Accidents Happen: Fall & Head Injury

No other age group is as busy, curious, energetic, fast-moving, agile, and fearless as toddlers.  We anxiously await the day they take their first steps and then protectively cringe as walking leads to running and climbing and falling.  Of course with every fall comes a fear of head injury.  I know of a mother who strapped a helmet on her son from the age of 2 to 3 - simply as a precautionary measure!  Yes, toddlers fall ... all the time. They fall off their own feet.  They fall from pieces of furniture.  They fall from atop stools.  They fall from swings and slides.  They fall through ... windows.  

Yep, my best friend Missy - known her since high school, lived with her in college, see her at least once a year despite living in different parts of the country - and her typical toddler, Emmett, recently had the "fall through the window" experience, and she's agreed to share their story with you ... it's a good one!

It was a beautiful, sunny Saturday. We were enjoying a cool breeze in our backyard when our 19 month old son, Emmett, decided that he wanted a snack. Not wanting to lose that fresh, cool Colorado breeze when we went inside, I did something that I never do--I opened the windows. Don't ask why I never do this...perhaps in my gut I knew what would happen if I did. After handing my little boy a treat, I joined my hubby on the couch for a little chit-chat. Behind our couch is a ledge with a wall of windows behind it. I have never understood why this ledge exists. It serves absolutely no purpose. It's just there. A constant annoyance that requires me to say many, many times on a daily basis, "Emmett! Get down from there!"

On this particular day, I was distracted and didn't notice E making the vertical climb up to the ledge. All I know is that about thirty seconds after taking my seat on the couch, I heard a little bump. Not a loud sound, barely audible, in fact, except to a mother's ears. I looked up and noticed that the window screen was torn. And E was nowhere is sight. "Oh, my god, Joe...Emmett fell out the window!"

We immediately bolted out the back door to our patio. Sure enough, there was Emmett...lying on his back and struggling to get up like a turtle that has landed shell-side down. I ran over to him and picked him up (probably too quickly since I didn't know if he was hurt). He didn't appear to be in pain, and he didn't even cry...until, of course, he saw the tears welling up in my eyes and heard the panic in my voice. Then, the floodgates opened..quickly, loudly and without pause, for a good five minutes. Then all of a sudden, he saw our cat walk in front of us, said "CAAAAT!", jumped off my lap and ran to his little feline friend. I thought, "What the heck? Could that be it?" Although my husband insisted that he was okay (typical man), I called the Children's Hospital and spoke with a nurse. She asked how far he had fallen. Luckily, it was only about 3 1/2 feet, but he did land on paver stones. She asked if he had any bumps or bruises...nope. Just one little cut above his forehead. Is he falling down or dizzy? Nope. Complaining of pain? Nope. She said that since he wasn't showing any signs of head trauma and since the fall wasn't more than twice his height, our only course of action was to observe him for 48 hours. He had to sleep with us for two nights, and each night we had to wake him up and make him walk around the room to make sure he didn't have a concussion. Now, unfortunately for E (and us), he is truly like his Momma in that he DOES NOT like to be woken up, particularly for a leisurely stroll at 3 o'clock in the morning. He was mad, mad, mad and he let us know it. After 48 hours, I was finally convinced that we had escaped this little episode unscathed.

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As I read this story, I realize just how easily something like this happens.  And how scary it can be.  As parents it is tough to cover all the bases of child-proofing, and I think we must accept that falls will happen.  We can somewhat "prepare" ourselves for the more serious falls by knowing how to react, what to look for, and who to call.  This Falls: Safety Sheet from KidsHealth.org is a great place to start and a handy reference to print and keep on hand.

In addition to Missy's firsthand account, I would encourage you to read this article ... for some common sense reminders and tips:

Household Safety:  Preventing Injuries from Falling, Climbing and Grabbing 

Accidents Happen: Choking

I know I've spent an exorbitant amount of time thinking about what to feed my toddler ... what she'll actually eat, what has some good nutritional value, what makes for a balanced meal, ... but I haven't spent nearly enough time considering the dangers posed by those foods.  Especially the danger of choking ... how to prevent it and what to do if/when it happens. 


