3- Accidents in and around the home: Part 3: Injuries, drowning, choking, electrocution and suffocation.

 

 There are so many different ways a child can be injured and harmed in and around the house.  Working in a paediatric emergency department, medical and surgical wards, I have

seen the outcomes of a few of these potentially preventable accidents.  Nothing replaces the role of supervision by a responsible adult- but there are other things we can do to make the home a safer place for our children.  Not all accidents can be completely avoided, but common sense and foresight goes a long way in prevention.  More than 2000 children die every day across the world as a result of an unintentional or accidental injury and 10s of millions of children are taken to hospital with injuries that often result in lifelong disabilities (UNICEF, WHO, cited in CP, 2009, p.24)..  Don’t let it happen to you and your child!

 

It is important to teach our children about danger and how to stay safe.  We must teach this from an early age, but do not depend on the fact that because you have taught your child not to do something that might harm them, that they will stay safe.  Young children have tunnel vision, cannot comprehend the big picture of a situation, and even though they may understand the word “no” or “stop”, may not obey or fully comprehend the entire concept of why.  Even when you teach a child about a particular danger, they may not understand the concept that it may hurt or kill them.  Don’t rely on your child to keep him/herself safe: continue to supervise and remove potential dangers as well.

 

Falls and climbing- Nearly 47 000 children fall to their deaths every year (CP, 2009, p.24).  This is a major cause of broken bones and head injuries.  Open windows, balconies, stairs, play equipment, baby walkers, bunk beds, cots and change tables all pose a risk for falls.  It is not advisable for household with young children to have bunk beds.  Prior to a child is able to pull himself up to standing, cot sides should be raised to their full height to prevent climbing out and falling.  Always have a hand on you baby when changing nappies on a change table.  Use harnesses on high chairs and prams, Ladders are exciting to climb and should be folded and put away after use.  Babies left on beds or couches fall off.  There will always be falls from play equipment- kids will be kids, BUT  play equipment should be over a soft surface, such as grass, to minimize injuries from falls. Encourage safe play and only use equipment for the purpose it was intended. 

TRAMPOLINES: Over 100 children per year are hospitalized from trampoline accidents.  Supervise, set rules, only 1 child at a time, sink the trampoline into the ground, place on a soft surface, have safety padding and correctly care for the trampoline.

 

ACTION:  assess consciousness, breathing and circulation. RICE: rest, ice, compression, elevation.  Seek medical attention if required.  Head injury management:

 

 

An accident may be investigated if it looks suspicious of negligence or intentional harm. A child protection unit should be involved for non-developmentally likely accidents- such as broken bones under the age of 12 months- ie. The child is not able to cause a broken bone through their own movements (walking, crawling) and a break would only be caused by the child being placed in an unsafe situation.

 

Strangulation- Curtain cords and blinds are the big risk here.  Make sure cords are secured to the wall and don’t position cots near windows with blinds.  Keep dangling cords as short as possible, or tie them out of reach.

 

Suffocation- toy boxes can be dangerous- remove handles that clip the lid of the plastic box closed, especially if there is more than one child in the house.  Discourage hiding in plastic and wooden boxes.  The use of bean bags should be supervised- children may hide in them and sit on top of the bean bag, suffocating the child underneath.  Always follow the SIDS safe sleeping guidelines.

 

Crushing injuries-

-Children that climb onto furniture sometimes end up with that piece of furniture on top of them.  This includes climbing on bookshelves.  To discourage climbing shelves, move books to the edge of the shelf. 

-Knock down cracked, unsafe external walls/fences.  An unsafe brick wall collapsed on 2 children- one was killed instantly, the other is still undergoing rehabilitation for serious head injuries.

- Crushed fingers from car doors, the hinged edge of cupboard doors (my daughter did this yesterday), closing drawers.

- Injuries from unsecure basketball backboards falling during play.

 

Choking- The obvious scenario here is food, but there are many incidents where a baby may choke on toys, especially if there are older children in the house.  Supervise play times and save play with smaller toys for baby’s nap time- ie- lego etc.  This also goes for children that like to stick things up their noses.  Objects such as pen lids, coins, beads from broken necklaces, batteries, buttons and pieces of toys can all be potential hazards.  I have seen some interesting x rays of children who have swallowed or inhaled strange objects.  Kidsafe choking factsheet.

