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Burns

• Burns are injuries to body tissue due to excessive heat, greater than 104°F
• They are the second most common type of unintentional injury in children
• Preventative measures include installing and monitoring smoke alarms, creating a family fire escape plan, never leaving food unattended on the stove, and checking water heater temperature

Assessment of Burns

• Determine the location and depth of the burn
• Burns on the face can lead to respiratory tract obstruction
• Inspect the entire body to find the cause of the burn

Emergency Management for Minor Burns

• Minor burns are typically first-degree burns causing pain and death of skin cells
• Apply cool water to decrease skin temperature and prevent further burning
• Use analgesics, antibiotic ointments, and gauze to prevent infection
• Assess and change the dressing after two days for signs of infection
• Educate parents to keep the dressing dry; healing should occur in about 1 week

Emergency Management for Moderate Burns

• Moderate burns are typically blistered but not necessarily drained to avoid infection
• Cover with topical antibiotics like silver sulfadiazine and burn dressing gauze
• This prevents damage to the burn site and promotes healing
• Blisters may be cut away to remove possible necrotic tissue

Emergency Management for Severe Burns

• Severe burns may be third or fourth degree burns
• Immediate care includes fluid therapy, systemic antibiotic therapy, pain management, and physical therapy
• The goal is to prevent disability caused by scarring, infection, or contracture

Emergency Management for Electrical Burns of the Mouth

• If blood vessels are burned, active bleeding from lesions will be present
• Immediate treatment includes unplugging the electric cord and controlling bleeding by applying pressure with a towel
• In the ER, pain management and wound care take place
• The child is monitored for airway obstruction and may be placed on a soft food and fluid diet
• Tissue necrosis may occur, and plastic surgery can restore lip contour

Burn Therapy

• Open treatment involves leaving the burned area exposed to the air
• Closed treatment involves covering the burn with antibacterial cream and multiple layers of gauze, applied loosely to prevent interference with circulation due to edema

Silver Sulfadiazine

• Favored topical burn treatment that keeps the eschar soft for easier debridement
• Alternative treatments like nitrofurazone or antibiotic injections may be necessary for deeper infections, such as Pseudomonas
• Escharotomy or debridement may be needed to relieve pressure and prevent complications in severe cases

ADHD

• Signs and Symptoms include inattention, hyperactivity, impulsivity, difficulty organizing tasks requiring mental effort, and interrupting conversations
• During preschool, children with ADHD may appear attentive; in adolescence, they start fidgeting or feeling impatient, showing rapid hand movements
• Therapeutic management involves a stable learning environment, consistent rules and expectations, counseling
• Medications like methylphenidate/amphetamine/atomoxetine may be used to control ADHD

Eating Disorders

• Eating disorders involve disturbances in eating or related behaviors, leading to altered consumption or absorption, impairing physical health or psychosocial functioning

PICA

• PICA involves persistent eating of non-food substances like dirt, clay, paint chips, crayons, yarn, and paper
• It can lead to unintentional poisoning and complications like constipation, malabsorption, fecal impaction, and intestinal obstruction
• Environmental factors include neglect, lack of supervision, iron deficiency, or intellectual disability
• Treatment involves individualized therapy, parental education, and a safety plan

Rumination Disorder of Infancy

• Rumination disorder of infancy is characterized by repeated agitation and re-swallowing of previously ingested food
• Gastroesophageal reflux disorder or lack of stimulation may be causes
• Parents report constant spitting up or vomiting, and sour breath
• Fluid and electrolyte loss can lead to failure to thrive
• Reducing stimulation decreases rumination

Avoidance/Restrictive Food Intake Disorders

• Failure to eat adequately due to lack of interest in food, sensory characteristics, or related consequences
• Can lead to significant weight gain or loss
• Children may appear sleepy, upset, or stressed during feeding
• May be associated with emotional difficulties
• CBT therapy and counseling can assist

Anorexia Nervosa

• Refusal to maintain a healthy body weight due to disturbance and perception of body size
• Characteristics may include self-induced starvation, a drive for thinness, severely distorted body image, a BMI less than 17.5, and intense fear of gaining weight
• Individuals refuse to acknowledge the seriousness of weight loss and may limit intake, exercise excessively, or use laxatives/purge

Assessment for Eating Disorders

• Assess the use of laxatives/diuretics/enemas or intensive exercise to lose weight
• Check for lab abnormalities and distorted body image
• Signs include hypertension, hypothermia, bradycardia, yellowing of the skin associated with hypercarotenemia, anemia
• Check for elevated blood urea, nitrogen, and creatinine levels

Therapy for Eating Disorders

• Reestablish dietary intake, restore electrolytes, and balance
• An NG tube may be used to provide necessary fat, protein, and calories
• Identify emotional triggers, educate about nutritional needs
• CBT addresses self-image and eating behaviors, family counseling, and antidepressants

Bulimia Nervosa

• Bulimia includes episodes of binge eating followed by purging through vomiting, laxatives, fasting, or excessive exercise
• It often leads to guilt and depression
• Individuals are usually of normal weight
• Serious complications include electrolyte imbalances, tooth erosion, and esophageal tears
• Risk factors include genetics, low self-esteem, anxiety, depression, and societal pressures

