What to Expect the First Year (124 page)

Boo-boos happen. Even when you're conscientious, careful, and vigilant—even when you've taken all the precautions and then some—you can't prevent every injury. But, you can prepare for them—and that preparation can make all the difference. Hopefully, most of the boo-boos that happen in your baby's life will be small (the kiss-and-make-better variety). Still, you'll need to know how to respond in the event of a bigger mishap, and how to care for injuries (such as cuts, bruises, burns, and breaks) that need more treatment than a cuddle—and that's what this chapter is for. It'll also give you guidelines on lifesaving CPR and what to do if your child is choking.

Because quick action after an injury is often critical, don't wait until your baby dunks a hand in your hot coffee or takes a swig of laundry detergent to look up what to do in an emergency. Before an accident happens is the best time to get as familiar as possible with the procedures for dealing with and treating common injuries. Review the protocol for handling less common injuries (snakebites, for instance) when you're more likely to encounter them (say, you're about to go on a camping trip).

But don't stop there. It's one thing to read about injury treatment—it's another thing to apply your skills when an emergency strikes. So reinforce what you learn in this chapter by taking a course in baby safety, cardiopulmonary resuscitation (CPR), and basic first aid. Courses are available at many community centers and hospitals, and through fire departments, ambulance corps, the American Red Cross, and the American Heart Association—check online or with your child's doctor for options. Some certified instructors will even bring the course to you (that way, anyone who might be caring for your baby, including grandparents, aunts, uncles, and babysitters, can attend with you in your home). Keep your skills current and ready to use with periodic refresher
courses (or a video course approved by th AAP or Red Cross)—and be sure that anyone else who cares for your baby is also fully trained and prepared to deal with emergencies, from minor to major.

To further prepare yourself for emergencies:

• Discuss with your baby's doctor what the best course of action would be in case of a non-life-threatening injury as well as in a serious emergency: when to call the doctor's office, when to go to the emergency room (and when to do both), when to call 911, and when to follow some other protocol. For minor injuries, the ER—with its long waits, abundance of germs, and priority given to life-threatening conditions—may not be the best place to go.

• Keep your first-aid supplies in a childproof, easily manageable all-inclusive kit or box that can be moved where it's needed. Always keep a charged phone easily accessible so that it can be used at the site of an injury, wherever it happens.

• Always keep handy (and accessible to anyone who cares for your child):

• Emergency phone numbers. The pediatrician, the Poison Control Center (800-222-1222), the hospital emergency room of your choice, your pharmacy, the Emergency Medical Service (EMS, which can be accessed by dialing 911 in most areas), and your places of work, as well as the number of a close relative, friend, or neighbor who can be called on in an emergency. A regular care provider should have these numbers programmed into her own phone for instant access.

• Personal information (updated regularly). Your child's age, approximate weight, immunization record, medications, allergies, and/or chronic illnesses, if any. In an emergency, these should be supplied to the EMS and/or taken to the hospital or ER.

• Location information. Home address (include cross streets and landmarks, if necessary), apartment number, telephone number—for use by babysitters or other caregivers calling for emergency help.

• A pad and pen. For taking instructions from the doctor or 911 dispatcher, or Poison Control.

• Be sure there's a clearly distinguishable number on your house and a light that makes the number visible after dark.

• Know the quickest route to the ER or other emergency medical facility your child's doctor recommends.

• If you live in a city, keep some cash reserved in a safe place and the car seat handy in case you need to call a taxi to get to the ER or doctor's office in an emergency. (If you're very anxious, or you're busy caring for your injured child, it's best if you don't drive.) Let any babysitter who stays with your little one know where that
emergency money is, too. An easier option in cities where it's available: an app for a taxi or car service (like Uber) that pinpoints your location instantly, picks you up usually within minutes, and charges your account for the ride.

• If you tend to overreact in stressful or emergency situations, try to learn how to respond calmly to your little one's illnesses and injuries. Practice with everyday bumps and bruises, so that if a serious injury ever occurs, you'll be better equipped to keep your cool. Taking a few deep breaths will help you relax and focus no matter what you're facing. Try to remember that your expression, tone of voice, and general demeanor will affect how your baby responds to an injury. If you panic, your baby is more likely to panic—and less likely to be able to cooperate. And an uncooperative baby is more difficult to treat.