This post was written by my good friend Deann.  Her daughter Sahara, a cautious and neat eater ... uses utensils like a pro, takes one bite at a time and barely needs a bib (the complete opposite of my own toddler) has had two recent choking incidents. 

It was a routine lunch time. My girl was having some dinosaur style chicken nuggets, green peas, and some other yummy lunch item that I can't remember now. I was trying to get the nuggets cut up a bit smaller when my sweet Sahara grabs my fingers and looks at me with eyes wide open in a mix of shock and fear. She was choking on one of those darn chicken nuggets. I tried not to panic and whacked her on the back a few good times and the chunk came up, thankfully!

It was a scary moment for both of us! I am so thankful that I am usually very close when its a meal time, I would have felt more than horrible to have walked away for too long during that one crucial moment and not been there to help her. The realization of the possible outcome is more than I can bear to think about.

We recently had a second choking experience at dinner with my in-laws and husband present. Sahara was doing so well at chewing up green beans, loving eating them as a matter of fact, when suddenly she was choking on one. She didn't quite get it chewed up well enough and most of the bean was intact and stuck in her throat. My husband actually did a mouth sweep to get it out and that also worked well, especially for the bean scenario. Once again, we were reminded to make sure that things are cut up, even if they seem to be handling chewing the food item with ease.

So, some rules that I've set up are 1) always cut up food in smaller pieces, even if you think that he/she is old enough to handle bigger pieces; 2) DO NOT walk far away!; 3) Keep an eye on the kiddo while they are eating; 4) DO NOT let them walk around with snacks, make them finish them sitting down while you are nearby

Here are a few tips from the American Academy of Pediatrics:

What can I do to keep my child from choking?

Do not feed children younger than 4 years round, firm food unless it is chopped completely. Round, firm foods are common choking dangers. When infants and young children do not grind or chew their food well, they may try to swallow it whole. The following foods can be choking hazards:

Hot dogs, Nuts and seeds, Chunks of meat or cheese, Whole grapes, Hard, gooey, or sticky candy, Popcorn, Chunks of peanut butter, Raw vegetables, Fruit chunks, such as apple chunks, Chewing gum

Dangerous household items

Keep the following household items away from infants and children:

Balloons, Coins, Marbles, Toys with small parts, Toys that can be squeezed to fit entirely into a child's mouth, Small balls, Pen or marker caps, Small button-type batteries, Medicine syringes

What you can do to prevent choking

Learn CPR (cardiopulmonary resuscitation) (basic life support).

Be aware that balloons pose a choking risk to children up to 8 years of age.

Keep the above foods from children until 4 years of age.

Insist that children eat at the table, or at least while sitting down. They should never run, walk, play, or lie down with food in their mouths.

Cut food for infants and young children into pieces no larger than one-half inch, and teach them to chew their food well.

Supervise mealtime for infants and young children.

Be aware of older children's actions. Many choking incidents occur when older brothers or sisters give dangerous foods, toys, or small objects to a younger child.

Avoid toys with small parts, and keep other small household items out of the reach of infants and young children.

Follow the age recommendations on toy packages. Age guidelines reflect the safety of a toy based on any possible choking hazard as well as the child's physical and mental abilities at various ages.

Check under furniture and between cushions for small items that children could find and put in their mouths.

Do not let infants and young children play with coins.

Published online: 2/07

Source: Choking Prevention and First Aid for Infants and Children (Copyright � 2006 American Academy of Pediatrics, Updated 4/06)

Accidents Happen: Emergency Consent Form

No matter what kind of Accident Happens to your toddler, it's important that his/her caregivers know essential information and have your official permission to seek appropriate treatment.

The best way to have those things all in one place and in the hands of the caregiver ... an Emergency Consent Form.

This is one that was passed along from a friend. I tweaked it a little. This is what I use for my toddler. I found it especially helpful when hubby and I went out of the country - for our 10th anniversary - and Grammy came to stay with NHV.

