Don't you love it when someone brands something that you've always been doing? Advocacy is nothing new, but by making a big deal of it, we are all prompted to think about how we can do more of it and do it better. Every consultation involving a child or young person will tend to include a bit of advocacy. I am doing it every time I tell a parent that when their febrile child is refusing to drink, that usually means that they are in pain. Parents sometimes think that paracetamol and Ibuprofen are just for reducing fever. Part of my job is to put analgesia on the agenda. It is the perfect time to do it because this is when the parents want their child to feel as well as possible.
Similarly, the impact of safety advice is greatest following an injury. So when a child or young person comes to me with a mishap, I try to work a bit of prevention in alongside the cure.
Injury is the leading cause of death in children over the age of one in the UK. (1) So, while we worry about sepsis and meningitis, preventing injury may be the real battleground. Injury is inherently preventable, as demonstrated by the massive difference between rates in different countries. It is not just lethal injury that is important. In fact, to the children themselves it is the debilitating injuries that really matter. Missing a sporting event or the ability to swim just before a holiday is the end of the world. Or at least it is when 'the future' is essentially the next month or so.
Have you ever wondered why pen lids have a hole in the top? Before that little innovation, these were common choking hazards. Anything that fits neatly into the windpipe runs the risk of a fatal choking episode. The list of dangerous things includes many food and playthings that parents readily give to their children.
I think that any household mishap is a good opportunity to warn parents about choking hazards. Prevention can include avoidance. Supervision is also great but only if you know what to do, and with choking, prevention really is better than cure.
2. Make sure that children can't get hold of button batteries
Medication packaging always has on it 'keep out of reach of children.' What this fails to take into account is the incredible resourcefulness of children who may seem to small to get up to cupboards or high shelves. I can tell you from experience that nowhere is safe. The only completely safe place for a medicine is in a locked cupboard or box. Nor can you rely on 'child proof' containers to prevent accidental poisoning. Child proof containers seem to be adult proof (It can't be just me that struggles with the tops) while children who have time on their hands always seem to get them open in the end.
It is great that young people use the opportunity of time off school to go and have a bit of an adventure. One way that this sometimes goes very wrong is when water is involved. Getting into trouble in water is all too easy. The simplest way to avoid the danger is to make sure that all swimming is done in appropriate areas. Tempting though it is to jump into a reservoir or an abandoned quarry full of water, this is very high risk.
It is important to teach young people road safety, but also to let them know that at certain times of day, drivers may not see them at all.
We're already making every consultation matter. Giving parents a little suggestion every now and then about how to make their child's environment a bit safer is just another way of adding to the difference we already make. Paediatrics is so rarely about preventative medicine but when a child has a mishap, we have a golden opportunity to discuss ways to avoid the next accident.
Edward Snelson
Chronic Avoider
@sailordoctor
FOAMed is free. The clue is in the name. That said, if anyone would like to celebrate their enjoyment of the free open access education provided by GPpaedsTips by helping children to receive the best possible care, I have set up a donation page where I am raising money for a new Sheffield Children's Hospital Emergency Department. For more information about this or to donate, click on the link in the Just Giving logo:
Similarly, the impact of safety advice is greatest following an injury. So when a child or young person comes to me with a mishap, I try to work a bit of prevention in alongside the cure.
Injury is the leading cause of death in children over the age of one in the UK. (1) So, while we worry about sepsis and meningitis, preventing injury may be the real battleground. Injury is inherently preventable, as demonstrated by the massive difference between rates in different countries. It is not just lethal injury that is important. In fact, to the children themselves it is the debilitating injuries that really matter. Missing a sporting event or the ability to swim just before a holiday is the end of the world. Or at least it is when 'the future' is essentially the next month or so.
What I do is to try to throw in something relevant to the presentation. Whether injury or ingestion, there are lots of ways that we can make the environments of children and young people safer. Here are a few that are worth spreading the word about to parents and colleagues:
1. Warn parents of babies and toddlers about common choking hazards
Have you ever wondered why pen lids have a hole in the top? Before that little innovation, these were common choking hazards. Anything that fits neatly into the windpipe runs the risk of a fatal choking episode. The list of dangerous things includes many food and playthings that parents readily give to their children.
2. Make sure that children can't get hold of button batteries
If you were not aware of this, button batteries are
incredibly dangerous to children. There
is a misunderstanding about these miniature killers. It is not the contents leaking that are
dangerous, it is the electrical current which forms corrosive chemicals outside of the battery.
Button batteries have become more powerful, in order to meet the demands
of today's toys and gadgets. When
swallowed, the current may burn a hole in the gut (usually the oesophagus) and
bleeding can be fatal. A swallowed
button battery needs to be located as an emergency in case it is stuck, as
these carry the highest risk.
I find that many parents don't know about this, so I often mention it when a child has swallowed something concerning but less harmful, like a diamond ring.
I find that many parents don't know about this, so I often mention it when a child has swallowed something concerning but less harmful, like a diamond ring.
