CHILDHOOD ACCIDENTS

MUFTAU WASIU O.
OLUKOGA TAIWO
CONTENTS
 INTRODUCTION/DEFINITION
 TYPES
 POISONING
 CAR ACCIDENT
 BURNS AND SCALDS
 NEAR DROWNING
 FALL
 FOREIGN BODY OR FOOD ASPIRATION
 MANAGEMENT
 PREVENTION AND CONTROL
 CONCLUSION
 INTRODUCTION/DEFINITION
 Definition
 It is a sudden, unexpected event which may result in injury or
death of a person or damage to property.
 Are common in children, particularly under the age of 5yrs.
 It is commoner in males than females
 Risk Factors.
The frequency is increased in:
 broken homes
 overcrowding
 lack of outside play facilities with modern housing
 when home routine is altered, such as when moving house, during
decoration or when there has been a death in the home
 staying in other people’s houses
 poor supervision
 children whose vision, hearing or intelligence is impaired
 children who suffer from epilepsy or other physical handicap
 POISONING
Is ingestion of harmful substance or large amounts of non-
poisonous substance.
The peak incidence of childhood accident poisoning is between
the ages of 2 and 3 years. It is commoner in males than females
In older children,accidental self-poisoning should be suspected
as a possible suicide gesture.
Predisposing factors
 Curiosity
 Poor supervision
 Children of:
 Drug addicts
 Medical personnel
Poisoning Contd.....
 The commonest household chemicals are:
 Paraffin(kerosine)
 Disinfectants
 Cleansing agents e.g Bleach
 Insecticides
 The most common drugs are:
 Paracetamol
 Aspirin
 Iron tablets
 Alcohol
Paracetamol poisoning
 Cause hepatic damage
 Is a life threatening complications of over dosage
 A single, acute acetaminophen ingestion of >140mg/kg is
potentially toxic.
 Clinical manifestations
 Vomiting
 GIT haemorrhage
 Hyper or hypoglycemia
 renal tubular damage
 cerebral oedema may occur.
MGT OF PARACETAMOL POISOINING
 Treatment
 Admit
 Emesis or lavage
 N-acetylcysteine by infusion
 It is very effective when given up to 8hrs after
overdose. Thereafter its efficacy declines
progressively.
 It is no longer of value by 15 – 24hrs and if
given at that stage it may be harmful.
Kerosene poisoning
 Commonest cause of poisoning in our enviroment
 May be mistaken for water
 May be asymptomatic when small quantities are ingested
 Features resulted from:
 Systemic toxicity
 Aspiration hazard
Clinical Features Contd.....
 Systemic toxicity
 CNS(depression)
 Irritability
 Lethargy
 Seizure or coma
 CVS
 Arrhythmia
 Renal
 Haematuria
 Proteinuria
 GIT
 Hepatic damage
 Degenerative changes
 Hypoglycaemia
Clinical Features Contd.....
 Aspiration hazard → lipoid pneumonia
 Cough
 Respiratory distress
 ± rhonchi
 ± creps
 Cyanosis
Alcohol poisoning
Ethanol is the most frequently abused by adults
 Household source of ethanol are: local gin, brandy, whisky, wines,
perfumes, aftershaves but the most common mode is when
children gulp it in the absence of their parents.
 Ethanol is rapidly absorbed from the stomach and the intestine.
 Ethanol metabolism takes place in the liver (→CO2 + H2O).
 Lethal dose is > 3mg/kg
 Clinical features include Muscle
incoordination,drowsiness,slurred speech,blurred vision and
hypothermia.Others include Apneic attacks and coma.Convulsions
are a frequent manifestation of hypoglycemia.
Management Of Alcohol Poisoning
 Treatment
 Gastric lavage
 Useful if done within 30minutes of the
ingestion
 Activated charcoal
 Manage hypoglycaemia
Salicylate poisoning

Ingestion of > 200mg/kg is toxic.

