Pediatric Safety and
Prevention
Improving child health
• “health maintenance”
• “preventive health”
Health Promotion
Immunizations
• Effective in decreasing childhood
infectious diseases.
• Center for Disease Control (CDC) and
American Academy of Pediatrics
recommend that children be immunized
against 14 communicable diseases before
they reach 2 years of age.
• R
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Risks are outweighed by the lifesaving effects of immunizations.
Immunizations
• Specific recommendations by APA:
– Minor infections without fever are not
contraindication
– If reaction occurs, consult dr. before
next immunization
– Pertussis not give for children
over 6
Immunization Schedule
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)
Nursing Responsibilities
• Review immunization schedule for updates
• Know storing and handling requirements for all
vaccines
• Know the action of the vaccine
• Know administration routes, dosages, sites and
technique
• Aspirate with each injection
• May have multiple injections on same day,
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just be sure to give in separate sites
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Nursing Responsibilities
• Prior to administration, assess if
immunocompromised people are in the
household (discuss with M.D. alternatives to
live virus)
• Obtain careful history. Children should have
their immunization status assessed during all
health care visits, hospitalizations, and in
school. If immunizations are not current,
arrange to update them
• Assess if any reactions to past vaccines or any
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allergies to eggs.
Nursing Responsibilities
• Have parents sign permit with educational
instructions.
• Document - Record lot# and manufacturer of
vaccine; patient reaction
• Advise parents of side effects. Teach use of
antipyretics for fever. If fever persists for
>than 24 hours, or has other concerns - call M.D.
• Teach use of cold compresses to injection sites
for first 24 hours, then warm compresses
Do Not 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
Prevention of Injuries
Definitions
• Mortality- the # of deaths/100,000
• Morbidity- used to express the ratio
of sick to well in a community
• Infant mortality- # of children per
1000 live births who die before 1st
birthday
Major causes of death during infancy
and childhood (these represent death
rates for the ages of 1-14 yrs per
100,000)
• Accidents
• Congenital abnormalities
• Cancer
• Homicide
• Heart disease
• Pneumonia & influenza
• Suicide
• Human immunodeficiency
disease
Injuries
• Injuries are a major cause of death
in children.
• All children are at risk for injury
because of their normal curiosity,
impulsiveness, and desire to master
new skills.
INFANT
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SIDS
Motor Vehicle
Infections
Dehydration
Respiratory Problems
Child abuse
TODDLER
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Injuries: MVA
Toddler fracture
Poisoning
Foreign Body airway obstruction
Asthma, Croup, Respiratory problems
Vomiting, Dehydration
Child Abuse
PRESCHOOL
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Motor Vehicle -- Bicycle
Trauma
Poisoning
Asthma, Respiratory infections
Drowning
Child Abuse
SCHOOL AGE
• Motor vehicle: pedestrian - vehicle;
bike - vehicle
• Sports injuries
ADOLESCENT
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Trauma
Motor Vehicle
Knife and gunshot wounds
Pregnancy complications
Suicide
Poisoning
Drowning
Common Safety
Problems
Injury Prevention Measures
Common Safety Problems
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Aspiration
MVA
Burns
Drowning
Bodily injury/fractures
Aspiration
• Asphyxiation by foreign material in
respiratory tract is leading cause of fatal
injury in children under 1 year of age.
• Puts everything in mouth
• Very interested in body and newly found
openings
Aspiration – Preventive Measures
• Carefully inspect toys for potential danger /
removable parts.
• Keep small objects out of reach, floors free of
objects
• Do NOT feed hard candy, nuts, food with pits or
seeds, circular pieces of hot dogs
• Hold infant for feeding, do NOT prop bottle
• Use pacifier with one-piece construction and loop
handle.
Motor Vehicle Accident
• Vehicle – children improperly restrained
• Pedestrian
– Walking, running, especially after objects
thrown into street
– Poor perception of speed, lack of experience
to foresee danger
– Able to open doors and gates and get outside
– Children often unseen because of small size,
can be run over by car backing out of drive.
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Ride toys, bikes in path of danger
Motor Vehicle Accidents
Preventive Measures
– Use federally approved car restraints
– Supervise child while playing outside.
Do not allow playing behind cars.
Supervise riding of toys, bikes.
– Lock fences, gates, doors
– Teach to obey pedestrian safety rules
Burns
• Children are inquisitive and will
pull pots off stove, plays with
matches, inserts objects into
wall sockets
• They can climb - reaches stove, oven,
ironing board and iron, cigarettes on
table
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Unaware of sources of heat or
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fire
Burns - Preventive Measures
• Turn pot handles toward back of
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stove, place guardrails in front of
radiators, fireplaces, stoves.
