Common Injuries of Childhood – PediaCast 528

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Show Notes

Description

• Our Pediatrics in Plain Language Panel is back in the house as we explore common injuries of childhood. Topics include animal bites, cuts and scrapes, bleeding, bruises, broken bones, strains and sprains, drowning, poisons… and more. We hope you can join us!

Topics

• Animal and Human Bites
• Insect Bites and Stings
• Cuts and Scrapes
• Bleeding
• Bruises
• Strains and Sprains
• Broken Bones
• Burns
• Bumps on the Head
• Drowning
• Poisoning
• CPR
• AEDs

Guests

• Dr Mary Ann Abrams
  Primary Care Pediatrics
  Nationwide Children’s Hospital

• Dr Alex Rakowsky
  Primary Care Pediatrics
  Nationwide Children’s Hospital

Links

• Primary Care Pediatrics at Nationwide Children’s
• What To Do When Your Child Gets Sick
         Discount Code: POD917 (40% Discount)
• Pediatrics in Plain Language Survey
• Pediatrics in Plain Language Playlist – SoundCloud

• Dog Bites, Throwing Food, Head Banging – PediaCast 143
• 10 YEARS, Insect Bites, Parenting Books – PediaCast 349
• Cry It Out, Cuts & Scrapes, Herpes or Hand Foot Mouth – PediaCast 345
• Tongue Tie, Nosebleeds, Reading Skills – PediaCast 370
• Hypothermia, Frostbite, Basketball Injuries – PediaCast 392
• Martial Arts & Competitive Dance – PediaCast 445
• Concussions, Appendicitis, Forearm Fractures – PediaCast 217
• Breath Holding, Broken Bones, Muscle Tone – PediaCast 262
• Pediatric Burn Care – PediaCast CME 051
• Concussion Recovery and Return to Play – PediaCast 501
• Water Safety – PediaCast 348
• Prevention of Drowning – PediaCast 520
• Autism, Poison Safety, ADHD Meds – PediaCast 344
• AEDs, Vaccine Safety, Amusement Rides – PediaCast 251

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio.

It's Episode 528 for December 1st, 2022. We're calling this one "Common Injuries of Childhood". I want to welcome all of you to the program.

And we also want to welcome you to the final installment of PediaCast for the year 2022. It's been really terrific traveling on this journey with all of you, as we consider the health and wellbeing of children.

0:01:08

And, of course, we have lots more in store for you in 2023. That schedule is coming together. But we also have plenty of room to cover topics that might be on your mind.

So this would be a great opportunity to visit the contact page at pediacast.org and suggest a topic for the new year. We'd love to hear from you. Also, as we approach the holidays, all of us here at PediaCast and Nationwide Children's Hospital, we would love to extend to you and your family a very warm wishes for a happy holiday season.

As for us, on PediaCast, we are celebrating the end of 2022 with another visit from our Pediatrics in Plain Language Panel which means, of course, that Dr. Alex Rakowsky and Dr. Mary Ann Abrams will be joining us soon.

They are primary care pediatricians at Nationwide Children's and when they visit, we talk about very basic items that all parents really should know regarding the health and wellbeing of their children. And we strive to do that in a way that maximizes health literacy while using terminology that all of us can understand.

0:02:15

In other words, this episode will hopefully be free of medical jargon or, at the very least, if we have no other choice, then the medical jargon, we'll do our very best to explain exactly what the fancy words mean using regular everyday language. That is the goal of these episodes. And we do our best to hold each other accountable in that endeavor, this time around as we are considering common injuries of childhood.

And we have lots to cover because there are all sorts of ways that children and teenagers injure themselves, including but not limited to animal and human bites, insect bites, and stings, cuts, and scrapes, bleeding, bruises, strains and sprains, broken bones, burns, bumps on the head, drowning, poisoning. And we'll also talk about CPR and the use of AED's.

0:03:08

So, lots coming your way this week as we consider descriptions of each injury, when to seek help, where to seek help, typical management or treatment of the injury and prevention strategies. And, again, to help us explore these topics, we have two very seasoned pediatricians with us, Dr. Mary Ann Abrams and Dr. Alex Rakowsky. They are friends of the program and primary care pediatricians at Nationwide Children's. Together, they make up our Plain Language Panel, which we'll talk more about as the episode unfolds.

Before we get to them, let's roll through our usual quick reminders. Don't forget, you can find our podcast wherever podcasts are found. We're in the Apple and Google podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music, and most other podcast apps for iOS and Android. If you like what you hear, please remember to subscribe to our show so you don't miss an episode.

Also, please consider leaving a review wherever you listen to podcasts so that others who come along looking for evidence-based child health and parenting information will know exactly what to expect.

0:04:06

We're also on social media. We love connecting with you there. You'll find us on Facebook, Twitter, LinkedIn, and Instagram. Simply search for PediaCast. And again, that contact link over at pediacast.org, if you would like to suggest a topic for the program in 2023.

Also, I want to remind you, the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your healthcare provider. Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org.

So let's take a quick break. We'll get our Plain Language Panelists settled in to the studio and then we will be back to explore common childhood injuries. It's coming up right after this.

[Music]

0:05:22

Dr. Mike Patrick: Our Pediatrics in Plain Language panel is in the house once again. You will recall that Dr. Mary Ann Abrams is an assistant professor of Pediatrics at the Ohio State University College of Medicine and a pediatrician with Primary Care Pediatrics at Nationwide Children's Hospital. Dr. Alex Rakowsky, also an assistant professor of Pediatrics at Ohio State and a pediatrician with Olentangy Primary Care at Nationwide Children's. Let's give a warm welcome back to our friends. Thank you both for visiting with us again

Dr. Alex Rakowsky: Thank you as always for having us.

Dr. Mary Ann Abrams: Hi, Mike. And hi, Alex. It's great to be here.

Dr. Mike Patrick: Yeah, really great seeing the both of you. Are you getting all ready for the holidays?

Dr. Alex Rakowsky: Oh, yeah. Oh, yeah. I got two weeks off for Christmas, so very much so.

Dr. Mike Patrick: It's been such a busy virus season right out of the gate this year with RSV and the flu and COVID. And here in Central Ohio, we have some cases of measles. So I think that having a little break around the holidays is going to be good for all of us.

0:06:14

Dr. Alex Rakowsky: I like how you said some cases of measles. It's been overwhelming, so.

Dr. Mike Patrick: Yeah, yeah. We had a lot of it here. And, of course, the best way to prevent that is to get your MMR vaccine, right?

Dr. Mary Ann Abrams: Absolutely.

Dr. Mike Patrick: Everybody aged 12 months and older ought to have those. So, we are talking about plain language. Wd always begin with Mary Ann and a little primer on why plain language is important. So, why don't you fill us in?

Dr. Mary Ann Abrams: Plain language is important because if we don't speak in clear simple terms that people understand, we cannot communicate important messages about their health, what they need to know, what they need to do, how to take care of themselves or their children.

So we all need to think about using plain language which means plain simple terms, watching out for technical terms, especially complex medical words and also jargon which may be smaller words but they have different meaning in healthcare. And they can be puzzling or alarming to families and parents, and children when they hear those. So, plain language it is.

0:07:23

Dr. Mike Patrick: It is really important. And plain language helps parents and our young patients understand why we recommend what we recommend. And when people understand the why of something, they tend to be more compliant. And so then, if they're doing what you ask them to do because they understand why it's important, then that can in turn impact health outcomes. Because, again, they're following our advice, correct?

Dr. Mary Ann Abrams: Yeah. And we actually tried to talk about using the word adherent, rather than just doing what we tell them to do because we said so. But if we communicate more clearly and share in some of those discussions and decisions, it's much more easy, hopefully, for them to adhere to what we recommend.

0:08:11

Dr. Mike Patrick: Absolutely. And then that gets back to something that is really important and, here lately, has been talked about more and more, which is fantastic, and that is disparity in healthcare. And so the thought is that if you have more education, you may understand some of those bigger words and then be adherent and then improve outcomes.

But if maybe you don't have that language, maybe you don't have that education, perhaps you come from a poor background and you haven't had a lot of education, then you may not understand what we're saying. And then that may decrease your adherence, which can then negatively impact health outcomes, right?