3. Make sure that liquid gel detergent capsules are kept away from children
Ask any ophthalmologist what common household item is most dangerous to children's eyes and I am willing to bet that they say liquid gel detergent capsules. Why? They are the perfect thing to cause massive damage. Firstly, they look very appealing to a child. They are brightly coloured and a bit like something that might be good to eat. If bitten into, the contents come out under pressure, so the eye has no time to protect itself from the contents. The contents themselves are a highly concentrated alkali which will burn and dissolve the thin layers of the eyeball. While the industry has made some moves to warn people to keep these away from children, such messages can be interpreted as a standard bit of advice, which does no justice to the fact that these capsules are far more dangerous than the standard bottles or boxes of detergents.
So when a child has had a mishap with another item, I like to warn parents about other things that they may not have thought about.
4. Recommend that all children with a bike wear a bike helmet.
Ask any ophthalmologist what common household item is most dangerous to children's eyes and I am willing to bet that they say liquid gel detergent capsules. Why? They are the perfect thing to cause massive damage. Firstly, they look very appealing to a child. They are brightly coloured and a bit like something that might be good to eat. If bitten into, the contents come out under pressure, so the eye has no time to protect itself from the contents. The contents themselves are a highly concentrated alkali which will burn and dissolve the thin layers of the eyeball. While the industry has made some moves to warn people to keep these away from children, such messages can be interpreted as a standard bit of advice, which does no justice to the fact that these capsules are far more dangerous than the standard bottles or boxes of detergents.
So when a child has had a mishap with another item, I like to warn parents about other things that they may not have thought about.
4. Recommend that all children with a bike wear a bike helmet.
Heads injuries are the most common cause of fatal injury in
children. Bikes are great fun and a good
way for children to keep fit.
Unfortunately, injury is all about physics. I have yet to see a child run into something
and have a significant head injury.
Bicycles however, allow a young person to gain enough momentum to do
real damage even if another vehicle is not involved. While it can be difficult
to persuade young people to wear helmets, they are the must have accessory for
anyone who likes their brain or their face.
Road rash on the face is not a good look and helmets do a decent job of
protecting the face from being badly grazed in a fall from a bike.
I emphasise the facial injury as much as the head injury prevention as it often means more to the young person involved.
I emphasise the facial injury as much as the head injury prevention as it often means more to the young person involved.
5. Advise a bit of trampoline safety
Trampolines are a favourite for all ages. They are also one of the biggest sources of
injuries that come into children's emergency departments. While I am not suggesting that trampolines
should be avoided, the risk of broken bones can be minimised. One of the common factors in many of the
worst trampolining injuries that I have seen is that there has been another
person involved. The worst injuries tend
to occur when a small child is on the trampoline with an older child. I would recommend that younger children in
particular should never have someone larger than them on the trampoline. Ideally, they should be on the trampoline
alone, with onlookers cheering them on.
6. Make sure that parents lock up medicines
Medication packaging always has on it 'keep out of reach of children.' What this fails to take into account is the incredible resourcefulness of children who may seem to small to get up to cupboards or high shelves. I can tell you from experience that nowhere is safe. The only completely safe place for a medicine is in a locked cupboard or box. Nor can you rely on 'child proof' containers to prevent accidental poisoning. Child proof containers seem to be adult proof (It can't be just me that struggles with the tops) while children who have time on their hands always seem to get them open in the end.
7. Know about the surprise household poison - plug in air
fresheners
Many plug in air fresheners contain essential oils. These chemicals are potentially incredibly
poisonous due to their ability to dissolve into brain tissue. Parents are frequently surprised by this fact
so it is well worth letting people know about this dangerous household item. People are also surprised by the ability of toddlers
to drink the contents of these plug ins if they get hold of them. I don't know how they do it. And why won't they eat their vegetables???
8. Warn parents to beware of the sun
When the sun comes out and children quite
rightly make the most of it, we often end up seeing children with quite severe
sunburn. Babies are especially at risk
due to their thin skin and lack of protection from the sun. Make sure that people know that children can
get deep burns from the sun and that prevention is key. Children are also vulnerable to the dangers of overheating so hydration and sun avoidance are important when the sun is out.
9. Remind adolescents to respect water
It is great that young people use the opportunity of time off school to go and have a bit of an adventure. One way that this sometimes goes very wrong is when water is involved. Getting into trouble in water is all too easy. The simplest way to avoid the danger is to make sure that all swimming is done in appropriate areas. Tempting though it is to jump into a reservoir or an abandoned quarry full of water, this is very high risk.
10. A surprise danger
– twilight
Now for the sciency bit…
Twilight is a very dangerous time for pedestrians and young people are
already very much at risk due to their lack of perceived mortality. Why is it dangerous when the sun rises and
sets? The answer is probably due to a
little known chemical (found in the eye) called rhodopsin. This is the chemical that enables the eye to
adjust to lower levels of light. The
trouble is that it takes many minutes to produce the chemical and only seconds
for a flash of light to get rid of it completely. As a result, drivers can have their ability
to see reduced very suddenly by a moment of setting or rising sun, allowing a
person in the shadows to become almost invisible.
It is important to teach young people road safety, but also to let them know that at certain times of day, drivers may not see them at all.
Edward Snelson
Chronic Avoider
@sailordoctor
FOAMed is free. The clue is in the name. That said, if anyone would like to celebrate their enjoyment of the free open access education provided by GPpaedsTips by helping children to receive the best possible care, I have set up a donation page where I am raising money for a new Sheffield Children's Hospital Emergency Department. For more information about this or to donate, click on the link in the Just Giving logo:
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