Infant and Toddler Growth and Development

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Infant and Toddler Growth and Development

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Title: Infant and Toddler Growth and Development

1
Infant and Toddler Growth and Development

Elisa A. Mancuso RNC, MS, FNS
Professor of Nursing

2
Growth of Infant

Cephalocaudal (head ? toe)
Proximodistal (trunk ? periphery)
General ? Specific (Large ? fine muscles)
1 a month during 1st 6 months
Average Ht
6 months 25 ½ inches
12 months 29 inches
Use recumbent length until 3 years
than standing (vertical height)

3
Weight

5-7oz/wk until 5-6 months
Birth weight doubles at 6 month
Birth weight triples at one year
Always refer to kilograms
2.2 lbs 1 kg
All medications based on weight in kg!

4
Head Circumference HC

Reflects brain growth
Posterior fontanele closes _at_ 2 mos.
Anterior fontanel closes _at_12-18 mos.
Measure (Forehead ? Occiput)
For 1st 3 years

5
Chest (CC) and Abdomen

Chest Head circumference _at_ 1 year
Measure _at_ nipple line.
Barrel chested as infant
Chest gt Head after 3 years
After 1 year of age,
A/P transverse diameter 12
Abdominal Girth
Measure above umbilicus
v Abdominal distention
R/O liver or intestinal diseases

6
Growth Charts

Serial exams to assess growth progress
Plotted as percentiles
25th , 50th , 75th , 95th .
_at_ 95th Pt gt 95 of kids.
Used to notice any ? or ? in weight, height, or
HC.
Specific charts for premature infants

7
Denver Developmental Screening Test (DDST)
Denver II

Assesses from birth ? 6 years
Age divided monthly ? 24 months,
then q 3 mos. ? 6 years
Not an intelligence test
Four categories
Personal/Social
Fine motor/Adaptive
Language
Gross motor

8
Infant Reflexes

Moro - Startle
Loud sound extension abduction of extremities
Tonic neck Fencing
Turn head to one side
arm leg extend on side
Babinski
Dorsiflexion of big toe and toes fan out
All of above disappear in about 3-4 months

9
Developmental Skills

Trust vs Mistrust (Birth to one year)
Social responsiveness to others
Trust develops with regular consistent, loving
care
Self reliance and develops confidence
Early infancy 0 - 3 months
Smiles at significant other
Holds head chest up when prone
Reaches for objects-grasp
Laughs

10
Developmental Skills

Early Infancy 4-6 months
Pulls self to sitting position
Sits with support
Rolls over Safety issue
Tummy ? back first at 2-3 months
Back ? tummy by 6 months
stronger head and arm control
Transfers objects from hand to hand
Makes vowel sounds oh-oh

11
Developmental Skills

Late Infancy 6-9 months
Hold own bottle
Develops preference for dominant hand
Probes with index finger
Feeds self finger foods
Pincer grasp _at_ 9 months
thumb and index finger used
Sits erect-unsupported
Crawls
Separation Anxiety ?cries with strangers
Object Permanance
Searches for items outside field of
vision

12
Developmental Skills

9-12 months
Triple birth weight and ? height by 50
Releases objects
Pulls self to feet
Sits from standing position
Walks with help
independent walking can be as late as 18 months!
Responds to name
Recognizes no
Says 4 -5 words mama, dada, no, bye
Teething (age 6 of teeth)
12 mos 6 6 teeth
Cool cold items to chew on
Tylenol 10-15 mg/kg q 4-6 hours

13
Developmental Tasks

Achieve physiological equilibrium
Rest, eat, play patterns
Develop basic social interaction
Desire for affection
Manage a changing body
?motor skills eye-hand coordination
Learn to understand and control world
Develop a beginning symbol system
Communication