Dr. Mary Ann Abrams: We do know that some groups are at higher risk for having limited health literacy or limited vocabulary and words and exposure to health information and the words that we use in healthcare. But by the same token, we also recognize that even physicians, doctors, nurses can have low health literacy if they're exhausted or worried or sick or it's not their area of expertise.

0:09:18

So, as pediatricians, when geriatric physicians talk to us maybe about our parent, our eyes may glaze over. We may not understand and we need to have them explain to us in plain language just as much.

Dr. Mike Patrick: Really great points. We are loosely following a book called What to Do When Your Child Gets Sick which is a product of the Institute for Healthcare Advancement. They are non-profit organization. We do offer a link to that book and we have a discount code so that you can get at $7.77 if you use the discount code. We don't get any kickback from that. Again, they're non-profit. And we'll put a link to that book in the show notes over at pediacast.org for this episode, 528.

0:10:00

We also have a survey on this Plain Language episodes that we would just love for you to fill out, if you've not already done that. And that is also available in the show notes.

And then I want to remind you, all of these Plain Language episodes are packaged together in a playlist over at SoundCloud. We have covered lots of stuff lately from bedtime problems, stomach problems, your child's breathing, their mouth and nose and ears and eyes. We've talked about newborn baby care, reading, and family literacy. We talked about the skin. Just lots of them.

It's, again, kind of basic foundational material that all parents really ought to have some grasp on to improve their kid's health and wellness. So, please do check all of those out and that playlist over at SoundCloud. And again, the easiest way to find all that is in the show notes for this episode over at pediacast.org.

So, today, we are talking about common injuries of childhood. And we're going to start with Alex and animal and human bites, our first stop on our agenda. So talk a little bit about those in terms of what we worry about, when to seek help, where to go, how they're treated, that kind of thing.

0:11:11

Dr. Alex Rakowsky: I want to start off with when Mary Ann came up of the idea of going through this book through a series of podcast. It looked like an impossible task, but this is it, this is the last chapter. So, please listen to the prior podcast because we're at very end here. So, we're going to start off with a humdinger…

Dr. Mike Patrick: At the end of the year.

Dr. Alex Rakowsky: At the end of the year, yeah, yeah.

Dr. Mary Ann Abrams: There we go.

Dr. Alex Rakowsky: So human and animal bites is a humdinger. So, I'm going to start of like I think every topic today, why worry? So, what's the big deal? And some things to consider before we get into some of the details. The first is bites can get infected. So, human bites can get infected. Bacteria from the mouth, you can get Hepatitis C, for example.

So, there's a concern about infections of human bites. There's a concern about infections with animal bites, obviously.

You worry about rabies. We don't see much rabies anymore in the United States but it's still common on some parts of the world. And it's still concern and you don't want to be the person who misses the rabies on your child.

0:12:09

The next issue is cosmetic. If you have a large bite, then it has to be put together in a way that you don't have some permanent scarring or scarring that didn't heal very well.

And then the third thing is just the trauma of it all, where a child gets bitten by an animal or another child. And it's just having a discussion about that. So using that as a beginning of this discussion.

When do you worry? I think there's a couple questions you have to ask. First, is the skin broken or not? And if the skin is broken, then you kind of go into the next series of questions.

And then who or what bit you? So human or animal? And then do you know this animal? And if the animal has their rabies series or their other vaccines, it makes it easier. If it's somebody's dog that you have no idea who they are, a wild animal, et cetera, then there's more risk.

0:13:02

The depth of the cut or the depth of the bite. And then any other risk factor, as far as like the bite being over a joint or being an area there may not heal properly.

So, the rule of thumb is if the skin has been broken, we usually recommend to get seen by an urgent care and ER for cleaning, for a deep cleaning. So for example, cat bite can go very deeply and that takes a lot of irrigation to kind of get that area clean.

Dr. Mary Ann Abrams: Wait a minute, what about irrigation? I thought that was a farm thing.

A: Yeah, sorry. That's when you put the fertilizer down there. So actually, irrigation's when you actually put a lot of saline under pressure to kind of get all the dirt out of there. Because cat bites can actually get infected pretty commonly. And then if it's a large gaping wound, to have somebody stitch it up who can do a nice job with the stitching up.

So rule of thumb, if the skin is broken, go get seen. And then, as far as things that they may talk about with you and your child are testing, depending on what or who bit you. So if you got bit by another child, you may have to go through a hepatitis C series testing just to make sure you didn't get that from the other child.

0:14:13

If you got bit by an animal that could be potentially rabid or you just don't know what bit you, then you may have to go through a rabies series most likely go through a rabies series. If it's a deep cut, you'll probably going to get put on antibiotics.

So it really varies depending on the bites. And that's sort of I think at the level of going to an urgent care and ER to kind of get that fixed.

Dr. Mike Patrick: Different areas of the country have different rabies patterns. And so, it's really important to talk to a local health provider who knows what the situation is for you locally. So just as an example here in Central Ohio, dog bites are pretty low risk for rabies. Just because there haven't been a lot of dogs with rabies in Central Ohio in many many years.

On the other hand, bats do have a high amount of rabies. And so, even just having a bat in your house, especially if your child was asleep and maybe the bat was in their room. And you don't know whether the bat really encountered your child or not, there still could be a rabies risk.

0:15:14

So just knowing those local patterns of risk for rabies in different animals can be helpful. Again, another reason just to see your provider because they're going to know what the local patterns are.

Dr. Alex Rakowsky: Yeah, we had an interesting case, probably a month and half ago in urgent care where a child got bitten. They weren't sure what it was and just two bite marks on the forehead. So I called the Department of Health. And they haven't had a rabies from a dog since 1956. But they're like, "Bats still exist," and that was a potential. So we had to go through a whole series and give it out.

And again, it was like, "What do we do?" It's a tough area. But God forbid getting rabies, so we played it safe.

Dr. Mary Ann Abrams: And sometimes, you can't even see those. The bat bites, they can be such tiny, that even though you look really carefully, you can't see that bite. But the child or the baby or the adult even was asleep or intoxicated or something, and you noticed the bat was in the room, you have to…

0:16:08

Dr. Alex Rakowsky: Hopefully, your child was not intoxicated.

Dr. Mary Ann Abrams: Hopefully, but regardless.

Dr. Mike Patrick: The holidays are approaching and the parents might be.

Dr. Mary Ann Abrams: There's a whole lot of scenarios that we can cover in another podcast on that. But bottom line is rabies is almost universally fatal, and you have to err on the side of being careful.

Dr. Alex Rakowsky: Also, I think people has this misnomer, like misperception that if I have a large bite, I need to get seen. But some of the worse infections we have over the years are a deep cat bite or a bite from some amphibian or reptile in your house. Which doesn't seem to be that bad on the first bite, but once it gets infected, those things get badly infected.

So again, any kind of bite that breaks the skin, at least call or at least consider getting seen.

Dr. Mike Patrick: Yeah, absolutely.

Dr. Mary Ann Abrams: Also, I'll kind of add too, where you get bitten. Like the back of the hand or the hand is so important because there's all these muscle and tendon sheaths with these tight tight wraps wrapping around it. And when the bite punctures that and it gets infected in there, you can have terrible damage to the ability of your hand to actually function well. So that's another reason to get that checked and cleaned out.

0:17:22

Dr. Mike Patrick: And then tetanus is also a risk with animal bites. And with so many people not vaccinating their children, it's something to think about because most kids are going to be protected against tetanus as long as they're up to date with other vaccines, through parent choice. But then, also from the pandemic, a lot of kids got behind on their vaccines because of the distancing and the difficulty it may have been to get in to see your doctor. But you definitely want to get caught up on those and be protected against tetanus before you get bitten by an animal.

Dr. Alex Rakowsky: And also, I think this is going to come up with every topic today, how do you prevent these things? So we love seeing you in urgent care but I rather not have your child get irrigated and scream because we're irrigating them. We're giving them rabies shots.

0:18:06

So it's important to teach your child, especially younger kids. If they approach or see a dog at a park, unless they are fully aware of who that dog is, ask the owner the first what can I do with this dog? Always ask permission.

