Accidental asphyxia in bed in severely disabled children

OBJECTIVE: To determine whether there are specific situations which may increase the risk of accidental asphyxia during sleep in children with physical and mental disabilities. METHODOLOGY: Review of all cases where death was attributed to accidental asphyxia caused by unsafe sleeping situations in children listed in the Department of Histopathology database over a 10-year period from March 1989 to February 1999. RESULTS: A total of 26 cases were found (M:F, 19:7; age range, 1-48 months; average age, 7.4 months). Of those cases, two involved children with significant mental and physical impairment. Case 1: A 4-year-old boy with Klippel-Trenaunay-Weber syndrome, macrocephaly and severe developmental delay, was found dead with his head hanging over a wooden board attached to the side of his bed. Case 2: A 4-year-old boy with lissencephaly and severe developmental delay was found dead wedged between a retractable mesh cot side and the side of his bed. In both cases the devices resulting in death had been put in place to prevent the boys from falling out of bed. CONCLUSIONS: Accidental asphyxia in physically and mentally impaired children may be caused by devices that have been used to prevent injury from falling out of bed. Careful assessment of the specific developmental problems that children suffer should be undertaken before their beds are modified. It may be safer for these children either to have no barrier, or to have drop-sided cots/beds that meet recognized safety standards.     

Child injury in Brisbane South 1985-91: Implications for future injury surveillance

Specific childhood injury types are ranked by occurrence rate for mortality, hospital admission and emergency department attendance. Cases are drawn from the resident population of Brisbane South, 0-13 years of age, for the period 1 July 1985 to 30 June 1991. A total of 47244 injuries, 7056 admissions and 99 deaths were analysed. The overall mortality rate was 12.6/100 000 per year (95% confidence interval (Cl), 10.2-15.3), the overall admission rate was 911/100 000 per year (95% Cl, 890-932) and the overall hospital attendance rate was 6013/100000 per year (95% Cl, 5958-6067). A fall was the most frequent injury mechanism for admissions and 65% of attendances involved injury in the child's own home. The surveillance data establish regional variation for childhood injury risk within Australia and identify an unexplained downward trend in head injury that requires further investigation. The future development of injury surveillance in Australia requires simplified coding which can be integrated into new computerized patient management information systems.     

227 ROAD ACCIDENTS TO CHILDREN

Abstract. In a 9-month period, 227 children attended the Accident and Emergency Dept. of the Children's Hospital, Sheffield, after accidents on the road—about 12% of all new attendances. 169 were accidents to pedestrians, 31 to cyclists and 27 to passengers. Of the 169 pedestrian accidents, 157 were hit by moving vehicles, 72 (45.9%) suffering serious injury, with two dead. 45% of the pedestrians, 22.6% of the cyclists and 11.1 % of the passengers were admitted. 29.6% of the 227 had severe head injury (concussion with or without a fractured skull). 22 % of the 227 had a fracture or fractures. 55 children had had previous accidents. Compared with 225 previously described skateboard injuries and 200 playground equipment injuries, those injured on the roads were much more serious, though with fewer fractures. 37 % of the road accidents were serious, compared with 10.7 % of those injured on skateboards and 7.5 % of the play equipment cases; 40.9 % of the skateboard injuries but only 22.0 % of the road accidents involved fractures, but 29.6 % of the latter, 6.0 % of the play equipment injuries and 0.9 % of the skateboard injuries involved serious head injury. 4.0 % of the skateboard injuries, 10.0 % of the play equipment injuries, but 45.0 % of the pedestrian road accident cases necessitated admission.     

Neurological complications of balloon angioplasty in children

Summary We report on the occurrence of cerebrovascular accidents as a possible complication of balloon angioplasty in children. The first patient underwent balloon angioplasty for aortic stenosis and subsequently developed a right temporoparietal infarct in the vascular territory of the right middle cerebral artery. The second patient developed a right temporoparietal infarct also in the vascular territory of the right middle cerebral artery following balloon angioplasty of native coarctation of the aorta. This experience suggests that, in addition to the previously reported complications of balloon angioplasty, the occurrence of a potential cerebrovascular accident must be considered in the risk-benefit analysis of this procedure.     

