Pediatric Safety and Prevention

Improving child health “health maintenance” “preventive health”

Health Promotion

Immunizations Effective in decreasing childhood infectious diseases. Center for Disease Control (CDC) and American Academy of Pediatrics recommend that children be immunized against 14 communicable diseases before they reach 2 years of age. R Risks are outweighed by the life- saving effects of immunizations.

Immunizations Specific recommendations by APA: –Minor infections without fever are not contraindication –If reaction occurs, consult dr. before next immunization –Pertussis not give for children over 6

Immunization Schedule 4mos-6 yrs of age: DTaP (4 doses) IPV (3 doses) HepB (3 doses) MMR 12 months) PCV (1 dose) 7-18 yrs of age Td (every 10 years after initial immunizations) IPV (not rec. if >18 yrs of age)

Nursing Responsibilities Review immunization schedule for updates Know storing and handling requirements for all vaccines Know the action of the vaccine Know administration routes, dosages, sites and technique Aspirate with each injection May have multiple injections on same day, just be sure to give in separate sites

Nursing Responsibilities Prior to administration, assess if immunocompromised people are in the household (discuss with M.D. alternatives to live virus) Obtain careful history. Children should have their immunization status assessed during all health care visits, hospitalizations, and in school. If immunizations are not current, arrange to update them Assess if any reactions to past vaccines or any allergies to eggs.

Nursing Responsibilities Have parents sign permit with educational instructions. Document - Record lot# and manufacturer of vaccine; patient reaction Advise parents of side effects. Teach use of antipyretics for fever. If fever persists for >than 24 hours, or has other concerns - call M.D. Teach use of cold compresses to injection sites for first 24 hours, then warm compresses

Do Not Forget! Assess for reaction min after injection Epinephrine 1:1000 available Check immunization records with each visit Parent teaching: fever, or other symptoms

Prevention of Injuries

Definitions Mortality- the # of deaths/100,000 Morbidity- used to express the ratio of sick to well in a community Infant mortality- # of children per 1000 live births who die before 1 st birthday

Major causes of death during infancy and childhood (these represent death rates for the ages of 1-14 yrs per 100,000) Accidents Congenital abnormalities Cancer Homicide Heart disease Pneumonia & influenza Suicide Human immunodeficiency disease

Injuries Injuries are a major cause of death in children. All children are at risk for injury because of their normal curiosity, impulsiveness, and desire to master new skills.

INFANT SIDS Motor Vehicle Infections Dehydration Respiratory Problems Child abuse

TODDLER Injuries: MVA Toddler fracture Poisoning Foreign Body airway obstruction Asthma, Croup, Respiratory problems Vomiting, Dehydration Child Abuse

PRESCHOOL Motor Vehicle -- Bicycle Trauma Poisoning Asthma, Respiratory infections Drowning Child Abuse

SCHOOL AGE Motor vehicle: pedestrian - vehicle; bike - vehicle Sports injuries

ADOLESCENT Trauma Motor Vehicle Knife and gunshot wounds Pregnancy complications Suicide Poisoning Drowning

Common Safety Problems Injury Prevention Measures

Common Safety Problems Aspiration MVA Burns Drowning Bodily injury/fractures

Aspiration Asphyxiation by foreign material in respiratory tract is leading cause of fatal injury in children under 1 year of age. Puts everything in mouth Very interested in body and newly found openings

Aspiration – Preventive Measures Carefully inspect toys for potential danger / removable parts. Keep small objects out of reach, floors free of objects Do NOT feed hard candy, nuts, food with pits or seeds, circular pieces of hot dogs Hold infant for feeding, do NOT prop bottle Use pacifier with one-piece construction and loop handle.

Motor Vehicle Accident Vehicle – children improperly restrained Pedestrian –Walking, running, especially after objects thrown into street –Poor perception of speed, lack of experience to foresee danger –Able to open doors and gates and get outside –Children often unseen because of small size, can be run over by car backing out of drive. – Ride toys, bikes in path of danger

Motor Vehicle Accidents Preventive Measures –Use federally approved car restraints –Supervise child while playing outside. Do not allow playing behind cars. Supervise riding of toys, bikes. –Lock fences, gates, doors –Teach to obey pedestrian safety rules

Burns Children are inquisitive and will pull pots off stove, plays with matches, inserts objects into wall sockets They can climb - reaches stove, oven, ironing board and iron, cigarettes on table Unaware of sources of heat or fire

Burns - Preventive Measures Turn pot handles toward back of stove, place guardrails in front of radiators, fireplaces, stoves. Store lighters and matches in locked container Cover electrical outlets with protective covers. Keep electrical cords hidden Check bath water. Do not allow child to play with faucet

Drowning Child does not recognize danger of H2O Unaware of inability to breath underwater No conception of water depth Has curiosity about water Hypoxia greatest concern

