Identifying infant and toddler injuries that require emergency medical care

Bianca Edison, MD, MS is an attending physician in the Children's Orthopaedic Center at Children's Hospital Los Angeles, and is assistant clinical professor of Orthopaedics at the Keck School of Medicine of the University of Southern California. Edison is a licensed, Board-Certified pediatrician and Fellow of the American Academy of Pediatrics who completed a fellowship in Primary Care SportsMedicine. Her interests and experience include orthopaedic conditions affecting young children, teens, and athletes. Here she reviews common infant and toddler injuries, and how parents can determine if emergency medical care is needed.

It's wonderful to see children grow and learn new things. But along with every developmental milestone kids achieve is a new layer of curiosity. Think of kids as little scientists who like to experiment. They like to see cause and effect without knowing the risks and because of that, they can get into a bit of trouble and sustain injuries.

When a child sustains an injury of any type, it's difficult to see them experiencing pain or discomfort. But when that child is an infant or toddler, it's often more difficult to ascertain what happened and where they are hurting as the child lacks verbal communication skills.

Here's a staggering statistic: 45 percent of playground injuries are severe - fractures, dislocations and concussions. That's why it's important for parents and caregivers to be aware of the physical cues that accompany common pediatric injuries. These signs can help determine whether a child needs to seek emergency medical care.

HEAD INJURIES

Head injuries are extremely common with young children. Signs of a concussion that follow a head injury are significant and severe crankiness above and beyond what the child normally display, vomiting, slurred speech, exhibiting a difference in the way he/she walks. These symptoms are causes of significant concern and need immediate medical attention.

If a child is less than two years of age and sustains a fall more than three feet, or if a child is over two years of age and has sustained a fall more than five feet, a trip to the Emergency Room is in order.

Also, seek medical attention if your child has a soft spot on his head, called a fontanel, and it feels like it's bulging. A slowed or undetectable pulse, multiple vomiting episodes or any seizure-type activity can also be signs of head injuries. Those symptoms indicate there may increased pressure in the brain, swelling of the brain, or actual bleeding in the brain.

EYE INJURIES

An eye injury is detectable by a nosebleed in association with a black eye or bleeding within the whites of the eye. Go to the ER if there are two black eyes resulting from a head injury, sudden vision changes that are persistent like seeing double or blurred vision, or if the child has difficulty moving their eyes. Ask the child to follow your finger. If one eye follows it and the other eye stays straight, or if there's pain with the movement of the eye, there may be more significant trauma to the eye or there might be a brooding infection within the eye.

MOUTH and TOOTH INJURIES

When children are still learning how to walk or run and coordinate that movement with their growing bodies, they often fall and injure their mouths and teeth.

If a primary tooth (also known as a baby tooth) falls out, it's not an emergency, but a dentist should examine the child within 24 hours. An injury to permanent teeth is a dental emergency. If a permanent tooth comes out, gently rinse it off with saline (salt water) or warm milk. Always hold the tooth by the crown only, never by its roots because that can damage the nerves. Once the tooth has been rinsed off, you can re-implant it the best that you can, ensuring correct orientation. You want to do this within five to 20 minutes so the tooth doesn't die and an adult should always hold the tooth in place with a moist napkin or paper towel. A child should not be in charge of this task as they may not hold the tooth still, or the tooth could become dislodged and the child could choke on it. If re-implanting the tooth is difficult, place it in saline or warm milk and then seek emergency treatment. Remember that all missing teeth should be accounted for, and always follow up with your child's dentist to ensure there's not an underlining injury.

FRACTURES

The most common injury amongst toddlers and infants is fractures. Common locations where this happens are falling off beds, changing tables, sofas, coffee tables and even falling from a standing height. All it takes is the right angle and the right force for a fracture to be sustained. The most common fracture is the clavicle. Other common fractures are the elbow, wrist, legs and fingers.

How do you know if your child has a fracture? Some indicators include immediate swelling at the site of the injury, deformity and reluctance to use that body part (holding an arm close to the body or not putting weight on the leg).

Other signs that should prompt an immediate trip to the ER are the five Ps:

•Pain (extreme discomfort and sensitivity)
•Pallor
•Pulse (weak or not detectable)
•Parasthesia (numbness or tingling)
•Paralysis (inability to move the injured body part)

With a suspected fracture, always take your child to a facility that has a radiology center and someone there who can read the x-rays as soon as they are taken.

Remember, kids are very active and curious and injuries will occur, no matter how many safety precautions are put in place. That's why it's important to know what to do when something does happen.