An unusual domestic accident: a penetrating abdominal wound with intestinal evisceration in a child

We report a penetrating abdominal injury due to a piece of glass, a very unusual domestic accident, in a 2-year-old boy who was admitted to the emergency department with an evisceration through the umbilicus. His mother reported that she was asleep when the boy came to her room, and did not know how it had happened. We primarily suspected child abuse, but the presence of a piece of glass in the boy's heel led us to think of a domestic accident. He had poured himself a glass of water, and then fell on the glass. We could not find a similar case in the literature on domestic accidents. Accepted: 25 June 1997     

CHILD-ENVIRONMENT SUPERVISORS—A NEW STRATEGY FOR PREVENTION OF CHILDHOOD ACCIDENTS

Abstract. Gustafsson, L. H. et al. (Department of Paediatrics, University Hospital, Uppsala, Sweden). Child-environment supervisors—a new strategy for prevention of childhood accidents. This paper is a provisional report from an ongoing field experiment in Uppsala, Sweden, with the aim to reduce the number of serious childhood accidents. Groups of parents have been systematically trained to function as child-environment supervisors. The experiences have been very positive so far. The child-environment supervisors have proved to possess good knowledge about how to prevent accidents. A large number of hazards have been detected and successfully eliminated. The groups are now taking an active part in the planning of new housing estates. The findings also indicate that the Child Health Organization should be able to play a more active role in the work of environmental improvement for the safety of children. A suggestion for a collective strategy for such activity has been worked out.     

The socio-economic context of child injury in Australia

Abstract  After the first year of life, injury is the leading cause of mortality in children and adolescents in Australia and a major cause of morbidity and hospitalization. Studies from Europe and North America and more recently New Zealand have demonstrated that injury rates differ between different socio-economic groups, with a relatively consistent pattern of higher rates being found in lower socio-economic groups. To date, the pattern of child injury morbidity by socio-economic group has not been studied in Australia. Eighteen months of data from Brisbane and Melbourne collections of the National Injury Surveillance Unit data base were analysed and linked to census data from each postcode in the collecting area to calculate injury rates. Injury rates for each postcode were correlated with measures of disadvantage derived from the same census data. There was a consistent pattern of moderately strong statistically significant associations (Pearson correlation coefficients generally 0.30-0.60) found between measures of disadvantage and injury rate at the postcode level of aggregation. This association was present across cities, age groups, type of injury and for those hospitalized as well as those treated as outpatients. It is apparent that residence in a low income area is a significant predictor of child injury in Australia.     

Childhood injuries in Japan

Approximately 2000 children aged between 0 and 14 years die annually of accidents and their sequelae in Japan. Moreover, accidents and their sequelae are the leading cause of death in the 1–4 year, 5–9 year and 10–14 year age groups. Accidental drowning and traffic accidents account for 2/3 of all such deaths. Measures for preventing injury in these age groups are clearly necessary, since the mortality rate due to accidents and their sequelae in children 0 to 4 years old is higher in Japan than in European countries. It is considered that the lives of 824 infants aged between 0 and 4 years might be saved annually in Japan if the mortality rate could be reduced to a level comparable to that in Sweden by accident prevention and control. Therefore, a systematic approach for prevention of childhood injury is a high priority in Japan.     

Product-Related Home Accidents in Children: A Survey of 1590 Accidents

ABSTRACT. In a well defined geographical area a total of 1590 accidents related to home products in children 0–15 years of age were prospectively registered. The incidence of product-related accidents was 279 per 10 000 children per year. A higher incidence in boys and a decreasing incidence of accidents with age was found. The most common localization of lesions was upper extremities 41% and face and skull 30%. In children 0–4 years of age household and child furniture, constructional features of the house and corrosives, hot liquids and heating equipment were the most common products causing accidents, whereas in children 5–15 years of age playthings and sports equipment as well as constructional features of the house were involved in a higher percentage of accidents.     

