Child safety

Dr M. A. Maleque Molla; FRCP, FRCPCH

September 20, 2017

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Case scenario 1.

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15 month old child was admitted in PICU with Coma and Hyperpyrexia T 420C

Child was left inside the car for >8 hour

He was severely dehydrated, hyper thermic and comatosed.

With an intensive treatment child expired after 5 hour.

Case scenario 2.

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3yr & 7 month old girl was missing while there was family gathering in a farm house.

She was found in the small water house using for irrigation.

Child was brought to nearest hospital. No signs of life was found.

Started CPR. Patient ‘s heart rate returns but remained comatosed.

Admitted in ICU with life support. MRI brain showed badly brain damage Patient started to breath but remained comatosed till the

date.

Overview

Injury and violence is responsible for about 950000 deaths in children <18 years each year.

Unintentional injuries account for 90% of these cases & are the leading cause of death aged 10–19 years.

Road traffic injuries are the leading cause of death among 15–19-yearolds and the second leading cause among 10–14-year-olds.

Tens of millions of children require hospital care for non-fatal injuries.

WHO Global Burden of Disease: 2004 update 4

Types of Injury

Children are suffering following major types of injuries:

1. Unintentional: Motor vehicle occupancy injuries

Falls

Bicycle-related injuries,

Fire and non burn injuries

Poisonings.

2. Intentional: resulting from assault, abuse, or suicide

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Fatal childhood injury

Five categories of unintentional injuries make up 60% of all child injury related deaths: 1. Road traffic accident 2. Drowning 3. Burns (fire or scalds) 4. Falls 5. Poisoning

Other unintentional injuries, causes 23% of childhood deaths includes:

1. Choking, Suffocation, 2. Asphyxiation, 3. Animal or snakebites, 4. Hypothermia and hyperthermia

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Why children are prone to injury?

Their bodies are smaller and more fragile.

Their motor coordination and reflexes not yet mature.

They have limited life experience.

Infants learn by constantly observing, making predictions about how things work and then testing these ideas.

They can’t appreciate the risk & Consequences.

By the end of the first year of life, infants crawl or walk into off-limits places and reach for dangerous items in the name of learning.

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Injury risks

4 developmental stages to classify the injury risks to children:

Infancy -0 to 12 months

Early Childhood- 1 to 4 years

Middle Childhood-5 to 9 years.

Early Adolescence-10 to 14 years o

Ref: Safe Kids USA, 2013 9

Fall related injury Falls accounted for 61% of all infant injuries.

Infancy 0-12 month:

Most frequently fall mechanism:

Falls from furniture (3-11 mo)

Drop by an adult(0-2 mo)

Car seat falls

Fall down the stairs

Early Childhood- 1 to 4 years

Underdeveloped muscles and bones

limited sensory abilities.

Development of balance is still not complete.

Social skills are not well developed and imitate others called parallel play & increasing the risk of injury

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Fall related injury (cont..) Middle Childhood:

They are more vulnerable to peer pressure for participating in risky playground behaviors.

Bicycle Injuries are more common in this age

They do not have adult-like hand-eye coordination and obstacle avoidance abilities.

Early adolescent:

10 to 14 year olds struggle for independence and control, and often are not supervised by the adults.

peer influence and acceptance becomes very important.

risk-taking behaviors put them at risk for injury

Bicycle related injury common in 8-12 yrs of age

visual perception is less defined than that of older teens

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Motor Vehicle Injury (cont..)

Infancy: Infants are vulnerable;

The muscle and bone development of spine not mature for proper restraint.

They do not have adequate neck control & can lead to a blocked airway and prevent the child from breathing properly even using baby seat.

Early Childhood:

Resist to put in child safety seat and may become a distraction to the driver during car rides.

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Motor Vehicle Injury (cont..)

Middle childhood & Early Adolescent:

Children have a higher vehicle related injury & death rate as compared to younger age groups.

Resist to use booster seat is prime cause of injury in this age.

