than simply going to an emergency room. Usually the physician will be able to provide you with critical first aid instructions by phone (e.g., for burns, animal bites, or fractures). Your physician can help you decide rather a rescue squad should be sent out or if it is safe for you to come in. Your physician can also tell you where to take your child for the best care.

Poisoning Call your child’s physician or the nearest Poison Control Center. (each region has a toll-free number )

Biting Burns Choking Coma Convulsion Drowning Poisoning Delirium

How to cut through red tape When you call in, always state assertively, “this is an emergency.” Do not let the answering service or receptionist put you on hold before talking with you. If you are put on hold, hang up or call back immediately.


symptoms All the conditions discussed in this chapter are emergencies. I am sure you won’t overlook or underestimate the importance of a major burn, major bleeding, choking, a convulsion, or coma. The following emergency symptoms, however, are highlighted because they are either difficult to recognize or not considered serious y some parents. If you child has any of the following symptoms contact your child’s physician immediately.

Purple spots

Severe Lethargy

The sudden onset of drooling, especially associated with difficulty in swallowing, can mean that your child has a serious infection of the tonsils, throat, or epiglottis.

Purple or blood-red spots on the skin can be a sign of a serious blood stream infection. They don’t explained bruises (see Purple Spots, page 348.)

To be tired during an illness is normal, but if your child stares off into space, wont smile, and has no interest in playing, these are serious symptoms.

105.2°F

Stiff Neck

Bluish lips

Fever of 105° F

To test for a stiff neck: have your child lay down, lift his head until the chin touches the middle of the chest. A stiff neck can be early signs for meningitis.

Cyanosis or bluish lips can indicate a reduced amount of oxygen in the bloodstream (see Blueish Lips, page 384.)

Serious infections become a frequent cause of the fever only when it rises about 105° F (see temperature page 373).

38 emergencies

Drooling


why do children bite

They’re in pain When babies bite, typically it’s because they’re teething. Their little gums and budding teeth aren’t discriminating -- they’ll just as soon aim for your hand as a teething ring.

They’re frustrated Biting, is a way for some children to assert themselves when they’re still too young to express feelings effectively through words. To your child, biting is a way to get back a favorite toy, tell you that he or she is unhappy, or let another child know that he or she wants to be left alone.

biting 39

All can bites carry a big risk of infection, but by immediately cleaning the wound you greatly reduce this risk. If the wound is bleeding, you should stop that bleeding by putting pressure on the wound and then after the bleeding is stopped or greatly slowed, extensive cleaning is necessary. If bleeding resumes, reapply pressure on the wound. Get the patient to the doctor as soon as possible.

Snake Bites In the United States the poisonous snakes are rattlers, copperheads, cottonmouths (water moccasins), and coral snakes. Over 90 percent of snake bites occur on the let. In about 30 percent of poisonous snakebites, luckily, no venom is injected. If the venom was injected (envenomation), the fang marks will begin to burn, hurt, and swell within 5 minutes. Therefore, begin first aid.

Tamed Animal Bites, Most of these bites are from dogs or cats. Bites from domestic animals such as horses can be handled using these guidelines. Small indoor pets (such as gerbils, hamsters, guinea pigs, and white mice) are at no risk for rabies. Dogs and cats are free of rabies in many metropolitan areas. The main risk in pet bites is serious would infection, not rabies. cat bites become infected five times more frequently than dog bites. Puncture would are more likely to become infected than cats claw wounds are treated the same as bit wounds, since they are contaminated with saliva

Human Bites Most of these bites occur during fights. Sometimes a fist is cute when it strikes a tooth. Human bites are more likely to become infected at increased risk of complications.


They’re craving attention In older kids, biting is just one of several bad behaviors used to get attention. When a child feels ignored, discipline is at least one way of getting noticed -- even if the attention is negative rather than positive.

They’re exploring their world Very young children use their mouths to explore, just as they use their hands. Just about everything infants or toddlers pick up eventually winds up in their mouths.

Home Care for Human Bites First Aid for Puncture Wound or Laceration

step one

Wash the area with mild dish washing detergent and running water for 10 .Then head to the emergency room for further treatment, make sure you know your child’s medical records and last tetnaneuos shot Scrapes and Superficial Cuts Wash the area with lots of water

step one

and mild dish washing detergent for 5 minutes. You can leave it exposed to the air, or put a bandage on it for 12 hours if it’s

step two

on an area that easily gets dirty. No antiseptic is necessary. see page 320 for extra help.

emergencies

step two

40


call physician LATER NOW Any blisters break open

more than 2 blisters are present

The burn starts to look infected

The burn is on the face, neck, feet or genitals

Tenderness or redness increases after day 2 Burn hasn’t healed after 10 days Your child is getting worse

Charred or white skin present Extremely hot substance cause the burn An explosion caused the burn

41

burns Thermal Most of these burns are from hot water or hot drinks. A few are from hot ovens, stoves, electric or kerosene space heaters, exhaust pipes, grease, hair curling irons, clothes irons, heating grates and cigarettes. Usually the burn is first degree (see diagram on next page) or second degree (with blisters). Neither of these leave any scars. Second-degree burns take up to 3 weeks to heal. A thirddegree burn is deep and leaves pain free areas of black leathery or white skin. During healing it usually need a skin graft to prevent bad scarring if it is larger than a quarter.