Accidents among Children below Schoolage Changes of incidence after intervention

ABSTRACT. Children aged 0 to 6 years old admitted to hospital due to an accident were registered. Registration was carried out for two yearly periods; September 1982 to September 1983 and June 1985 to June 1986. The incidence of accidents dropped from 125 per 1000 a year to 116 accidents per 1000 children a year. The youngest children showed the most significant decrease in incidence. Home accidents were the most common type of accidents in both registration periods. Accidents due to falling from heights and poisoning accidents increased in the second period. Children injured during the second registration period required 3.4 times fewer days of hospitalization compared with the first period. Fractures and thermal injuries demanded most hospital care in both registration periods.     

Secular trends in fatal and disabling child trauma

Abstract Types and rates of childhood accidents are constantly varying. From the point of view of the potential child victim, the danger-safety equilibrium is disturbed by changes in lifestyles, availability of new consumer goods, and changes in social order. Balance is achieved by the implementation of preventive measures, particularly safety legislation. 'Old' hazards affecting children in pre-industrial societies can re-emerge at any time as wealthy sophisticated societies aspire to recapture the delights of open space, the water, and 'country-style' living. Age-specific fatal accident rates are given for Australian children for the period 1960–1982. Whereas the total child (1–14 y) death rate has fallen from 159 per 100 000 (in 1960) to 86 (in 1982), road traffic deaths have risen from 8.3–11.7 (1–4 year olds) and have remained static (8.3–8.9) for 5–14 year old children. Drowning in older children has been reduced, but drownings among toddlers are still high (9.2 in 1960; 11.7 in 1982). The causes of secular trends, and factors which are known to influence these, are discussed.     

Accidental Childhood Death and the Role of the Pathologist

The following study provides an overview of accidental childhood death. This study is based on a review of 369 cases of fatal childhood accidents taken from the records of the Department of Histopathology, Women's and Children's Hospital, Adelaide, Australia, over a 34-year period from 1963 to 1996. Data provide information on deaths due to motor vehicle accidents, drownings, accidental asphyxia, burns, poisonings, electrocution, and miscellaneous trauma. In addition, certain categories have undergone further examination, including asphyxial deaths due to unsafe sleeping environments and unsafe eating practices, drowning deaths, and deaths on farms, following identification of significant child safety problems in these areas as part of the “Keeping Your Baby and Child Safe” program. Previously unrecognized dangers to children detected through this program include mesh-sided cots, V-shaped pillows, and certain types of stroller-prams. The production of information pamphlets and packages for parents and the recall of certain dangerous products following recommendations made by pathologists demonstrate that pediatric and forensic pathologists have an important role to play in preventive medicine issues and in formulating public health strategies. Received March 1, 1999; accepted March 1, 2000.     

Childhood deaths due to electrocution in Adana, Turkey

AIM: This retrospective study was conducted to determine the general features of childhood deaths due to electrocution, and draw the attention of community to these preventable deaths. METHODS: The autopsy records of the Morgue of the Adana Branch of the Turkish Forensic Medicine Council were used. Thirty-seven cases of childhood (under 18) electrocution during the period 1999-2004 were analyzed. RESULTS: Electrocution deaths comprised 0.8% of all the medico-legal autopsy cases (4515) during these 6 years. Thirty-one (83.8%) of the victims were male and only six (16.2%) were female. They were between 18 months and 18 years of age, and the mean age was 11.35, and all deaths were recorded as accidental. CONCLUSION: Medical units, and paramedical and educational centres should play important roles in formulating public health strategies to tackle preventable deaths such as electrocution.     

