Paediatric skin, ENT, and safeguarding

ENT and skin items in pediatrics mix airway bleeding after tonsils, contagious skin rules, and the legal duty to report when a child’s story and injuries do not add up. This chapter stays in words and supplies; no injury photographs.

Tonsillectomy and pediatric ENT

After tonsillectomy the surgical bed can bleed quietly. Blood trickles down the throat, the child swallows again and again, and the room may look calm until pallor and tachycardia catch up. Frequent swallowing, throat clearing, restlessness, vomiting blood, or bright oral blood is a bleed pathway, not “thirst after surgery.” Escalate now; do not wait for a puddle on the pillow.

Bleeding risk is highest early after surgery and again when the scab loosens days later, so home teaching stays sharp after discharge. Soft cool foods and approved fluids keep the site from drying and cracking. Straws create suction that can tug the healing bed; crunchy or abrasive foods scrape it. Red or brown fluids are usually avoided early because they look like blood and hide a real bleed on the exam and at the bedside.

1. Watch for frequent swallowing, vomiting blood, restlessness, rising HR; bleed pathway.
2. Position and comfort per order; avoid trauma to the surgical site.
3. Hydrate with approved fluids; skip straws and abrasive/crunchy foods early.

Ear and eye items in this chapter are anatomy and spread control. The toddler ear canal runs more horizontally, so pull the pinna down and back to straighten the path for drops. Pulling up and back is the adult move and pools medicine at a bend. Otitis media prevention targets what keeps fluid near the eustachian tube: propped bottles while flat, smoke exposure, and missed vaccines when due. Hold feeds upright; never prop a bottle for unsupervised feeding.

Bacterial conjunctivitis spreads on hands and shared towels, so hygiene and finishing prescribed drops matter as much as the bottle itself. For strabismus or amblyopia plans, patch the stronger eye so the weaker eye has to work; covering the weak eye defeats the purpose. Follow the ophthalmology schedule rather than inventing “as much as the child will tolerate.” The distractor that looks kind is giving red popsicles after T&A, pulling a 2-year-old’s pinna up and back, or patching the lazy eye “so it can rest.”

Contagious skin and eczema

Contagious skin stems ask whether you interrupt contact spread without shaming the family. Impetigo (often honey-crusted lesions) moves by touch and fomites: hand hygiene, separate towels and linens, cover lesions as directed, finish antibiotics, and follow return-to-school rules. Stopping meds when crusts fade leaves organisms and classmates exposed.

Head lice are about head-to-head contact and shared hats or bedding more than “dirty hair.” Treatment is the pediculicide as directed plus wet combing to remove nits, with wash or bag guidance for linens and close contacts as taught. Nits alone are not the same teaching point as active live lice; know what your policy uses for school return. Reassure parents that infestation is common and not a moral failure, then still treat thoroughly.

• Impetigo spreads by contact; hand hygiene, separate towels, cover lesions as taught.
• Lice: medicated product + combing; clean bedding/hats; reassure parents this is not about cleanliness alone.
• Eczema: moisturize relentlessly, trim nails, avoid wool/fragrance triggers when relevant.
• Diaper rash: dry clean skin, barrier ointment; yeast patterns need antifungals as ordered.

Eczema (atopic dermatitis) is a broken skin barrier that itches, not an infection to scrub raw. Moisturize often, keep nails short so night scratching does not open skin, prefer loose cotton, and cut wool or fragrance triggers when they clearly flare the child. Topical steroids go on as a thin layer when ordered, on inflamed skin, not as a thick “more is better” coat over the whole body. Diaper dermatitis improves with frequent changes, gentle cleansing, air time, and barrier ointment on clean dry skin. Satellite lesions and persistent beefy redness suggest Candida and need an antifungal as ordered, not endless zinc alone. The distractor treats lice as proof of neglect, stops impetigo antibiotics early, or steroids every inch of dry skin instead of the inflamed patches prescribed.

Child maltreatment: recognition and reporting

Suspect maltreatment when the history does not fit the developmental stage, care was delayed without a clear reason, or there are patterned burns/bruises or injuries in protected locations; described in documentation, never displayed as images here. A crawling infant with a spiral femur fracture story that only fits a much older child, or a clearly demarcated immersion burn with a changing caregiver story, are classic “history does not match” patterns on exams.

• Stay calm and nonaccusatory with caregivers while protecting the child.
• Use exact quotes and body diagrams per policy; objective facts only.
• Do not confront in a way that lets a dangerous caregiver leave with the child when imminent harm is suspected; follow facility security/protective protocols.

The distractor that looks fair is waiting until you are “sure” or until a physician agrees before reporting. Mandatory reporting laws generally set the threshold at reasonable suspicion, not conviction. Another miss: accusing the parent in the hallway so they remove the child from care. Keep the child safe, document, and use the designated pathway.

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