What to Expect the Toddler Years (218 page)

Method of transmission.
Sore throat of a cold is transmitted like a cold; strep is almost always transmitted by direct contact with respiratory secretions from an individual with an active infection. A person can carry strep for months after the acute illness has passed, but is not likely to spread the germ.

Duration.
Sore throat of a cold usually lasts just a few days; a strep throat usually responds to treatment in a couple of days.

Ask your toddler to “Stick out your tongue and say Aaah,” demonstrating as you do (you probably won’t need a tongue depressor or spoon to get a clear view). With a penlight, examine for redness around the edges (the dotted line), white spots, and swelling of the tonsils (A) or the uvula (B).

Treatment.
Warm liquids (see page 588); soothing, nonacidic foods and beverages; humidification; and, if necessary, acetaminophen for pain, but only once the doctor has ruled out or diagnosed strep (giving it sooner could mask pain that would help with diagnosis). A strep throat or other bacterial infection always requires antibiotic treatment.

Prevention.
Avoid those with colds or strep infections; see also Common cold, page 598.

When to call the doctor.
See Sore Throat in the When to Call the Doctor section, page 569. A throat culture to determine if the sore throat is caused by a streptococcus is usually necessary if: yellowish-white, thick spots are visible on throat or tonsils (see illustration, facing column); fever is over 101°F (38.3°C); a rash develops with or right after the sore throat; the child has been exposed to strep or has had rheumatic fever or rheumatic heart disease or has kidney disease.

Complications.
Rarely, with strep: rheumatic fever; rheumatic heart disease; scarlet fever. These complications can be virtually eliminated by treating strep throat with antibiotics.

Symptoms:
Often, frequent urination, painful urination, incontinence, blood in the urine, pain above the pubic area or on the side, lethargy, and fever; sometimes, no symptoms. Often, what looks like a gelatinous vaginal discharge is not a sign of a vaginal infection or other problem, just a sign that the diaper’s absorbent jelly material has oozed out. Not to worry.

Season.
Anytime.

Cause.
Most often, bacteria that enter through the urethra (the tube that carries urine from the bladder for excretion). Because the urethra is shorter in girls and bacteria can travel up it more easily, girls have UTIs more often than boys. Occasionally, bacteria from elsewhere in the body can enter the kidney through the bloodstream. An infection may affect just the urethra (urethritis), the bladder
(cystitis), or the kidney (pyelitis, pyelonephritis), or all three. An inadequate fluid intake could encourage UTI. A urine specimen may be obtained and cultured to confirm the diagnosis and determine the causative organism.

Method of transmission.
Most often via contamination of the urethra by bacteria from the stool (especially in girls).

Duration.
Varies; most cases clear up quickly on antibiotic therapy.

Treatment.
Antibiotics; the antibiotic to be used may be determined by a urine culture. It is absolutely necessary for a child to finish the full course of medication prescribed, even if the symptoms have subsided. Also, an ample fluid intake. Cranberry juice, which seems to prevent bacteria from adhering to the lining of the urinary tract, may be particularly helpful. A serious urinary tract infection or repeated milder UTIs should be followed with tests to check the health of the urinary tract; sometimes a urinary tract abnormality or obstruction is present that requires the attention of a specialist.

Prevention.
Sanitary bathroom habits and diapering techniques: wiping front to back, washing hands after toileting. Also, an adequate fluid intake, regular diaper changes, cotton underwear for children out of diapers, the opportunity to urinate when necessary (no “holding it in”), the avoidance of tight pants in non-breathing synthetic fabrics and of potentially irritating bubble baths and soaps.

When to call the doctor.
As soon as you notice symptoms of a possible UTI. Prompt treatment is necessary to protect your child’s urinary tract from damage.

Complications.
Kidney damage, although if UTI is treated promptly, it is unlikely.

Accidents are rarely truly accidental. In fact, some safety experts believe there are no accidents, or at least that true accidents are extremely rare. And that most of the so-called “accidents” that kill some 10,000 children under 14 in the United States each year and permanently disable another 50,000 don’t have to happen. When accidents aren’t preventable, the injuries that result from them often are.

Most injuries, however, are as preventable as polio and whooping cough, and implementing what is known about injury prevention can be as effective against injuries as immunization is against childhood diseases. To underscore that injury prevention should be a priority on a par with disease prevention, the Department of Health and Human Services has created the National Center for Injury Prevention and Control as a part of the Centers for Disease Control and Prevention.

Generally, several factors must come together to “create” an accident that results in injury: a dangerous object or substance (a bottle of pills, a staircase, a bucket); a vulnerable victim (such as an unsuspecting toddler); and often, environmental conditions (the bottle doesn’t have a safety cap, the staircase is ungated, the bucket has a couple of inches of water in it). In the case of childhood accidents, there is an additional factor that can make an injury more likely to happen: insufficient adult vigilance.

To prevent injury, it is necessary to modify each of these factors. Remove the dangerous object or substance from your toddler’s reach. Make your toddler less susceptible by gradually instilling good safety habits. Change the hazardous environmental conditions that make an injury more likely—be certain all medicines have childproof caps, that all stairs have gates, that no bucket or other container is left around with water in it. And possibly most important of all in the case of toddlers, you have to be certain that whoever is caring for the
child is consistently alert to potential dangers and knows how to avert them.

To minimize the chance that your toddler could be injured:

Though you should begin the education process now, it will be years before your child will be able to take full responsibility for his or her own safety. Right now,
your
behavior has the greatest impact on your child’s safety. If you want to greatly reduce the risks of unintentional injury:

Be eternally vigilant. No matter how carefully you attempt to childproof your house, your car, the backyard, the places you visit, it’s virtually impossible to make these environments completely safe. Toddlers are curious, impetuous, unpredictable; they lack judgment and need to be protected from their own impulses by the constant, careful supervision of adults.

Don’t let your attention be diverted when using household cleaning products, medicines, electrical appliances, power tools, or other hazardous objects or substances when your toddler is on the loose. It takes no more than a second for a toddler to get into serious trouble. If the doorbell or phone rings, or you have to run into the kitchen to check something in the oven while you’re involved in a possibly risky activity, be sure to take your toddler with you.

Be particularly alert during times of stress and at stressful (or especially hectic) times of day. It’s when you’re distracted or preoccupied that you’re most likely to forget to put a knife away after using it, to close the medicine bottle and lock it away, or to shut the gate at the top of the stairs.