Red Flags: The Findings That Mean Act Now, the Injuries That Mean Report

When the injury does not match the age crit

A bruise on an infant who is not yet cruising is a red flag. Bruising of the torso, ears, or neck in a child four years or younger is a red flag. Bruising of the frenulum, angle of the jaw, cheek, eyelid, or sclera is a red flag, as is any patterned bruise. A sharply demarcated immersion burn with no splash marks and a clean stocking or glove line is a red flag. A spiral fracture in a child who cannot yet walk is a red flag. A history that changes between tellings, a history that does not explain the injury, and an unexplained delay in seeking care are all red flags.

The nurse reports reasonable suspicion. The nurse does not investigate, does not confront the caregiver, does not need proof, and does not wait for a colleague to agree. Document what was seen and what was said, in quotation marks, without conclusions.

Gut red flags crit

• Bilious, green vomiting at any age is obstruction until proven otherwise. Report immediately.
• Intussusception, typically between three months and three years: sudden colicky pain with the knees drawn up alternating with normal play, a sausage-shaped right upper quadrant mass, and a currant-jelly stool of blood and mucus. The paradox: passage of a normal brown stool may mean the telescoped bowel reduced on its own, and it must still be reported, not celebrated.
• Pyloric stenosis, in an infant of roughly two to eight weeks: projectile, forceful, non-bilious vomiting followed by immediate hunger, a firm movable olive-shaped mass in the right upper quadrant, visible peristaltic waves, weight loss, and hypochloremic metabolic alkalosis. Correct the fluid and electrolyte state before surgery.
• Hirschsprung disease: no meconium in the first day or two of life, then ribbon-like foul-smelling stools, abdominal distention, and failure to thrive. Fever with explosive diarrhea signals enterocolitis and is an emergency.

Head and spine red flags crit

• Rising intracranial pressure in the infant: a bulging tense fontanel when the infant is upright and quiet, a head circumference crossing percentile lines, a high-pitched shrill cry, irritability that worsens when held, downward-deviated sunsetting eyes, and separated cranial sutures. In the older child, headache worst on waking, vomiting without nausea, and altered level of consciousness.
• Open myelomeningocele in the neonate: position prone, cover the sac with sterile moist saline gauze, keep the environment strictly latex-free, measure head circumference daily for developing hydrocephalus, and monitor for infection. Never place the neonate supine and never apply a dry dressing.
• Febrile seizure, typically between six months and five years: turn the child to the side, time the event, protect the head, loosen clothing, restrain nothing, put nothing in the mouth. When it ends, look for the source of the fever.

Legal panel crit The nurse is a mandatory reporter in every US state. The governing statute, the reporting window, the receiving agency, and the documentation requirement vary by state. Verify against the state Nurse Practice Act, the state statute, and facility policy.

Margin noteif they aren't cruising, they shouldn't be bruising.

Takeawaya pediatric red flag is usually a mismatch, between the vomit and its color, the head and its percentile, or the injury and what the child is physically able to do. → BOOK 03 · P5