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スポック博士の育児書786-9OBJECTS 英並

2016-10-20 06:40:32 | 育児
Therefore, never try to move a person after an injury that may have damaged the neck or back. This includes any trauma in which the child has lost consciousness and any serious high- impact injury. Instead, make the child comfortable and keep her quiet until an ambulance arrives. Only a specially trained health-care professional should move a child suspected of hav­ ing a neck or back injury.
If the child must be moved and professional help has not ar­ rived, one person should hold the child's head and neck in a neutral position. When the child is being moved her head and neck should be kept in this exact position at all times. Never turn the body separately from the head. These maneuvers will reduce the chance of further injury to the spinal cord.
Even before a baby has begun to walk, she may suffer a head in­ jury by rolling off a bed or changing counter. If she cries imme­ diately but stops crying within fifteen minutes, keeps a good color, doesn't vomit, acts as if nothing has happened, and doesn't develop significant swelling on her head, there is little chance that she has suffered an injury to her brain. A swelling that puffs out quickly on a child's forehead after a fall isn't seri­ ous in itself as long as there are no other symptoms. It was caused by a broken blood vessel just under the skin. Swellings on other parts of the skull may be a sign of broken bones.
When a head injury is more severe, the child is likely to vomit, lose her appetite, be pale for several hours, show signs of head­ ache and dizziness, alternate between agitation and lethargy, and seem sleepier than usual. If a child has any of these symp­toms, get in touch with your doctor or nurse practitioner so she can examine the child. Any child who lost consciousness after a fall should certainly be examined by a doctor immediately, even if there are no other symptoms.
After any head injury, a child should be observed closely for



the next twenty-four to forty-eight hours. Bleeding under the bones of the scalp can put pressure on the brain, causing symp­toms that are not obvious at first but develop over a day or two. Any change in behavior, especially increased sleepiness, agita­ tion, or dizziness, is a red flag.


the next twenty-four to forty-eight hours. Bleeding under the bones of the scalp can put pressure on the brain, causing symp­toms that are not obvious at first but develop over a day or two. Any change in behavior, especially increased sleepiness, agita­ tion, or dizziness, is a red flag.
Finally, keep an eye on your child's performance in school, after a head injury. Children who have a concussion—that is, a head injury with loss of consciousness or memory of the inci­dent—may develop difficulty with concentration or learning.
For dental injury, see page 812.
Objects that aren't food often pass through a child's stomach and intestines without difficulty. They may not even be noticed. However, they may become stuck somewhere- in the digestive tract, usually the esophagus (the tube between the throat and stomach). The objects that are most likely to cause problems are needles, straight pins, coins, and button batteries. These can cause coughing or choking, the sensation of having something caught in the throat, pain or difficulty with swallowing, refusal to eat, drooling, or persistent vomiting.
If your child has swallowed a smooth object, like a prune pit or a button, without discomfort, the object is likely to pass on its own (although you should still notify your physician or nurse practitioner). Obviously, if your child develops vomiting, pain or any of the symptoms listed above, consult your doctor right away. Button batteries are especially dangerous, because they can leak acid that damages the esophagus or intestines. They need to be removed.
Metal objects show up on X-rays; plastic or wooden objects may not. An MRI scan might be necessary; or a doctor may have to look directly, using an endoscope. A skilled ear-nose-throat surgeon or gastrointestinal (GI) doctor can often remove a swal­ lowed object with the endoscope.