Chemical Chemical burns are external burns from lye, acids, or other tissue-damage in chemicals splashed on the skin. Most of these accidents cause only first-degree burns, which may peel like a sunburn during the following week. A few of the stronger chemicals may cause deep burns.


Chemical burn

Thermal Burn

Sun Burn

Remove contaminated clothing and rinse off the burned part of your child body with clear water for 20 minutes, using the shower or tub. Don’t rub the skin during this rinse. Don’t apply any burn ointments because washing them off will cause pain. Also, don’t apply butter; it only increases the infection rate. If the burned area is large, cover it loosely with a wet clean sheet.

Immediately (don’t take time to remove clothing) put the burned part in cold tap water or pour cold water over it for 10 minutes. If you are outside, the nearest garden hose will do. If the burn is small, massage it with an ice cube. This will lessen the depth of the burn and relive pain. Don’t apply any butter or ointment. If the burned area is large, cover it loosely with a wet clean sheet (a dry sheet may stick to the burn). You can also use plastic wrap . the covering will keep it clean and reduce pain.

Soak a clean, soft washcloth in cool water, wring it out, and gently place it on the sunburned area for ten to 15 minutes a few times a day, making sure your child doesn’t get chilled. Try a cool bath. To make it more soothing, add baking soda or an oatmeal-based bath treatment (found in drugstores). Pat your child’s skin dry – don’t rub! Apply a water-based (alcohol-free) moisturizing lotion or an aloe vera gel to relieve itching. Itching can get worse if the burn starts to peel.

42 emergencies

epidermis [

dermis

[

hypodermis [


foods to avoid hard foods

soft foods

Nuts of any kind

Hot Dogs

Orange, Sunflower, Watermelon seeds

Sausage

Cherry Pits

Grapes

43

Gum, Hard Candy Caramels

Popcorn

Carrots


Infant Heimlich Maneuver step 1 - give 5 black blows Place your baby facedown on your forearm and grip their jaw with your hand. Rest your arm on your leg. With the heel of your other hand, give the child five forceful and rapid blows between his/her shoulder blades.

step 2- give 5 chest thrusts If the object does not dislodge, turn the baby to face upward and resting on your thigh. With your index and middle fingers on the center of their breast bone, them five chest thrusts one half inch to three quarters of an inch deep).

step 3 - look in the mouth to see the object

Choking is the coughing If you can see the object remove spasm and sputtering that it carefully with your finger. follows getting liquids or solids on the vocal cords or into the airway. Most chilstep 4 - If the infant becomes dren choke on liquids that unconscious perform CPR go down the wrong way or and call 911 mucus from sniffling back nasal secretion. The child’s cough reflex will clear the windpipe of aspirated liquid within 10 to 30 seconds. Complete blockage occurs when solid food (a piece of hot dog, for instance) or a foreign object becomes lodged in the voice box. (It can also occur with severe croup.) Under these conditions, the child is unable to breath, cry, or speak, the child will be in a state of panic, and if the obstruction isn’t relieved in 1 or 2 minutes, the child will pass out and have a convulsion due to lack of oxygen. As long as your child is breathing and coughing, do nothing except encourage him to cough that material up by himself. Reassure him that it will come out. The main purpose of your child’s cough reflex is to clear the windpipe. Don’t offer anything to drink..

emergencies

choking

44


General Symptoms of Illness

371

COMMON ILLNESSES

Fever

Temperature Eye Brain Skin Burns Ears Nose Lungs

While the body’s average temperature is 98.6° F, it normally fluctuates during the day from a low of 97.6° F in the morning to a high of 100° F in the late afternoon (called normal dinurnal variation. Mild elevations of 100.4 to 101.2° F can be cause by exercise, excessive clothing, hot weather, or warm food or drink. If you suspect one of these causes, retake the temperature in a half hour, after eliminating the possible cause. For Convulsions or Delirium (acting very confused), go directly to those guidelines (see page 31 and 35). Both symptoms should stop if you reduce the fever below 102° F with medicine and cool sponging.