 Clinical manifestations
 Over breathing
 Earliest clinical features
 Due to direct stimulant action of the
salicylate on the respiratory centre
 Vomiting
 Diarrhea
Clinical Manifestations Contd.....
 Hyperpyrexia
 Results from the action of salicylates in increasing
heat production
 Sweating
 Occurs at first but stops once dehydration develops
 Hyperglycaemia and glycosuria
 Results from disturbance of carbohydrate
metabolism
 Increase glycogen breakdown i.e.uncoupling of
oxidative phosphorylation
Clinical Manifestations Contd......

 Ketosis
 Results from increase rate of fat metabolism
and disturbance of carbohydrate metabolism
 Hypernatraemia
 Hypokalaemia ← alkalosis
 Hypoprothrombinaemia ] cause
 Platelet dysfunction ] bleeding
Iron poisoning
 Many of the tablets are highly coloured and look like
sweets.
 The ingestion of > 20mg/kg of elemental iron is potentially toxic.
 Clinical manifestations
 Immediate effect is its corrosive action on the
gastric mucosa which may be sufficient to
perforate the stomach
 Vomiting – vomitus appear rusty(coffee
grounds) and has a characteristic metallic smell
 Abdominal pain
 Melaena stool may also be present
Clinical Manifestations Contd.....
 ± shock
 ± severe acidosis
 ± coma
 If the child survives, pyloric stenosis may develop from
scarring
 ± death
Management Of Iron Poisoning
 Treatment
 Admit
 Induce vomiting(emetics e.g )
 Gastric lavage
 With a phosphate solution(e.g.sodium dihydrogen
phosphate) to form insoluble iron salts
 Correct acidosis
 Antidotes
 IM/IV/oral desferoxamine or
 IV calciumdisodium EDTA(less powerful chealating
agent
Caustic Ingestion
 Present in:
 Clinitest tablets(contain NaOH)
 Caustic soda
 Paint removers
 Dye
 Some water softners
 Bleaches

 Clinical manifestations
 Initially
 Burns in the mouth, pharynx and oesophagus
 The mucosa looks soapy white, later becoming brown, oedematous and
ulcerated
Clinical Manifestations Contd......
 Later
 Perforation of the oesophagus → retrosternal or neck pain
 Respiratory obstruction from laryngeal oedema
 Inability to swallow secretions → drooling of saliva
 Oesophageal stricture may develop after recovery

Treatment
 Wash mouth with water
Manage as for corrosive oesophagitis
General management of Poisoning
 Admit all children who have:
 Ingested iron, pesticides, paracetamol, aspirin, narcotics, or antidepressants
drugs
 Ingested deliberately
 Been given the drug or poison intentionally by another child or adult
 Children who have ingested corrosive or petroleum products
 Identify the poison(s)
 Estimate the quantity ingested
 Find out the time of ingestion
 Maintain patent airways
 Ensure breathing
 Maintain circulation
Physical Examination.