14
Immunizations

Regulated by CDC and American Academy of
Pediatrics (AAP)
www.cdc.gov/nip/vacsafe
www.immunize.org
? Infectious diseases ?morbidity mortality
? incidence of recent outbreaks
immigration from poorly compliant countries
religious beliefs or cultural influences
? trust of medical care or poor education
2003 Nigeria stopped IPV
Rumors that IPV could transmit AIDS
2006 20 of kidslt5 no IPV and ? polio
outbreak
2005 Amish Polio outbreak

15
2009 Immunizations

Hep B Hepatitis B Vaccine (IM)
Birth, one month and six months
Mom () HBsAg
give baby HBIG (0.5mL) Hep B within 12H
_at_ 2 separate sites
90 infected infants ? chronic Hep B carriers
25-50 infected before age 5 RT HBV Carriers
? Transmission risk in adolescents
All kids entering 7th grade must have Hep B
3 dose series

16
Immunizations

IPV - Inactivated Polio Vaccine (SC)
2, 4, (6-18) months and (4-6) years
Formerly used OPV Virus shed
Contraindication Allergy to neomycin
HIB - Hemophilus Influenza Type B (IM)
2, 4, 6 and (12-15) months
Not associated with Flu
Protects against many serious infections
Epiglottitis and Bacterial Meningitis

17
Immunizations

PCV7 - Polysaccaride Conjugate Vaccine-
(Prevnar) (IM)
2,4,6 and (12-15) months
PPV Pneumococcal Polysaccharide (IM)
One dose gt 2 years
Protects against Strep pneumonia
6-12 months of age at high risk for S. pneumoniae
? Risk patients
Sickle cell disease, HIV/immune deficiency
chronic cardiac or pulmonary etc
Must receive PPV vaccine in addition to PCV

18
Immunizations

DTaP - Diptheria, Tetanus and acellular Pertussis
(IM)
Diptheria
Rare throat infection
Gray/yellow film
difficult to remove
Air flow obstruction
Sepsis
Tetanus
Clostridium produced in infected wounds
Severe muscle extension

19
Immunizations

Pertussis
Gram negative bordetella pertussis
whooping cough
Post-tussive vomiting
Cyanosis
Subconjuctival hemorrhage
Three stages
catarrhal, paroxysmal (2 weeks) and decline
? outbreaks in Adolescents and Adults
RT ? titers
www.pertussis.com

20
Immunizations

DTaP Schedule
2,4,6,15 months and 4-6 years for DTaP
v Side Effect Redness swelling _at_ site
New booster recommendations 2005
Tdap Adacel one dose 11- 64 years or
Boostrix single dose 10 -18 years of age
Adolescents 11-12 years of age should receive
single dose of Tdap instead of Td
(if up to date and have not yet received Td
booster)
Need 5 year interval from Td to Tdap to ?SE
Contraindication
Encephalopathy in 7 days of DTaP

21
Immunizations

MMR - Measles, Mumps and Rubella (IM)
Measles
Viral illness - macular/papular rash
Kopliks spots oral mucosa
Encephalitis/pneumonia
Mumps
Inflammation salivary glands/parotid
Boys develop orichitis/sterility
Rubella
Viral illness- rash (face ? body ? extremities)
Pregnancy exposure
Fetal deafness, cataracts, cardiac defects,
encephalitis

22
Immunizations

MMR is live attenuated (weakened) vaccine
12-15 months and 4 - 6years
Contraindication
Pregnancy
Immunocompromised
Allergy to neomycin

23
Immunizations

Varicella (SC)
Varicella chickenpox
Live attenuated virus healthy children only
12-18 months
2nd dose _at_ 4-6 years
2005 - All kids entering 6th grade
?Risk gt 13 years
Give with MMR
MMRV new vaccine
Contraindication
Pregnancy
Immunocompromised or
Allergy to neomycin

24
Immunizations

MCV4 - Meningococcal Conjugate Vaccine 4 (IM)
MPSV4 - Meningococcal Polysacharide (SC)
Protects against N.meningitids (not all strains!)
MCV4/ Menactra
One dose 11-12 years or _at_ high school entry or
college freshman in dormitories
(?risk smoking and crowds)
MPSV4/Menomune
Childrengt 2- 10 years ?risk factors
Sickle cell disease.

