Boo-boos happen. Even when you’re conscientious, even when you’re painstakingly careful and ever vigilant, even when you’ve taken all the precautions and then some. Hopefully, most of the boo-boos that happen in your baby’s life will be small (the kiss-and-make-better variety). Still, you’ll need to know how to respond in the event of a bigger mishap, and how to care for injuries (such as cuts, bruises, burns, and breaks) that need more treatment than a cuddle—and that’s what this chapter is for. It will be even more helpful if reinforced with a live first-aid course. But don’t wait until baby tumbles down the stairs or chews on a rhododendron leaf to look up what to do in an emergency.
Now—before those incidents happen—become as familiar with the procedures for treating common injuries as you are with those for bathing baby or changing a diaper, and review less common ones when appropriate (snakebite, for example, if you live in a desert area or before you go on a camping trip). See that anyone else who cares for your baby does the same.
Below are the most common injuries, what you should know about them, how to treat (and not treat) them, and when to seek medical care for them. Types of injuries are listed alphabetically (abdominal injuries, bites, and broken bones, for example), with individual injuries numbered for easy cross-reference.
A gray bar has been added to the top of these pages, making them easy to flip to in an emergency.
ABDOMINAL INJURIES
1. Internal bleeding. A severe blow to your baby’s abdomen could result in internal injury. The signs of such injury would include: bruising or other discoloration of the abdomen; vomited or
coughed-up blood that is dark or bright red and has the consistency of coffee grounds (this could also be a sign of baby’s having swallowed a caustic substance); blood (it may be dark or bright red) in the stool or urine; shock (cold, clammy, pale skin; weak, rapid pulse; chills; confusion; and possibly nausea, vomiting, and/or shallow breathing). Seek emergency medical assistance by calling 911. If baby appears to be in shock (#46), treat immediately. Do not give food or drink.
2. Cuts or lacerations of the abdomen. Treat as for other cuts (#49, #50). With a major
laceration, intestines may protrude. Do not try to put them back into the abdomen. Instead, cover them with a clean, moistened washcloth or diaper and get emergency medical assistance immediately.
BITES
3. Animal bites. Try to avoid moving the affected part. Call the doctor immediately. Wash wound gently and thoroughly with soap and water. Do not apply antiseptic or anything else. Control bleeding (#49, #50, #51), and apply a sterile bandage. Try to restrain animal for testing, but avoid getting bitten. Dogs, cats, bats, skunks, and raccoons that bite may be rabid, especially if they attacked unprovoked. Infection (redness, tenderness, swelling) is common with cat bites and may require antibiotics.
Low-risk dog bites (bites from a dog that is known not to have rabies) do not usually require antibiotics, but it’s important to consult your baby’s doctor for any animal bite, both to decide on the need for antibiotics and for post-exposure rabies protection. Call the doctor immediately if redness, swelling, and tenderness develop at the site of the bite.
4. Human bites. If your baby is bitten by a sibling or another child, don’t worry unless the skin is broken. If it is, wash the bite area thoroughly with mild soap and cool water by running tap water over it, if you can, or by pouring water from a pitcher or a cup. Don’t rub the wound or apply any spray or ointment (antibiotic or otherwise). Simply cover the bite with a sterile dressing and call the doctor. Use pressure to stem the bleeding (#50), if necessary. Antibiotics may be prescribed to prevent infection.
5. Insect stings or bites. Treat insect stings or bites as follows:
Scrape off the honeybee’s stinger immediately, by scraping it horizontally with the edge of a blunt butter knife, a credit card, or your fingernail, or gently remove it with tweezers or your fingers.
(Try not to pinch the stinger, because doing so could inject more venom.) Then treat as below.
Remove ticks promptly, using blunt tweezers or your fingertips protected by a tissue, paper towel, or rubber glove. Grasp the bug near the head as close to baby’s skin as possible and pull upward, steadily and evenly. Don’t twist, jerk, squeeze, crush, or puncture the tick. Don’t use such folk remedies as Vaseline, gasoline, or a hot match—they can make matters worse. If you suspect Lyme disease (see page 770), call the doctor.
Wash the site of a minor bee or wasp sting, or an ant, spider, or tick bite with soap and water.
Then apply ice or cold compresses (see page 756) if there appears to be swelling or pain.
Apply calamine lotion to itchy bites, such as those caused by mosquitoes.
If there seems to be extreme pain after a spider bite, apply ice or cold compresses and call 911 for emergency help. Try to find the spider and take it to the hospital with you (avoid being bitten yourself), or at least be able to describe it; it might be poisonous. If you know the spider was poisonous—a black widow, brown recluse spider, tarantula, or scorpion, for example—get emergency treatment immediately, even before symptoms appear.
Watch for signs of hypersensitivity, such as severe pain or swelling or any degree of shortness of breath, following any bee, wasp, or hornet sting. Individuals who exhibit such symptoms with a first sting usually develop hypersensitivities, or allergies, to the venom, in which case a
subsequent sting could be fatal if immediate emergency treatment is not administered. Should your baby’s reaction to a sting be anything more than pain or swelling at the immediate site of the sting, report this to the doctor, who is likely to recommend allergy testing. If allergy is diagnosed, it will probably be necessary for you to carry a beesting emergency kit with you on outings during bee season.
It’s possible, of course, for sensitization to bee venom to occur without a previously noticed reaction, especially in a baby. So if after a sting your baby should break out in hives all over the body, experience difficulty breathing, hoarseness, coughing, wheezing, severe headache, nausea, vomiting, thickened tongue, facial swelling, weakness, dizziness, or fainting, get immediate
emergency medical attention.