Epidemiology of non-intentional injuries in an Australian urban region: Results from injury surveillance

Injury surveillance provides an opportunity to determine non-intentional injury rates for those injuries which are treated in hospital accident and emergency departments. The first full calendar year of injury surveillance in north-western greater Melbourne was used to calculate incidence rates of a wide range of injury types and causes for 1989. In a population at risk estimated to number 150,604 children aged 0-14 years, the all-cause injury mortality was 10.5/100,000 per year (95% confidence interval [Cl], 5.4-15.8). There were 8207 attendances by children from the denominator area for non-intentional injury at the three hospitals participating in surveillance, representing rates of 6437/100,000 per year (95% Cl, 6258-6616) and 4406/100,000 per year (95% Cl, 4254-4558) for boys and girls respectively, while the rates for admission to hospital were 957/100,000 per year (95% Cl, 888-1025) and 649/100,000 per year (95% Cl, 590-707). The leading causes of hospital attendance were related to injuries involving sports, play equipment, bicycles and poisoning. These rates are substantially lower than those reported from other countries. The possible reasons for this include differences in health care utilization, under-ascertainment of cases, and a real difference in injury risk. Injury Surveillance Information System codes are defined for a standard set of injuries and injury causes which may be used for future comparative studies. Problems related to assessing the reliability of injury ascertainment are discussed, and the importance of integrating injury surveillance into routine hospital information systems is emphasized.     

Car transportation conditions of preschool children: use of children's car safety seats

The objective of this study was to evaluate children's car safety seat usage in a non-random study population of the Capital and surrounding area of Attica and a provincial region in Greece. One or both of the parents of 1556 children (aged 0–4 years) were interviewed. A questionnaire covering car safety seat usage by area of residence, age of parents, educational background, socioeconomic status and the number of siblings was completed. Optimal car safety seat restraint usage in the Attica region was 10.4% for infants 0–6 months old, 37.6% for infants 7–12 months old, 40.9% for children aged 1–2 years and 12% for children aged 3–4 years; the use of restraint systems in the provincial area was even lower at 4.9%, 15.2%, 24% and 6.6%, respectively. The mother's age, number of children and the socioeconomic status of the family seemed to influence the purchase and usage of the car safety seat. Such a high percentage of non-usage of car safety restraint seats has led to the Paediatric Society's initiative to create informative general public educational programmes and to urge governmental legislation regarding mandatory usage of children's car safety seats.     

Accidental poisoning in the first three years of life

ABSTRACT. The incidence of accidental poisoning was examined prospectively in a birth cohort of 1124 children.
Nineteen percent of children had at least one incident of poisoning or suspected poisoning by the age of three years.
No medical treatment was sought for 33.5% of poisoning incidents and of those poisonings for which treatment was sought, only two cases required management beyond observation, induced vomiting or gastric lavage.
The most frequent sources of poisoning were medicines, household cleansers and petrochemicals.
Poisoning occurred more frequently in children of young mothers; children who entered single parent families at birth; children whose mothers reported a large number of problems with the child; children from homes reporting a large number of life events and stresses; children from homes where parental separation had occurred; children from families who made multiple changes of residence and in children whose mothers had been prescribed tranquillisers and/or antidepressant medication. Logistic regression analysis showed that the strongest predictors of poisoning were the mother's reports of problems with her child and the mother's use of tranquillisers and/or antidepressant medication.     

Antibiotics for sore throats?

Although not explicit, recommendations in the new edition of Therapeutic Guidelines: Antibiotic¹ have taken a lurch towards an evidence basis. What does this mean, and what is the basis of the recommendation that antibiotics be used for sore throat in very limited circumstances?     

Psychological screening of children for post-traumatic stress disorder

One hundred and seventy children attending a hospital accident and emergency department following everyday trauma were interviewed and completed the Post-traumatic Stress Disorder (PTSD) screening battery suggested by Yule and Udwin (1991). Diagnostic interviews (CAPS-C) confirmed that 39 (22.9%) fulfilled the DSM-IV criteria for PTSD. There were significant differences between children with and without PTSD on each individual component of the screening battery. Various criteria for caseness were evaluated and at 6 weeks post trauma the screen identified up to 90% of children diagnosed with PTSD and 73% with borderline conditions. A subset of 36 children were reassessed 8 months post trauma and all children with persistent PTSD were correctly identified by initial screen scores. The limitations of the study and the role of screening for PTSD in the absence of proven psychological interventions are discussed.