Store lighters and matches in locked
container
Cover electrical outlets with
protective covers. Keep electrical
cords hidden
Check bath water. Do not allow
child to play with faucet
Drowning
• Child does not recognize danger of
H2O
• Unaware of inability to breath
underwater
• No conception of water depth
• Has curiosity about water
Hypoxia greatest concern
Drowning – Preventive Measures
• Fence around pools , have self-locking
gate
• Supervise when near water
sources
• Keep bathroom doors
closed and toilet seat down
• Teaching swimming and water safety
Bodily Harm - Fractures
• Like to climb, run, jump
• Still developing sense of balance
• Easily distracted from tasks
and hurt self
• Able to open doors and
windows
• Poor depth perception
Bodily Harm – Prevention
Measures
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Keep screens in the windows and locked
Place gates at top and bottom of stairs
Apply non-skid decals in bathtub or shower
Remove unsecured rugs, scatter rugs
Never leave unattended in shopping cart
Avoid giving sharp or pointed objects.
Do not allow lollipops in mouth when
running
Poisoning
Ingestion of toxic agents is common during
early childhood. Most common in 2 y/o
• 75% of poisons are ingested, others are by
dermal, inhalation, and ocular
• Reasons for poisoning:
 Improper storage
 Learning new tastes /textures, loves to
put things in mouth
 Developing fine motor skills – able to
open bottles, jars, cabinets. Climbs onto
shelves
 Cannot read labels
Sources of Poisoning
• Cosmetics, personal care products
• Household cleaners: Soaps, polishes
• Plants
• Drugs
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• Insecticides
Hydrocarbons -- gasoline
Therapeutic Interventions
 A poisoning may or may not
require emergency
intervention, but all should
have medical attention
 Parents are advised to call
the Poison Control Center
BEFORE initiating any
interventions
Therapeutic Interventions
1.
Assess the child – treat the child first,
not the poison
– Take vital signs– assess ABC’s
– Maintain respiratory function – provide
ventilatory and oxygen support
– Start IV infusion
– Draw blood for toxicology screen
– Apply cardiac monitor
– Initiate measure to reduce effects of
shock if applicable.
Therapeutic Intervention
2. Remove the child from exposure
– Empty out mouth of any pills, plants, or
other material
– Flush eyes with tap water
– Flush skin and wash with soap
– Bring child of inhalation poison into
fresh air
Therapeutic Intervention
3. Identify the Poison
 Question the child and witnesses. Try
to find out if only single product
ingested.
 Look around environment for clues
 Do the products ingested breakdown to
other substances?
 Find out amount ingested? Amounts
that cause concern
 1 ½ - 3 year old = 4.5 ml
 Adult = 15 ml
Therapeutic Intervention
4. Remove the Poison and Prevent absorption
Therapeutic Intervention
• Give activated charcoal
– Give orally
• Available in ready to drink solution
• Give in covered cup with a straw so child
does not see the black liquid
– Give through a gastric tube
– Give only after vomiting stops
Therapeutic Intervention
• Do NOT induce vomiting if:
– Patient is lethargic, comatose, seizuring, has an
absent gag reflex
– Patient ingested an unidentified material, a
corrosive substance or petroleum product
• Insert gastric tube and perform gastric
lavage with normal saline once airway is
protected with a cuffed endotracheal tube
• Place child in side-lying position to
decrease chance of aspiration.
Lead Poisoning
• Also called
Plumbism
• An environmental
disease caused by
the ingestion of
lead-based
materials.
Lead Poisoning
Causes
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Lead based paint
Lead solder
Battery casings
Lead fishing sinkers, curtain weighs
Bullets
Some ceramic ware, pottery, pewter
Lead Poisoning
Pathophysiology
• Lead in the body moves in the blood to soft
tissues and organs, teeth, and bones.
• Competes with calcium interfering with the
regulation of calcium
• Interferes with neurotransmission in the
brain causing encephalopathy and mental
retardation
• Interferes with synthesis of heme causing
anemia
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Damages tubules in the renal system
Assessment
• Gastrointestinal symptoms:
– Unexplained, repeated vomiting
– Vague chronic abdominal pain, colic
– Anorexia, anemia
• Central Nervous System symptoms
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Irritability, difficulty concentrating
Drowsiness
Ataxia, loss of skills, paresis or paralysis
Convulsive seizures from encephalopathy
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Arthralgia
Diagnostic Tests
Blood tests that indicate presence
of lead in the blood
*Levels of 10 u is harmful to the body
Therapeutic Intervention
• Criteria for treatment:
– < 9 units = not lead poisoning
– 10-14 units = trigger prevention activities,
rescreen
– 15-19 units = nutritional and educational
interventions and rescreening
– 20-44 units = environmental evaluation and
medications.
– 45-69 units = medical and environmental
interventions. Chelation therapy
– > 70 units = medical emergency
Stats on drug poisonings
Ask yourself:
• Why do you think the American
Pediatric Association no long advises
parents to keep syrup of Ipecac in
the home?
Lead Poisoning
Therapeutic Intervention
• Acute care
– Gastric lavage followed my magnesium sulfate.
Enema. Just want to rid body of lead.
• Chronic Care / Chelation therapy
– Administer meds that bind with the lead
• Calcium disodium edentate (EDTA) -- IV
• Dimercaprol (BAL) or D-Penicillamine -- IM
• Succimer -- orally
– Assess I & O – must have adequate urinary
output. Force fluids.
– Monitor mineral levels
Preventive Measures
• 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)