6. Snakebite. It’s rare that a baby is bitten by a poisonous snake (the four major types in the U.S.
are rattlesnakes, copperheads, coral snakes, and cottonmouths or water moccasins—and all have fangs, which usually leave identifying marks when they bite), but such a bite is very dangerous.
Because of an infant’s small size, even a tiny amount of venom can be fatal. Following such a bite, it is important to keep the baby and the affected part as still as possible. If the bite is on a limb,
immobilize it, with a splint if necessary, and keep it below the level of the heart. Use a cool
compress, if available, to relieve pain, but do not apply ice or give any medication without medical advice. Get prompt medical help; and be ready to identify the variety of snake if possible. If you will not be able to get medical help within an hour, apply a loose constricting band (a belt, tie, or hair ribbon loose enough for you to slip a finger under) 2 inches above the bite to slow circulation. (Do not tie such a tourniquet around a finger or toe, or around the neck, head, or trunk.) Check pulse (see page 596) beneath the tourniquet frequently to be sure circulation is not cut off, and loosen it if the limb begins to swell. Make a note of the time it was tied. Sucking out the venom by mouth (and spitting it out) may be helpful if done immediately, but do not make an incision of any kind, unless you are four or five hours from help and severe symptoms occur. If baby is not breathing, give CPR (see page 593). Treat for shock (#46), if necessary.
Treat nonpoisonous snakebites as puncture wounds (#52), and notify baby’s doctor.
7. Marine animal stings. Such stings are not usually serious, but an occasional baby or child will have a severe reaction. Medical treatment should be sought immediately as a precaution. First- aid treatment varies with the type of marine animal involved, but in general, any clinging fragments of the stinger should be gingerly brushed away with a diaper or piece of clothing (to protect your own fingers). Treatment for heavy bleeding (#51), shock (#46), or stopped breathing (see page 596), if needed, should be begun immediately. (Don’t worry about light bleeding; it may help purge toxins.) The sting of a stingray, lionfish, catfish, stonefish, or sea urchin should be soaked in very warm water, if available, for 30 minutes, or until medical help arrives. The toxins from the sting of a jellyfish or Portuguese man-of-war can be counteracted by applying alcohol, diluted ammonia, or meat tenderizer. (Pack a couple of alcohol pads in your beach bag, just in case.)
BLEEDING see #49, #50, #51
BLEEDING, INTERNAL see #1
BROKEN BONES OR FRACTURES
8. Possible broken arms, legs, collarbones, or fingers. It’s hard to tell when a bone is broken in a baby. Signs of a break include: a snapping sound at the time of the injury; deformity (although this could also indicate a dislocation, #17); inability to move or bear weight on the part; severe pain (persistent crying could be a clue); numbness and/or tingling (neither of which a baby would be able
to tell you about); swelling and discoloration. If a fractured limb is suspected, don’t move the child (if possible) without checking with the doctor first—unless necessary for safety. If you must move baby immediately, first try to immobilize the injured limb by splinting it in the position it’s in with a ruler, a magazine, a book, or other firm object, padded with a soft cloth to protect the skin. Or use a small, firm pillow as a splint. Fasten the splint securely at the break and above and below it with bandages, strips of cloth, scarves, or neckties, but not so tightly that circulation is hampered. Check regularly to be sure the splint doesn’t cut off circulation. If no potential splint is handy, try to splint the injured limb with your arm. Though fractures in small children usually mend quickly, medical treatment is necessary to ensure proper healing. Take your child to the doctor or ER even if you only suspect a break.
9. Compound fractures. If bone protrudes through the skin, don’t touch the bone. Cover the injury, if possible, with sterile gauze or with a clean cloth diaper; control bleeding, if necessary, with pressure (#50, #51); and get emergency medical assistance.
10. Possible neck or back injury. If neck or back injury is suspected, don’t move baby at all.
Call for emergency medical assistance. Cover and keep child comfortable while waiting for help, and if possible, put some heavy objects (such as books) around the child’s head to help immobilize it.
Don’t give food or drink. If there is severe bleeding (#50), shock (#46), or absence of breathing (see page 596), treat these immediately.
BRUISES, SKIN see #47
BURNS AND SCALDS
Important: If a child’s clothing is on fire, use a coat, blanket, rug, bedspread, or your own body to smother the flames.
11. Limited burns from heat. If it’s an extremity (arm, leg, foot, hand, finger) that has been burned, immerse the part in cool water (if possible, and if baby is cooperative, hold it under running cool water). If baby’s face or trunk is burned, apply cool compresses (50°F to 60°F). Continue until baby doesn’t seem to be in pain anymore, usually about half an hour. Don’t apply ice, butter, or
ointments to the burn, all of which could compound the skin damage, and don’t break any blisters that form. After soaking, gently pat burned area dry and cover with nonadhesive material (such as a
nonstick bandage, or in an emergency, aluminum foil). Burns on the face, hands, feet, or genitals should be seen by a doctor immediately. Any burn, even a minor one, on a child under a year old warrants a call to the doctor.
12. Extensive burns from heat. Keep baby lying flat. Remove any clothing from the burn area that does not adhere to the wound. Apply cool wet compresses (you can use a washcloth) to the injured area (but not to more than 25 percent of the body at one time). Keep the baby comfortably warm, with extremities higher than heart if they are burned. Do not apply pressure, ointments, butter or other fats, powder, or boric acid soaks to the burn. If baby is conscious and doesn’t have severe
mouth burns, nurse or give water or another fluid. Transport the child to the ER at once or call for emergency medical assistance.