Symptoms and Characteristics Rectal temperature over 100.4° F Oral temperature over 100° F Auxiliary (armpit) temperature over 99° F

For instruction on how to take the temperature or how to reduce the temperature turn to next page.

Decreased Appetite with Illness If you child starts to reduce food intake on recent onset meals because he or she does not feel like eating then this could be a sign on an illness (however some children are just picky eaters so maybe try two or three options to see if your child is just not wanting to eat a certain type of food.) The cause of this falloff to appetite is normal with most minor illnesses. This is not a harmful. It is not very helpful in assessing the seriousness or cause of the illness. * CALL DOCTOR IMMEDIATELY IF YOUR CHILD IS UNDER 2 MONTHS


guideline for common contagious diseases The Contagious Period The contagious period is defined as that time interval during which a sick child’s disease is contiguous to others. Knowing the period of contagion helps answer the question how long does my child have to stay home from school?

DISEASE Skin Infections Chicken pox Fifth disease (Erythema infectiosum) Hand, foot mouth disease Impetigo (strep) Lice Measles Scabies Scarlet fever Shingles (contagious for chicken pox) Staph skin infection

INCUBATION PERIOD (DAYS) CONTAGIOUS PERIOD (DAYS) Until all sores have crusts Until all sores have crusts Until fever gone Until 24 hours on antibiotic Until 1 treatment Until rash gone (7) Until 1 treatment Until 24 hours on antibiotic Until all sores have crusts Until 24 hours on antibiotic Until 24 hours on antibiotic

2-5 2-12

Until fever gone Until fever gone

2-5 2-6 1-2 2-5 2-5 14-70

Until fever gone Until fever gone Until fever gone Until 24 hours on antibiotic Until 2 weeks on drugs Until 7 days on antibiotic

Intestinal Infections Diarrhea, bacterial Diarrhea, viral Hepatitis Pinworms Vomiting, viral

1-5 2-5 14-42 21-28 2-5

Until fever gone Until fever gone Until jaundice resolved O Until vomiting stops

Other Infections Meningitis, Bacterial Mumps Pinkeye without pus, viral

2-10 16-18 2-7

Hospital IV antibiotics 24 hrs Until swelling gone (7) Until fever gone

Warts

Respiratory Infection Colds Cold sores (herpes) Coughs (viral) Croup (viral) Influenza Sore throat, strep Tuberculosis Whopping cough

372 common illnesses

14-16 10-14 3-6 2-5 7 10-12 30 3-6 14-16 2-3 30-120


call physician office hours immediately Your child is 2 to 4 months

Your child is under 2 years old

Fever is between 104 and 105°F especially if your child is under 2 years

The fever is 105°F

Burning or pain occurs with urination The fever has been present more than 72 hours

373

temperature Fevers usually don’t indicate anything serious. Although it can be frightening when your child’s temperature rises, fever itself causes no harm and can actually be a good thing — it’s often the body’s way of fighting infections. And not all fevers need to be treated. High fever, however, can make a child uncomfortable and worsen problems such as dehydration. Fever occurs when the body’s internal “thermostat” raises the body temperature above its normal level. This thermostat is found in the part of the brain called the hypothalamus. The hypothalamus knows what temperature your body should be around 98.6° and will send messages to your body to keep it that way.

Expected Course of Fever Most fevers associated with viral illnesses range between 101 and 104°F and last for 1 to 3 days. In general, the height of the fever doesn’t relate to the seriousness of the illness. How sick your child acts is what counts.

Your child is crying inconsolably or whimpering Your child cries if you touch or move them Your child is difficult to awake


Where to take your kids temperature?

Under 5 years old: axiliary (armpit) or rectal Over 5 years old: oral (mouth)

Axillary Temperatures

Rectal Temperatures

Oral Temperatures

Place the tip of the thermometer in a dry armpit. Close the armpit by holding the elbow against the chest for 4 minutes (5 or 6)minutes after 2 years of age. If you’re uncertain about the result, recheck it with a rectal temperature.

Have your child lie stomachdown on your lap, Lubricate the end of the thermometer and the opening of the anus with petroleum jelly. Carefully insert the thermometer about 1 inch, but never force it. Hold your child still while the thermometer is in, and press the buttocks together to stabilize it. Leave the thermometer inside the rectum for 2 minutes. Practice doing this a few times on days your child is happy.

Be sure your child has not recently taken a cold or hot drink. Place the tip of the thermometer beside the back of the tongue. Have your child hold it in place with the lips and fingers (not the teeth). Have your child breathe through the nose and keep the mouth closed. Leave the thermometer in the mouth for 3 minutes. If your child can’t keep the mouth closed because the nose is blocked, take an axillary temperature.