• To help you both stay calm when there's been an injury, big or small, divert your baby's attention from the injury by engaging at least three senses. Stand where your baby can see you, speak calmly so he or she can hear you, and touch a part of the body that doesn't seem to be injured.

Following are the most common injuries, what you should know about them, how to treat (and not treat) them, and when to seek medical care for them. Types of injuries are listed alphabetically, with individual injuries numbered for easy cross-reference.

1. Internal bleeding.
A severe blow to your baby's abdomen could result in internal injury. The signs of such injury would include bruising or other discoloration of the abdomen, vomited or coughed-up blood that is dark or bright red and has the consistency of coffee grounds (this could also be a sign that a caustic substance has been swallowed), blood (it may be dark or bright red) in the stool or urine, and shock (cold, clammy, pale skin; weak, rapid pulse; chills; confusion; and possibly nausea, vomiting, and/or shallow breathing). Seek emergency medical assistance (call 911). If baby appears to be in shock (
#48
), treat immediately. Do not give food or drink.

2. Cuts or lacerations of the abdomen.
Treat as for other cuts (
#51
,
#52
). With a major laceration, intestines may protrude. Do not try to put them back into the abdomen. Instead, cover them with a clean, moistened washcloth or diaper and get emergency medical assistance immediately (call 911).

3. Animal bites.
Try to avoid moving the affected part. Call the doctor immediately. Then wash the wound gently with soap and water. Do not apply antiseptic or anything else. Control bleeding (
#51
,
#52
,
#53
) as needed with pressure, and apply a bandage.

Bats, skunks, coyotes, foxes, and raccoons that bite may be rabid, especially if they attacked unprovoked. The
same is true for dogs and cats. Although most household pets are vaccinated against rabies, you can't be sure unless you see proof of vaccination. You'll need to consult with the pediatrician to determine if your baby needs postexposure rabies protection. Keep in mind that while rabies in humans is extremely rare, it is almost always fatal if not treated.

If a dog or cat bite breaks the skin, call the doctor for advice, even if the animal is known not to have rabies. Antibiotics may be prescribed to prevent infection. Call the doctor immediately if redness, swelling, and tenderness develop at the site of the bite—these are signs of infection, which must be treated with antibiotics. Infection is more common with a cat bite than a dog bite.

4. Human bites.
If your baby is bitten by another child, don't worry unless the skin is broken. If it is, wash the bite area thoroughly with mild soap and cool water. Don't rub the wound or apply any spray or ointment (antibiotic or otherwise). Simply cover the bite with a sterile dressing and call the doctor. Use pressure to stem the bleeding (
#52
), if necessary. Antibiotics will likely be prescribed to prevent infection.

5. Insect stings or bites.
Treat insect stings or bites as follows:

• Apply calamine lotion or another anti-itching medication to itchy bites, such as those caused by mosquitoes.

• Remove ticks promptly, using blunt tweezers or your fingertips protected by a tissue, paper towel, or rubber glove. Grasp the bug as close to the child's skin as possible and pull upward, steadily and evenly. Don't twist, jerk, squeeze, crush, or puncture the tick. If you're not sure whether it's a deer tick, you can save it and compare it with a picture of a deer tick (or take a photo of it and email or show the doctor later). But there's no need to save it for any other reason—the doctor won't need it for testing.

• If your baby is stung by a honeybee, remove the stinger by scraping it horizontally, using the edge of a blunt butter knife, your fingernail, or a credit card, or gently remove it with tweezers or your fingers. Try not to pinch the stinger, because doing so could inject more venom into the wound. Then treat as below.

• Wash the site of a minor bee, wasp, ant, spider, or tick bite with soap and water. Then apply cold compresses or ice wrapped in a towel if there appears to be swelling or pain.

• If there seems to be extreme pain after a spider bite, apply cold compresses and call Poison Control for emergency advice. If possible, describe the spider's appearance to help determine if it is poisonous. If you know the spider is poisonous—a black widow or brown recluse spider, a tarantula, or a scorpion, for example—get emergency treatment (call 911) immediately, even before symptoms appear.

