What to Expect the First Year (126 page)

25. Injury to the eye with a blunt object.
Keep baby lying face up. Cover the injured eye with an ice pack or cold compress for about 15 minutes. Repeat every hour as needed to reduce pain and swelling. Consult the doctor if there is bleeding in the eye, if the eye blackens, if baby seems to be having difficulty seeing or keeps rubbing the eye a lot, if the object hit the eye at high speed, or if there seems to be continued eye pain.

26. Check for breathing and pulse.
If they are absent, begin CPR immediately (
click here
). If you detect breathing, keep baby lying flat, head slightly lower than the rest of the body, lightly covered for warmth if necessary. Loosen clothing around the neck. Turn baby's head to one side and clear the mouth of any food or objects. Call 911 immediately.

27. Bruises.
Babies, ever curious, are particularly prone to painful bruises from catching fingers in drawers and doors. For such a bruise, soak the finger in cold water (add a couple of ice cubes to keep it cool). As much as an hour of soaking is recommended, with breaks every 10 minutes (long enough for the finger to rewarm) to avoid frostbite. Though few babies will sit still for this long, you may be able to treat your little one's injury for a few minutes by using distraction or holding him or her tightly.

A stubbed toe will also benefit from soaking, but again, it often isn't easy to do with a baby. Bruised fingers and toes will swell less if they are kept elevated.

If the injured finger or toe becomes very swollen very quickly, is misshapen, or can't be voluntarily straightened by the baby, call the doctor. It may be broken (
#8
). Call the doctor immediately if the bruise is from a wringer-type injury or from catching a hand or foot in the spokes of a moving wheel. In these kinds of “crush” injuries, there may be more damage than is visible or apparent.

28. Bleeding under the nail.
When a finger or toe is badly bruised, a blood clot may form under the nail, causing painful pressure. If blood oozes out from under the nail, press on it to encourage the flow, which will help to relieve the pressure. Soak the injury in cold water if baby will cooperate. If the pain continues, the doctor may have to make a hole in the nail to relieve the pressure.

29. A torn nail.
For a small tear, secure with a piece of adhesive tape or a bandaid until the nail grows to a point where it can be trimmed. For a tear that is almost complete, carefully trim away along the tear line with scissors or baby nail clippers, and keep covered with a bandaid until the nail is long enough to protect the finger or toe tip.

30. Detached nail.
If your baby injures a fingernail to the point that it detaches or almost detaches, don't try to pull it off—just let it fall off by itself in time. Soaking the finger or toe is not recommended, since moisture can increase the risk of fungal infections. Do make sure, however, to keep the area clean. An antibiotic ointment can be applied but isn't always necessary (ask the pediatrician). Keep the nail bed covered with a fresh bandaid until the nail starts growing back in (after that, you can leave it uncovered). It usually takes 4 to 6 months for a nail to grow all the way back. If at any point you notice redness, heat, and swelling, it could mean the area is infected, and you should call the doctor.

in the ear, see
#19
; in the eye, see
#22
; in the mouth or throat, see
#40
; in the nose, see
#42

see
#8
,
#9
,
#10

31.
Babies are extremely susceptible to frostbite, particularly on fingers and toes, ears, nose, and cheeks. In frostbite, the affected part becomes very cold and turns white or yellowish gray. In severe frostbite, the skin is cold, waxy, pale, and hard. If you notice any signs of frostbite in your baby, immediately try to warm the frosty parts against your body—open your coat and shirt and tuck baby inside next to your skin. You can also breathe warm air on baby's skin. As soon as possible, get to a doctor or an ER. If that isn't feasible immediately, get baby indoors and begin a gradual rewarming process. Don't massage the damaged parts or put them right next to a radiator, stove, open fire, or heat lamp—the damaged skin may burn. Don't try to “quick-thaw” in hot water, either, since this can further damage the skin. Instead, soak affected fingers and toes directly in tepid water (about 102°F—just a little warmer than normal body temperature and just slightly warm to the touch). For parts that can't be soaked, such as nose, ears, and cheeks, very gently apply warm compresses (wet washcloths or towels soaked in water slightly warm to the touch). Continue the soaks until color returns to the skin, usually in 30 to 60 minutes (add warm water to the soaks as needed to maintain tepid temperature). Nurse baby or give warm (not hot) fluids by bottle or cup. As frostbitten skin rewarms, it becomes red and slightly swollen, and it may blister. Gently pat the skin dry. If baby's injury hasn't yet been seen by a doctor, it is important to get medical attention now.

