By Nancy Gottesman

Ahh, the thrills and spills of toddlerhood. Toddlers are curious and, hence, with every new play date, art project or outdoor discovery, there’s potential for a bump here and an owie there. As a parent, you’ll likely need to call upon your knowledge of first aid—however sketchy—on more than one occasion.

To help you be ready for the unexpected, we’ve talked to some of the best pediatric emergency medicine experts in the country to get their first-aid tips for treating everything from scrapes and puncture wounds to nosebleeds and burns. We’ve also noted when you should contact your doctor.

Our experts say that unless it’s a 911 emergency, you should call your pediatrician fi rst. Even if you do need to go to an ER or urgent care facility, your doctor can call ahead and try to expedite your admission.

Two things to remember:

1) TLC should be first in line when it comes to fi rst aid. “A few minutes of comforting goes a long way—even for a paper cut,” says Richard A. Saladino, M.D., chief of the Division of Pediatric Emergency Medicine at Children’s Hospital of Pittsburgh in Pennsylvania.

2) Children are very sensitive to their parents’ emotions, so tempering your own reaction will also benefi t your child. If you’re upset, your son or daughter will likely be more so. “There’s no doubt that anxiety can be transmitted from parent to child,” Saladino says.

Remaining calm is difficult when your child is hurt, but consider this: Reassuring talk from you will soothe your child, which is vital to your treatment and examination efforts. The more relaxed you both are, the more easily you can begin to assess and treat the wound. That said, here is our step-by-step guide to first-aid care for your toddler:


Cuts and scrapes

What you should do:
With a minor break in the skin or a raspberry, cleaning the wound is your first step. Place the finger, knee or elbow (or whatever the extremity) under running water, or drag a wet washcloth over the owie. Then pat dry with a fresh towel. Bacitracin or Polysporin ointment can be dabbed on next, but experts say this isn’t necessary for preventing infection.

“Any time the skin is broken, antibiotic ointment can be used, but our immune systems work better,” maintains Saladino. “Ointment provides a barrier and prevents contamination.” (Experts recommend that you avoid Neosporin because some children are allergic to neomycin, an active ingredient.) Cover the abrasion with a cartoon character bandage, which will not only comfort and delight your child, but also keep out the dirt when he goes outside to play. With a raspberry-like abrasion, apply antibiotic ointment first, so the bandage won’t stick to the wound. The best reason to cover the wound? “Out of sight, out of your child’s mind” is the experts’ thinking on this.


Call your pediatrician if…

+ The wound becomes infected (usually within two days). Signs of infection are pus-like discharge or increased redness or pain.

+ The edges of the cut are not touching. Your child may need stitches.

+ A scrape covers an unusually large area.

+ Your child exhibits signs that the joint below the abrasion may be affected, such as refusal to use the leg or arm, or favoring the uninjured limb.



What you should do:
As with every sore or scratch, wash first: Run water over any cut before you try to staunch bleeding. After the wound is clean, hold a 2×2-inch or 4×4-inch sterile gauze dressing over the cut; use direct pressure for about three to four minutes, until it stops bleeding. (If you don’t have gauze, use a clean towel or washcloth.) Cover the laceration with a bandage or a Steri-Strip (tape used for wound closure).

In healthy kids, most nosebleeds are caused by “digital trauma,” aka nose-picking, and they generally look worse than they are. “Parents think that their child is losing too much blood,” says Powell, “but it’s a modest amount as far as blood volume goes.” First, have your child sit down and stop all activity. Seat him upright, with head tilted slightly forward.

Leaning backward can cause gagging or even vomiting from swallowing blood. With your thumb and index finger, pinch the soft part of his nose right below the bone. Keep a firm pinch for at least five minutes, which will stop the bleeding in most cases. If it’s still bleeding, pinch it again for another five to 10 minutes. “This method rarely fails,” says Powell. Forget any advice you heard about ice packs—they’re not of any value for stemming nosebleeds.

