What to Expect the Toddler Years (245 page)

Difficulty walking or clumsiness (beyond usual toddler clumsiness), or the inability to move an arm, a leg, or another body part

Abnormal speech or behavior (slurred speech, extreme irritability)

Dizziness that persists longer than an hour after the injury (the child’s balance may seem off)

Convulsions (seizures; see #16)

Unequal pupil size, or pupils that do not get smaller in response to the light of a penlight or larger when the light is removed (see above illustration)

Unusual paleness that persists for more than an hour or so.

While waiting for help, keep the child lying quietly with his or her head turned to one side.
Do not move
the child
if you suspect a neck injury, unless not doing so would be dangerous (see page 665). If symptoms of shock (cold, clammy, pale skin; weak, rapid pulse; chills; confusion; and, possibly, nausea, vomiting, and/or shallow breathing) develop, treat (see #48). If breathing stops, begin CPR (see page 688). Don’t offer any food or drink until you get an okay from the doctor or EMS.

34.
Heat exhaustion,
or mild hyperthermia (high body temperature), is the most common form of heat injury. Signs may include: profuse sweating, thirst, headache, muscle cramps, dizziness or light-headedness, and/or nausea (a toddler may be cranky and put a hand to the throat, indicating a need to vomit). Body temperature may rise to 101°F to 105°F (38°C to 40°C). Treat heat exhaustion by bringing the child into a cool environment (air-conditioned, if possible) and giving cold beverages (such as diluted, but not full-strength, fruit juice) to drink. Ice packs and a fan may also help. If the child doesn’t quickly return to normal, vomits on drinking, or has a high fever, call the doctor.

Heatstroke
, or severe hyperthermia, is less common and more serious. It typically comes on suddenly after overheating, as when a child has been playing in hot, glaring sunshine or has been enclosed in a car in warm weather. Signs to watch for include hot and dry (or occasionally, moist) skin, very high fever (over 106°F, or 41°C), diarrhea, agitation or lethargy, confusion, convulsions, and loss of consciousness related to overheating. If you suspect heatstroke, wrap your toddler in a large towel that has been soaked in cold water (dump ice cubes, if available, in the sink while it’s filling with cold tap water, then add the towel, or use any cool water available) and summon
immediate
emergency medical help (
call 911
), or rush the child to the nearest emergency room. If the towel becomes warm, repeat with a freshly chilled one.

see #34

35.
After prolonged exposure to cold, when heat loss exceeds heat production, a child’s body temperature may drop to below normal levels. A child with hypothermia may seem unusually cold to the touch, be pale and have blue lips, shiver, be lethargic, move stiffly, and/or have trouble speaking. Hypothermia is a medical emergency. In severe hypothermia, shivering ceases and there is loss of muscle control and a decline in consciousness. No time should be wasted in getting a child who appears to have hypothermia to the nearest emergency room (
call 911
if you have no quick transportation). Remove any wet clothing, wrap the child in heavy blankets, and turn on the car heater en route to the hospital. If you are awaiting emergency medical help at home, tuck your toddler under an electric blanket, if you have one, or in a hot bath (not hot enough to burn, of course). If your child is alert, offer warm beverages, such as milk or diluted juices.

see #5

see #36, #37

36. Split lip.
Few toddlers escape their first few years without at least one cut on the lip. Fortunately, these cuts usually heal very quickly. Apply an ice pack to ease pain and control bleeding. Or let the child suck on an ice pop or a large ice cube
only
under adult supervision (switch to a fresh ice cube before the first becomes small enough to choke on).
Call the doctor
if the cut gapes open or if the bleeding doesn’t stop in 10 to 15 minutes. Also call if you suspect a lip injury may have been caused by the child chewing on an electrical cord.

37. Cuts inside the lip or mouth.
Such injuries are also common in young children. To relieve pain and control bleeding inside the lip or cheek, give the child an ice pop or a large ice cube to suck on
only
under adult supervision (again, switch to a fresh ice cube before the first becomes small enough to choke on). To stop bleeding of the tongue that doesn’t stop spontaneously, squeeze the sides of the cut together with a piece of gauze, a clean washcloth, or a cloth diaper.
Call the doctor
if the injury is in the back of the throat or on the soft palate (the rear of the upper mouth), if there is a puncture wound from a sharp object (such as a pencil or a stick), or if the bleeding doesn’t stop within 10 to 15 minutes.

38. Dislodged tooth.
If a
permanent
tooth in an older child is knocked out, it should be rinsed gently under running water while being held by the crown (not the root). It can then be reinserted into the gum, if possible, or held in the mouth (or in tap water or milk) en route to the dentist, who may be able to reimplant it if no more than 30 to 45 minutes have elapsed since the accident. But since there is little chance that the dentist will try to reimplant a dislodged
baby
tooth (such implantations often abscess and rarely hold), precautions to keep a baby tooth alive generally aren’t necessary. The dentist will, however, want to see it to be sure it’s whole; fragments left in the gum could be expelled and then inhaled or choked on, or the area could become infected. So take the tooth along to the dentist—or to the doctor or ER if you are unable to reach a dentist.

39. Broken tooth.
Clean dirt or debris carefully from the mouth with warm water and gauze or a clean cloth. Check thoroughly to be sure there are no broken parts of the tooth still in the child’s mouth. Place cold compresses (see page 836) on the face in the area of the injured tooth to minimize swelling.
Call the child’s dentist immediately
for further instructions; if your child has no dentist as yet, call the doctor for a recommendation.

40. A foreign object in the mouth or throat.
Removing a foreign object that has already been inserted and can’t be grasped easily from the outside is tricky. Unless done carefully, the effort can push the object in even further. Pinch the child’s cheeks to open the mouth, and use a tweezer to remove a soft object (such as a piece of tissue paper or bread). For anything else, try a finger swipe: Curl your finger and swipe quickly at the object with a sideways motion.
Do not
attempt a finger swipe, however, if you can’t see the object. If a foreign object is lodged in your child’s throat, see choking rescue procedures, beginning on page 689.

41. Nosebleeds.
With the child in an upright position or leaning slightly forward (so blood won’t drip down the throat), pinch together the outer sides of the nostrils gently between
your thumb and index finger, pushing firmly back toward the face, for 5 minutes. (The child will automatically switch to mouth breathing.) Try to keep the child calm; crying increases the blood flow. If bleeding persists, try packing the bleeding nostril with a wad of absorbent cotton and pinch for 10 minutes more and/or apply cold compresses or ice wrapped in a washcloth to the nose to constrict the blood vessels. If this doesn’t work and bleeding continues, call the doctor—keeping the child upright while you do. Try to keep your toddler quiet (with stories, DVDs, games) for several hours following the nosebleed. Frequent nosebleeds, even if easily stopped, should be reported to your child’s doctor. Sometimes, adding humidity to the air in your home (see page 838) will reduce the number of nosebleeds.