Once the injured parts have been warmed, and you have to go out again to take baby to the doctor (or anywhere else), be especially careful to keep the affected areas warm (wrapped in a blanket) en route, since refreezing of thawed tissues can cause additional damage.

Much more common than frostbite—and fortunately, much less serious—is frostnip. In frostnip, the affected body part is cold and pale, but rewarming (as for frostbite) takes less time and causes less pain and swelling. As with frostbite, avoid dry heat and avoid refreezing. Though an office or ER visit isn't necessary, a call to the doctor makes sense.

After prolonged exposure to cold, a baby's body temperature may drop
below normal levels. This is a medical emergency known as hypothermia (see
#35
). Don't waste any time getting a baby who seems unusually cold to the touch to the nearest ER. Keep baby warm next to your body en route.

IMPORTANT: Head injuries are usually more serious if a child falls onto a hard surface from a height equal to or greater than his or her own height, or is hit with a heavy object. Blows to the side of the head may do more damage than those to the front or back of the head.

32. Cuts and bruises to the scalp.
Because of the profusion of blood vessels in the scalp, heavy bleeding is common with cuts to the head, and bruises there tend to swell to egg size very quickly. Treat as you would any cut (
#51
,
#52
) or bruise (
#49
). Check with the doctor for all but very minor scalp wounds.

33. Possibly serious head trauma.
Most babies experience several minor bumps on the head during the first year. Usually these require no more than a few make-it-better cuddles and kisses. However, after a bad blow to the head, it's wise to keep a close eye on your baby for the first 6 hours. Symptoms may occur immediately or not show up for several days—so continue to watch a child who has had a serious head injury even if he or she initially seems fine. Call the doctor or 911 immediately if your baby shows any of these signs after a head injury:

• Loss of consciousness (though a brief period of drowsiness—no more than 2 to 3 hours—is common and nothing to worry about)

• Difficulty being woken. Check every hour or two during daytime naps, and two or three times during the night for the first day after the injury, to be sure baby is responsive. If you can't wake a sleeping baby, immediately check for breathing (
click here
).

• Vomiting

• Black-and-blue areas appearing around the eyes or behind the ears

• A depression or indentation in the skull

• A large swelling at the site of the injury, through which you would be unable to detect a depression or indentation

• Oozing of blood or watery fluid (not mucus) from the ears or nose

• Inability to move an arm or leg

• Unusual lack of balance that persists beyond 1 hour after the injury (a sign of dizziness)

• Unequal pupil size, or pupils that don't respond to the light of a penlight by shrinking or to the removal of the light by growing larger (see
illustration
)

Pupils should constrict (get smaller, top) in response to a light, and dilate (expand, bottom) when the light is removed.

• Unusual paleness that persists for more than a few minutes immediately after the injury

• Convulsions (see
#16
)

• Your baby just isn't acting like him-or herself—seems dazed, confused, doesn't recognize you, is unusually clumsy or unable to coordinate movements as usual, or any other behavior that is unusual, unexpected, or worrisome.

While waiting for help, keep your baby lying quietly with his or her head turned to one side. Do not move your baby if you suspect a neck injury, unless not doing so would be dangerous. Treat for shock (
#48
), if necessary. Begin rescue techniques (
click here
) if baby stops breathing or doesn't have a pulse. Don't offer any food or drink until you talk to the doctor.

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 baby may be cranky, refuse food, or vomit). Body temperature may rise to 101°F to 105°F. Treat heat exhaustion by bringing your baby into a cool environment (air-conditioned, if possible) and giving cold fluids to drink. Cool compresses applied to the body and a fan may also help. If baby doesn't quickly return to normal, vomits after 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 baby has been enclosed in a car in warm weather. Signs to watch for include hot and dry (or occasionally, moist) skin, very high fever (sometimes over 106°F), diarrhea, agitation or lethargy, confusion, convulsions, and loss of consciousness. If you suspect heatstroke, wrap baby in a large towel that has been soaked in cold tap water and summon immediate emergency medical help (call 911), or rush baby to the nearest ER. 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 below normal levels. A child with hypothermia may seem unusually cold, shiver, be lethargic, or move stiffly. In severe hypothermia, shivering stops and there is a loss of muscle control and a decline in consciousness. Hypothermia is a medical emergency. Don't waste any time in getting a child who appears to have hypothermia to the nearest ER (call 911 if you don't have quick transportation). Remove any wet clothing, wrap your baby in blankets, and turn on the car heater en route to the hospital. If you are waiting for emergency medical help at home, tuck your baby under an electric blanket (if you have one), in a very warm bath (not hot enough to burn, of course), or against your body skin-to-skin and covered with blankets.

see
#5