Tic Disorders

• Tic disorders are characterized by sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations
• Causes may involve the basal ganglia, neurotransmitter dysfunction, and interaction with motor, sensory, limbic, and executive networks

Types of Tics

• Motor tics include eye blinking and facial twitching
• Vocal tics include throat clearing, coughing, and snorting
• Simple tics are short in duration (milliseconds)
• Complex tics are longer and may seem purposeful, such as head turning or touching objects

Types of Tic Disorders

• Provisional Tic Disorder begins before 18 years old and lasts less than 1 year
• Persistent Chronic Tic Disorder presents symptoms that occur almost daily for more than 1 year, with no tic-free period longer than 3 months; it is more common in males and children with OCD or ADHD; it worsens with stress but reduces during sleep

Treatment for Tic Disorders

• Treatment for tic disorders includes stress reduction
• Behavior modification may help, but pointing out tics can increase them
• Persistent tics are treated based on severity and social impact

Tourette Syndrome

• Tourette Syndrome is an inherited disorder with both motor and vocal tics
• Onset is typically between 4–6 years, peaking around 10–12 years
• It affects males three times more often
• It often presents with a family history of movement disorders

Vocal Tics

• Coprolalia: Involuntary use of obscene words
• Palilalia: Repeating one's own words
• Echolalia: Repeating others’ words

Diagnosis and Treatment of Tics

• Diagnosis may include nonspecific EEG abnormalities
• Comprehensive Behavioral Intervention for Tics (CBIT) helps individuals recognize urges and replace tics with alternative responses

Failure to Thrive

• Failure to thrive is defined as an infant falling below the 5th percentile for weight/height or showing declining growth percentiles
• Organic causes include medical conditions like cardiac disease
• Nonorganic causes include poor parent-child interaction, lack of emotional attachment, or neglect
• Some cases involve both organic and nonorganic causes

Signs and Symptoms of Failure to Thrive

• Include lethargy, poor muscle tone, loss of fat, skin breakdown, weak response to being touched or examined, and excessive rocking
• Minimal interaction, little or no crying, and staring hungrily at people are other signs
• Delayed milestones such as sitting, crawling, and walking
• Delayed or absent speech
• Severe cases can lead to starvation, acidosis, and life-threatening infections

Assessment and Management of Failure to Thrive

• Obtain a detailed pregnancy and parental history
• Weigh and plot growth on a standard chart at every checkup
• Observe for signs of neglect or emotional deprivation
• Hospitalization may be required to prevent neurologic damage or cognitive delays
• Infants are placed on a diet for their ideal weight; rapid weight gain confirms nonorganic failure to thrive
• Minimize painful procedures initially
• Long-term care focuses on improving parent-child interaction, emotional support, and nutrition

Neglect

• Neglect is a subtle but harmful form of maltreatment with failure to meet a child’s basic needs or leaving them unattended

Common Forms of Neglect

• Failure to provide basic needs like food, clothing, and shelter
• Leaving children unattended
• Substance abuse by caregivers

Medical & Educational Neglect

• Not seeking medical care for illnesses or injuries
• Keeping a child out of school without a homeschooling plan
• Allowing children to go unsupervised after school
• There was an increase in neglect during the COVID-19 pandemic

Identification & Prevention of Neglect

• Electronic health records help track neglect cases
• Anticipatory guidance helps parents understand child development and appropriate care
• It involves action of a caregiver that causes intentional physical injury to a child

Physical Maltreatment

• Children may exhibit burns, bruises, and fractures

Assessment of Physical Maltreatment

• Question the child and parent separately regarding the injury because their answer may vary
• Maltreated children may fear adults, resist touch, or show unusual reluctance to be examined

Emotional and Behavioral Signs of Maltreatment

• Growth Delay
• Hand Injuries
• Burn Patterns
• Cigarette Burns
• Fractures & Bone Injuries

Sexual Maltreatment

• Sexual maltreatment is any sexual contact between a child and an adult or a person in a position of power or trust
• It includes molestation, incest, child pornography, and prostitution
• Adolescents are at the highest risk
• Perpetrators are family members, trusted adults, or online predators

Types of Sexual Maltreatment

• Molestation – Includes fondling, oral-genital contact, and indecent exposure
• Incest – Sexual contact between family members
• Child Pornography & Prostitution – Involves photographing or engaging children in sexual acts

Sexual Maltreatment: Assessment & Signs

• Physical Signs: Vaginal or rectal tears, inflammation, or STDs (though less than 5% of cases show physical findings)
• Behavioral Signs: Advanced sexual knowledge for their age, low self-esteem, feelings of worthlessness
• Fear of a specific person or anxiety when left alone with them, sudden concern about pregnancy
• Therapeutic Management is required, along with mandatory reporting because sexual maltreatment is a criminal act
• Objective documentation is crucial for legal purposes
• Psychological counseling is essential for both the child and offender
• Education and prevention involve teaching children that their bodies are their own and reporting inappropriate contact
• Megan’s Law requires authorities to notify the public when a sex offender moves into an area
• The National Child Advocacy Center provides support and resources for victims and families