 Odour
 Alcohol; kerosene
 Patient sensorium
 Excitement
 Incoordination/tremor
 Coma
 Pupils
 Dilatation → atropine poisoning
 Constriction → organophosphate poisoing
Physical Examination Contd.....
 Respiratory system
 Tachypnoea → aspirin poisoning
 Respiratory depression→ barbiturate poisoning
 Mouth
 Burns
 Particles of tablets
 Discolouration
Physical Examination Contd.....
 CVS
 Body fluids
 Vomitus
 Haematemesis
o Iron tab poisoning
o Aspirin poisoning
 Urine
 Blood
Removal Of The Poison
 Emesis
 Should not be induced in the unconscious patient or after ingestion of
corrosives, kerosene or white spirit.
 It may be ineffective after the ingestion of antiemetics, phenothiazines,
atropine and amphetamines.It can be used in paracetamol poisoning.
 Gastric lavage
 Useful within 30min of ingestion of a liquid poison e.g Alcohol or 2hrs of
a solid e.g iron,paracetamol except when salicylates or anticholinergic
drugs e.g antidepressants, have been taken
 Is only necessary if removal of the poison is urgent or if emesis has failed
 Exception to the use of lavage are:
 If a corrosive poison has been taken
 If household paraffin(kerosine) has been taken
Removal Of The Poison Contd......
 Activated charcoal administration
 Is an adsorbent
 Can reduce the absorption of many drugs including
aspirin,paracetamol,carbemazepine,phenytoin,kerosene,barb
iturates ,alcohol and TCA
 Purgatives and enemas
 Magnesium sulphate
 Milk of magnesium
 Kaolin
 Raw eggs
Removal Of The Poison Contd.....
 Increase urinary excretion by
 Forced diuresis with fluid intake using IV mannitol or IV lasix
 Urine may be alkalinized or acidified to increase excretion of poisons.
 Acidic poison are remove by alkaline diuresis while alkaline poison are
remove by acidic diuresis Removal of the poison by (cont)
 Acidic drugs
o Sulphonamides
o Barbiturates
o Salicylates
 Basic drugs
o Chloroquine
o Ephedrine
o Pethidine
Removal Of The Poison Contd.....
 Dialysis
 Exchange blood transfusion e.g in salicylate poisoning and
patient is unconscious
 Administration of antidote – these are of two types:
 Chemical agents which, by direct combination make the poison
harmless or unabsorbable
 Agents which counteract the action of the poison after it had
been absorbed
Not every poison has an antidote
Some Poisons And Their Antidotes.
POISON ANTIDOTE
 Paracetamol Acetylcysteine
 Iron Desferoxamine
General Management Of Poisoning
 Supportive treatment – depends on poison involved
 Those which depress the nervous systems → give stimulant
 Those which stimulate the nervous system → give depressant
 Respiratory failure
 Artificial respiration
 Give respiratory stimulants
 Shock
 General measures to alleviate shock
 Electrolyte imbalance should be corrected
 Correct temperature abnormality present
Car Accidents
 These could result from placing a child in the front seat and
on impact with an oncoming vehicle or sudden halt expels
the air bag which could suffocate a child,cause rib fractures.
 Overheating in a locked car
 Improperly installed car seats
 To Prevent this:
Keep children restrained by car seat or seat belt
No texting or calling using handhelds while driving
Burns and Scalds.
 There are different forms of thermal imjury to the body:
 Contact with fire,
 Scalding fluids,
 Chemicals.
 Electricity.
 Inhalation of flame, heated vapor and toxic fumes
 Cold:freezing injury
Symptoms;
Features of Hypovolemia:Tachcardia,weak pulses,hypotension,cold
extremities,coma,tachypnoea
Inhalation in the lung: Tachpnoea,Stridor,
crackles,wheeze,cough,resoiratory distress,black sputum
Burns And Scalds Contd.....
Pain
 Other symptoms
CNS:Confusion,dizziness,headache,restlessness,coma,seizures
Skin:Facial burns,nasal burn,cherry-red color
Investigations
Major burns > 5% body surface or hands,face,genitals,joint
involvement: Investigations include Arterial blood gas, Full
blood count
Burns And Scalds Contd.....
 Major burns > 5% body surface or hands,face,genitals,joint
involvement: Investigations include Arterial blood gas, Full
blood count
Near Drowning.
 It is a very common childhood accident and a major cause of
disability and death.At least one third of survivor suffer moderate
to severe neurologic sequelae. It is a process resulting in primary
respiratory impairment from submersion in a liquid medium.The
temperature of the water is important and the incident is classified
as warm,cold and very cold when the water tempertaure is 20,6-
19, and ,less than or equal to 5 degree celsuis respectively
 Symptoms Hypoxemia,hypothermia,respiratory acidosis,brain
swelling, raised intracranial pressure,shock.
 Resuscitation: Clear mouth,immobilise neck, intubate
Remove all wet clothes to avoid cooling the child,warm the child.
Monitor Vital signs
Fall
 This can result in contusions; bruises under the skin,fractures
,sprains. Children tend to break bones more easily because
they have soft areas near each of the bones ;growth plates
Foreign Body or Food Aspiration
 Foreign body aspiration is more common in toddlers and infants who
tend to put objects in their mouth which can be inhaled into the airway
or get caught in the oesphagus and compress the trachea.
 Food aspiration is more common in force-fed children.
 Symptoms include
LARYNX:Hoarseness,cough,dysphonia,hemoptysis,stridor,wheezing,dy
spnoea,cyanosis or apnea due to complete obstruction.
TRACHEA AND BRONCHUS: Dyspnoea,stridor,respiratory
failure,Chestpain
OESOPHAGUS: Drooling,dysphagia or vomiting
DIAGNOSIS: Monophonic wheeze or absent breathsounds on one side off
the chest
Radiographs:Chest and neck with lateral view.
Arterial blood gas:Indicated in severe distress.
Foreign Body Or Food Aspiration Contd.
 Foreign body removal;if child is in distress but maintaining
good air exchange,back blows or chest thrust may be done
 If unconsious, Give oxygen until bronchoscopy is done
MANAGEMENT
 STANDARD PROTOCOL
 A: Establish Airway; 100% Oxygen
Suction if needed.
B:Check Breathing: Intubate, Mechanical ventilaion
C: Assess Circulation,establish IV access
Educational Programme Contd.....
Every home should have a first aid kit

