What to Expect the Toddler Years (247 page)

Try to control bleeding. Apply heavy pressure to the wound with several sterile gauze pads, a fresh sanitary napkin, or a clean diaper or washcloth. If bleeding continues, increase the pressure. Don’t worry about doing damage by pressing too hard. Do not apply a tourniquet without medical advice.

Treat shock if it is present (#48).

Check for breathing, and begin CPR immediately if the child isn’t breathing (see page 688).

Preserve the severed limb or digit. As soon as possible, wrap it in a wet clean cloth or sponge, and place in a plastic bag. Secure the bag shut and place it in another bag filled with ice (do not use dry ice). Do not place the severed part directly on ice and don’t immerse it in water or antiseptics.

Get help. Call or have someone else
call 911
for immediate emergency medical assistance or rush to the ER, calling ahead so they can prepare for your arrival. Be sure to take along the ice-packed limb or digit; surgeons may attempt to reattach it. During transport, keep pressure on the wound and continue other basic life-support procedures, if necessary.

48.
Shock can develop in severe injuries or illnesses. Signs include cold, clammy, pale skin; rapid, weak pulse; chills; convulsions; and, frequently, nausea or vomiting, excessive thirst, and/or shallow breathing.
Call 911 immediately
for emergency medical assistance. Until help arrives, position the child on his or her back. Loosen any restrictive clothing, elevate the legs on a pillow or a folded blanket or garment to help direct blood to the brain, and cover the child lightly to prevent chilling or loss of body heat. If breathing seems labored, raise the child’s head and shoulders very slightly. Do not give food or water or use a hot-water bottle to warm a child in shock.

Important:
Exposure to tetanus is a possibility whenever the skin is broken. Should your child incur an open skin wound, check to be sure tetanus immunization is current. Also be alert for signs of possible infection (swelling, warmth, tenderness, and reddening of surrounding area; oozing of pus from the wound), and call the doctor if they develop. Don’t apply tincture of iodine or Merthiolate; they can delay healing.

49. Bruises or black-and-blue marks.
If the injury is painful, encourage quiet play to rest the injured part. Apply cold compresses, an ice pack, or cloth-wrapped ice (do not apply ice directly to the skin) for half an hour (or for as long as your toddler will sit still). If the skin is broken, treat the bruise as you would an abrasion (#50) or cut (#51, #52). Call the doctor immediately if the bruise is from a wringer-type injury or if it resulted from catching a hand or foot in the spokes of a moving wheel. Bruises that seem to appear from “out of nowhere” or that coincide with a fever should also be seen by a doctor. Also report tiny pinpoint bruises, or under-the-skin hemorrhages. (These are
petechiae,
which may occur on the face and neck when a child has been coughing a lot or crying very vigorously, on the extremities when clothing has been restrictive, or because of viral infection or other illness.)

50. Scrapes or abrasions.
In such injuries, most common on the knees and elbows, the top layer (or layers) of skin is abraded (scraped off), leaving the
underlying area red, raw, and tender. There is usually slight bleeding from the more deeply abraded areas. Using sterile gauze, cotton, or a clean washcloth, gently sponge off the wound with soap and water to remove dirt and other foreign matter. If the child strenuously objects to this, try soaking the wound in the bathtub. Apply pressure if the bleeding doesn’t stop on its own. Apply a spray or cream antiseptic, if your toddler’s doctor generally recommends one, then cover with a sterile nonstick bandage that is loose enough to allow air to reach the wound. If there is no bleeding, no bandage is necessary. Most scrapes heal quickly.

51. Small cuts.
Wash the area with clean water and soap, then hold the cut under running water to flush out dirt and foreign matter. Some doctors recommend applying an antibacterial spray or ointment before taping on a sterile nonstick bandage. A butterfly bandage will keep a small cut closed while it heals. Remove the bandage after 24 hours and expose the cut to air; rebandage only as necessary to keep the wound clean and dry. Check with the doctor about any cuts on your child’s hands or face or if a cut shows signs of infection (redness, swelling, warmth, and/or oozing of pus or a white fluid).

52. Large cuts.
With a sterile gauze pad, a fresh diaper, a sanitary napkin, a clean washcloth—or your bare (preferably washed) hand if necessary—apply pressure to try to stop the bleeding; at the same time, elevate the injured part above the level of the heart, if possible. If bleeding persists after 15 minutes of pressure, add more gauze pads or cloth and increase the pressure. (Don’t worry about doing damage with too much pressure and don’t remove the original gauze pad—you could disturb any clotting that has already begun.) If the wound gapes open, appears deep, is jagged, if blood is spurting or flowing profusely, or if bleeding doesn’t stop within half an hour, call the doctor for instructions or take the child to the emergency room. If necessary, keep the pressure on until help arrives or you get the child to the doctor or ER. If there are other injuries, try to tie or bandage the pressure pack in place so that your hands can be free to attend to them. Apply a sterile nonstick bandage to the wound when the bleeding stops, loose enough so that it doesn’t interfere with circulation. Do not put anything on the wound, not even an antiseptic, without medical advice. If stitches are needed, ask if self-dissolving sutures can be used to spare your child the added ordeal of having them removed. If the cut is on the face, consider having a plastic surgeon look at it.