Prematurely move from a booster seat to an adult lap and shoulder belt, thus an increased risk for head injury and spinal damage in the event of a crash.

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Burn related injury

Non fire burn injury:

Infants & young children are risk of non fire burn injury:

They are exploring their environment, often by touch or taste.

Their cognitive skills are not mature to recognize the risks associated with hot liquids or other items.

They do not have the ability to control their impulses or understand the consequences of their actions

Their skin is thinner than that of adults.

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Burn related injury (cont..)

Fire burn:

Infant & Young children can not escape without an adult’s assistance if a fire occurs.

Smoke inhalation injuries are of significant risk because of their smaller airways & higher respiratory rates

Fire escape plan: Only few family(23%) practiced a in their home

Older children are more likely to start fires with matches, lighters and other heat sources

they are less likely to wake up from sleep if a smoke alarm sounds

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Poisoning

Infants are at increased risk:

The infant’s desire to put any objects in the mouth.

Toxic chemicals stay in bodies for prolonged periods of time.

Slower digestion and increased stomach emptying, which promotes absorption.

Kidneys and livers have lower functioning capacity than adults.

Due to lack of keratin, infant’s skin readily absorbs chemicals.

Infants have higher respiratory rates making more vulnerable to respiratory poisons.

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Poisoning (cont..) Early childhood: Most vulnerable for accidental poisoning:

By 18 months they are completely mobile.

Able to open cabinets, drawers and containers, can access chemicals stored in low cabinets and medications that are left within their reach.

They are still lacks the ability to fully understand or remember directions or rules.

Pre adolescent:

Peer pressure and risk-taking behaviors my lead to experimenting with psychoactive substances such as inhalants or recreational prescription medication use.

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Safety recommendations

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Safety recommendation Falls Prevention

Infancy :

Install stair gates.

Secure furniture to the wall.

Do not leave the child unattended on furniture.

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Safety recommendation Falls Prevention (cont.)

Early child hood

Install stair gates

Do not place toys on top of furniture that attract children.

Place furniture away from windows and secure it to the wall.

Supervised when they are on a playground and provide safe places to play

Maintain separate play areas for children <5 yrs age

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Safety recommendation Falls Prevention & Bicycle safety

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Middle childhood & Early adolescent:

Children should use age appropriate playground equipment for 5-12 year olds.

Teach children proper playground behavior.

Teach children the rules of the road.

Make sure children wear a helmet and protective gear every time while riding bicycle.

Model safe behaviors: Set a good example for your children by wearing helmet, right safety gear and obeying traffic signals.

Safety recommendation Motor vehicle safety

Infancy

Use a rear facing, semi-reclined car seat until at least age 1 yr and wt. 20 lbs

Never leave a child alone in a car

Never drive the car holding the child on your lap

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Early childhood:

Use a forward-facing car seat or a booster seat.

Hold a child's hand in driveways, parking lots and sidewalks.

Never leave them alone to cross the road.

Drivers should walk all the way around the car before getting in.

Never leave a child alone in a car

Booster seat

Forward facing seat

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Safety recommendation Motor Vehicle safety (cont.)

Middle Childhood:

All children under age 13 should ride in a back seat

Keep children in booster seats with the vehicle lap and shoulder safety belts until they pass the Safety Belt Fit Test.

Talk to children about car safety

Teach them how to cross the road using ‘Zebra crossing’

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Safety recommendation Motor Vehicle safety (cont.)

Infancy: Install smoke alarms

Practice an escape plan with your family

Set water heater to 1200F or lower

Test the bathwater with wrist or elbow before placing the baby in it.

Do not hold a baby while cooking or carrying hot foods and liquids

Never microwave a baby’s bottle:

Drinks heated in a microwave may be much hotter than their containers

Heat bottles with warm water and test them before feeding an infant

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Safety recommendation Non fire & fire Burn safety

Early childhood(cont.)

Set water heater to 1200F or lower.