The form can be downloaded as a Word document. Save it to your computer, edit it with your information and print it out. Or just print and hand-write the information.

Hope you find this useful!

Accidents Happen: Knocked Out Tooth

Baby teeth. We anxiously await their arrival. We document the milestone of when our babies get their "first tooth." We dread the sleepless nights, the drooling, the biting (especially if still nursing). We hate to see our babies in pain. We marvel at that little pearly white as it pokes through the gum.

But what happens when one of those cherished baby teeth gets knocked right out of your precious toddler's mouth? Well, that's exactly what happened to Owen, NHV's good buddy and son of my friend Tammy.

It happened when O was about 21 months old. He was running on the sidewalk in front of Safeco Field when he tripped and fell on his face. Now, O has been walking since he was 10 months old, so he's had plenty of practice bracing his falls. This time, however, he was not so successful. When he came up for air, his face was cut, his lips all bloody, and little white bits of teeth were floating around in his mouth.

Needless to say, we peeled out so fast our stroller left dust clouds in our wake! We set up an emergency visit with Owen's pediatric dentist, who, bless her heart, had to come in on a beautiful Saturday morning when she was just getting ready to spend the day at the park with her husband. After a lot of screaming and prying, we were able to take an x-ray of O's mouth. Both front teeth were badly chipped. The one on the left had chipped in half horizontally, in a crescent shape. The one on the right was not so lucky. Not only did it have a huge triangle chunk cut out of it, but it had a vertical fracture into the root.

Diagnosis? Extraction of the doomed tooth.

There was no other choice. I wanted to cry. What does this mean?? O will have one, albeit compromised, front tooth until his permanent ones come in. For the next 8 or 9 YEARS, he'll be known as the kid with one tooth! "Isn't there anything you can do?", I asked the dentist. "Baby dentures? Implants?" Unfortunately, no. They don't want to disturb or disrupt the growth of the permanent tooth. On top of that, Owen had to be sedated for the extraction process, unless we want him to be traumatized for the rest of his life, not to mention the fact that it'd probably take 2-3 large adults to hold him down for the removal if we choose to forgo the anesthesia ...

Click here to read the details of O's surgery.

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As you saw in the photo above, ultimately, the decision was made to extract one of Owen's front teeth ... and clearly, having one less tooth hasn't slowed him down or made him any less adorable! But what a tough experience for parents to go through and clearly this is an accident that could happen to any toddler at any time! And any teenager, as my mom can attest to ... my 17 year old brother got his braces off and had his front tooth knocked out - playing tackle football without pads or a helmet - all within the same month! Talk about an expensive set of chompers!

As kiddos get older, this becomes an even more serious injury. According to kidshealth.org, A dislodged baby tooth can't be replaced and does not need to be put back in. On the other hand, a permanent tooth, which is more sharply defined than a baby tooth, can often be saved if prompt action is taken and the tooth is handled carefully. A permanent tooth has the best chance of survival if replaced within 30 minutes.

In this case, prevention is a tough one. With toddlers the advice is to make sure the child is supervised ... which is a no-brainer. But an exuberant runner and unbraced falls, well, those things just happen - whether you're watching or not! For older kids, it's extremely important that proper protection is worn while playing sports.

Read more about Tooth Injuries here.

Click here for a Knocked-out Tooth Instruction Sheet.

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Disclaimer: Clearly the Accidents Happen series is meant to be informative but also from a mother's point-of-view. The information provided in these posts are medically accurate - to the best of our knowledge - but we are not licensed physicians. We are mothers sharing an experience.

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You may also want to read my other Accidents Happen posts:
Nursemaid's Elbow
Object in Nose

Accidents Happen: Allergic Reaction

It's hard to imagine that something you feed your child - or something that your child finds in your house and ingests - could cause a very serious, life-threatening reaction. But that's exactly what can and does happen. In this situation, it is imperative that you act quickly.

This post focuses on peanuts as an allergen, and with good reason, "Peanuts are among the most common allergy-causing foods. It's likely that more Americans are allergic to peanuts than any other food." Insect bites, other foods, and certain medications can also trigger anaphylaxis.