• Watch for signs of hypersensitivity, such as severe pain or swelling or any degree of shortness of breath after a bee, wasp, or hornet sting. About 90 percent of children react to an insect sting with brief (less than 24 hours) redness, swelling, and pain in a 2-inch area at the site of the sting. But the other 10 percent have a much more severe local reaction, with extensive swelling and tenderness covering an area 4 inches or more in diameter that doesn't peak until 3 to 7 days after the sting. Those who experience such symptoms with a first sting usually
develop hypersensitivities (or allergies) to the venom, in which case a subsequent sting could be fatal without immediate emergency treatment. Life-threatening anaphylactic reactions (which are uncommon) usually begin within 5 to 10 minutes of the sting. They may include swelling of the face and/or tongue; signs of swelling of the throat, such as tickling, gagging, difficulty swallowing, or voice change; bronchospasm (chest tightening, coughing, wheezing, or difficulty breathing); a drop in blood pressure causing dizziness or fainting; and/or cardiovascular collapse. Fatal outcomes in children are extremely rare, but do seek medical help immediately if you notice any systemic reaction (affecting body parts and/or systems other than the site of the sting). Should your child have a life-threatening systemic reaction, call 911 immediately.

After any systemic reaction, a skin test, and possibly other testing, will be performed to determine sensitivity to insect venom. If it is determined that your child is at risk of a life-threatening episode from an insect sting, it'll probably be recommended that an epinephrine auto injector (EpiPen or other brand) be taken along on all outings during bee season.

6. Snakebites.
Babies are rarely bitten by poisonous snakes, but such a bite is very dangerous. The four major types in the United States are rattlesnakes, copperheads, coral snakes, and cottonmouths or water moccasins. All have fangs, which usually leave identifying marks when they bite. Because of a baby's size, even a tiny amount of venom can be fatal. After a poisonous snakebite, it is important to keep the baby and the affected part as still as possible. If the bite is on a limb, immobilize the limb with a splint and keep it below the level of the heart. Use a cool compress if available to relieve pain, but do not apply ice or give any medication without medical advice. Get prompt emergency medical help, and be ready to identify the variety of snake, if possible. If you won't be able to get medical help within an hour, apply a loose constricting band (a belt, tie, or scrunchie loose enough for you to slip a finger under) 2 inches above the bite to slow circulation. (Do not tie such a tourniquet around a finger or toe, or around the neck, head, or trunk.) Check the pulse beneath the tourniquet frequently to be sure circulation is not cut off, and loosen it if the limb begins to swell. Make a note of the time the tourniquet was tied. Sucking out the venom by mouth (and spitting it out) may be helpful if done immediately. But do not make an incision of any kind, unless you are 4 to 5 hours from help and severe symptoms occur. If baby is not breathing and/or the heart has stopped, begin rescue techniques (
click here
). Treat for shock (
#48
), if necessary.

Treat nonpoisonous snakebites as puncture wounds (
#54
), and notify the doctor.

7. Marine animal stings.
The stings of marine animals are usually not serious, but occasionally a child can have a severe reaction. Medical treatment should be sought immediately after any marine sting. First-aid treatment varies with the type of marine animal involved, but in general, any clinging fragments of the stinger should be carefully brushed away with a diaper, a credit card, or a piece of clothing (to protect your own fingers). Heavy bleeding (
#52
), shock (
#48
), or cessation of breathing (
click here
), should
be treated immediately, and if necessary, call 911. Don't worry about light bleeding, since it may help purge toxins. If possible, the site of the sting of a stingray, lionfish, catfish, stonefish, or sea urchin should be soaked in warm water (to break down the toxins) for 30 minutes, or until medical help arrives. The toxins from the sting of a jellyfish or Portuguese man-of-war can be counteracted by applying regular white vinegar or rubbing alcohol on the sting (pack a couple of alcohol pads in your beach bag, just in case). Unseasoned meat tenderizer, baking soda, ammonia, and lemon or lime juice can also help prevent pain.