Make the stove area a "kid-free" zone

Cook with pots and pans on back burners and turn handles away from the front of the stove

Place hot foods and liquids on the center of the table

Install smoke alarms

Practice an escape plan with your child

Lock up matches and lighters out of their sight and reach & teach not to play with match or lighter.

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Safety recommendation Non fire & fire Burn safety (cont.)

Middle Childhood : Discuss fire safety and practice an escape plan with

your child.

Lock up matches and lighters and teach children not to play with them.

Teach children to never use candles in their bedrooms

Do not allow children to use a microwave until they are tall enough to reach the items in it safely .

Place hot foods and liquids in the center of the table.

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Safety recommendation Non fire & fire Burn safety (cont.)

Early adolescent:

Warn children to never use candles in their bedrooms.

Practice a fire escape plan with your family.

Teach them not to play with matches, lighters or fireworks.

Do not allow children to use a microwave until they are tall enough to reach the items in it safely

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Safety recommendation Fire & Non fire burn safety (cont.)

Infancy:

Be safe & careful when giving medicines to a baby

Make sure to read labels and give babies the proper dosage

Keep poisons out of sight and out of reach for the kids under lock up.

Install carbon monoxide alarms

Learn the National Poison Control number

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Safety recommendation Poison Prevention

Early & Middle childhood :

Use child-resistant packages

Lock up poisons out of children’s sight and reach of the children.

Keep products in their original containers.

Never refer to medicine or vitamins as “candy”.

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Safety recommendation Poison Prevention (cont.)

Early adolescent:

Talk to the child about the dangers of poisonous items like gasoline, spray paint and medicines

Install carbon monoxide alarms

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Safety recommendation Poison Prevention (cont.)

Make it a Safe Kids Ride Safe- safety seat or safety belt

Swim Safe- supervise young children near water

Wheel Safe- wear properly fitting helmets and other protective gear

Walk Safe - never let children under 10 yr. to cross the street alone

Play Safe- supervise children at playgrounds & wear the right, properly fitted protective gear when they practice and play team sports.

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First aid for burn

Call the doctor if;

The burned area is charred or white.

Electric shock or chemicals caused the burn.

The burn is on the face, hands, feet, genitals, or a joint.

The burn covers 10% or more of the body.

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First Aid for burn(cont..) For severe burns, call your local emergency number right away. Until help

arrives, follow these steps Cool the burn:

Cool the burned area with cool running water for a few minutes. Do not use ice on a burn. Do not rub a burn; it can increase blistering. For 3rd degree burns, cool the burn with wet, sterile dressings until help

arrives.

Remove burned clothing: Lay the person flat on her back and take off the burned clothing that

isn't stuck to the skin. Remove any jewelry or tight-fitting clothing from around the burned

area before swelling begins. If possible, elevate the injured area.

Cover the burn: After the burn has cooled, cover it loosely with a dry bandage or clean cloth. Do not break any blisters.

Keep the child from losing body heat: Keep the body temperature normal. Cover unburned areas with a dry blanket.

Reduce Pain: Use an infant or child pain reliever. 34

Drowning Drowning: the process of experiencing respiratory

impairment from submersion/immersion in liquid medium.

Near-drowning: is the term for survival after suffocation caused by submersion in water or other fluid.

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Epidemiology Drowning ranked 13th as the overall cause of death

among children under 15 years old, third most common cause of accidental death world

wide. 1–4 year age group appearing at greatest risk. A small child can drown in a few centimeters of water

at the bottom of a bucket, in the bath, or in a rice field.

Fatality rate among the boys, twice as high as the rate for girls

Children who survive drowning, many are left with long-term consequences and disability

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Risk factors Age and development:

Infants- Mostly the result of a child being left alone or with an unqualified caregiver – such as a young sibling.

Children- are more mobile and inquisitive, but still not developed an awareness of hazards or avoidance skills

Adolescence-The increased risk due to less supervision and increased independence & increased risk-taking behavior

Gender: fatal drowning are higher in males than females in all ages except <1yr

Poverty: drowning mortality rates more in low-income countries.

