Childhood poisoning in Queensland: an analysis of presentation and admission rates

OBJECTIVE: To determine the presentation rates for paediatric poisoning by ingestion and the determinants of hospital admission. METHODOLOGY: Cross-sectional survey using an injury surveillance database from emergency departments in South Brisbane, Mackay and Mt Isa, Queensland, from January 1998 to December 1999. There were 1516 children aged 0-14 years who presented following ingestional poisoning. RESULTS: The presentation rates for poisoning were 690, 40 and 67 per 100000 population aged 0-4, 5-9 and 10-14 years, respectively. The admission rates to hospital for poisoning were 144, 14 and 22 per 100000 population aged 0-4, 5-9 and 10-14 years, respectively. Although presentation rates for poisoning were higher in the rural centres the admission rates were disproportionately high for the 0-4 years age group. The agents most frequently ingested were paracetamol, Dimetapp, rodenticides and essential oils. CONCLUSION: There is a need to design and implement interventions aimed at reducing poison exposures and unnecessary hospital admissions in the 0-4 years age group.     

National guideline for the management of suspected sexually transmitted infections in children and young people

The Children Act 1989 defines a child as "a person who has not yet reached 18 years of age." In England, Wales, and Scotland the present age of consent for heterosexual and homosexual sex is 16 years and in Northern Ireland it is 17 years. The proportion of young people who report heterosexual intercourse before the age of 16 years increased in the 1990s compared with the previous decade.     

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??Unintentional injuries and acute poisoning are leading causes of disability and morality in children.The main type of unintentional injuries in children include falls??traffic accident??foreign body injury??drowning and acute poisoning. Severe patients often suffer from acute hypoxic-ischemic brain damage??which causes a series of neurological deficits??such as disorders of consciousness??physical and cognitive deficits??and dysphagia. Early rehabilitation is benefical for minimizing sequelae of the primary injury??preventing secondary injury and complications??promoting rapid rehabilitation and maximizing positive outcomes. The manegement of consciousness disturbance and various neurological dysfunction is the most important in early rehabilitation.     

National guideline for the management of suspected sexually transmitted infections in children and young people.

The Children Act 1989 defines a child as "a person who has not yet reached 18 years of age." In England, Wales, and Scotland the present age of consent for heterosexual and homosexual sex is 16 years and in Northern Ireland it is 17 years. The proportion of young people who report heterosexual intercourse before the age of 16 years increased in the 1990s compared with the previous decade.     

Deliberate poisoning in the context of Induced Illness in children

Deliberate poisoning of children is rare in the UK but carries a high morbidity and mortality. Two-thirds of cases in the major UK epidemiological survey in the early 1990's were associated with FII abuse. Diagnosis is often delayed with severe consequences for the child concerned. This paper reviews how poisoning may present in the context of FII abuse and describes the types of poisoning agents that may be identified, along with a brief guide to diagnosis and management of cases. Detailed guidance on managing cases is available through RCPCH and government documents.     

Inequalities in hospital admission rates for unintentional poisoning in young children

OBJECTIVE: To determine the relationship between deprivation and hospital admission rates for unintentional poisoning, by poisoning agent in children aged 0-4 years. DESIGN: Cross sectional study of routinely collected hospital admissions data. SETTING: East Midlands, UK. PARTICIPANTS: 1469 admissions due to unintentional poisoning over two years. MAIN OUTCOME MEASURE: Hospital admission rates for unintentional poisoning. Incidence rate ratios (IRRs) comparing hospital admission rates for poisoning in the most and least deprived electoral wards. RESULTS: Children in the most deprived wards had admission rates for medicinal poisoning that were 2-3 times higher than those in the least deprived wards (IRR 2.49, 95% CI 1.87 to 3.30). Admission rates for non-medicinal poisoning were about twice as high in the most compared to the least deprived wards (IRR 1.77, 95% CI 1.19 to 2.64). Deprivation gradients were particularly steep for benzodiazepines (IRR 5.63, 95% CI 1.72 to 18.40), antidepressants (IRR 4.58, 95% CI 1.80 to 11.66), cough and cold remedies (IRR 3.93, 95% CI 1.67 to 9.24), and organic solvents (IRR 3.69, 95% CI 1.83 to 7.44). CONCLUSIONS: There are steep deprivation gradients for admissions to hospital for childhood poisoning, with particularly steep gradients for some psychotropic medicines. Interventions to reduce these inequalities should be directed towards areas of greater deprivation.     