If you see something wild outside, don't walk towards it. If you have a dog or a cat eating, even if it's your own pet, don't try to take their food away. Again, most animals don't go looking for humans to kind of bite them. But they have they do defend themselves. And it's sort of like a subconscious, "I'm going to bite because you're taking away my food," or "I have no idea who you are so I will bite you."

So avoid those situations where you're scaring an animal into being protective of themselves.

Dr. Mike Patrick: Yeah, it's a really good point. As we move on to insect bites and stings, I just want to point out that in the show notes for this episode, you're going to find a huge collection of past PediaCast programs. Because I knew we were covering a lot of common childhood injuries today and we wouldn't have a ton of time for each one of them, and so there is going to be a link for each of these topics to another episode of PediaCast where we also talked about these things.

0:19:14

So after listening to this one, if you want to learn more about childhood injuries, you can check out that collections of podcasts over in the show notes.

So Mary Ann, let's move on to insect bites and stings which we don't see quite as many at this time of year but that's only here in Ohio. And of course, we have listeners in Florida and New Mexico, and Arizona. And there's plenty of insects and stinging bugs out there right now.

Dr. Mary Ann Abrams: And we have a pretty mild fall. And I remember going out and cutting some flowers and there were some kind of sleepy… I would have called them yellow jackets but I think they're actually bees. They were very content sort of sitting on these flowers in the sun. And if I had just been raunching around in there, I might have startled one and he or she might have gotten upset with me. So always be vigilant.

0:20:06

So we're talking about insect bites and stings and I was like, "Okay, bites and stings." Sounds like one big happy group of things but they're different, right? Stings are more likely to occur with, here's my million-dollar word today, Hymenoptera, a species. So that's a deliberate use of a big word there. Fancy word for things like bees, yellow jackets, wasps, hornets, imported or like fire ants that are new to this part of the world. So things that actually stings.

And they're usually stinging and injecting venom to kill food or prey. It's purposeful and they would also do that if they were disturbed or startled or alarmed, I suppose. So what's the big deal, right? So you get sting, most of us have probably been stung and it hurts. So the risk with it is the general unpleasantness of a sting, which can be severe or a little mild, depending on how deep and how long and how much venom gets in there.

0:21:15

We're also concerned about the potential for infection. And then, people talk about being allergic, allergic to bee stings in particular. So in general, the pain will usually last a few hours or a day. And you want to clean off that sting regardless because the chances of it being infected, getting infected, are low but not zeros.

So just clean it off. You can use a cool compress. You can take acetaminophen which is ingredient in Tylenol or something like that to help be more comfortable.

If you find that it starts to get red after a few days. Maybe it is getting a little infected. And usually, unless you have a high fever and really spreading redness, you might use this little antibiotic ointment on the skin.

0:22:02

So keep keeping it clean. I've kind of talked about what to look for if you think it's getting infected. If it would get really red in broad area and hot warm tender fever and getting bigger and bigger, that would definitely be a reason to seek help at the doctor's office or the urgent care or the ER to see if you need something stronger to help contain that infection.

So then, we think about allergic reactions to the venom. And that can run the gamut from mild to very very severe and life threatening. So a minor allergic reaction is just going to be maybe the size of, does anybody know what a 50-cent piece is anymore?

[Laughter]

Dr. Alex Rakowsky: I think so, yeah.

Dr. Mary Ann Abrams: Two or three quarters of maybe a little bit red and a little swollen and warm. That would usually go away in several hours. And again, keeping that kind of cool with a cool compressor puff will help that.

0:23:00

You can have a large local reaction which is a lot bigger, maybe five inches or ten inches on a big part of the arm or the leg. And that can be very annoying and irritating. It can start a little bit later and lasts several days. It usually hits its peak about two days in and starts to get better. And that will probably take a little bit something like ibuprofen or something to help with that discomfort.

It might be irritating or even itchy, so you could use an antihistamine to help with that itching and that uncomfortableness to help that.

But then the last thing people worry about is bee sting allergies that cause life-threatening anaphylaxis or a severe life-threatening allergic reaction where you get maybe hives. You feel like your throat is closing up. People can be hoarse. They're flushed. They can get shorter breath. They'll be wheezing.

They may feel faint because the blood pressure can go down. And that is a major emergency, you call 911. You get help as soon as possible.

0:24:13

And then once you know that that is a health problem, you hopefully will have an auto injector of epinephrine. And once you have one of those, you need to keep it with you all the time. You don't know when you're going to be stung and you don't want it at home in the kitchen when you're on a picnic.

Dr. Mike Patrick: And use it. If you think you should use it, you just use it. There's no harm in using it. If it's early anaphylaxis, you could save your child's life.

Dr. Mary Ann Abrams: Absolutely. Don't be afraid. And actually, while I was looking a little bit of this reading, it talked about this is a perfect place for us to use plain language. So we can see a patient, tell them they need this, write a prescription, tell them the directions are on it, and the pharmacist will talk to you, whatever, but we aren't using plain language to explain when to use it, how to use it, why to use it, take the cap thing off and to make sure they really understand. Because if A, they don't fill that prescription, or B, they don't know how to use it, especially when they're anxious, it won't do any good.

0:25:18

Dr. Mike Patrick: Yeah, very important. Alex, cuts and scrapes. So these are very common.

Dr. Alex Rakowsky: Yeah, I actually have four in my hands currently from putting up Christmas lights. So these are even outside of childhood.

And so starting off, again, what's the worst-case scenario? It's these things getting infected and they commonly get infected if you have something in them. So we'll talk about them in a second. Or you have a lot of bleeding, so you can't stop the bleeding. Or they're wider and you can't really put them together for Band-Aid. So then they scar funny.

So those are your worst-case scenarios. So compared to animal and human bites, this is one you're probably not going to go to ER or urgent care, except if you have those three potential scenarios.

0:26:02

So cuts and scrapes are I think part of being human and they're really common. The key is to clean them up and then try to close them. And don't close them like with stitches at home. There's something where you can kind of put it together to kind of help that skin to start to heal.

Also, it's important to make sure there's nothing in that cut. So we commonly see kids who will fall down on blacktop at the park and now have a piece of blacktop or piece of wood chips in a cut. And it's hard to get it out without a child being upset but that can get infected down the road. So it's important to clean that out.

So, basically get seen if you have a larger cut that you think is going to need stitches. You can usually eyeball it or if it's been bleeding for more more than 10 or 15 minutes, or if there's something in there, you just can't get that something out.

Again, rule of thumb is most of this can be taken care at home. Do you need to use an antibiotic cream? Probably not, if you clean it off really well. Big believer to kind of cover it up during the day because kids are active.

0:27:01

Let it breathe at night. Air it out. Change the bandage because bandages are going to get wet and kind of gross. So last thing you want is like a big gross Band-Aid that can lead to an infection. So I think most people know how to take care of cuts and scrapes and all that. So it's the deep ones, bleeding ones, something in them that you kind of worry about.

Dr. Mike Patrick: The body has an amazing ability to heal even deep cuts. But by sewing them together, they heal a little faster. You don't have as much of a scar. So there's reasons why suturing or using the glue may be helpful. But your body will heal, which is an amazing thing.

As we talk about bleeding, I remember an old adage that I had heard as a young medical student, was that all bleeding stops.

Dr. Mary Ann Abrams: One way or another.

Dr. Mike Patrick: So how can we stop bleeding before you don't have any blood left to bleed?

0:28:01

Dr. Mary Ann Abrams: That's not how I thought we're going to start this conversation. But I love it. That's great. I like that.

Dr. Alex Rakowsky: More of it, more of it.

Dr. Mary Ann Abrams: I think bleeding, from that, the other thing is the sight of blood can be very frightening to people. Because blood looks like a lot, even when it's not. If it's actively bleeding, it gets all over and it's bright red and a little bit goes a long way. And people truly worry that somebody's losing way too much blood or that the amount of red blood they see is an indicator of severity.

Now, obviously if it's spurting out that, this is a very potentially dangerous situation because that could indicate that maybe an artery has been cut. If it was one of those cuts that was a little more severe than just the one where you fell in the playground. So clearly, if that is spurting, you want to get help right away.

