What to Expect the Toddler Years (250 page)

1. Get help.
If someone else is present, have them call 911 for emergency medical assistance. If you’re alone, give care for about 2 minutes before calling 911. If you are unfamiliar with rescue procedures—or if you panic and forget them—take the child with you to the phone (or bring a cordless or cell phone to the child’s side) and call 911 for emergency medical assistance immediately. It’s usually recommended that even if you’re familiar with rescue procedures, you take the time to call. That way help can be on the way in case the situation worsens.

If the child is unconscious, see instructions on page 691. If the child is conscious, a combination of 5 back blows followed by 5 abdominal thrusts as follows provides an effective way to clear the airway obstruction:

2. Position yourself.
Stand slightly behind the child.

3. Position your hands.
Provide support by placing one arm diagonally across the chest and leaning the child forward. Firmly strike the child between the shoulder blades with the heel of your other hand five times, then continue to Step 4.

4. Administer abdominal thrusts.
Stand or kneel behind the child and wrap your arms around his waist. Make a fist with one hand and place the thumb side against the middle of the child’s abdomen, just above the navel, and well below the lower tip of the breastbone. Grab your fist with your other hand and give quick, upward thrusts into the abdomen. Each thrust should be a separate, distinct movement.
Continue back blows and abdominal thrusts until the object is dislodged and the child can breathe or cough forcefully, or becomes unconscious.

Important:
If the child loses consciousness, attempt to open the airway, and if necessary, attempt rescue breathing. If the airway remains obstructed, follow the instructions below to perform first aid for an unconscious choking child.

If the child is unconscious, proceed this way:

1. Rescue breaths.
Place the child face-up on a firm, flat surface (a floor or a table). Tilt the child’s head. Attempt 2 rescue breaths. If the chest does not rise, retilt the head and try 2 rescue breaths again.

Note:
If the child was choking and conscious but then became unconscious, skip Step 1 and go right to Step 2, chest compressions.

2. Chest compressions.
If the chest does not rise, give 30 chest compressions. Check the mouth and look for an object. If a foreign body is visible, use a finger sweep with a hooked finger to remove it. If you can’t see anything, try 2 rescue breaths. If breaths do not go in, repeat chest compressions, a foreign body check, and then 2 rescue breaths.

Continue repeating this sequence until the airway is clear and the child is conscious and breathing normally or until emergency medical assistance arrives.

Important:
Even if your child recovers quickly from a choking incident, medical attention will be required. Call the doctor or the emergency room immediately.

Remember, this information is not a substitute for training. Red Cross first aid, CPR, and automated external defibrillator (AED) training can give you skills and confidence to act in an emergency. Contact your local chapter, or go to
www.redcross.org
for training information and online demonstrations.

Figure 8: When administering abdominal thrusts, care must be taken to avoid pressing on the ribs or the tip of the sternum (the xiphoid process).

Every child needs special attention. But over 10 million children in the United States—and their number is increasing as more very-low-birth-weight babies survive—need somewhat more attention than the rest. Whether the special needs are a result of an allergy, a mild chronic illness, a minor birth defect, or a condition that severely impairs function, providing the extra special attention these children need can make a remarkable difference in the quality of their lives—not just in the toddler years, but in all the years to follow.

If your child’s special needs are minor, you may find much of this chapter irrelevant; if they are major, the information that follows can form a foundation for dealing with them now and in the future.

Though the well-being of special-needs children depends a great deal on the quality of professional care they receive, it depends even more on parental participation. In most situations no one can help a child more than a parent can, but to be able to help most effectively you will need to:

Be sure you know what the condition is.
Early diagnosis and early intervention are extremely important. If you have any doubt about the accuracy of a diagnosis or if your child’s doctor is unable to come up with a diagnosis at all, don’t hesitate to get a second opinion. (To avoid putting your child through duplicate testing, obtain the records from the first round of tests for the second doctor’s review.)

In many cases, learning the cause of a condition is also important. Knowing can often help to ease guilt and increase understanding and acceptance. In some cases, it may also help you to prevent a repeat in other children.

Be sure to listen.
Pay careful attention to what the doctors, therapists, and others involved with your child’s care have to say. If hearing the diagnosis initially left you in such a state of shock that you
didn’t hear anything else that was said, be sure to follow up with a visit or phone call as soon as possible to ask the questions and receive the answers you need to understand your child’s condition. You can also ask the medical professionals who are treating your child for a written report or evaluation.

Be sure you’re being heard.
Are the professionals paying attention; do they take your concerns and your input seriously? They should—after all, you know your child better than anyone else and your role is vital in caring for your child. Make sure the lines of communication between you and each care provider stay open
all
of the time, not just during crisis periods.

Become an expert.
Eventually, most parents of children with special needs become so well educated about their child’s condition that anyone eavesdropping on a discussion between them and their child’s doctors would find it difficult to pick out the professionals. The sooner you begin your education, the better for your toddler (when you know what you’re talking about, you can ask educated questions and make sound judgments about doctors, therapies, and interventions, helping to ensure the best treatment pronto) and for you (you will feel more in control of the situation and have less fear of the unknown). Learn all you can about your child’s condition and care and treatment by keeping track of articles in medical journals, reading books, joining a relevant organization (see page 694), and checking out medical resources online.

Keep up with the latest treatments and technology. Every day new medical procedures, new prosthetics, and new types of support equipment are developed that can turn a child’s life around, or at least improve the quality of that life. “Miracle” technologies include everything from surgery that can bring hearing to a deaf ear or correct a disfiguring and/or disabling birth defect to a computer that can help paralyzed children play games, do homework, even “speak” by moving their eyes. Consult with your child’s specialist or contact The Alliance for Technology Access (
www.ataccess.org
; 707-778-3011) for the latest information specific to your child’s condition.

Be sure you get the best help.
For many chronic childhood conditions, the expertise of a specialist may be needed to make a diagnosis and to recommend treatment. In some cases, the treatment can be supervised by your child’s doctor, with or without consultation with a specialist; in others, it’s best supervised by a specialist or subspecialist. A specialist affiliated with a children’s hospital or a major medical center is most likely to have the resources available to offer the most up-to-date care. Often, a chronic condition is best managed by the combined efforts of a team of medical specialists, other professionals, and parents.

Ideally, anyone treating or working with your child should have a subspecialty in pediatrics as well as experience with children who have special needs. In some communities, a case manager (usually a physician, nurse, or social worker) may be available to help you organize your child’s care by drafting an Individualized Family Service Plan (IFSP).