Pediatric Safety and Prevention Susan Beggs, RN MSN Summer 2008

Safety risks to developmental levels Infant Toddler Preschool School age Adolescent

Major childhood prevention measures Aspiration MVA Burns Drowning Bodily injury/fractures

Aspiration Leading cause of fatal injury under 1 year of age Prevention: Inspection of toys, small parts Out of reach objects Selective elimination of certain foods Proper posturing of the infant for feeding Pacifier with one piece construction

Motor Vehicle Accidents Vehicular risk greatest when child improperly restrained Pedestrian Prevention

Burns Children are inquisitive Become able to climb and explore Prevention of household injury:

Drowning Child does not recognize danger of H2O Unaware of inability to breath underwater No conception of water depth Hypoxia greatest concern Prevention

Bodily injury/fractures Still developing sense of balance Easily distracted from tasks Prevention:

Poisonings Common in early childhood (2 yrs) 75% poisons are ingested Major reason for poisoning:

Poisonings Sources of poison: Cosmetics Household cleaners Plants Drugs Insecticides Gasoline Household items

Stats on drug poisonings

Poisonings, cont Therapeutic interventions In every instance, medical eval is necessary Call poison control center 1st Remove child from exposure Identify poison Prevent absorption

Ask yourself: Why do you think the American Pediatric Association no long advises parents to keep syrup of Ipecac in the home?

Lead Poisoning Ingestion of lead-based materials “Maybe it’s the lead poisoning!”

Lead poisoning, cont Lead poisoning can cause: Brain and nerve damage Behavior problems Learning disabilities Slowed growth Headaches Low energy

Implications of lead poisoning Life threatening More likely to drop out of school Become disabled Disturbed brain and nervous system function Prevent child from full potential

Lead poisoning, cont Pathophysiology of lead poisoning System assessments Therapeutic Interventions

Criteria for treatment of lead poisoning < 9 not lead poisoned 10-14: prescreen 15-19: nutritional and educational interventions 20-44: environmental eval and medication 45-69: chelation therapy >70: medical emergency

Prevention is the key! Make environment lead-free Inspect buildings >25 years of age Areas painted with lead paint should be covered with plywood or linoleum Educate the parents Follow up testing for lead levels Screening all school age children (required in some states)

Immunizations Specific recommendations by APA: Minor infections without fever are not contraindication If reaction occurs, consult dr. before next immunization

Immunization schedules 4mos-6 yrs of age: DTaP (4 doses) IPV (3 doses) HepB (3 doses) MMR (@ 12 months) PCV (1 dose) 7-18 yrs of age Td (every 10 years after initial immunizations) IPV (not rec. if >18 yrs of age)

Nurses responsibilites with immunizations Know the action of the vaccine Careful history of patient Aspirate when injecting Educate parents (schedule, side effects) Proper documentation

Don't Forget! Assess for reaction 15-30 min after injection Epinephrine 1:1000 available Check immunization records with each visit Parent teaching: fever, or other symptoms