The following post was written by Terri, a very good friend of mine here in the NW. Recently, her little guy Gavin had a scary allergic reaction. My heart aches a little as I read her experience. I am so glad that G is okay! The insight that Terri provides is so honest and her tips could be quite possibly life-saving.

We found out the hard way about Gavin's peanut allergy. We had talked about having him try peanuts before we went on a European cruise, thinking that if he was allergic, we'd rather find out when we were 8 minutes from the ER, as opposed to 800 miles. He was 19 months old, so we figured getting close to the age he'd be ok. Neither of us have any food allergies in the family, so we were not expecting him to have one. We hadn't planned it, but Brian and I were eating peanut butter toast one day, and Gavin wanted to try it. He reached out for it, and took a bite. I didn't think much of it, until his face started getting a red rash. I panicked a little when it started going down his neck, and had Brian get the Benadryl. Gavin took some, and then he seemed fine. We decided to go to the park. At the park, Gavin started coughing (like he had something stuck in his throat) and a drink of water wouldn't help. His nose started running, and I knew a cold couldn't come on that fast. We went home, and tried to put him down for a nap, but he was very irritable. After a while of crying and labored breathing, I had Brian call the doctor, and when he was on the phone, I turned on the light to look at Gavin. Sure enough, his face was swelling, and he had hives all over. We asked the doctor (still on the phone) what to do.

• Was he wheezing? Kind of... definitely breathing heavy.
• Was he swelling? Yes.
• How far away is the ER? less than 10 minutes.
• Okay, take him there now.
  

We hopped in the car and drove off. On the way there, I sat in back with my baby while he continued to swell, had even more shallow breathing, runny nose, and he started drooling. He was staring off into space. To say I was scared is the understatement of the year. I wanted to scream at my husband to drive faster! I wanted to grab my baby and cradle him in my arms! I watched helplessly begging God to let us get there in time, and to keep my baby safe. I tried to hold back the tears so I wouldn't scare him, but I have never been so scared in my entire life. My whole being was afraid of losing this precious little baby.

We made it to the ER, raced in, and they got him an epinephrine shot and loaded him up with Benadryl right away. Eventually the swelling stopped and started to get better, and he finally slept. Once the doctor said he'd be okay, and began asking questions, I lost it. I couldn't move and just clutched my little boy that we could have lost. He had a full anaphylactic reaction but - thanks to treatment - would be okay. We were transferred to the hospital downtown for 24 hour observation, and he got better through the hours. It was a day I will never forget, and that has changed our life forever. I learned so many things, a few of which I'd like to pass on to every mom:

• ALWAYS CALL 911 if you think there is an allergic reaction. We were told time and time again that we should have just called 911. It could mean life or death for your child. Even if you already have an epi pen, use it, then ALWAYS call 911 if there is a reaction.
• Kids can have a food allergy even if no one in your family has one. If you have OTHER allergies (hayfever, eczema) that can make a child more prone.
• Keep Childrens' Benedryl on hand even if you never use it. The doctors think that us giving it to him right away could have saved him from going into Anaphylactic Shock. (Always check with your pediatrician before you give any meds).
• Potential signs of an allergic reaction: Hives, Itchy or Runny Nose, Swelling (lips, eyes, face is serious), Coughing (meaning they are having trouble breathing), Red Eyes -- typically a child won't be able to go to sleep with all this going on, according to the ER doc which is also a sign.
• Allergies to peanuts (and other items) can vary in sensitivity (meaning amount of exposure needed to cause a reaction) and severity (what happens when a reaction occurs). Anaphylactic reactions mean that it starts to affect their breathing, Anaphylactic Shock means it also affects their circulatory/nervous system and is even more serious.
• Over 1% of US kids have allergies to Peanuts. There are many theories as to why, which range from an increased amount of peanut products in our diets (US eats over 8 billion lbs of peanuts a year!), to how they are prepared here in the US, to us not exposing our kids to enough bacteria to build up their defenses.
• Peanuts hide in all kinds of food. Specifically many types of Chinese foods, cookies, ice creams, candy (including plain M&M's), sauces, and more. READ LABELS. It becomes a habit. Remember if you have a peanut allergic child over - and you make PB&J for your kids, and dip a knife in peanut butter before the jelly - don't give them jelly from that same jar!
• Always consult your pediatrician if you have any concerns or questions about any allergy or allergic reaction. Allergies to any foods can be very serious.
• Be sensitive to others that have an allergic child. Understand that it can be extremely serious, and what should be done if a child you know has an allergic reaction when you are with them (using an epi pen is EASY!). Mom's with allergic kids will be so appreciative of your sensitivity, understanding, and knowledge, and feel more comfortable letting their kids come to play. All these kids want is to fit in, feel happy, and be safe!