Call your pediatrician if…

+ A laceration won’t stop bleeding.

+ The cut appears deep and the edges are separated (stitches may be needed).

+ A nosebleed is not staunched after two 10-minute pinching sessions (cauterizing may be required).


Puncture wounds

What you should do:
In a small child, these types of wounds can result from pencils, scissors, needles, a deep splinter, cat and dog bites, or from stepping on the proverbial rusty nail.

First, wash the wound. Unlike surface cuts and scrapes, punctures are difficult to clean, so wash with some vigor, as if you’re trying to get yourself clean from being in the outdoors.

If the wound is not a deep one (say, from a pencil point or a staple), simply cover it with a bandage after washing.

Tetanus is not really a concern with puncture wounds anymore because most American children receive the DTaP vaccination (diptheria, tetanus and pertussis) at 2, 4, 6, and 12 or 18 months old.

Call your pediatrician if…

+ The puncture wound is caused by the teeth of a dog, cat or any other animal. The bacteria in an animal’s saliva can cause serious infection.

+ The wound is anywhere on the head. Call as soon as possible, because the doctor may want to take an X-ray to check for further damage.

+ It’s a deep wound (from a knife, scissors or nail, for instance). Use your instincts. If you’re worried, the doctor may want to see your child to rule out bone damage.



What you should do:
Toddlers love to explore by touching everything, which is why the hands are one of the most common locations of burns. Most of these are first-degree burns caused by brief contact with heat, resulting in redness, some swelling and pain. Second-degree is a more severe burn, resulting in blisters and more redness. For these types of burns, placing a towel filled with ice cubes or a cold can of soda right on the burn should do the trick. The coolness is a very effective treatment for pain. However, if the child still feels discomfort, you can try administering some children’s ibuprofen.

Call your pediatrician if…

+ The burn area is large.

+ The burn came from a fire, an electrical socket or wire, or chemicals.

+ The burn blisters. A medical professional will need to apply a topical treatment to prevent infection.

+ The burn is on the face, scalp or genitals.

+ Swelling, pus or increasing redness appears near the burned area.

+ Burnt skin appears white or black (it may be a third degree burn).


Joint injuries

What you should do:
Kids fall often, so twisted ankles or wrists—resulting in soft tissue injuries like a sprain (a stretched or torn ligament), strain (injured muscle and tendon) or bruise (broken small veins and capillaries)— are common. “Ice is helpful for most types of soft tissue injury,” says Elizabeth C. Powell, M.D., M.P.H., of the Pediatric Emergency Medicine Division of Children’s Memorial Hospital in Chicago.

Most of us know of the RICE treatment (rest, ice, compression, elevation) for soft tissue injuries. But for toddlers, think RIE; compression with elastic wraps doesn’t provide significant protection. “I rarely use an Ace bandage with toddlers—there just isn’t much benefit,” says Powell, who is also an associate professor of pediatrics at Northwestern University’s Feinberg School of Medicine in Chicago. Experts recommend children’s ibuprofen for pain.

Call your pediatrician if…

+ Swelling occurs. Professional evaluation and X-rays will rule out fracture or injury to the growth plate, developing tissues at the end of children’s long bones. During late adolescence, the growth plate is replaced by solid bone.

+ Your child favors the injured area, or is not using the limb as he usually does. Again, a doctor will want to rule out a fracture, which in toddlers isn’t as alarming as it sounds. “Most fractures are minor,” asserts Powell. “They usually heal in three to six weeks.” If there is a fracture, a medical professional may need to apply a splint or a cast.

+ Pain lasts longer than 24 hours. Even if there’s no serious injury, your doctor may elect to treat the discomfort with children’s pain medication.


Nancy Gottesman has successfully treated her son Robby’s cuts, scrapes and nosebleeds for 12 years in Santa Monica, Calif.

We talked to some of the best pediatric emergency experts in the country to get their first-aid tips.

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