Toddler : Safety promotion and injury prevention : Discipline

    • Discipline
      • Limit setting: parents must be encouraged to set realistic limits on their children’s behavior beginning in the toddler period
      • Time out is an excellent form of discipline for toddlers 
      • Parent should be encouraged to redirect the child to an acceptable activity
      • Once the child is exhibiting appropriate behavior, or once time out is complete, the child should be praised for correct behavior 
      • Spanking is not recommended
    • Safety
      • Toddlers are inquisitive and must be watched at all times 
      • Toddlers are at high risk for accidental injury
    • Childproofing the home
      • Poisoning threats
        • Selected accidental poisoning in children
          • Corrosives (Strong Acids or Alkalis)
            • Items
              • Drain, toilet, or oven cleaners
              • Electric dishwasher detergent (liquid, because of higher pH, is more hazardous than granular)
              • Mildew remover
              • Batteries
              • Clinitest tablets
              • Denture cleaners
              • Bleach
            • Clinical Manifestations
              • Severe burning pain in mouth, throat, and stomach
              • White, swollen mucous membranes; edema of lips, tongue, and pharynx (respiratory obstruction)
              • Coughing, hemoptysis
              • Drooling and inability to clear secretions
              • Signs of shock
              • Anxiety and agitation
            • Comments
              • Household bleach is a frequently ingested corrosive but rarely causes serious damage.
              • Liquid corrosives cause more damage than granular/solid preparations. Liquids may also be aspirated, causing upper airway injury. Solid products tend to stick to and burn tissues, causing localized damage.
            • Treatment
              • Inducing emesis is contraindicated (vomiting redamages the mucosa).
              • Assess child’s breathing and level of consciousness.
              • Contact poison control center (800-222-1222) immediately. If the PCC or medical advice and treatment is not immediately available, it may be appropriate to dilute corrosive with water or milk (usually ≤120 mL [4 oz]).
              • Do not neutralize. Neutralization can cause an exothermic reaction (which produces heat and causes increased symptoms or produces both a thermal and a chemical burn).
              • Maintain patent airway as needed.
              • Administer analgesics (under medical supervision).
              • Esophageal stricture may require repeated dilations or surgery.
          • Hydrocarbons
            • Items
              • Gasoline
              • Kerosene
              • Lamp oil
              • Mineral seal oil (found in furniture polish)
              • Lighter fluid
              • Turpentine
              • Paint thinner and remover (some types)
            • Clinical Manifestations
              • Gagging, choking, and coughing
              • Burning throat and stomach
              • Nausea
              • Vomiting
              • Alterations in sensorium, such as lethargy
              • Weakness
              • Respiratory symptoms of pulmonary involvement, such as tachypnea, cyanosis, retractions, and grunting
            • Comments
              • Immediate danger is aspiration (even small amounts can cause bronchitis and chemical pneumonia).
              • Gasoline, kerosene, lighter fluid, mineral seal oil, and turpentine cause severe pneumonia.
            • Treatment
              • Contact poison control center (800-222-1222).
              • Inducing emesis is generally contraindicated.
              • Gastric decontamination and emptying are questionable, even when the hydrocarbon contains a heavy metal or pesticide; if gastric lavage must be performed, a cuffed endotracheal tube should be in place before lavage because of a high risk for aspiration.
              • Symptomatic treatment of chemical pneumonia includes high humidity, oxygen, hydration, and antibiotics for secondary infection.
          • Acetaminophen
            • Clinical Manifestations
              • Occurs in four stages:
                • Initial period (0 to 24 hours after ingestion)
                  • Nausea
                  • Vomiting
                  • Sweating
                  • Pallor
                • Latent period (24 to 72 hours)
                  • Patient improves
                  • May have right upper quadrant abdominal pain
                • Hepatic involvement (72 to 96 hours)
                  • Pain in right upper quadrant
                  • Jaundice
                  • Vomiting
                  • Confusion
                  • Stupor
                  • Coagulation abnormalities
                  • Sometimes renal failure, pancreatitis
                • Patients who do not die in hepatic stage gradually recover.
            • Comments
              • It is the most common accidental drug poisoning in children.
              • Toxicity occurs from acute ingestion. Toxic dose is 150 mg/kg or greater in children.
            • Treatment
              • Antidote N-acetylcysteine (Mucomyst) is equally effective given intravenously or orally. When given orally, may first be diluted in fruit juice or soda because of the antidote’s offensive odor. An antiemetic may be given if vomiting occurs.
              • It is given as 1 loading dose followed by 17 additional doses in different dosages. Intravenous administration is given as a continuous infusion.
          • Aspirin (Acetylsalicylic Acid [ASA])
            • Clinical Manifestations
              • Acute poisoning (early symptoms)
                • Nausea
                • Hyperventilation
                • Vomiting
                • Tinnitus
                • Diaphoresis
              • Acute poisoning (later symptoms):
                • Hyperactivity
                • Fever
                • Confusion
                • Seizures
                • Renal failure
                • Respiratory failure
              • Chronic poisoning