 

ACTION: If your child is choking, the 1st course of action is to see whether then child can cough the object out.  Most children will be able to produce an effective cough and get the object out of the airway without assistance.  If your child is still struggling and has an ineffective cough, lay the child over your lap, face down and give 5 hard blows to the back to try to remove the object.  Check the mouth and airway.  If this is unsuccessful, lay the child on his/her back and do 5 chest thrusts (push hard on the lower sternum using an upwards thrusting action).  Check the mouth and airway.  If you child is still struggling to breath (by now there may be colour changes as the child becomes cyanotic and unconsciousness) you will need to clear the airway by closing the nose and give one hard breath via the mouth (or for babies, place your mouth over the mouth and nose of the baby). The aim is to blow the object down one of the bronchi to clear a pathway for air down the 2nd bronchi.  Once the airway is clear, administer 2 breaths and you may need to commence CPR.

 CALL AN AMBULANCE. The object will need to be retrieved via endoscopy under general anaesthetic at a later time, once the more important breathing issues are under control.  (NOTE: the Heimlich manouvre and the lateral thrust are no longer recommended -current June 2009)).

 

 

Cuts- Knives, scissors, shed tools, open food cans, glass (falls through plate glass, such as windows), cheese graters- all sources of cuts, some requiring stitches.  Don’t leave power tools unattended. Very close supervision is required with sharp objects and if not developmentally appropriate- then the child should not have access to these objects at all.

CYH-Managing cuts/grazes and bruises:  

 

 

Near drowning- swimming pools, ponds, the bath, nappy buckets etc- all dangerous.  Kids can drown in only a few cm’s of water.  Be mindful of the potential water dangers around your home.  Drowning kills more than 175 000 children per year (CP, 2009, p.24).  Ponds should be cover with a wire mesh, pools should have fencing adhering to the legislative requirements in your state, don’t run baths until you are ready to use them, empty baths as soon as they are finished with, don’t leave toys in the bath as incentive for a child to want to get into the bath.

 

Electrocution- Don’t have appliances in bathrooms (including heaters) or near kitchen sinks.  Discourage playing with electrical outlets.  Use safety covers for power points that are not in use.  Install safety switches.

 

 

WHAT YOU CAN DO:

**LEARN FIRST AID and CPR.  St John’s offers a “Care for Kids” first aid course.

**Take this home safety questionnaire NOW:

**Kid-safe fact sheets can be found in the foyer of the WCH, possibly also at other major children’s hospitals. And online.

**Assess your home from a child’s perspective- what can you see, what can you reach, what looks interesting, what would encourage your curiosity, what is potentially UNSAFE?

**make sure smoke detectors are functioning and have fire safety equipment near the kitchen.

**keep important phone numbers (like poisons hotline) on speed dial or written near your phone.

**keep a stocked first aid kit in your home and car.

**read more about safety and first aid- most of this information you need to know before an accident happens.  See these links:

 

Kidsafe

http://www.indiaparenting.com/raisingchild/data/raisingchild027.shtml

http://www.hkfsd.gov.hk/home/eng/source/safety/Children_home_accident.html

child and youth health:

Child and Youth Health home safety:

Child and Youth heath toddler safety:

CPR current recommendations:

 

 

 

Conclusion:  Adequate prevention strategies and supervision could potentially prevent over half of childhood accidents.  Look around your house from a child’s perspective, room by room, and predict any potential dangers.  Do this regularly- children grow fast and their development progresses rapidly- one day you are considering when the first roll will be, before you know it, your child is dragging chairs to reach things in high places.  You need to constantly assess your home and be one step ahead of your child- don’t wait until your child can access a danger before you do something about it!!

 

references

CP (author not stated)- 2009, ‘Study: Over Two Thousand Kids Die of injuries Each Day’, Contemporary Pediatrics, vol 26, no1, p.24

Sids and Kids website

Kidsafe website 

CYH website.