Underlying conditions: Epilepsy

Lack of safety equipment

Unsafe vessels on water

Alcohol consumption 37

First aid for drowning Most lives are saved by the immediate action of at the scene

by people or professional rescuers

1. Get Help-Notify a lifeguard, if one is close. If not, ask someone to call 997.

If you are alone, follow the steps below.

2. Move the Person- Take the child out of the water.

3. Check for Breathing

Place your ear next to the person's mouth and nose. Do you feel air on your cheek?

Look to see if the person's chest is moving.

4. If the Person is Not Breathing, Check Pulse

Check the person's pulse for 10 seconds.

5. If There is No Pulse, Start CPR 38

First aid for drowning (Cont..) 5. If there is no pulse, start chest compression Carefully place person on back Place the heel of one hand on the center of the chest at the

nipple line. For an adult or child, press down about 2 inches. For an infant, press down about 1 and 1/2 inches. Do 30 chest compressions, at the rate of 100 per minute or more Check to see if the person has started breathing.

6. If person is still not breathing open the airway by tilting the head back and lifting the chin. Pinch the nose of the victim closed. Take a normal breath, cover

the victim's mouth with yours to create an airtight seal, and then give 2 one-second breaths as you watch for the chest to rise

Give 2 breaths followed by 30 chest compressions Continue this cycle of 30 compressions and 2 breaths until the

person starts breathing or emergency help arrives. 39

Drowning prevention Drowning is preventable in most cases Secure fencing and gating of swimming

pools can ↓ swimming pool drownings by 80%, < 4yrs

Adequate adult supervision for young & mentally subnormal children

Water Safety, Life Guards like personal flotation devices during swim.

Avoidance of alcohol and illicit drugs while swimming or boating

Training program for swimming in every school and should be a part of education

Parents must also be warned that toddlers can drown in shallow water, including toilets and buckets of water, if not adequately supervised

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Choking/ Strangulation/ Suffocation

Toddlers & young children particularly at risk Choking aspirated food or small toys Accidental strangulation of infants– entangled in any

cord/telephone wire etc. Increasing incidence of both accidental and intentional

hanging in teenage boys

Prevention

Public Health Campaigns

Parent & Child Education

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Choking Signs and symptoms of choking may

be: clutching the throat,

coughing, wheezing, gagging,

having difficulty speaking or swallowing,

making strange sounds or no sounds at all,

making a whistling or ‘crowing’ noise,

face, neck, lips, ears, fingernails turning blue.

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First aid for chocking Conscious Adult If the victim cannot cough, speak or

breathe 1. Give 5 back blows Place one arm across the chest and bend

the victim forward at the waist. Firmly strike the victim between the

shoulder blades with the heel of your hand

2. Give 5 abdominal thrusts Place the thumb side of your fist against

the middle of the victim’s abdomen, just above the navel.

Grab your fist and give quick, upward thrusts.

If chest thrusts do not work, alternate between 5 back blows and 5 chest thrusts until medical help arrives.

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First aid for chocking in child First aid for a choking child is very similar to an adult:

1. Call for help and activate EMS.

2. Lean the child forward and make 5 back blows with the heel of the hand.

3. If this does not work, stand behind the child and wrap with arms around the child’s waist.

4. Make a fist with one hand. Place the thumb side of your fist just above the child’s navel, well below the breastbone.

5. Grasp the fist with your hand.

6. Make 5 quick, upward and inward thrusts with your fists.

7. Alternate between 5 back blows and 5 abdominal thrusts until the object is dislodged and the child breathes or coughs on their own.

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First aid for chocking Conscious infant 1. Carefully position the infant face-

down along your forearm

2. Give 5 back blows

3. Position the infant face-up along your forearm

4. Give 5 chest thrusts

5. Continue giving 5 back blows and 5 chest thrusts until:

The object is forced out.

The infant begins to cough forcefully, cry or breathe.

The infant becomes unconscious 45

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