Printable Allergic Reaction Instructions ... from KidsHealth.org

Disclaimer: Clearly the Accidents Happen series is meant to be informative but also from a mother's point-of-view. The information provided in these posts are medically accurate - to the best of our knowledge - but we are not licensed physicians. We are mothers sharing an experience.

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You may also want to read my other Accidents Happen posts:

• Nursemaid's Elbow
• Object in Nose

Accidents Happen: Object in Nose

At some point before they start picking their nose incessantly (don't get me started about boogers!), toddlers have been known to give nasal "input" a try. I'll admit it, even I have a personal (and I do mean, personal) story of nasal ingestion, but first read Chitown Momma's story of her toddler B and the wheel that almost got away!

Causes: Curious toddler given a toy to have in his crib during nap, apparently wants to see if the wheel from his Matchbox tank will fit in the facial crevice (otherwise known as the nose!) Now, this toy has been played with countless times, so this unsuspecting momma never gave it a thought. Fast forward through a delightful three hour nap…

Symptoms: Come in when I hear him fussing over the monitor, he says “Nose.” (my little guy is a man of few words, literally!) He typically has me wipe his nose, so no red flags just yet. He then says, “Dirt” while pointing to his nose…hmmm. Finally says, “Tickle,” in a not so much haha voice but rather a little pathetic, painful whimper (note to self: work on the meaning of tickle.) So I touch the outside of his nose and sure enough I can feel something hard up there.

My Response: Call pediatrician’s office, which of course it is right at closing time, and leave a message on the medical advice mailbox. Then call my husband. At this point I still didn’t know what it was. He tells me to get a flashlight and look up there (so smart!) I then see that it is green, army green, and make the connection. Find the tank in his crib and sure enough two of the wheels are missing. (I later broke off a third one just to see, and it required quite a bit of force). Hubby suggests trying to take it out with tweezers. I wasn’t so keen on the idea, but knew I needed to do something. However, holding down a toddler by yourself and working with tweezers is next to impossible. Luckily the dr.’s office called back.

Recommended medical treatment: Pinch the unobstructed nostril shut. Place your mouth over your child’s mouth forming a seal (envision administering mouth-to-mouth). Blow forcefully into your child’s mouth. It totally works. The object does not come flying out but it definitely gets pushed down to where you can get it without tweezers! However, this method does require 2 adults, as the little one does not enjoy this experience! This method only produced one of the two wheels, so we can only assume that the other was swallowed or had previously been broken off and I didn’t know. I had intentions of monitoring diapers to find it, but silly me served peas that night for dinner. I felt the danger had passed and did not feel the need to determine if each little green morsel was a pea or the MIA wheel!

Note: Prior to getting the phone call from the office, I emailed my Ped (love that she offers this!). She emailed me back saying to bring him in at 9 the next day. Now I don’t think I could have put B to bed knowing there was a wheel in his nose, but clearly the doc didn’t think it was an emergency. When I emailed her to say we got the one out we could see, but the other was MIA, she said there was no need to come in at all. Enough time had passed that there was no danger of choking.