0:29:00

But you still want to kind of apply the same response, whether it's a little cut that's bleeding or large amount of blood or a bloody nose. And that's basically to put pressure on it, to help stop the bleeding. Because unless someone has a bleeding disorder or a clotting disorder, the body also has a magnificent ability to make blood clots that stop the bleeding.

We let the body get to work if we kind of put that pressure on it, stop the flow of blood, so what's there has a chance to kind of accumulate the platelets and all the different parts of the body that make blood clot. So I think one of the biggest mistakes people probably do make is, it may feel like you've been holding pressure on a bloody nose or a cut on hand for a long time and in fact, it's really not been that long.

And I always tell people, at least five minutes by the clock. Don't just guess that it's been five minutes. Look at your watch, look at the clock, look at your phone. Because you just need that ability to let the body kind of get a grip on things and put that pressure on it.

0:30:11

Later, you can let it stop if you want to look at it and see if there's any foreign matter, foreign bodies. And it shouldn't be there. If there, clean it off gently. Because once that clot has started to form, you can do some gentle cleansing and make sure that you minimize the chance of getting infected, if it's a bleeding due to a break in the skin or something like that.

Dr. Alex Rakowsky: I think all of us are parents here, we're all parents here, but a lot of it is just calming down because if you are stressed out and your blood pressure is high because you fell down and Mom and Dad are not freaking out, you're going to still pump blood.

So sometimes, you just have to have everybody calm down. And I think the rule of thumb is like give it five minutes. And most people, "Okay, I got five minutes. I can chill for a few minutes and see what's happening."

0:31:02

If blood is spurting out, 911. But if it's something like a nose bleed or a bad cut, then wait till five minutes. I like that five-minute rule, because then parents can calm down for a few minutes or the school personnel can calm down for a few minutes and say, "Okay, I'm fine for five minutes. I don't have to really worry about this child like die in front of me." And sometimes that child then calms down. Sometimes, that kind of helps the blood flow also.

Dr. Mike Patrick: Yeah, I'm only surprised when I'm working in the emergency department, we see some pretty large cuts that are no longer bleeding. I would say most of them, by the time you get to the emergency room, the bleeding has stopped. We don't have to apply pressure very often at all.

And that really is a testament to our body's ability to clot and to stop bleeding unless someone has a bleeding disorder. And then also, direct pressure is usually enough. If it's a massive wound, then you're calling 911 and it's on an extremity, then that's when a tourniquet might be helpful. And that's just to tie something tight around the end of cut that is closest to the heart.

0:32:09

So, you want to see blood flowing from the heart to that area. But you don't want to do that unless you absolutely have to because then you're also cutting off blood to the whole extremity, and that could cause more damage. On the other hand, if just applying direct pressure is not enough and they're continuing to bleed, you may need to do that while you're waiting for 911.

So bruises are basically the same thing as bleeding and cuts. It's just that there's not a defect in the skin, right? So you're bleeding under the skin, so to speak.

Dr. Alex Rakowsky: I've got to mention for cuts, make sure that you do tetanus shots also.

Dr. Mike Patrick: Oh, yeah, good point.

Dr. Alex Rakowsky: Another reason to get the tetanus shots or be up to date. Bruising tends to be again, very very common. When do you worry? A very deep bruise or bruise in an area that you aren't suspicious of having a bruise. Or you're bruising for no good reason, I'll get to details for that.

So, 99.9% of bruises are just, you fell down, you hurt yourselves, you're putting out Christmas lights and they swing over and kind of hit your thigh. There's your bruise. I have one now.

0:33:11

And there are other sorts of bruises that we all have, as long as the bruise is a reasonable size, not growing too much and isn't over a part of the body that can potentially lead to problems, then most times you just watch it. They turn funky colors towards like three or four days as the blood breaks down. So if you have yellow or green, then that's actually part of the blood breaking down.

And the rule of thumb is that, every child who bruises their head, it's usually before a Christmas picture and they have big green or yellow knot on their Christmas picture. So that's actually part of growing up.

So when do you worry? So, if you have a bruise on a part of the body that is physically impossible, you worry about abuse. If you see an infant that has a bruise on their spine. Or you have somebody who's not mobile actually or walking around have bruises that look like you get from falling down, that's a concern.

If you have a child who wakes up with bruises, do they have leukemia or lymphoma? And that's something where again, it's rare. But parents should be aware, if I'm seeing bruises and I can't explain them, then I need to get a better look at this.

0:34:18

And then, bruises that tend to be very big or deep. So like abdominal bruises worry me, and thigh bruises worry me. I've seen a child a couple times playing soccer and got a huge bruise on their quad, the front of the thigh, and that thing kept on growing. And that area can get really large bruising and that child actually needs to go to the ER, just too kind of get a better look.

Bruising, again, almost every time is going to be fairly easy but things you need to be aware of to kind of not to miss something bad.

Dr. Mike Patrick: So lots of bruises and especially if they're unexplained, we know that the areas that bruise the most are going to be where you have skin right over bone, because the blood vessel gets squished between the bone and whatever it is that you've hit. But like in the belly, where there's not bone right underneath it, you worry a little bit more too about the mechanism of injury that caused that bruise.

0:35:13

Dr. Mary Ann Abrams: Yeah, and that's where you want to tie it into the developmental age of the child. When you see toddlers that they're walking but they're still a little unsteady but they're pretty brave and bold. So they're trying things like to go up the steps and then they fall, or they trip and hit their head on the coffee table. So they have a bruise on their forehead, you either saw it happen or it's very compatible with what kids that age do, and what you think happened.

So, we always want the answer to the question, "Tell me what happened," because that's going to tell us half the story of whether it's a potential bleeding problem or a potential non-accidental trauma or abuse. We have to put that whole picture together.

0:36:04

Dr. Mike Patrick: Absolutely. And really, it is another red flag, if a parent doesn't know what happened. And so it is important, especially young kids, they need supervision, constantly. Because you know what do they do, they climb up on the couch and next thing you know, they're on their head on the coffee table.

And so young kids really do need pretty constant supervision. And so if something happens, you want to be able to say "Oh, this is what happened." And I always get concerned as an ER doctor if parents don't know how it happened.

Dr. Alex Rakowsky: Yeah, I'll just put a little comedy here. So I saw a great t-shirt in the mall the other day and a little toddler had a shirt that said, "In my defense, I was unsupervised."

[Laughter]

Dr. Mike Patrick: That is great, I love that.

Dr. Alex Rakowsky: I'll get me one for our grandson.

Dr. Mary Ann Abrams: And parents, I had a toddler, maybe a two- or three-year-old way back when, who somehow tangled his leg up still the crib and it got all tangled up, in between the edge of the crib and mattress. And he fell and it twisted and he had a spiral fracture of his extremity.

0:37:11

But the parent had seen it happen and described what happened and it was totally compatible with that injury. But if hadn't been witnessed, you have to worry that that was someone who had grabbed that child and then just wrenched them, because that's another example of the story has to match what actual injury happened to the child. So you can have these really unusual situations that may tell a story one way but when you put the whole picture together, it makes sense.

Dr. Mike Patrick: Let's move on to strains and sprains. And those are two words, obviously, they rhyme, they sound a lot alike. But they're a little bit different. What is a strain versus a sprain and what do we do about those?

0:38:00

Dr. Mary Ann Abrams: Yeah, they're kind of fun. A strain is more related to the muscle and it's more of a stretch, maybe S T R strain, S T R stretch, maybe that works kind of well. I just that thought that makes quite sense. So, that's the person who just decided I'm going to go for a long run and just walks out the door and takes off. There's no warming up, there's no stretching before you go.

They're normally a couch potato, or they just decided to put up a million Christmas lights, instead of just half a million. And then suddenly, their muscles, they're not just sore from being used, but they got overused and kind of stretched.

And it hurts. You don't fix that with any kind of major intervention. Sometimes putting a wrap on it, ice, not putting a lot of stress on it, elevating it, some ibuprofen if that is needed, and giving it some tincture of time.

0:39:11

So most of the time, those will do better over time. And then, you want to prevent that from happening again by paying more attention to warming up and some stretches before and after you use those muscles.

Sprains, on the other hand, affect the ligaments, which are the connecters that attach our bones to each other that keep our feet to our legs. They make up our ankle. They give strength to our ankles, and our elbows and all those things.