Finally, never give ipecac (a medicine to induce vomiting) or a cathartic to a child who has swallowed an object. Doing so will not help, and may possibly make the situation worse. For objects lodged in the windpipe or bronchial tubes, see Choking and Rescue Breathing (page 790).
First aid for suspected poisoning is simple: If your child appears ill, call an ambulance (911), then the National Poison Control hotline, 800 222-1222. If your child appears well, call the poison hotline directly. Other tips:
1. Stay with your child and make sure she is breathing easily and is alert. If not, call 911 or your local emergency unit for immediate help.
2. To prevent her from ingesting any more, remove any re­maining substances or solutions. If you can, bring the sub­stance with you if you take your child to the doctor to aid in identifying it.
3. Do not delay seeking help even if your child seems well. The effects of many poisons—aspirin, for instance—may take hours to show but can be prevented by early treat­ment.
4. Call the National Poison Control hotline, 800 222-1222. Tell them the name of the medication or product and the amount of the substance your child swallowed, if known.
Poisons on the skin. Although we often think of the skin as a protective barrier, it is important to realize that medications and poisons can be absorbed through the skin and can reach toxic levels in the body. If your child's clothes or skin come in contact with a potential poison, remove the contaminated clothing and flush the skin with plenty of plain water for fifteen minutes (which will seem like a very long time). Then gently wash the


area with soap and water and rinse well. Place the contaminated
clothing in a plastic bag, keeping it away from other children.
Call the National Poison Control hotline (800 222-1222) or
your doctor. If they refer you to a hospital, take the contami-
nated clothes with you in case they wish to test the clothes to
identify the poison.

Harmful fluids in the eye. If a child is accidentally squirted or
splashed in the eye with a possibly harmful fluid, promptly flush
the eye. Have the child lie on his back and blink as much as pos-
sible while you flood the eye with lukewarm (not hot) water
poured from a large glass held two to three inches above his face,
or hold the eye open under a stream of lukewarm water from the
faucet. Keep this up for fifteen minutes, then call the poison hot-
line, your doctor, or nurse practitioner. Some liquids, especially
caustics, can cause serious damage to the eye and require a med-
ical evaluation by your doctor or an eye specialist. Try to keep
the child from rubbing his eyes.


Children may have an allergic reaction to a food, a pet, a medica-
tion, an insect bite, or almost anything. The symptoms can be
mild, moderate, or severe.

Mild: Children who have mild allergies may complain of wa-
tery, itchy eyes. There is often sneezing or a stuffy nose. On occa-
sion they may develop hives, a very itchy localized swelling of the
skin that looks like a large mosquito bite. Other rashes, with
small, itchy bumps, can also be caused by allergies. Mild allergic
symptoms are usually treated with medications known as anti-
histamines, such as diphenhydramine (Benadryl), which is
available without prescription.

Moderate: Moderate allergic symptoms occur when in addi-
tion to hives, the child develops respiratory symptoms, such as
wheezing and coughing. Children with these symptoms need to
be prompdy evaluated by a doctor.


Severe: Symptoms of severe allergic reactions, also called ana-
phylaxis, include swelling in the mouth or throat, difficulty in
breathing due to blockage of the airway, and low blood pressure.
Most of the time anaphylaxis is merely uncomfortable and
frightening; rarely, it has very serious consequences, including
death. Emergency treatment for anaphylaxis is a shot of adrena-
line (also called epinephrine) injected under the skin; the child
must be immediately brought to a hospital emergency room.
Any child who has had an anaphylactic reaction should be eval-
uated by a physician, who may prescribe a preloaded syringe of
epinephrine; Epi-Pen and AnaKit are common brand names.
Parents and teachers carry the syringe with them so that the
child can receive an injection without delay.

An allergist can help you decide if allergy desensitization
makes sense for your child.


A generalized seizure or convulsion is frightening to witness. It's
important to remain calm, and to realize that the child is not
usually in danger. Place the child in a position where she can't
hurt herself—for example, on a rug some distance from the fur-
niture. Lay her on her side so that any saliva will run out of her
mouth and her tongue does not block off her airway. Don't
reach down her throat. Call the doctor or 911. See page 879 for
more on convulsions.


A child found unconscious by a lake, pool, or bucket of water
needs immediate resuscitation, ideally by a person trained in
CPR (see page 791). To give rescue breathing, follow the instruc-
tions on page 792. Be prepared to roll the child to one side if he
vomits, to protect his lungs. If the child could have been diving,
assume that his neck might be broken. Move his head as little as
possible to avoid damaging the spinal cord. A child who almost


drowns, but then seems to recover, still needs to be seen by a
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