Drowning – Preventive Measures Fence around pools, have self-locking gate Supervise when near water sources Keep bathroom doors closed and toilet seat down Teaching swimming and water safety

Bodily Harm - Fractures Like to climb, run, jump Still developing sense of balance Easily distracted from tasks and hurt self Able to open doors and windows Poor depth perception

Bodily Harm – Prevention Measures Keep screens in the windows and locked Place gates at top and bottom of stairs Apply non-skid decals in bathtub or shower Remove unsecured rugs, scatter rugs Never leave unattended in shopping cart Avoid giving sharp or pointed objects. Do not allow lollipops in mouth when running

Poisoning Ingestion of toxic agents is common during early childhood. Most common in 2 y/o 75% of poisons are ingested, others are by dermal, inhalation, and ocular Reasons for poisoning:  Improper storage  Learning new tastes /textures, loves to put things in mouth  Developing fine motor skills – able to open bottles, jars, cabinets. Climbs onto shelves  Cannot read labels

Sources of Poisoning Cosmetics, personal care products Household cleaners: Soaps, polishes Plants Drugs Insecticides Hydrocarbons -- gasoline

Therapeutic Interventions  A poisoning may or may not require emergency intervention, but all should have medical attention BEFORE  Parents are advised to call the Poison Control Center BEFORE initiating any interventions

Therapeutic Interventions 1. Assess the child – treat the child first, not the poison –Take vital signs– assess ABC’s –Maintain respiratory function – provide ventilatory and oxygen support –Start IV infusion –Draw blood for toxicology screen –Apply cardiac monitor –Initiate measure to reduce effects of shock if applicable.

Therapeutic Intervention 2. Remove the child from exposure –Empty out mouth of any pills, plants, or other material –Flush eyes with tap water –Flush skin and wash with soap –Bring child of inhalation poison into fresh air

Therapeutic Intervention 3. Identify the Poison  Question the child and witnesses. Try to find out if only single product ingested.  Look around environment for clues  Do the products ingested breakdown to other substances?  Find out amount ingested? Amounts that cause concern  1 ½ - 3 year old = 4.5 ml  Adult = 15 ml

Therapeutic Intervention 4. Remove the Poison and Prevent absorption

Therapeutic Intervention Give activated charcoal –Give orally Available in ready to drink solution Give in covered cup with a straw so child does not see the black liquid –Give through a gastric tube –Give only after vomiting stops

Therapeutic Intervention NOTDo NOT induce vomiting if: –Patient is lethargic, comatose, seizuring, has an absent gag reflex –Patient ingested an unidentified material, a corrosive substance or petroleum product Insert gastric tube and perform gastric lavage with normal saline once airway is protected with a cuffed endotracheal tube Place child in side-lying position to decrease chance of aspiration.

Lead Poisoning Also called Plumbism An environmental disease caused by the ingestion of lead-based materials.

Lead Poisoning Causes Lead based paint Lead solder Battery casings Lead fishing sinkers, curtain weighs Bullets Some ceramic ware, pottery, pewter

Lead Poisoning Pathophysiology Lead in the body moves in the blood to soft tissues and organs, teeth, and bones. Competes with calcium interfering with the regulation of calcium Interferes with neurotransmission in the brain causing encephalopathy and mental retardation Interferes with synthesis of heme causing anemia Damages tubules in the renal system

Assessment Gastrointestinal symptoms: –Unexplained, repeated vomiting –Vague chronic abdominal pain, colic –Anorexia, anemia Central Nervous System symptoms –Irritability, difficulty concentrating –Drowsiness –Ataxia, loss of skills, paresis or paralysis –Convulsive seizures from encephalopathy – Arthralgia

Blood tests that indicate presence of lead in the blood *Levels of 10 u is harmful to the body Diagnostic Tests

Therapeutic Intervention Criteria for treatment: –< 9 units = not lead poisoning –10-14 units = trigger prevention activities, rescreen –15-19 units = nutritional and educational interventions and rescreening –20-44 units = environmental evaluation and medications. –45-69 units = medical and environmental interventions. Chelation therapy –> 70 units = medical emergency

Stats on drug poisonings

Ask yourself: Why do you think the American Pediatric Association no long advises parents to keep syrup of Ipecac in the home?

Lead Poisoning Therapeutic Intervention Acute care –Gastric lavage followed my magnesium sulfate. Enema. Just want to rid body of lead. Chronic Care / Chelation therapy –Administer meds that bind with the lead Calcium disodium edentate (EDTA) -- IV Dimercaprol (BAL) or D-Penicillamine -- IM Succimer -- orally –Assess I & O – must have adequate urinary output. Force fluids. –Monitor mineral levels

Preventive Measures Make environment lead-free Inspect buildings >25 years of age Areas painted with lead paint should be covered with plywood or linoleum Educate the parents Follow up testing for lead levels Screening all school age children (required in some states)