So, when those ligaments get torn or stretched, that's more of a sprain, like a sprained ankle. And those, you kind of treat the same way. They probably may depend on how severe that is, that may not heal quite as quickly because there's not as much blood flow in the ligaments.

0:40:04

But again, ice, elevation, some compression or pressure, some nonsteroidal anti-inflammatory medications which are otherwise known as things like ibuprofen or even acetaminophen can help with that. And avoiding a lot weight bearing depending on if it's in your ankle versus a different joint.

Dr. Mike Patrick: Yeah, sometimes we can strain muscles that we don't often think about until it's strained and it hurts. And as an example, during cold and virus season, coughing a lot, you can actually strain the muscles between your ribs. And sometimes, you can have chest pain just from coughing because you pulled those muscles. And if you sleep on your neck wrong, you can pull a muscle in your neck and have a muscle strain there as well. So places that we don't often think about the muscles, once we stretch them, then you feel them, then you think about them.

0:41:01

Dr. Alex Rakowsky: I went to sport once, not a lot of skating around here but it's still too warm. But when a lot of kids go on Christmas break or holiday break then go skating, they'll get an inner thigh strain. Because now all of a sudden you kind of use those muscles to add up to bring your thigh muscles back.

And that's a common strain you see in urgent or in clinic this time of year, for some reason the winter sports seem to have you use more of your inner thigh muscles.

Dr. Mary Ann Abrams: And because they haven't experienced that kind of overuse of that muscle group, that's why they come into urgent care. They may not come into urgent care if they just sort of strain their calf or whatever, but there's actually something going on with this, with their parents.

Dr. Mike Patrick: Absolutely. Broken bones are also common in kids. The big broken bones where the bone is angulated and the arm looks crooked. There's no question that there's going to be a broken bone there when you get an X-ray. But sometimes, when we're talking strains and sprains, I mean there could be a smaller fracture or broken bone there, how do you tell the difference between those things?

0:42:08

Dr. Alex Rakowsky: So again, worst-case scenario is if I have a bone that's broken and it's not set properly. For two reasons, one, further down the road for cosmetic reasons, that bone doesn't heal well, et cetera. But also, like initial reasons, if I have a bone that's mal-aligned, meaning, it doesn't line up properly after a fracture, it can actually impact your blood flow through that limb or through that finger or whatever. And then that can lead to problems downstream.

So if I have a broken bone of my upper forearm, that could lead to problems in my hand, because another bloodstream isn't working properly. So that's the reason why again, if there's any suspicion of a broken bone, just like human and animal bites, get it seen.

Unless you have a broken finger, and I have a few of those just from basketball, and most of them you can take care of, unless it's like popped out of place. But otherwise, broken fingers, broken toes, we're not going to do a whole lot for those. I won't even X-ray some of them if they're sort of lined up properly. But otherwise, if you're concerned, go get it checked out.

0:43:11

And then, the key is to line up that bone so that it heals properly, and make sure that you have blood flow, we call cap refill and pulse, further downstream after that fracture, after you splint it or after you cast it.

Dr. Mike Patrick: Yeah, yeah. Absolutely. That's going to be really important. I love that you say for the cuts, if you're worried that there could be a broken bone or not, just see someone, because that's why we're here. And a lot of times you can come in and we see you and give you reassurance but that was still a worthwhile visit.

Dr. Alex Rakowsky: And that's why X-ray machines are so valuable on urgent cares and ERs. Even some primary care doctors have X-ray machines.

And also talking about prevention, for toddlers, avoid staircases, really have a good control of access to staircases, especially if you're going to be visiting family over the break. Grandma has a steep staircase and you're sleeping on the second floor. Make sure there is a gate that literally nobody can open except like a muscle man because toddlers are amazing in opening up a gate.

0:44:15

Avoid situations where a small child can run into an area where they can fall easily. Socks on a floor that just got waxed, bare feet on areas it can be slippery, et cetera, then you have to worry about it.

And then also, if you're doing some sports, skateboarding, skating, skiing, et cetera. Make sure you have the protective things on your head, on your wrist and your elbows and knees to avoid a fracture.

Dr. Mike Patrick: Yeah, absolutely.

Dr. Mary Ann Abrams: And a fracture is a broken bone.

Dr. Alex Rakowsky: That's true. That's a good point, I just realized.

Dr. Mary Ann Abrams: A lot of times people don't realize that.

Dr. Mike Patrick: That's a really good point. It's so easy for us to say fracture. Parents sometimes will get puzzled look on their face, and like "Oh, broken bone."

Dr. Mary Ann Abrams: Or they'll say, "Oh, so it's not broken."

0:45:02

Dr. Alex Rakowsky: Yeah, I actually have the habit, too.

Dr. Mike Patrick: Yeah, I had, too.

Dr. Mary Ann Abrams: Yeah, multiple, yeah, same here.

Dr. Mike Patrick: That is definitely one of those words that we think everybody knows what it means, but they may not.

Another common broken bone in toddlers, it happens when kids jump off a couch. So even though you think, "Oh you know, kids being active, they're playing, they're up on the couch, they jump down." But they can get what's called a toddler fracture of the lower leg. Those are actually pretty common.

Jumping up and down on the floor is probably fine, definitely something that's designed to be jumped on. But kids jumping off the couch, you would think that that wouldn't be such a bad thing, but kids break their legs doing that.

Dr. Alex Rakowsky: Yeah, depends on how they land.

Dr. Mike Patrick: Burns are next up. We do have a lot of pediatric providers who also listen to this podcast. We had a really terrific CME podcast on pediatric burn care. And that's one of the links I'm going to put in the show notes for you.

So I was with one of our burn surgeons. And it's a really great podcast in terms of up-to- date burn care, especially big burns, and ones that are going to go to an emergency room or be admitted to the hospital. That's available in the show notes.

0:46:13

But for mild, small burns, Mary Ann, what do we do for those?

Dr. Mary Ann Abrams: Yeah, I think people tend to think of burns as just like a sunburn, "Oh, I got burnt on the stove," "The water was hot. I got burnt by a cup of coffee that's spilled," or whatever. But thinking about the range of harm or damage that can occur with a burn, also kind of recognizing we've talked a lot today about holidays and what do people do at holidays. They have a lot of candles where they have fires.

Dr. Alex Rakowsky: They bake.

Dr. Mary Ann Abrams: They bake, oh yes, goodness. And they're cooking and they're busy. So they've got tons of thing going on. And as you said earlier, someone's got to have their eyes on the little ones, right?

So I'm sort of starting out with being vigilant, and thinking where are the hazards here and how can we avoid them? Because very few burns in children are planned or deliberate. Unfortunately, there are some.

0:47:15

But on the whole, so if children, I think about burns as what's the damage they can cause, right? So we think about them in terms of how deep they go into the skin. And we used to call those first and second and third-degree burns.

And now, there's a little bit more complex way of describing them that's based on how deep that burn is and how thick it goes or how deep it goes into the skin, whether it's partial thickness or full thickness or just superficial, at the top. And that's because that helps describe whether that surgeon needs to see that child or whether they need to go to the ER, or even be admitted or have more intense treatment. Because sometimes they could have damage that isn't as readily visible.

0:48:08

However, so thinking about what does it look like, how deep is it. Is it just red? Is it blistered? Is the top of the skin almost like shredded off? Maybe there's a blister there that just popped and now the top of the skin is peeling back.

Do you see damage? Below that, is it red? Is it black? Does it look charred almost? Obviously, something like that needs to be seen and evaluated.

And then thinking about how much of the skin is burnt? Is it just a little penny-sized or is it a whole, a big area like a pie or a dinner plate or a whole arm or leg?

And then, also the location. Because even if it's not a really big area, if it's a part of the body that has to be able to move and be flexible a lot, that can also cause long-term damage. Could it be on the face or the fingers, or over a joint that has to move all the time in order to walk or function? Those are all the things that go into that decision-making.

0:49:15

So if it's a relatively small area, and they accidentally hit a pan, and they've got a red area on the side of their hand or their arm, what you want to do right away is to cool that off to stop the burn, stop the heat. Don't put ice directly on it, but just run that hand or that part of the body under slightly cool water. Not ice-cold water, but just something to stop the damage from the heat.

