Common Childhood Injuries

The bumps, bruises, scrapes, cuts and boo-boos of childhood are the true battlefield of parenting. In the beginning it will be your job to protect them from their environment. When they learn to move you will be protecting the environment from them. Accidents will happen no matter how well you protect them. A good parent will try to minimalize injuries by good baby-proofing and close supervision. The same good parent will take care of things when all the planning falls apart and life takes over. Hopefully this chapter will help reassure you and let you know injuries happen to all children and will allow you to respond with some preparedness and knowledge. Good luck, may the scars be minimal, the healing fast and the stories be funny.

Choking:

When anything except air gets in the way or goes down the airway we call the episode choking. Most of the time when a baby coughs the force of the air coming out of the lungs is enough to move whatever is in the airway out of the way. What we are worried about is when something gets stuck in the airway and coughing does not get it out. The most common cause of choking is going to be food and happens because the baby is trying to eat pieces that are too large, too much food at one time, swallow a hard piece of candy, or eat while walking and suck the food down the wrong tube when they fall. Other common objects found lodged in their throats are nuts, pins, small toys, marbles and coins. A good rule of thumb is any object that can fit through a toilet paper roll is a possible choking hazard. A child with a choking episode may present with difficulty breathing, coughing, a weak cry or cough, cyanosis (which is a way of saying turning blue), or unconsciousness. Depending on the symptom your child is showing, the intervention you make may change. If your baby is breathing with difficulty, coughing or crying then you know they do not have a complete obstruction. Watch the baby carefully and see if they can cough the obstruction out of the airway. If the baby starts to turn blue and stop breathing then it is time to intervene and begin rescue techniques you learned in your infant CPR class. Here is a quick review of the current choking recommendations from the American Red Cross.

Infant less than one year old: 

• If your baby is not able to cough up the object, ask someone to call 911 while you begin rescue treatment.
• If you are alone give two minutes of care then dial 911.
• If your baby cannot clear his airway and you believe they have an object lodged in their airway, position the baby facedown with the baby’s body lying on your forearm and his head and neck supported by your hand. Lay your forearm holding the baby across your thigh for support. Try to make sure the baby’s head is lower than his body. Use the heel of your free hand give five firm back blows between the shoulder blades to try to dislodge the blockage. Then with your free hand support the back of the baby’s head and neck and turn the baby face up. Still keep the head lower than the body, place two or three finger tips in the midline of their chest just below their nipples and give five chest thrusts pushing down ½ to 1 inch each time.
• Continue the sequence of five back blows to five chest thrusts until the object comes out or the baby starts to cough again. If coughing let the baby try to cough up the object. If the baby stops breathing again then restart the sequence. Only pull out the object if you can see it. A blind sweep in the baby’s mouth could push the object down farther into the throat.

Child older than one year of age:

• If your child is not able to cough up the object, ask someone to call 911 while you begin rescue treatment.
• If you are alone give one cycle of five back blows and five abdominal thrusts, then dial 911.
• Give five back blows using the heel of your hand between the child’s shoulder blades.
• Give five abdominal thrusts (Heimlich Maneuver). Accomplish this by wrapping your arms around the child’s waist, tipping them slightly forward, making a fist with one hand and placing it above the child’s belly button, and with the other hand grabbing the fist and beginning quick upward thrusts toward their upper back. Look in the child’s mouth for the object and if seen grab and remove.

Take a CPR class! The time you spend could very easily save your baby’s life.

Fractures:

Broken bones unfortunately happen in babies. The most common symptom of a fracture is going to be pain and they quit using that particular limb. The most common fractures vary depending on the age of the baby. In a newborn the most common fracture we see is a broken clavicle that often occurs in bigger babies with difficult deliveries. During the infant period fractures are going to happen most commonly when people drop them or they roll off of things. The fracture is going to vary depending on where they hit. During the toddler years the most common fractures are going to be skull fractures from falling and hitting their head, arm fractures from falling and trying to catch themselves with their arm, and finger fractures from getting their fingers slammed in doors. All suspected fractures should be seen by a doctor so the proper plan can be made to make sure the bone heals correctly and as quickly as possible. Luckily babies bones heal very fast so it will usually not have them down for long.