What paediatricians should know about eating disorders in children and young people

Any health professional working with children and young people may become involved in the care of a child or young person with an eating disorder. Morbidity and mortality can be high, and paediatricians have an important role to play. There are broadly two aspects of underweight that the paediatrician may face – acute medical instability and a more chronic underweight which can impact greatly upon growth and development. Ultimate weight restoration means an adequate nutritional status to allow appropriate growth and development. Key to success is a team approach with paediatric and mental health and dietetic expertise combined. This paper provides an overview of eating disorders and explores current best practice, written in collaboration by a paediatrician and child and adolescent psychiatrist.     

Palliative care for disabled children and young people

Palliative care for disabled children and young people embraces holistic, high quality, evidence-based care, recognition and timely management of symptoms, recognition and discussion with the multidisciplinary team and with families about the possibility of dying and care and support through life, death and bereavement.Systems are being piloted across the UK to collect data about who and where children and young people with palliative care needs are and to ensure robust funding mechanisms are established for provision of care in an equitable way.Decision-making within a legal and ethical framework is paramount in this area of clinical practice, along with clinical networking within care pathways to ensure care delivered is of the highest standard.     

The management of poisoning

Ingestion of a potentially toxic substance is a common reason for children and young people to attend the emergency department or primary care. Fortunately, mortality and significant morbidity is very low and the vast majority of children require little more than observation. The challenge for the paediatrician is to identify those children at risk of severe symptoms and manage them appropriately. This review aims to provide an overview of the recognition, evaluation and management of the poisoned child or young person.     

Childhood poisoning: access and prevention

OBJECTIVES: To investigate the circumstances and means of access to six poisoning agents by children under 5 years of age and to make recommendations for countermeasures and strategies for implementation. METHODOLOGY: A case series study of access to six poisoning agents was conducted. Cases were identified prospectively through a poisons information centre and hospital emergency departments. Interviews were conducted with 523 parents and caregivers using a structured questionnaire. RESULTS: The majority of children (94.1%) accessed the agent in their own home or another home and, in 38% of cases (excluding mistakes in administration), the parent or caregiver was present in the immediate area at the time of the incident. In cases in which the child was alone in the room, caregivers were frequently involved in household duties (51%), with only 10% undertaking leisure activities and 8% on the telephone. The span of unsupervised time reported was 5 min or less in 79.5% of these cases. The means of access was generally during periods of use of the agent (75.3%), including just purchased, rather than when agents were in their usual storage place. CONCLUSIONS: There is little scope for improved supervision as a major intervention. Design and regulatory changes such as local safe storage for bench tops and while travelling, improved labelling and packaging, improved child-resistant packaging and its more general application are required. These and agent-specific interventions, including child-resistant bait stations for rodenticides and well covers for vaporizers, are more likely to prevent poisoning. The recent identification of childhood poisoning prevention as a national priority may lead to coordinated action to implement these and other preventive measures.     

Clonidine poisoning in young children

We reviewed 47 consecutive inpatient records to determine the clinical course, role of supportive measures, and response to naloxone in children with clonidine poisoning. Severity of illness was assigned by means of the "pediatric risk of mortality" (PRISM) score. The children's ages ranged from 9 to 84 months. Central nervous system effects were noted in 44 patients; bradycardia occurred in 25, and apnea or depressed respiration was seen in 18. Thirty-four patients had symptoms within 1 hour of presentation, but no patient had further clinical deterioration more than 4 hours after presentation. Six patients required endotracheal intubation and mechanical ventilation. There was no difference in PRISM score or duration of symptoms between those patients who received naloxone and those who did not. More patients receiving naloxone required intubation, and only three patients had definite improvement after naloxone administration. We conclude that (1) young children who ingest clonidine have a wide spectrum of serious findings, (2) delayed progression of symptoms after clonidine poisoning is unlikely in a young child with normal renal function, and (3) naloxone is an inconsistent antidote for clonidine poisoning.     