25
Immunizations

TIV -Trivalent Inactivated Vaccine Influenza
(IM)
Influenza virus ? pneumonia and death
2004 -152 pediatric deaths
?? of cases in February
6 mos - 5 years of age annually
gt 5 years only high risk population.
0.25mllt3 years or 0.5mlgt3 years
Contraindication Egg Allergy
v Eat baked goods can have vaccine
LAIV - Live Attentuated Influenza Vaccine
gt 5 years (2 doses 1st time)

26
New Vaccines Added

Rotavirus vaccine Rototeq
Rotavirus is primary cause of acute
gastroenteritis in US
Three oral doses given at 2, 4 and 6 months
Dosing must be complete by 8 months of age
No catch-up for older infants
Do not re-administer if infant spits up

27
New Vaccines Added

Human Papillomavirus (HPV)
Non-enveloped dbl stranded DNA virus
gt100 types with 15-20 oncogenic types
75 of sexually experienced men and women age
15-49 years have had some type of HPV
Quadrivalent HPV vaccine (Gardasil)
Protects against HPV 6,11, 16 18
Type 16 and 18 account for approx 70 of cervical
cancers
ACIP recommended 6/29/06
Routine vaccination of girls 11-12 years but may
begin _at_ 9
Catch-up vaccination for adolescents and young
women who have not been previously vaccinated
Not indicated in pregnancy or hypersensitivity to
substances

28
New Vaccines Added

HPV administration (3 separate doses 0.5ml IM )
1st dose on elective date
2nd 2 months from first
3rd 6 months after first dose
SE
Very painful
Syncope tonic clonic movements
v Pt remains seated or lies down x 15 minutes
Compliancy Issues
Moral issues can intervene
Study with boys shows a good immune response
? Vaccinate girls RT ?? risk of Cervical CA

29
Only true contraindications to vaccine
administration

Fever gt102
Immunocompromised (No MMR Varicella)
HIV, Leukemia, Lymphoma
Alkylating agents or Antimetabolites
Daily Corticosteroids Dose
gt 2 mg/kg or 20 mg/day
Allergy to vaccine component
Vaccine Adverse Event Reporting System
(VAERS)

30
Congenital defects

Cleft palate
1/750 births cleft lip
1/2500 births cleft palate
Incomplete closure of the roof of the mouth
6th -10th week of gestation
Opening from uvula? soft palate ? hard palate ?
lip
Cleft palate 1st sign
Formula coming out of nose
Gloved finger to assess soft and hard
palate in
newborn

31
Etiology

Multifactorial
Genetic-familial tendency
? in Asians and lowest in African Americans
? Caffeine
? ETOH
Dilantin or Valium
?Folic Acid ? Vit A
Sequella
Feeding difficulties
Speech difficulties
High risk for Otitis Media
Serous and Bacterial

32
Interventions

Review defect
Impact on infant
Before and after photos
Support Groups
3P Feeding technique
Position - upright
Pore - soft, premie nipples
enlarged opening
Patience - burp frequently

33
Surgery

Lip repair usually 1-3 months
Protect incision line after operation
Palate repair _at_ 18 months
Supine with ? HOB
Elbow restraints
v I O

34
Tracheoesophageal (TEF) Fistula

Fistula
Opening between trachea and esophagus
Fluids enter lungs
? Aspiration PN
Large amounts of air into stomach
Esophageal Atresia EA
Esophagus ends in a blind pouch
? in Pre-term and/or Polyhydramnois
30-50 multiple anomalies

35
TEF/ EA Clinical Signs

Increased salivation
Drooling
3 Cs
Choking
Coughing
Cyanotic episodes
Laryngospasms
Abdominal distension
Unable to pass NGT with atresia

36
Interventions

NPO
? HOBgt30º
Maintain patent airway
NGT to low intermittent suction
Prophylactic antibiotics
Aspiration PN
Surgery correction of fistula
ASAP

