PED Derm / Maltreatment

physical indicators of neglect

• underweight

• always hungry

• dirty clothes

• inappropriate clothes for the weather

• first dropped off and last picked up

• misses school

• overly tired

safe haven law

• fire department / hospital

• 30 days old or less

• 24 hours to reclaim the child

environmental factors on infant

• temperature instability

• skin injury risk (sunburns)

• fire arms

infant skin (caregiver behavior)

• poor supervision can lead to burns, poisonings, bites

• abuse and neglect can lead to skin injuries

children skin due to lack of hygine

• impetigo

• lice

• scabies

toddler developmental stage is at a risk for

poisoning risk

adolecent developmental stage is at a risk for

acne

infant skin is very

• fragile

• permeable

infants have a thinner epidermis that allows

• topical meds to absorb FAST

• risk for toxicity (especially steroids)

what are the five differental factors from infant skin to adult skin

• thinner epidermis

• loosely bound layers

• less melanin

• more water content

• immature immune barrier

with infants having loosley bound skin layers they are at risk for

• easy blisters

• burns, friction injuries

with infants having less melanin they are at risk for

• sunburns easily

• out of the sun between 10 and 2

with infants having more water content they are at risk for

easier skin break downs

with infants having immature immune barriers they are at risk for

infections spreading quickly

no chemical sunscreens on infnats untill

• 6 months of age

• need hats, clothing

Children lose heat more quickly through the skin, increasing risk

hypothermia

in terms of child maltreatment you are not to diagnose abuse, only

recognize and report suspicion

brusing in infants is always a red flag, if located on the

• chest

• back of legs

• ears

• neck

• under clothing

report

high suspicions of physical abuse

• middle of long bones

• rib fractures under 3

• skull fractures

• any fracture under 18 months

immersion burns

• clear line

• buttocks/ legs

• indicated forced submersion

circular burns

• cigarettes

• hot objects

spiral fracture

twisting force abuse

skull fractures

always concerning

signs of shaken baby syndrome

• retinal hemorrhage

• brain injury

caregiver behavioral signs of abuse

• overly controlling

• doesn’t believe injury

child behvioral signs of abuse

• fearfull when other children cry

• withdrawn

• afraid of strangers

injuries in different healing stages indicate

abuse

legal responsibilites of the nurse

• report based on suspicion

• do NOT wait for proof

• good faith immunity (legal protection)

• if do not report than Class C misdemeanor

contact dermatitis

• direct contact with an irritant (urine, feces, wipes, diapers)

• red / inflamed skin

• diaper ares/ skin folds

• need barrier creams with zinc oxide

• keep the skin clean and dry

• no scented wipes or soaps

erythema multiforme

• allergic reaction to medications / infection

• target shaped lesions with a red center surrouned by a lighter ring

• hands, feet, mucous membranes

• discontinue med

• give topical or oral steroids

scabies

• mites on the skin

• extreme itching

• blister / pimple like spots on the hands feet and trunk

• pencil line marks on the hands

• entire family treated

scabies teaching

• cool baths

• short nails

• antihistamines

head lice ( pediculosis capitis)

• 3-12 years of age

• 48 hours w/o host

• not from pets / do not jump

• all stuffed animals bagged for 2 weeks

• boiling water / dryer 2x

• child may be irritable and awake at night

• pediculicide shampoos / fine tooth comb

cellulitits

• strep / staph bacteria through a break in the skin

• red / swollen and warm to the touch

• well defined boarder

• fever

why is periorbital cellulitis so concerning

becuase its close to the central nervous system

management for cellulitis

• oral antibioitcs

• intravenous antibioitcs

• mark the affected area

atopic dermatitis (eczema)

• erythematous patches / vesicles / exudate / crusts

• intense itching

• scaly / plaquelike appearence

• food triggers (milk , eggs) / pollen / dust

• keep skin moisturized with emollients / topical cortico

acne

• pimples/ leisons

• blackheads/ whiteheads (noninflammatory)

• male adolescents

• impact self esteem and body image

• not associated with eating greasy foods

management of acne

• hygiene

• topical treatments (benzoyl peroxide / salicylic acid )

• oral antibiotics / retinoids

impetigo

• highly contagious bacterial skin infection

• honey- colored, fluid filled blisters

• popping and crusting

• contagious until crusted over

first degree burns

• superficial

• epidermis only

• redness and pain / no blisters

• 3-7 days to heal

• cool compressess / alovera

second degree burns

• partial thickness

• dermis

• blistering / pain / red / shiny

• 2-3 weeks

• need silver sufadiazine ointment

third degree burns

• full thickness

• subcutaneous tissue

• chared or white skin

• may not feel due to nerve damage

• skin grafting and fluid resuscitation

• sterile dressing / IV fluids