Chapter 13: Toddler/Preschool Problems: Injury & Maltreatment

Toddler/Preschool Problems: Injury & Maltreatment begins by differentiating between common sleep pathologies, such as nightmares, which occur during REM sleep, and sleep terrors, which occur during deep non-REM sleep, while also addressing cultural nuances regarding co-sleeping and the adverse effects of media exposure on sleep hygiene. A substantial portion of the chapter is dedicated to the emergency management of investigating injurious agents, emphasizing that the immediate clinical priority is stabilizing the child's cardiorespiratory status rather than focusing solely on the poison. It details the pathophysiology, clinical manifestations, and specific treatment protocols for the ingestion of corrosives, hydrocarbons, acetaminophen, and aspirin (salicylates), noting that traditional induction of emesis is no longer standard practice. Instead, the text explores gastric decontamination methods like activated charcoal and the administration of specific antidotes such as N-acetylcysteine. The chapter provides an in-depth analysis of heavy metal poisoning, particularly lead toxicity, outlining its detrimental effects on the developing neurologic, renal, and hematologic systems. This section covers environmental risk factors, screening via blood lead levels (BLL), and therapeutic management using chelation therapy agents like calcium EDTA and BAL. Finally, the content addresses the critical social issue of child maltreatment, categorizing abuse into physical neglect, emotional abuse, physical abuse, and sexual abuse. It defines specific syndromes such as Abusive Head Trauma (shaken baby syndrome) and Munchausen syndrome by proxy (medical child abuse). The summary concludes by outlining the nurse's essential role in identifying abuse through discordant histories and physical assessments, executing mandatory reporting laws, and providing supportive care to vulnerable families.