重金属中毒与儿童肾损伤

随着经济发展相伴随的环境污染全球化,儿童重金属中毒日益成为全球性健康问题。重金属中毒可致肾损伤,由于儿童早期临床表现不明显或缺乏特异性改变,易误诊和漏诊。早预防、早发现、早干预中毒性肾损伤有利于儿童健康成长及肾脏功能的恢复。该文综述了重金属中毒性肾损伤的机制及儿童常见的铅、汞、镉、铬4种重金属中毒致肾损伤的临床表现、诊断与防治。     

It's getting hot in here: heat stroke in children and young people for paediatric clinicians

Children and young people are at increased risk of heat-related illness such as heat stroke. This is largely due to their anatomy, physiology and overall development. What makes them particularly vulnerable is their reliance on others to protect them from extreme heat and provide shade and water at times of prolonged exposure. With a rise in environmental temperatures associated with global warming, experts are warning of an increase in paediatric heat-related illnesses. Management of heat stroke in adults is well documented, however literature on children and young people is variable. The aim of this paper is to provide an overview of the presentation of paediatric heatstroke for clinicians caring for children and young people.     

Headache in children and young people

This article aims to provide a practical guide to the common causes of headache and their assessment in children. Contrary to popular belief, headaches are very common in children. The primary headache disorders, which include migraine and tension-type headache, account for the majority of headaches, while secondary headache, that is those with underlying pathology, are much less common. A thorough history and examination is the key to determining the cause and should be the most important means of reassuring the child and family that there is no serious cause for the headaches. To manage childhood headache, you need to be able to distinguish the painful from the harmful, and therefore must recognize the common headache patterns and the signs and symptoms that may indicate serious intracranial disease. Most non-acute headaches do not need further investigation. Neuroimaging is rarely necessary. Recurrent headaches, of whatever cause, are a cause of considerable morbidity especially in terms of school loss.     

Carbamate and organophosphate poisoning in young children

OBJECTIVE: Retrospective evaluation of the clinical course of carbamate and organophosphate poisoning in young children. DESIGN: The records of 36 children intoxicated with carbamate and 16 children intoxicated with organophosphate (age range: 2 to 8 years, median: 2.8 years) were examined retrospectively. The carbamate agents were identified as methomyl or aldicarb, and the organophosphate as parathion, fenthion, malathion, and diazinon. The causes of poisoning were accidental ingestion in 46 children and inhalation in six children. CLINICAL SETTING: Pediatric Intensive Care Unit of a teaching hospital. INTERVENTIONS: Gastric lavage was performed, and activated charcoal was administered to all children who had ingested poisonous pesticides. Atropine sulphate was administered intravenously in repeated doses to all children with bradycardia, diarrhea, salivation, and miosis. Obidoxime chloride was administered to patients with organophosphate poisoning and to those in whom the ingested material was unidentified on admission. RESULTS: Predominant symptoms were related to central nervous system depression and severe hypotonia. Other clinical signs such as miosis, diarrhea, salivation, bradycardia, and fasciculation were less frequent, while tearing and diaphoresis were not observed. Pulmonary edema developed in six patients with organophosphte poisoning. Three children required mechanical ventilation for several hours. One child (organophosphate poisoning) died shortly after arrival at the emergency department. All other children recovered completely. CONCLUSION: Based on a relatively large group of young pediatric patients with carbamate and organophosphate poisoning, it is concluded that the clinical presentation differed from those described in adults. Absence of classic muscarinic effects does not exclude the possibility of cholinesterase inhibitor agents poisoning in young children with central nervous system depression.     

小儿急性中毒的特点和诊治进展

儿童急性中毒的发生与周围环境密切相关.我国儿童急性中毒以农药、药物和灭鼠药为主,主要因误服误食所致,重症急性中毒的病死率仍较高.加强对药物和上述毒物的管理,可以从源头减少中毒机会.对疑似中毒的患儿,除详细询问病史和查体外,多数情况下毒物鉴定是明确有元中毒和病情严重程度最直接、客观的方法.及时诊断、合理使用解毒药物、普及血液净化治疗技术、重视支持疗法是成功救治的关键.准确而全面的临床流行病学资料有助于对地区性、年龄阶段性及不同性别的中毒起到警示作用.