37
Safety in Infants

Accidents leading cause of death btwn 6-12 mos
Suffocation/Aspiration
1 cause of fatal injuries lt1 year
v toys, mobiles
No H2O mattress or pillows
Falls
Walkers 45
Burns
H2O temp _at_ 160 scalds skin in 10 seconds
? Temp to 120
Poisonings
Plants, Cleaners, Grandmas purse v meds
Cars
Car seat lt 1 year back seat, facing rear

38
Nutrition

Vitamins for Infants
Fluoride
0.25mg/day gt 6 months - 3 years
Poly-vi-flor 1cc QD
gt3 years ? 0.50mg/day
FeSO4
0.5mg/kg/day gt 6 months
if BF mother not taking supplements
after 6 months fetal stores are depleted)
Vit D
400 IU/day
if BF mother not taking supplements

39
Breast Milk

Contains all nutrients and
A,B, E
Immunoglobulin IgA, T and B cells
Lacks Vit C, D and Fe
Twice sugar (lactose) laxative effect
? of stools
?? lactalbumun more complete protein
?? caesin easier to digest

40
Formula

No more than 32 oz/day
No whole milk in infants!
No iron in milk
Infants unable to properly digest
? ? irritation of intestinal mucosa, bleeding and
anemia

41
Solids

Begin at 4-6 months
Too early introduction of solids
? incidence of allergies and celiac disease.
No cereal in formula bottle!
Assess physiological readiness
? Tongue extrusion reflex
? Coordinated suck swallow
Tooth eruption ? biting chewing
? Pancreatic enzymes for complex nutrients
Introduce foods one at time
New food after 3 days
Cereal ? vegetables ? fruits ?meats ? egg yolks
No egg whites lt1 year
No honey/corn syrup lt2 years
? Risk of botulism
No Nuts, Seeds or Popcorn

42
Kwashikor

Severe protein deficiency
Adequate caloric intake and ? ? carb diet
Mycotoxin mold found in intestines
Signs and Symptoms
Scaly, dry skin and ? pigmentation
Hair thin/dry and coarse
Ascites
Edema RT ? protein
Muscle atrophy
Irritable, lethargic, withdrawn
Permanent Blindness
Diarrhea?Infection ?Death

43
Nursing Interventions

Assess degree of malnutrition
Neurological/muscular impairments
v Developmental milestones
Hyperalimentation
? Protein diet
Antibiotics
Skin Care
Collaborate with OT and PT

44
Skin Disorders

Eczema (5-7 Infants)
RT allergies (egg, soy and cows milk)
? Ig E levels RT ? Histamine, Prostaglandins,
Cytokines
? with stress
90 develop asthma
Signs and Symptoms
? in winter
Skin Rash
Erythematous, edematous,
Pruritic, dry and cracked
? Lesions in skin creases,
Cheeks, forehead scalp
? Risk of secondary infections

45
Treatment

Hydrate
Brief bath with Dove soap
Lubricants Eucerin cream
Topical steroids
Antibiotics if secondary infections
Elidel and Protopic 0.03 non-steroidal
Pimercrolimus and Tacrolimus
Only for children gt 2 years
Black box warning
?? risk of cancer

46
Impetigo

Toddlers and Preschoolers
? incidence in Summer (hot/humid)
1st Skin is broken via bug bite
infected - staph A or B strep
Very contagious
1st Macular Pruritic
2nd Honey crusted, thick bleed
Therapy
Wash lesion c warm soapy H2O
Soak and remove crusts
Bactraban BID 7 days
PO Antibiotics
PCN, EES, Lorabid, Zithromax

47
Sebborrheic Dermatitis

Cradle Cap
Chronic inflammatory
condition
Dysfunction of
sebaceous glands
Infants produce a lot of sebum
Yellow scales from eyelids ? Scalp
Therapy
Apply lotion, massage scalp
Fine comb remove scales