Other likely culprits, according to BabyCenter:

• Candies: Brightly colored and just the right size; need I say more? Jelly beans, M&M's, Nerds, Skittles,


• Food: Because of easy access (hello, toddlers have to eat) probably the most common thing that a toddler will stick up his nose. Spaghetti noodles, French fries, beans, peas, Cheerios, ...


• Small Toys: Guessing this is part of the reason there's a toy category known as three and older. Legos, crayons or pencils, marbles, small action figure or doll accessories, ... are you saying, "Ouch," right about now?


• Household Items: So many small things around the house, so little time! Q-Tips, pet food, batteries, caps to bottles, beads, paperclips, ...


• Mattress/Pillow stuffing: Small pieces of foam, fabric, batting can either come loose or be torn loose and then "stuffed" into the nose. I apparently did this when I was about two years old - without my parents realizing it. My mom claims that I had the worst breath she had ever smelled (nice, huh?) and my nose began running constantly with a bright green colored snot. At the doctor's office, it was found that the foam inside my nasal passage was rotting and causing an infection ... thus the bad breath and disgusting snot!

Other Symptoms: If a strange object has made its way into your toddler's nose, you may notice that just one nostril is runny, and the discharge could be stinky. (If the runny nose is due to a cold, both sides will probably be runny.) Your child may complain of a tickle, pain or discomfort, or he may get a nosebleed.

On a More Serious Note: A lodged object can cause infection and long-term damage. Some objects cause a bigger problem the longer you wait. (A bean can swell and become more difficult to remove, for example, and a small button battery can cause serious tissue damage.)

A final thought: Yes, my mommy (and daddy) friends, Accidents Happen, and sometimes odd objects find their way into tiny orifices (I've been itching to use that word!). All we can do is ensure toys are appropriate for our toddler and supervise him/her closely. When all else fails, it's important to rely on knowledge of symptoms and how to respond.

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You may also want to read my other Accidents Happen posts:

Nursemaid's Elbow

Accidents Happen: Nursemaid's Elbow

Twice in NHV's two years, she's had an injury known as nursemaid's elbow.

CAUSES:

The first time Natalie was about 7 months old, and she actually caused this injury to herself while rolling over in her crib. Click here if you're interested in the full details.

And then, recently, my husband and Natalie were playing like daddies and their little girls do ... a little rougher than I would like. Natalie was behind Chad with her arms stretched up toward his neck. He was crouched down reaching over his shoulder to grab her hands. As he stood up - raising her with him, there was a quick holler of pain from our baby girl. Again, full details here.

Actions that can increase risk of this type of injury, according to KidsHealth.org:

• Pulling a child up by the hands. Lifting under the armpits is the safest way to lift a child.
• Swinging a toddler by the arms. This seems like lots of fun but it is never a good idea.
• Breaking a fall with the arm. The natural response to falling is outstretching an arm for
  protection.
• Rolling over in an awkward way. Sometimes rolling over in a crib, bed, or on the floor can cause nursemaid's elbow in infants.

SYMPTOMS:

Both times it was very clear that something was wrong with Natalie's arm - she would not use it and was calm unless her arm was moved. Both times I immediately thought it was her shoulder - not her elbow - come to find out, that is a a common mommy misdiagnosis for this injury.

A quick call to our family doctor confirmed that it was probably her elbow. More specifically an injury called nursemaid's elbow, which is a partial dislocation of the elbow. And it sounds much worse than it is ... I say this mainly because visually Natalie's elbow looked totally fine and once we immobilized the arm, she didn't appear to be in any pain.

RESPONSE:

• Immobilize the arm. If your toddler will leave the arm pulled across his tummy, that's sufficient. If not, use a bandana to make a quick sling.


• Call the pediatrician's office. Chances are he will be able to confirm over the phone that it's nursemaid's elbow. If the accident happens during office hours, it can be reset by your doctor.


• Make a trip to the ER. If the accident happens after office hours, you'll need to go to the ER to have the elbow reset. Do not attempt to reset the elbow yourself.

Next week's edition of Accidents Happen ... Strange Object in Nasal Passage with help from Chitown Momma and her boy B ... you won't want to miss this one!