 child proofing our homes with stair gates and fire guards
 Medicines: Keep them out of the child's reach in a locked cupboard.
 Household chemicals: These should be stored in their original containers for easy
identification, and should be kept in a locked cupboard. Maintain a strict watch over
the chemicals while using them; never leave them unattended even if you are only
leaving the room for a brief moment.
 Insist on packages with safety closures and learn how to use them properly.
 Keep household cleaning supplies, medicines, garage products, and
insecticides out of the reach and sight of your child. Lock them up whenever
possible.
 Never store food and cleaning products together. Store medicine and
chemicals in original containers and never in food or beverage containers.
 Avoid taking medicine in your child's presence. Children love to imitate.
Never suggest that medicine is candy—especially aspirin and children's
vitamins.
Educational Programme Contd.....
 Stove: Always turn the handles of pans inward on
the stove. Attach a saucepan guard, if available. The
oven door should be equipped with a locking
device. Further, if there's the danger that the child
could burn himself by touching the oven door, then
a guard should be attached to prevent the child
from directly touching the hot door.
 Sharp household utensils: Items such as knives,
scissors and other dangerous appliances should be
kept in cupboards with locks. When using such
utensils and you have to temporarily put them aside,
place them away from the edges of a table or
counter, away from a child's reach. Matches and
plastic bags are also dangerous for children. Plastic
bags must be tied in a knot when being stored.
Educational programme Contd.....
 Stairs: These should be fitted with gates of at
least 70-75 cm in height at both ends of the
stairs.
 Bookshelves: If the child likes to climb and
hang on things, then secure bookshelves and
other tall furniture to the wall, to keep them
from falling over.
 Windows and balcony doors: Equip these
with childproof safety catches or chains of
considerable height to prevent the child from
opening them or squeezing through them
when they are opened for air.
Educational Programme Contd.....
 Power outlets and electric cords: Outlets not in use
must be equipped with some kind of lock. Never
leave electric iron on the ironing board, and do not
let the cord hang down loose.
 Toys: Toys having sharp corners or edges should be
discarded. Same goes for very small toys or even
bigger toys that can be pulled into small pieces, as
the child can put these into his mouth and get
choked. Older siblings should be taught to put their
toys away when the baby is on the floor
CONCLUSION
 Children would always be an inquisitive bunch prone to
accidents but with adult supervision and child safety being
paramount,accidents can be reduced to a barest minimum.