48
Toddler 12-36 months

Growth slows Physiological anorexia
Average weight gain 4-6 lbs/year
BW quadrupled by 2 ½ years
Height 3 inches/year
HC growth slows
A/P diameter 12
Visual acuity 20/40
Eyes can accommodate objects _at_ distance
? Neuromuscular control
Manipulates objects people

49
Psychosocial Development

Autonomy vs. Shame and Doubt
Me do stage
Intense exploration of environment
Fighting for autonomy
Negativism No
Ritualistic behavior to control their environment
Body Image develops

50
Psychosocial

2nd Separation Anxiety
Cling and cry when left by parent
Be honest regarding separation do not disappear!!
Body image develops
knows certain body parts eye, pee pee
Begins to acquire socially accepted behaviors

51
Toilet training

Holding on and letting go is very important!
Need to recognize the urge to let go
1st Bowel control after 18 months
2nd Bladder control _at_ 2½ - 3½ years
Daytime bladder control before nighttime
Regular BM and patterns or child will alert you
Needs ? awareness and self discipline
Harder to train children with history of
constipation

52
Temper tantrums

Common response to helplessness or frustration
Inadequate verbal skills
Cant communicate needs!
Strike out physically
Monitor for speech delay children!

53
Interventions

Set appropriate, clear and consistent limits
Safely isolate and ignore behavior
Remove from situation
Redirect or introduce another activity to restore
self-esteem
Time out minute per age
Do not let toddler get too tired, hungry or
stimulated
After tantrum subsides provide love and
attention

54
Developmental skills

300 words by 2 years.
Understand more than they say
2 yr old 65 of speech should be comprehendible
Knows first and last name
Dressing - takes off own clothes
Walk, run, and jump with both feet
Ride tricycle, build tower of blocks
Parallel play
Possession ownership
Ritualism
Comforting ? Anxiety

55
Intellectual development

5th Stage of Sensorimotor _at_12-18 months
Object permanence
Exists when not visible Whered it go?
Peek a Boo
Active experimentation
Time perception
Holidays, morning, noon, night
1 minute 1 hour
Space perception
Nesting
Stands on stool to get object
Magical thinking

56
Pre-operational Stage

Transitional Stage 18 - 24 mos
? Trial and error
Memory and imitates actions.
sweeping floor with broom is mom cleaning
? Problem solving
Egocentric- I me mine
Concrete thinking
Literal translation
A little stick for IV tree branch
Sense of Time
Orientation RT activities
Mom will be back after nap instead of at 2
oclock.

57
Toddler Developmental Tasks

Differentiate self from others
Toleration of separation of parents
Slight delayed gratification
Basic toilet training
Socially acceptable behavior
Biting and spitting bad!
Communicates effectively
Transitional objects
Favorite toy, blanket
? stress

58
Nutrition

? Growth period ? protein and fluids
Physiological Anorexia _at_ 18 mos
? nutritional need ? ?appetite
Daily diet
Milk 2-3 cups/day
? FE, CA, PO4
Very fussy and food jags (1-2 items only!)
Only peanut butter and bananas!
Want to feed themselves MESSY!
May eat a lot one day
and not much following day

59
Nutrition

Offer small, frequent nutritious snacks
Toddlers love to graze
Not too much milk or juice (? sugar)
Fills them up wont eat
Do not force child to eat.
Will eat when hungry.
If child is not losing weight it is ok.

60
Dentition

Twenty primary teeth by 30 months
Brush teeth 2 x/day!
No bottles of juice or milk at bedtime.
Dental carries can occur.