Head Injuries:

It is a good thing skulls are made of very thick bones because babies are going to hit their heads a lot. Part of this is because their head is so big in proportion to their body, part is because they are kind of klutzy, and part is because they are little risk takers and always trying to kill themselves. There are several things to consider when they hit their head. Does their head look abnormal? Did they cut themselves and need stitches? Did they hurt their teeth or bite their tongue? Did they lose consciousness? Do they act like they know who you are and where they are? Did they start vomiting? Are they having seizures? If you answered yes to any of the questions then you need to give your doctor’s office a call. Many people are worried about the size of the bruise or the amount of swelling they see. These are usually things we do not worry about and can vary depending on how many blood vessels were damaged with the injury and started to bleed. Luckily most hits to their head are going to be slight and the answer to the questions most of the time will be no. Try and reduce the amount of head injuries by baby proofing your house, wearing helmets if riding bikes, and watching them to make sure they are not trying to climb of the furniture, cabinets or drapes. What happens if they did lose consciousness? If they passed out on impact or shortly afterward then they have suffered a concussion. A concussion can happen without losing consciousness, but definitely if they are knocked out. A concussion is a bruise to the brain and your baby will need to be evaluated by a physician immediately. A concussion can be a sign of a more serious brain injury such as a skull fracture or a bleeding blood vessel in the brain. Most concussions will be self-limited and result only in a bad headache, a scary story and a good reason to avoid head injuries. When a person gets hit in the head and cannot remember what happened we call the condition amnesia. Amnesia is a common symptom of a concussion. The amnesia results in them not knowing who they are or where they are and is usually temporary. The amnesia to the details of the injury may be permanent. Doctors worry amnesia may be a sign a brain injury may be progressing such as a bleed in the brain. If your baby starts vomiting after a head injury, call your doctor immediately. The most common reason for vomiting after the injury is the baby is crying so hard they make themselves throw up. Vomiting can be a sign of increased pressure on the brain occurring from swelling of the brain or from blood around or in the brain accumulating to increase the pressure. If your baby starts to have seizures after a hit to the head, CALL 911 IMMEDIATELY! Your baby has a severe head injury with swelling or bleeding of the brain until proven otherwise. You will be seen immediately in the emergency department and have an emergency CT scan to determine where the injury is and what needs to be done. If they only have a large bump it is from swelling and blood accumulating under the skin. It is best to apply pressure and ice to the bruise. Do not put ice directly onto the skin. I recommend wrapping an ice cube in a paper towel or washcloth and applying to the swelling for 3-5 minutes at a time. If the bruise is large and over the eyes or at the bridge of the nose, as the blood settles the baby may develop a black eye.

Knocked out teeth:

Sad but true, sometimes a baby with those shiny white teeth takes a tumble or gets whacked and will knock out their teeth. Most of the time they are going to now be toothless until their permanent teeth come in, but before we give up hope there is some stuff to try. First take the tooth and try to shove it right back in where it came from. Sometimes it will stick in there and become tight in place again (to be completely honest I have heard this statement my entire career, but never had it work). If that did not work (you join my list of failures) drop the tooth into some milk. Now it is time to find a dentist quickly to see if they can help us out. Call the local emergency room and see if they have a dentist on call. If they do go there, if not you will want to get to a dentist’s office to see if they can salvage the tooth. If they cannot, do not despair, it happens frequently and they all seem to grow up fine and the missing tooth did not cause them any longterm problems.

Lacerations:

This is the fancy name for a cut. If a cut looks deep stitches may be required. So what makes a cut require stitches? We stitch up a laceration if it will not stop bleeding, if it is gaping open and looks like it would make a bad scar, or closing it up will reduce infections. If a laceration needs to be stitched up, a doctor needs to be seen right away. The longer it takes to fix the laceration the more likely it is to get infected. If a laceration is over 13 hours old most doctors will not stitch it up because of the increased risk of infection. Until you can get to the doctor try to wash the wound up thoroughly and keep pressure against the wound to reduce bleeding.

Nurse Maid’s Elbow:

This is a common toddler injury and will make you feel like a terrible person if it happens to your child (it is very common and you aren’t necessarily a bad person…although you might be). The most common way this happens is by pulling up on your baby’s hand when the weight of the baby is pulling down. This is the right mechanism to dislocate the end of the radius bone of the forearm at the elbow. Now you tell yourself this couldn’t happen to you…. right? Wrong, the most common way I see it happen is you are walking with your young toddler and you are holding their hand. They decide to throw a fit and before you realize what they are doing they throw themselves to the ground. Unfortunately their hand is stationary and attached to you as their body is hurtling its way to the ground. The next thing you know your have a baby who is crying, refusing to move its arm and holding it against their chest in the position you would normally see someone hold their arm if it was in a sling. This is something you are going to need to see a doctor about because it is very easy to fix and the pain is going to stop when it gets fixed. This is one of the most satisfying things to take care of as a doctor, because when you put the bone back in place they feel completely better.

Sprains:

Toddlers can sprain their ankles just like an adult and it’s more likely to happen to them. Sprains can happen with falls, getting their feet stuck while walking, or going up or down stairs. Just like an adult, their ankle will swell and it will hurt. The good thing is they will heal much faster than an adult would. Apply ice and elevate the foot. Try to get them to wear shoes with more support of their ankle for the next several days. If their limp is worsening or pain is not improving after a day or two it would be a good idea to have your pediatrician take a look and make sure there is not a fracture.