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In this article, the second in a series focusing on the health and safety of children, Shari L. Platt, MD, Chief of Pediatric Emergency Medicine at the Phyllis and David Komansky Center for Children's Health, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, describes some of the more common injuries and illnesses that can befall toddlers and young children, what parents should do in an emergency situation, as well as tips to prevent them.

Accidental Poisonings

Young children are particularly at risk for accidental poisoning, especially at home. "Toddlers have an oral fixation and everything goes into their mouth," says Shari L. Platt, MD, Chief of Pediatric Emergency Medicine at the Phyllis and David Komansky Center for Children's Health. A common source of accidental poisons is what Dr. Platt refers to as "Grandma's purse," in which small children find "treasures" such as candy and pills. "Parents should know that there are certain pills, such as calcium channel blockers, or some iron preparations, that may be lethal to a small child with the ingestion of just one pill. The important message here is 'prevention.' "

Safety bottle caps are not foolproof, and children may open most. "Safety bottle tops are only a temporary deterrent, and are not infallible. Parents should never leave medicines accessible to children, and any poisonous chemicals or cleaning material should be kept locked away and out of reach at all times," says Dr. Platt. Parents need to be especially vigilant when their child is visiting a home where there are no small children, as it is likely not childproofed.

If parents know or even suspect that their child has eaten or ingested a poison, they should call their regional poison control center immediately. In New York City, the number is 212-POISONS (212-764-7667), and the center is staffed 24/7 by trained toxicologists, ready to offer information and guidance. "If your child is stable, call them first," says Dr. Platt. "If your child is not stable, call 911 or go straight to an emergency department. If you know or suspect what was ingested, bring it with you."

Foreign Bodies

In keeping with the oral fixation of young children and toddlers, another common emergent entity is an airway or gastrointestinal tract foreign body. Many small objects may be placed in the mouth of a small child, and are either swallowed or accidentally slip into the narrow airway. Airway foreign bodies will immediately cause symptoms of choking and difficulty breathing. Over time, they may lodge in the large bronchial branch, leading to the lung, causing symptoms that may mimic pneumonia or asthma. The child may present either immediately, or at a later date, with symptoms of coughing, wheezing, fever, and rapid breathing. The symptoms are usually on one side, and a history of choking may direct the physician to suspect a foreign body. Objects may also be lodged in the esophagus, and will cause less obvious symptoms.

"Whenever a small child with new onset of respiratory symptoms comes to our emergency department, we must consider the possibility of a foreign body," says Dr. Platt. "Toys, beads, marbles, and foods such as peanuts, grapes and hotdogs are the most common objects that can lodge. Sometimes symptoms can be subtle, and parents may not notice them right away. Eventually, however, the child will start to have more obvious symptoms, and even develop difficulty breathing. It takes an astute physician to consider and explore for a foreign body."

X-rays will show items such as glass, metal and coins, however, many objects, such as food, plastic and beads do not appear. An otolaryngologist (ear, nose and throat doctor) will sometimes be called in to examine the airway with a special scope, when a foreign body is suspected. Objects that enter the stomach and pass through the gastrointestinal tract pose no problem. Parents may examine the stool for the object, and if it does not pass, they should follow up with their primary physician. If the child has no symptoms, such as abdominal pain or vomiting, it is most likely that the object had already passed, though it was not noticed.

Food Allergies

Today, nearly 6 to 8 percent of children under the age of 3 will have a food allergy. "The onset of food allergies typically begins at age 3, and 90 percent of children who have food allergies, will have presented by age 7," notes Dr. Platt. Infants may be allergic to milk, eggs, wheat, and soy, while older children may have allergies to nuts, shellfish, berries, and chocolate. Symptoms may include:

• hives; a red, raised itchy skin rash
• swelling in the face, tongue, or lips
• difficulty swallowing, speaking, or breathing
• burning in the mouth and throat
• wheezing or coughing
• abdominal pain or vomiting
• increased heart rate
• sense of impending doom

Parents should call 911 immediately if symptoms involve the mouth or airway. "Keep antihistamines and an EpiPen an auto-injector of epinephrine used to treat severe allergic reactions with you at all times, and develop a plan with your child's school in case an allergic reaction occurs during the school day. Use of the EpiPen may save a child's life, when it is needed." The food allergy and anaphylaxis network website offers outstanding education for parents of children with food allergies.

Burns

Burns are the 3rd leading cause of death in children, and the leading cause of unintentional death in the home for children 1 to 14 years of age. Children are often burned by contact with hot liquids, household appliances, and sun exposure; scalding burns (water over the temperature of 120oF) occurring in the bathroom or kitchen are the most common burn injury in young children. These burns can happen in the "blink of an eye", as a toddler knocks over a cup of coffee or tea, or grabs the handle of a pot of boiling water off the stove. Parents need only turn their back for a split second, and the spill occurs. Flame burns and electrical injuries are more typical in older children and adolescents, who may play with matches and fireworks, for example.

"Children are more susceptible to the adverse effects of burns, because they have a larger body surface area, thinner skin and less subcutaneous fat to protect their body from injury," explains Dr. Platt. "They are also more prone to hypothermia a drop in body temperature, so keeping them warm after a burn is important." In treating a burn at home:

Do not apply:

• butter, oil or toothpaste
• ice
• ointment or creams
• medicine
• fluffy cotton or adhesives

Do apply:

• cool water
• light gauze dressing
• and administer pain medicine (infants' or children's acetaminophen)

All burns in children should be evaluated immediately by a trained physician. If the skin is pink or reddened with no blisters (bubbles), it is likely a superficial burn (first degree) and will heal well with minimal risk. Skin burns that form blisters or cause the skin to be open and blackened may be either partial or full thickness burns, involving deeper layers of the skin, and require immediate emergency care. If the area of the burn is small, cover it with a clean cloth and take the child to the emergency department. If the area of the burn is large, call 911. Cover the child with a clean sheet or cloth and do not move the child unless there is a risk of further danger.

As with all injury, prevention is the best practice:

• Keep hot fluids (coffee, soup) out of reach at all times.
• Put matches in a high, safe place.
• Set the water thermostat at 120oF.
• Keep children out of the kitchen and away from boiling pots and pans (turn handles toward the center of the stove).
• Ensure safe use of irons or curling irons, and remember to unplug them and wrap cord up after use.
• Install outlet covers, as well as smoke and carbon dioxide detectors. Change batteries in smoke alarms with each daylight savings date.
• Avoid the use of extension cords or dangling cords.
• Don't smoke inside or leave lit cigarettes around the household.
• Always supervise children while they are in a bathtub, keeping their hands away from the faucet knobs.
• Teach children "Stop, Drop and Roll," a simple fire safety technique to extinguish fire on a person's clothes or hair.
• Develop a family evacuation plan, and where to go in case of a fire-related emergency.

In an upcoming Children's e-newsletter, Dr. Platt will discuss summer health and safety tips for children.

Faculty contributing to this article:
Shari L. Platt, MD, Chief of Pediatric Emergency Medicine at the Phyllis and David Komansky Center for Children's Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and Assistant Professor, Emergency Medicine, Weill Cornell Medical College