61
Safety

Toddlers have no sense of danger
?? Locomotion DANGER!!
Injuries cause gt death in ages 1-4
Motor Vehicle Crash (MVC) 1!
? Caused by lack or improper restraint
SUV
toddlers wander behind truck and get hit.
DWI
2500 kids/year
7/10 in car with impaired parent

62
Car Seat Safety Rules

Universal Child Safety System (UCSS)
2 point attachment with tether system
by 2002 all new cars must have entire UCSS
lt12 years of age sit in back of car
Infant rear facing (1 yr and 20 lbs)
Forward facing convertible seat till 40 lbs
gt40 lbs belt positioning booster seat
New York State Seatbelt Laws
March 2005 any child lt7 years of age
appropriate restraint system or booster seat
80 lbs or 4 ft 9 inches may use
seatbelt
Seat belt must fit properly
on hips not stomach
on shoulder not neck

63
Drowning

2 cause of death for toddlers
Totally Preventable!
Only need 1 of H2O to drown
Bucket to clean car
Ponds
Pools
Beach
Always supervise near water!

64
Burns

3rd cause of death (boys)
2nd among girls
20,000 injuries/year and 1,000 deaths
16 RT child abuse
Types
Thermal- flames, scalds (85),hot objects
Electrical- socket, chewing wires
Chemical- Ingesting cleaning products
Radiation- sunburn

65
First Degree/Superficial (epidermis)

Minor sunburn
Red, dry and painful
Heals spontaneously
3-7 days
No therapy needed

66
Second Degree Partial Thickness

Involves epidermis and upper layer of dermis
Moist, bulla
Skin bright red
Painful
Heals in 14 - 21 days with scarring

67
Third Degree/ Full Thickness

Includes subcutaneous tissue
Dry, pale or brown/black
PAINLESS
Eschar-
thick leather like
dead skin
Healing requires skin grafting
? painful

68
Fourth Degree/ Full thickness

Extends all the way to bone
Dry, whitish leathery appearance
?Sensation to pain
Scarring and contractures

69
Total Body Surface Area (TBSA)

Varies with age
? age ? TBSA
? surface area ? Injury
Rule of Nines
Determines of burns
Transfer to burn unit BSAgt10
Open palm of hand 1 of BSA
Thorax 18 Head 19
Arm 8 Leg 13

70
Management

Respiratory
Maintain patent airway
R/O Inhalation injury
Smoke, steam, toxic fumes
Charred lips, singed nasal hairs,
soot covered nares
Humidified 100 O2
Assess for
Respiratory Acidosis
? RR, retractions, nasal flaring, ??effort, ?O2
Moist Breath sounds Pulmonary edema
v Carboxyhemoglobin (CoHb) levels
gt 10 need hyperbaric chamber

71
Fluid Resuscitation

Hypovolemic Burn Shock
?? capillary permeability
Leakage of intravascular fluids
?? Perfusion, ?? BP, ?? HR, ? Output
Parkland Formula 4mL LR x kg x TBSA
1st 24 - 48 hours until capillary integrity is
restored
IV Maintenace Fluids 421 Rule
4mL/kg for 1st 10 kg 45 kg child 4 x 10 40
mL
2mL/kg for 10-20 kg 2 x 10 20
mL
1mL/kg gt20 kg 1 x 25 25 mL
85 mL/H
Maintain urine output 1-2ml/kg/hour-(foley)
Strict I O!
v SG v Wt.
v VS and LOC

72
Monitor Lab values

Hyperglycemia
? NE/E, ?stress, insulin resistance, glycogen
released
Hyponatremia
3rd spacing 1st 24 hours ?NA excretion
Hyperkalemia
1st 24 hours ? cell release of K
Hypokalemia
2nd 24 -48 fluid shifts back to cell ? K
Hypoalbuminia (lt2)
? serum proteins 3rd spacing
Albumin 1 gm/kg/day
Metabolic acidosis
Renal failure, tissue damage RT sepsis
?BUN ?Creatine ? SG
Dehydration renal failure

73
Pain Management

Acute
Burned skin and exposed nerves
Moaning, grimacing, restlessness, guarding,
dilated pupils, clenched fists,?? movement
Procedures PAIN
Dressing changes ?? anxiety ?? fear
Medicate prior to all procedures.
MSO4, Propofol, Fentanyl, Hydromorphone
Imagery, relaxation, distraction
Therapeutic Touch