374 common illnesses

medicine this is just a reference table make sure to ask your doctor before dosing type and brand total amount (mg.)

strength

child’s weight (lbs) 6-11

Acetaminophen drops Tylenol, Tempra, Panadol Acetaminophen syrup Tylenol, Tempra, Panadol

80 mg./dropper 160/5 ml.(1tsp.)

––

Chewable Acetaminophen

80 mg. tablets

––

Adult Acetaminophen

325 mg. tablets

1/2 dropper

––

age (years)

12-17

18-23

2-4

4-5

1

11/2

160

240 325

485

650

3/4

1

11/2

2

21/2

4

––

11/2

2

3

4

5-6

8

––

––

––

––

1

1

2

1/2 tsp

6-8

9-11 12+

1/2


eyes Common Eye Problems Allergies of the Eyes

Some symptoms of allergic eyes are itchy, increased tearing without pus, red or pink eyes, mid swelling of the eyelids, similar symptoms during the same month of the previous year, previous confirmation of this diagnosis by a physician is helpful. Similar symptoms are is the nose is also involves, save time by turning directly to the guideline on hay fever (see page 420)

375

Itchy Eye For itchy, watery, red eyes, the possible causes are many, turn directly to the guideline that pertains to your child. Allergies (see page 409) Chemical in Eye (see page 38) Red or Pinkeye (includes minor irritants)

Red or Pink Eye Red or pink eye symptoms are redness of the sclera around the white part of the eye, redness of the inner eyelids, a watery discharge “watery eyes,� no yellow discharge or matting of eyelids, not from crying, and also called pinkeye or bloodshot eyes. Similar conditions are suspected from red eye are the following: Allergies (see page 409) Chemical in Eye (see page 38) Foreign body in eye, dust or eyelash (see page 39)

Swelling of Eyelid Symptoms of a swelling eyelid are a larger irritation bump around the eye usually from a mosquito but other similar conditions are Eye trauma (see page 53) Allergies (see page 409) Red or Pinkeye (see page 411)


Home Care for Cleaning Eyes Cleaning your babies eye

Washing with Soap

step one

Wash the face, then the eyelids, with a mild soap and water. This will remove any irritants.

Irrigating with Water

step two

Eyelids are red or swollen

Your child is under 1 month old

The eyes are constantly tearing or blinking

The eye has been red for more than 7 days

Your child is complaining of pain in the eyes

You have other questions

Vision blurred

376 common illnesses

call physician office hours immediately

Rinse the eyes out with warm water as often as possible, at least every 1 to 2 hours while your child is awake. Use warm (not hot) water, and use a fresh cotton ball each time, Wipe toward the inside of the eye. This usually will keep a bacterial infection from occurring.


Parents tricks and tips to training your child

what works

368

Celebrate with stickers

Tips for brushing teeth

To encourage our son Alexander to obey us, we put a drawing of a racetrack on the wall. Every time he listened or obeyed us he got to place a sticker on the racetrack. When the racetrack was filled with stickers, he got to pick a toy at the store as a reward. — Cheryl

I bought an electric Elmo tooth brush and my 14 month old loves it. This way when she just holds it in her mouth it is actually moving around and cleaning her teeth. I also brush along side her so that she duplicates everything I do including brushing her tongue. ­ — Molly’s Mommy

When to say “by” to the Blanket We took my son’s binky away just before he turned 6 months and never looked back. He fussed the first night and the next day didn’t seem to notice he didn’t have it. Prior to taking it away, he was hooked on the binky to help him sleep but we were going nuts at night because he would wake up when it came out of his mouth and we’d have to get up and settle him back to sleep with his binky in hand. — Sarah


& doesn’t work Blanket to the trash

If your child can not go to the rest room like ours couldn’t do not punish him with time out. My husband and I were desperate to get Tommy to become potty trained but he just became more fearful of telling us he needed to go potty because if he didn’t go he would be in time out. —Tommy’s Mom

Our child was obsessed with her boopy (blanket) she has had since she was born. The blanket was trashed and her father and I wanted to get rid of it so we told he that the boopy needed to go bye. She saw us place the blanket in the trash and was upset for days. We waited too long to act on getting rid of the blanket so get rid of the blanket when you can. — Ashley’s Mom

the tooth brush

John, our first born was just learning how to brush his teeth. We started teaching him how to rub around a liquid on your tooth by using frosting. My wife and I quickly found out that he only liked the frosting and made the swallowing of tooth paste almost an impossible habit for us to break. Moral is do not trade sugar for toothe paste. — Peter

369 behavior

Punish with Time out Putting frosting on


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