Keeping it clean, managing the pain because it's going to sting and it's going to hurt depending on how deep or how big that is. So once again, our friends, acetaminophen and ibuprofen can be helpful.

0:50:00

Dr. Mary Ann Abrams: But if there's a break in the skin, more than just a little blister that might've popped, probably should at least go to your pediatrician, your family medicine doctor or the urgent care, to have a deeper and more thorough examination and maybe more in-depth treatment.

Dr. Alex Rakowsky: I can't over-emphasize the pain management, because a lot of kids may have a minor burn but it's like a raw nerve feeling. My one daughter got a minor burn. But she'll be off and she was smaller that time and just crying. And it didn't seem painful.

And then later on, she had a similar burn when she was older, and she's like, "It just feels like a raw nerve." And it's like, you know, when you're sick, you get that raw nerve feeling. And Tylenol takes it away somewhat, but a lot of it is just put cold compresses on. And just a lot of TLC, because burns can be very annoying and very irritating. And it's important to even just pre-dose with Tylenol or ibuprofen to make sure.

Dr. Mary Ann Abrams: Yeah, stay on top of it.

Dr. Mike Patrick: Anything other than a really small burn, if there's large blistering, if it crosses joints, again you mentioned the flexibility, and if you get scar tissue across that joint that may hinder flexibility in the future.

0:51:13

Burns on the face, these are all ones that you really want an expert, a burn specialist to look at and kind of follow along, and make sure that it's healing okay and there's no loss of function. Of course, if it's a large burn, call 911. Because sometimes, kids need fluid replacement if they're really large burns.

And you can get something called "compartment syndrome" where you get pressure build up in an extremity in an arm or a leg that has a large burn associated with it. Anything other than a really small burn, you really do need to see someone.

Dr. Alex Rakowsky: One final point is that we've had three children in our clinic in the last month. We had scalding, where the parents were making tea on the front burner where they had a hot cup of tea on a table and then a child hold it down. And those things can be pretty large. And we had one who had to go to burn clinic for almost a month just to kind of get followed up.

0:52:07

So another, if you have some hot liquid, people are coming over, have a safe place to put it. And if you're making hot water or something hot like cocoa, then put it in the back burner, where the toddlers just can't reach it.

Dr. Mary Ann Abrams: Because they're curious, they're going to reach it, they're going to say "What's that?" And it just tips right in front to their face or down the front of their chest.

Dr. Alex Rakowsky: So those things are nasty, because they go on your face, your chest, your thigh.

Dr. Mike Patrick: I would say almost every day, the emergency department, we see kids who pour something hot on themselves. It goes back to supervision, to keeping an eye on your little ones, especially when they're in the kitchen, but elsewhere in the house, too. They're all dangerous, kids will find the danger in every room of the home.

Dr. Mary Ann Abrams: This is another case too, where you want to make sure tetanus vaccines or tetanus toxoids are up to date because that break in the skin, especially at a large area that's under the superficial part of the skin, that's a beautiful entry point for tetanus and other infections.

0:53:07

Dr. Mike Patrick: Yeah, absolutely. Kid’s bump their heads a lot and we have to kind of differentiate between is there a skull fracture, do they have a concussion, is there a brain bleed? When should parents be upset about head injuries?

Dr. Alex Rakowsky: That's a good way to kind of start off the discussion, because it's not the bump you worry about. It's how strong was that bump that could lead to stuff inside the skull.

So if I have a large enough head injury, that now the child's throwing up, lost consciousness, isn't acting normally after 10 or 15 minutes, then that injury may have been serious enough, that that bump may not be super large but there's still enough damage. I think that bumps on the head, to kind of change the perspective is, what was the mechanism and how much damage could that mechanism cause that child's either skull or the brain below it.

0:54:00

If the child's acting normally, you just have a bump on the head, it's one of the most what you call vascular or bloody parts of the body. So getting a small bump on the head will give you a big goose egg. The size of the goose egg doesn't really matter unless it's like humongous, but some kids are going to bleed a fair amount after a bump because that area's tight. So the blood doesn't have a lot of places to go. And we're designed to have a lot of pressure up there so that part of the body will bleed a lot.

So the bump itself usually isn't all that concerning. But if you're concerned about the brain at all and again, loss of consciousness, not acting normally, throwing up, acting different, the eyes look different, the pupils look different, that's an automatic, "Let's get you seen." And the key for bumps on the head, is to avoid them best you can.

So again if you're skateboarding, biking, skiing, skating, put a helmet on. I mean skating people are going to put a helmet on. But I've seen some nasty head injuries from people falling backwards on a skating rink.

So when in doubt, try to avoid them best you can. And don't avoid activities but put a helmet on. And the helmet again takes that pressure, spreads it out. It's not going to avoid a bump but it's going to avoid at least that pressure going down to your brain and giving it the real damage.

0:55:16

Dr. Mike Patrick: Yeah, yeah absolutely. One thing I want to point out is if you have a child with a head injury and you're worried, if it's available, you're probably better off going to a pediatric facility. Because in the adult world, when adults hit their head and have some behavior change and maybe vomit a couple of times, they're always going to get a head CT, CAT scan of the head. And in the adult world it's just an automatic "This is what you do."

With kids, we really try to avoid radiation exposure when we can because they got their whole life ahead of them and we know that the more you're exposed to radiation, the more likely you can get tumors and cancers that develop.

And so, we're not as quick to do CAT scans of the head in kids, unless there's specific criteria that are met. And it's not something that as a parent you want to, "Will they meet those criteria or not?" You really want a pediatric expert to council you on whether a head CT is needed or not, because a lot of those kids don't end up needing a head CT.

0:56:19

Dr. Alex Rakowsky: And I think a lot of parents expect the head CT. But there've been a lot of studies and one huge study done by a group called PECARN, which is a group of emergency physicians. So we use the PECARN rule, and I think all of us in pediatric ER or urgent care will put the PECARN rule, because we're really trying to avoid the CT.

So, we're not avoiding because we don't like you or we're saving money. We're doing it because we don't want to radiate a child's brain. And the PECARN rules are very liberal, as far as like get a CT scan if there is a concern. So they're designed to make sure that there's no reason to get a CT scan, even there is a potential reason you're getting a CT scan.

So if your ER doc is saying, "I don't think a CT scan is needed," that's based on a lot of studies that have shown that the chance of finding anything is so low, that there's more risk from the radiation than there is from the benefit of finding something.

0:57:12

Dr. Mike Patrick: The other reason to go to a pediatric specific place is the CT scanners of many children's hospitals actually use lower doses of radiation compared to a CT scanner in an adult hospital, which is another reason to seek pediatric care instead of adult care, if possible. I mean obviously, if your child has altered state of consciousness, don't drive two hours to the big city to see a children's hospital, go to your local ER. In that case, you have to.

Next up, we have talked about drowning, which we could easily and have done a whole episode on water safety and drowning. And in the show notes, actually, I have one episode completely on water safety and another on prevention of drowning. We'll have those in the show notes for you.

But what are the keys points, Mary Ann, to drowning that all parents really ought to know for water safety.

0:58:04

Dr. Mary Ann Abrams: Gosh, yeah. I think the most important thing is, I'm trying to see here and decide if I can say this. With all the things we've talked about today, we've talked about how important it is to keep an eye and watch and be vigilant on your kids, whether you're the parent, the babysitter, the neighbor, it takes a village.

Drowning is probably one of the ones that you just cannot believe how quickly things can go wrong and how horrible they can be, when they go wrong. Don't leave them alone in the bath tub to just check something else. Don't leave them playing in the kiddie pool while you run in the house to do X.

Don't talk on the phone while they're playing and then wonder where they are and find them in the bottom of the neighbor's pool. Just don't let them out of your sight if there's any potential for, especially for drowning.

0:59:00

And keeping in mind that little ones can drown in a very small amount of water. They don't have the reflexes and the ability or the judgement to see what it is they're falling into and to get back out. Especially if they're surprised, when they fall in and then they gasp, and then they inhale a bunch of water, and then that just becomes a cycle of drowning.

