What to Expect the Toddler Years (244 page)

27. Finger or toe bruises.
Young children, ever curious, are particularly prone to painful bruises from catching fingers in drawers and doors. For such a bruise, soak the finger in ice water (see page 836). As much as an hour of soaking is recommended, with a break every 10 minutes (long enough for the finger to rewarm) to avoid frostbite. Unfortunately, few toddlers will sit still for the duration, though you may be able to treat your child for a few minutes by using distraction (see box, page 680) or—if necessary—force. A stubbed toe will also benefit from soaking, but again, lengthy treatment often isn’t practical with a young child. 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 extended or straightened, suspect a break (#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.

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 the nail to encourage the flow, which will help to relieve the pressure. Soak the injury in ice water if your child will tolerate it. If pain continues, a hole may have to be made in the nail to relieve the pressure. Your doctor can do the job or may tell you how to do it yourself.

29. A torn nail.
For a small tear, secure with a piece of adhesive tape or a Band-Aid until the nail grows to the point where the tear can be trimmed. For a tear that is almost complete, trim away along the tear line with a scissors and cover with a Band-Aid until the nail is long enough to protect the finger or toe tip.

30. A detached nail.
Your toddler’s injured nail will fall off by itself in time, so it’s not necessary to pull it off yourself. Soaking the finger or toe is no longer recommended because constant moisture of a nail bed without the protection of a nail will increase the risk of fungal infections. Do make sure, however, to keep the nail area clean. Antibiotic ointments can be applied but are not always necessary (ask your toddler’s pediatrician). Cover the nail bed with a fresh Band-Aid often, but once the nail starts growing back in, Band-Aids are not necessary. It usually takes four to six 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 your child’s 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.
Young children are extremely susceptible to frostbite (freezing of body tissue), particularly on their fingers, toes, ears, nose, and cheeks. With frostbite, the affected part becomes very cold to the touch and turns white or yellowish gray, sometimes with white spots. In severe frostbite the skin is cold, waxy, pale, and hard. Should you note
any
signs of frostbite in your toddler, immediately try to warm the frosty parts against your body—open your coat and shirt and tuck the parts inside next to your skin (under your arm is best). You can also breathe warm air on your child’s skin. Get to a doctor or an emergency room as soon as possible. If that isn’t feasible immediately, get your child 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; this can further damage the skin. Instead, soak affected fingers and toes directly in water that is about 102°F—just a little warmer than normal body temperature and just
slightly
warm to the touch. For unsoakable parts, such as the nose, ears, and cheeks, use very gently applied warm compresses (apply 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). Also give sips of warm (not hot) fluids. As frostbitten skin rewarms it becomes red and slightly swollen, and it may blister. (Severely frostbitten skin may turn purple or blue, peel, or may become gangrenous.) Gently dry the skin and keep it from rechilling. Application of aloe vera may help healing. If your child’s injury hasn’t yet been seen by a doctor, it is important to get medical attention now.

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

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, 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, even tiny ones, and bruises there tend to swell up 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.
Every active toddler experiences an occasional minor bump on the head. Usually such an injury requires no more than a couple of make-it-better kisses. But a severe blow to the head requires more. It’s wise to observe a child carefully for 6 hours following a severe blow to the head. Symptoms may occur immediately or not show up for several days—so continue to observe a child who has had a serious head injury even if he or she seems okay initially.
Call the doctor
or summon emergency medical assistance
immediately (call 911)
if your toddler shows any of these signs following a head injury:

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

Headache that persists for more than an hour (a young toddler may just cry and hold his or her head), that seems to get worse over time, that interferes with normal activity and/or sleep, or that isn’t relieved by acetaminophen

Difficulty being roused (check every hour or two during daytime naps, 2 or 3 times during the night for the first day following the injury to be sure the child is responsive; if you can’t rouse a sleeping child, immediately check for breathing; see page 684)

Eyes should contract (top) in response to a pen-light, and expand (bottom) when the light is removed.

More than 1 or 2 episodes of vomiting

Oozing of blood or watery fluid from the ears or nose

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

Any depression or indentation in the skull