74
Wound Care

Aseptic/sterile technique
??risk of infection
Invasive lines, compromised immune
Protective Isolation
Debridement
Remove dead tissue
Hydrotherapy
Soaking wounds - remove old dsg
10 mins to prevent electrolyte and fluid loss
Washing area
Clean area assess wound
v color, drainage, odor, sloughing, granulation
tissue

75
Antimicrobial creams

Mafenide Acetate (Sulfamylon cream)
Painful but penetrates eschar
Gram ()/(-) coverage
Apply leave OTA or light dsg
v Sulfa allergies
Hypersensitivity reaction
SE Metabolic acidosis

76
Antimicrobial creams

Silver Sufadiazine (Silvadene)
Painless
Gram (-)/() coverage
Not to use on face or electrical burns
1st Clean wound
Apply leave OTA or light dsg
v Sulfa allergy
SE Transient leukopenia

77
Antimicrobial creams

Silver nitrate 0.5
Most gram () some gram (-)
Painless soak
Dampen dsg q 2H or TID
Need large bulky dsgs
Stains clothing and linens -black
SE ? K ? Na ?Cl
v lytes

78
Skin Grafts

Autograft
Patients own skin
? risk for Host Versus Graft (HVG) response
Transcyte
Newborn foreskin
Bioactive skin substitute
? Re-epithelialization
? dsg changes ? hospitalization
?scarring

79
Nutritional Support

NPO x 24 hours
v Bowel sounds v Abd girth v N V
Curlings Ulcer
? GI perfusion ? occult blood via NGT stool
2-3 times daily calories for wound healing
? BMR RT ? Protein N loss
Protein 25 of calories-
eggs, peanut butter and milk
?? Vit A and C important for skin
oranges, grapefruit
strawberries, broccoli

80
Psychological Needs

? Contractures ?ROM RT scars
Pressure Ace wrap cover to ?? scars
Increase involvement in care
Play therapy counseling
Ease transition ? community
Prepare friends and school
Wounds/scarring emotional needs
Support groups

81
Poisoning

150,000 kids lt 5 years old 120 deaths/year
? risk _at_ 2 years (improper storage)
Poison Control 1-800-222-1222
www.nyc.gov/html/doh/html/poison/poison.shtml
Aspirin Intoxication-
1 most ingested drug
ASA acetylsalicylic Acid
? Availability in home
Combination OTC meds
Peptol bismal, cough and cold, wart preparations
Therapeutic Dose 40 -100 mg/kg
Toxic dose 200mg/kg
Severe toxicity 300 - 500mg/kg

82
Signs and symptoms

6 H delay before toxicity signs noted
Hyperventilation
?? RR ??CO2
? Metabolism
??BMR ?? O2 use ?? Glucose
Metabolic acidosis
? ketones and organic acids
Bleeding
?? platelets

83
Interventions

v Serum salicylate levels
Therapeutic 5-20mg/dl
Toxic gt25mg/dl
Gastric lavage up to 4 hours post ingestion
Activated Charcoal (1g/kg)
? absorption ? elimination via GI tract
Vit K for bleeding
Correct lyte imbalances-
?? Ca ?? K
?? Hydration
Flush kidneys
??Calories
May need hemodialysis

84
Acetaminophen Overdose

Most common acute drug poisoning
?? Risk c combination drugs
?? Risk for liver damage
RT metabolites binding to hepatocytes
½ life 3 hours
Liver necrosis within 2-5 days if not treated
Therapeutic dose 90 mg/kg
Toxic dose 150mg/kg

85
Clinical signs

Phase one (1st 24 hours)
N/V, anorexia and malaise
Phase two (24-36 hours)
Hepatomegaly, RUQ pain, ??LFTs
?INR, PT, hyperbillirubin and oliguria
Phase three (2-5 days)
Encephalopathy, cardiomyopathy, anorexia, emesis,
liver failure, hypoglycemia, coagulopathy, renal
failure and death
Phase four (7-8 days)
Recovery or fatal hepatic failure

86
Interventions