Because what is drowning? It's when you basically end up with water in your lungs to the point where you aren't able to get any oxygen to your brain, your heart and the rest of your body.

Dr. Mike Patrick: Yeah. I think a take-home for parents is that drowning is typically silent. So don't think, "Oh well, I'll hear my child splashing," or you know, "They'll be gasping for air and I'll hear them, and I can go rescue them." A lot of times kids just slip under and that's it, it's quiet. It's not necessarily a big splash event.

Dr. Alex Rakowsky: I know we're in winter here, but parents or families may travel to warmer places or people may listen to this outside of December. But also pool safety, where if you have a bunch of teenagers who are just goofing off in the pool, and they're like one of them falls to the bottom because they're holding their breath, there should be somebody supervising.

1:00:20

And we always made it a point, when we went to a pool, to have one of the adults, their job was just to look at the… You're thinking they're teens, what can they do wrong? Well, somebody may have just kicked somebody and now they have a little bit of concussion, and they're in the bottom of that pool.

And also alcohol and swimming or alcohol and boating do not mix. And two of us do ER, you do ER and I do urgent care. And seeing unfortunate cases where a teenager will fall into a river or a lake. There's a lake near us where I think a teenager drowned a couple years ago just from alcohol, and fell off a boat. They thought, "Well, that's funny," and next thing you know, he was drunk. And he did not come back out. And then, we received him in the ER, so it's a problem.

1:01:02

Dr. Mike Patrick: Yeah, yeah. Absolutely, and again just that constant supervision. Even if there's a life guard on duty at a pool, if your kids are in that pool, someone should have their eyes on your kid. And if you're with a group of parents, you could take turns doing that.

Parents need a break and maybe you were going to chat with your friend, or you're going to check your social media. Or are you're going to read a book. But at least one parent in that group ought to have their eyes on all the kids, and you can take turns but it's important.

Dr. Alex Rakowsky: Two of our sons life guarded for the YMCA, and they were both very well trained. And they had two lifeguards, which is one more than a lot of pools have. And even then, my one son was like, "I could not see every child on the water."

And he's like, "If you have 150 kids from the camp in the water at the same time, that's 75 kids per lifeguard." And you need the parents there. You need the camp counselors there. So that's important to know. 

Swimming is great, I love swimming. I think kids should all learn how to swim, but you have to be careful with the kids.

1:02:04

Dr. Mary Ann Abrams: Just a couple other examples, when the water can be murky, especially a little one, I remember walking at the edge of a pond and it wasn't deep but it was murky. And all of a sudden, I realized that if my son, who was four at that time, slipped and fell under that water, just like you could slip and fall in the driveway, I would never be able to see him. And then you don't know where he is going to go.

So then you have this panic reaction, right? So you don't want to alarm them but you do want to quickly move to them. We've had two or three drownings in this area lately with the water retention ponds and apartment complexes. Those are not fenced. There's no requirement to have them fenced. And they're made to look kind of decorative, and people just don't think of them that way.

1:03:03

And kids are gone all of a sudden, "Oh, my gosh!" And again, you can't see the bottom of those, most times. And just always being I hate to sound directive, but being vigilant.

Dr. Mike Patrick: Really important. One of the links in the show notes for this particular topic is "Prevention Of Drowning" PediaCast episode 520. And on that one, one of our guests was actually a parent who had a child who drowned at a day camp in a different state. But because they didn't have adequate supervision, didn't have adequate lifeguards there, too many kids in the pool, lost their child.

And so, he has really become an advocate at drowning prevention and trying to get legislation that actually mandates there be so many lifeguards. However   many kids are in the pool dictates how many lifeguards you have to have and all that, because a lot of states don't have any rules surrounding that.

Dr. Alex Rakowsky: We're pretty good about that here, so.

1:04:03

Dr. Mike Patrick: Another topic that we could do an entire episode on is poisoning. And we have had some excellent episodes in the past with the Central Ohio Poison Center folks here on PediaCast. And I have some of those links in the show notes as well.

But Alex, what's the most important thing parents need to know about preventing their kids from getting into chemicals?

Dr. Alex Rakowsky: So just a few kind of take-homes. The first is if you think your child may have gotten into something, eyeball them. And if there is a real concern that they're not breathing properly, that you need 911, call 911. Otherwise, I think it's important to figure out what they could've gotten into.

And we tend to think poisoning as only pills, but I actually have the numbers here. But the number one reason that the poison control got called, pills is number one. Cleaning supplies, eating detergent, eating moisturizers.

And one that kind of surprised me but I shouldn't since we had two kids admitted fairly recently, eating marijuana products, which is now legalized in a lot of states, where a child gets into a cookie, or a brownie, which was not designed for them.

1:05:15

So the key is figure out what you think the child may have eaten, take a picture if it's like a pill. If you don't know the name, take a picture, "This is what the pills look like." And then, I think every family should have the Poison Control number on their phone, on speed dial or like a sticker if people still have landlines. And it's 1-800-222-1222.

I have it on my phone. And it's one of those things where you will get connected to a Poison Control Center anywhere in the states. I think even Alaska and Hawaii. So it's important to kind of have that as a background.

So then, the key is going backwards the reasons for kids getting poisoned. Keep all medicines higher up for toddlers. If you have somebody that, unfortunately, is thinking about harming themselves, then keep medicines in a small amounts.

1:06:07

So if you have a bottle that Costco or Sam's Club bottle of Tylenol, which is actually the number one medicine that people try to harm themselves with, maybe break it into like 10 packs or 15 packs, if you have somebody at home that you are worried about doing something. So that's for medicines, keep all cleaners, keep all sort of other things that little kids can eat, higher up or locked cabinets if you don't have something higher up.

And then, in some states where marijuana paraphernalia or marijuana sort of foods are becoming more and more common, you have to demarcate things pretty well. Don't put marijuana brownies in the refrigerator with regular brownies, because all of a sudden, people are thinking you know that's…

Dr. Mike Patrick: Keep your drugs separate from your food.

Dr. Alex Rakowsky: And then the last thing is don't use regular bottles for… I saw a horrific case of a child and they came to urgent care. And they're just like salivating at the mouth.

1:07:11

And it turns out that dad took some like those decorative oils to use around the house. And it was like Christmas time a couple years ago. And he poured it into a Coke bottle because he had like a large bottle, got some from a friend, pour into a little Coke bottle. One of those four-ounce things, six-ounce thing.

And the child thought it was a Coke and started drinking it. And now they have this bad scenario, they got intubated. And it took a while to figure out in the urgent care what's going on and we end up shipping that child down the hall to the main campus ER. And he actually drank it because that child actually thought that it was Coke.

And that was a reasonably like older child, like a 10-year-old who wasn't looking to harm themselves. He was thirsty, it looked like coke, and he drank it. And so just put a big thing, like keep things that are packaged on purpose a certain way in their packaging.

1:08:06

Dr. Mike Patrick: So that you know what it is, if you have to call Poison Center, you want to tell them what it was. If it is in a Coke bottle, you know it's not Coke, but you don't know what it is.

Dr. Alex Rakowsky: Anti-freeze looks like Mountain Dew. It's identical, I mean, color-wise.

Dr. Mike Patrick: Intubated is a word that you use, can you use the plain language term, please?

Dr. Alex Rakowsky: Yeah, so this child couldn't breathe well. So they had to put a tube into his airway to kind of breathe for him until his lungs healed up. One of the sickest kids I've ever seen in urgent care.

Dr. Mike Patrick: Also, a vape cartridges with nicotine, really dangerous to kids and high levels of nicotine in those vape cartridges.

Dr. Alex Rakowsky: I've got the numbers here. And actually last year, 16 and a half thousand phone calls about vape cartridges to Poison Control. I mean, it's a staggering number.

Dr. Mary Ann Abrams: In the country or?

Dr. Alex Rakowsky: In the country, yeah.

Dr. Mary Ann Abrams: And I have to agree. The Poison Control Centers are such a fabulous resource. People just have no idea how incredibly helpful and valuable and important they are.

1:09:08

Even if you don't think it's a serious thing, like maybe they pulled a laundry detergent and it's got in their eye or something, call them. If your child decided to eat half a tube of toothpaste, call them. They will tell you whether to be worried, what to do or what not. "You don't have to go to the doctor," blah blah blah. Or how to watch and they'll sometimes call you back or have you call them back, or whatever. They're really wonderful.

And two other scenarios that I just remember seeing so many times, when purses are left out, company, visitors, especially in the holiday times, people have tons of medicines in their purses. And they just sit them on floor, they put them on the chair, and curious kids get into them. And then you find those opened bottle of pills and serious serious ingestions.

Dr. Mike Patrick: I remember seeing a grandparent that had cough drops in their purse that had dextromethorphan or DM. And that can be brain altering, behavior altering. And we had a kid who had altered state of consciousness.

1:10:14

And we're thinking do we need to do CAT scans? What is going on with this kid and it turns out he thought it was candy and was just eating these cough drops and had so many of them, that it was mind altering the child.

Dr. Alex Rakowsky: Two more points is, if you have a suspicion of something being eaten, don't call the docs because we know a whole lot less than Poison Control. They are remarkable. I love Poison Control. They do an amazing job.

Dr. Mike Patrick: Every ingestion that comes in the ER, anyone who has poisoned themselves, we call Poison Center. Every single case, the doctor calls Poison Center to make sure we're covering all our bases. So if ER is relying on the Poison Center, as a family at home, call them, I totally agree.

1:11:04

Dr. Alex Rakowsky: And they can really guide you, too. "Okay, this is a child that needs to get seen in ten mins, I will call 911 for you." So they'll take over the case.

And then the second point is a lot of parents were afraid of, "Oh, my child may have poisoned themselves. I'll call Poison Control and I'll get in trouble." They're not there to report you to Child Protective Services. They're there to kind of save your child's life.

So I think every family has called Poison Control at some point. And that's what they're designed to do. They're designed to help out.

And shoutout to a good friend, Marcel Casavant, who's our toxicology here. He's done tons of outreach about Poison Control Centers to some of our immigrant communities, that "This will not get you deported. This will not get you…" Just amazing work to kind of let people know this is a safe place to call and let us take it from there.

Dr. Mary Ann Abrams: And one other thing, you alluded to this earlier, when we were talking, I don't remember what we're talking about. I said something about alcohol, and you said, "Oh yeah, and the holidays."

1:12:03

So parents have had a lovely party and are very tired and will clean up in the morning. And the kiddies are waking up earlier and checking out mom and dad's and friends' half empty cocktail glasses or whatever.

Dr. Mike Patrick: Their red cup.

Dr. Mary Ann Abrams: Whatever, whatever. And then, parents get up an hour later and their child is acting really weird or having seizures or whatever. And they're not just drunk. They've got alcohol toxicity or poisoning. And it can be very severe. So clean them up. Clean up.

Dr. Mike Patrick: Clean up your party that night. Don't wait till morning, absolutely.

And then, finally, I wanted to talk about CPR and AEDs or automatic external defibrillators. I think, and we're pressed for time here, a little bit. We do have an episode of PediaCast where we go into a lot of detail about AEDs and I have a link to that in the show notes.

1:13:03

But I think the bottom line here, if you have kids at home, and really I think everybody ought to do this, especially if you have kids at home, you really want to take a first aid/CPR class with the American Red Cross. You're going to have that opportunity in just about city in America. If you call your local American Red Cross, they'll be able to hook you up with a CPR class.

And a lot of those CPR classes now also include AED training, and will actually show you how to use one. They'll have like a fake trainer AED that you can actually play with, so you get some familiarity with how to use it.

Dr. Alex Rakowsky: I agree.

Dr. Mary Ann Abrams: And I guess the two things I would add was with regards to AEDs, when you go to watch your kids' sporting events or your kids are on teams or whatever, find out where the AEDs are. Make sure they're not locked in the coach's office on the weekends because if someone running on the soccer field collapses with some unknown heart problem or some other reason, you want to be able to grab that AED and use it.

1:14:10

So find out where they are. And make sure the school or the athletic group has something in place to have those present.

And don't be afraid. If you really think CPR is needed, you're scared because you've never really done it on a real person, obviously, don't stand there and worry and wait. Start.

If you checked and they're not responding, they're breathing, you don't feel a pulse, start that CPR. And send somebody for help or call for help, and then start CPR.

Dr. Mike Patrick: And the chest compressions are the most important part of it. In fact, some of the training now is don't even worry about the rescue breaths. If someone else is getting a hold of 911, just start those chest compressions, because that's the most important thing.

Dr. Alex Rakowsky: Even if you're not good at it, there's an old motto. I used to coach a lot of basketball when my sons played. To let a shot clock expire without a shot, kids will be like "I don't want to take a bad shot." You will miss 100% of the shots that you don't attempt and have the shot clock run out.

1:15:09

So you may not be particularly good at the CPR but you're better than nothing. And then, take a class. And most of them are free.

Dr. Mike Patrick: All right, well this has been a fun conversation on common childhood injuries. Before we go, Alex, remind us about primary care pediatrics here at Nationwide Children's. We've got one of the largest groups in the entire country.

Dr. Alex Rakowsky: We're big. I think it's 15 clinics now, and some school-based clinics. We have evening hours. I think it's seven or eight of the clinics. And we follow about 120,000 patients of a quarter million visits. I think that's the latest numbers.

The clinic I'm at Olentangy, we see 82 different languages. So it's a neat place. Six of the clinics were training clinics for our resident and two of the clinics have family medicine residents, either in addition or by themselves, And then medical students go through a lot of the clinics as well.

1:16:06

It's a really big network. Does some great work, I'm really proud of the fact of how our division has really stepped up to help out the people in the community.

Dr. Mike Patrick: And we'll put a link in the show notes to Primary Care Pediatrics at Nationwide Children's. We also have our Primary Care referral line. So if you're in Central Ohio and you're looking for a pediatrician, just call 614-722-KIDS and that will put you in touch with a Nationwide Children's pediatrician.

Well, we really appreciate another year of Pediatrics in Plain Language episode. We finished our book, which I think we've going through that for like two years or three years. It was around the time the pandemic started I think, is when we were getting into them.

Dr. Alex Rakowsky: We started these by Zoom.

Dr. Mike Patrick: Yeah, I do remember those. We have links to all of the old Pediatric in Plain Language, that playlist on SoundCloud with all those episodes packaged together.

Dr. Alex Rakowsky: I think it's 15. It is a chunk.

1:17:08

Dr. Mike Patrick: It is a chunk, and a lot of great terrific information there. And then, of course all the other episodes. We've talked about other common childhood injuries. I'll put links to all of those in the show notes as well.

So in the meantime, and until we meet again in the new year, Dr. Mary Ann Abrams and Dr. Alex Rakowsky, thank you both so much for stopping by again today.

Dr. Alex Rakowsky: Thanks.

Dr. Mary Ann Abrams: Thank you. It was great to be here.

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1:18:01

Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.

Also, thanks to our guests this week, our Plain Language Panel, Dr. Mary Ann Abrams and Dr. Alex Rakowsky, both primary care pediatricians at Nationwide Children's Hospital.

Don't forget, you can find this podcast wherever podcasts are found. We are in the Apple and Google podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music, and most other podcast apps for iOS and Android.

Our landing site is pediacast.org. You'll find our entire archive of past programs there, along with show notes for each of the episodes, our Terms of Use Agreement, and that Contact page if you would like to suggest a topic for the program.

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Also, don't forget about our sibling podcast, PediaCast CME. That stands for Continuing Medical Education. Similar to this program, we do turn up the science a couple of notches and offer free Continuing Medical Education credit for those who listen.

1:19:11

And you will find medical jargon for sure in those episodes. They're really aimed for doctors, nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists.

And since Nationwide Children's is jointly accredited by all of those professional organizations, it's likely we offer the exact credits you need to fulfill your state's Continuing Medical Education requirements. Of course, you want to be sure the content of the episode matches your scope of practice.

Shows and details are available at the landing site for that program, pediacastcme.org. You can also listen wherever podcasts are found. Simply search for PediaCast CME.

Thanks again for stopping by. Have a really terrific holiday season with your friends and family. And then come on back here in 2023 for more trustworthy information aimed at keeping kids safe and well.

Until then, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long, everybody.

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Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.