Accidents and poisoning in children 2.pptx

Accidents and poisoning in children

1. Accidents and poisoning in children Dr Helen Akhiwu Department of Paediatrics JUTH MBBS, MSc Clinical epidemiology, FMCPaed

2. What is an accident It is an undesirable or unfortunate happening that occurs unintentionally and usually results in harm, injury, damage, or loss. Common accidents in children are cuts, poisoning, choking, electric shocks, falls, drowning Burns etc

3. Accidents contd Most accidents are preventable if the correct measures are put in place. First aid treatments provided at the scene of accidents before presentation to hospital are very important and can contribute significantly to patients survival.

4. Accident prevention Accident prevention refers to the strategies, preparatory methods, and the measures instituted to prevent accidents. Accident prevention is an umbrella term that encompasses all steps taken by an entity to reduce the risk of accidents, to save lives, and to mitigate the risks of injury or to lessen its severity.

5. Levels of prevention Health promotion Specific protection Early diagnosis and treatment Limitation of disability Rehabilitation

6. Management of common accidents Abrasions (Scrapes) and cuts Wash abrasion with soap and water (use antiseptic solution if available) Allow to dry Cover with a sterile non-stick plaster, bandage or dressing If cuts apply pressure until bleeding stops and apply dressing If cut is deep present to the hospital if not sure present to the hospital

7. Mgt of common accidents contd  Bruises Apply cold compresses to fresh bruises for the first 15 to 20 minutes. Look out for possible underlying fracture if the fall or knock is significant: Swelling Pain Tingling sensation Inability to move If signs of fracture present, present to the hospital

8. Mgt of accidents contd Burns and Scalds No blisters: Place burned or scalded extremity in cold water or cover the area with cold, wet cloths until pain stops (at least 15 minutes). Do not apply toothpaste With blisters: Same as for no blisters. Do not break blisters. Seek medical attention if the affected area is significant or if it affects the face, ear, joints or genital area) If in doubt, seek medical attention anyway!

9. Mgt of accidents contd Fall or injury to the head associated with Vomiting Unconscious or drowsy Behaving abnormally (“not his usual self”) Complaining of severe or persistent headache Oozing blood or fluid from ears or nose Twitching or convulsing Unable to move any body part Seek medical attention immediately If there is any open wound, seek medical attention immediately. If the wound is bleeding, apply direct pressure. Seek medical attention

10. Mgts of accidents contd Electric shock If the child is still connected to the electrical circuit, or lying near the wire or electrical power, disconnect or remove the child from the circuit using a non-conductive instrument e.g. wooden plank or plastic rod. If the child is conscious: check for wound and seek medical attention immediately If the child is unconscious, check if the child is breathing. If not, perform CPR then take to hospital

11. Management of accidents contd CHOKING This happens when someone's airway suddenly gets blocked, either fully or partly, so they can't breathe or breathe properly. The danger signs of choking are : cyanosis Difficulty breathing Loss of consciousness (unresponsiveness) if blockage is not cleared Inability to cry or make much sound Weak, ineffective coughing Soft or high-pitched sounds while inhaling

12. FIRST AID IN CHOKING DO NOT perform these steps if the infant is coughing hard or has a strong cry because strong coughs and cries can help push the object out of the airway. If you can see the object blocking the airway, try to remove it with your finger. Try to remove an object only if you can see it.

13. First aid for choking If the child is not coughing forcefully or does not have a strong cry, follow these steps: Lay the infant face down, along your forearm. Use your thigh or lap for support. Hold the infant's chest in your hand and the jaw with your fingers. Point the infant's head downward, lower than the body. Give up to 5 quick, forceful blows between the infant's shoulder blades. Use the palm of your free hand.

14. First aid in choking contd If the object does not come out of the airway after 5 blows: Turn the infant face-up. Use your thigh or lap for support. Support the head. Place 2 fingers on the middle of the breastbone just below the nipples. Give up to 5 quick thrusts down, compressing the chest one third to one half the depth of the chest. Continue 5 back blows followed by 5 chest thrusts until the object is dislodged or the infant becomes unconscious.

15. Choking first aid contd IF THE INFANT LOSES ALERTNESS If the child becomes unresponsive, stops breathing, or turns blue: commence CPR

16. Choking in older children Perform the Heimlich Maneuver  Avoid using excessive force in employing the Heimlich Maneuver to avoid injury to the ribs or internal organs if the person can speak, cough or breathe, do not interfere. If the person cannot speak, cough or breathe, give abdominal thrusts known as the Heimlich Maneuver.

17. Choking in older children The maneuver involves reaching around the person’s waist. Position one clenched fist above the navel and below the rib cage. Grasp your fist with your other hand. Pull the clenched fist sharply and directly backward and upward under the rib cage six to 10 times quickly.

18. Drowning Drowning is a process of experiencing respiratory impairment from submersion/immersion in a liquid medium. It may be associated with mortality, morbidity or no morbidity First aid in drowning Remove the child from the liquid medium Check if breathing , if not, Commence CPR Remove all wet clothing Take pt to hospital

19. Hospital management of drowning Stabilize the cervical spine Intranasal oxygen to maintain O₂ sat above 92%. Nebulized albuterol may be given for bronchospasm. Seizures should be appropriately treated. Blood glucose concentrations should be frequently monitored and normal glycemic values maintained. Hypotension should be avoided- they may require crystalloids or even dopamine infusion NGT can be passed to remove water from the stomach Rewarming of pt to temp of at least 32-34 degrees celcius

20. Electric shock This usually occurs when children chewing on electrical cords or stick metal items into unprotected outlets. When electric shock occurs - Switch off the power source Examine the child If there is an electrical burn, treat like any other burn. Put the burnt area under running water for at least 20 minutes then cover with a sterile gauze bandage, if available, or a clean cloth.

21. Indication for presentation to hospital for electric shock Any noticeable burn to the skin. Any period of unconsciousness. Any numbness, tingling, paralysis, vision, hearing, or speech problems. Confusion. A hard time breathing. Seizures.

22. Hosp mgt of electric shock ABC of resuscitation Set an IV line, fluid replacement as in thermal burns there is massive fluid shift and acidosis. So monitor urine output, look for myoglobinuria ensure adequate urine output. Intranasal oxygen Cardiac monitoring. some patients need  initial debridement, fasciotomy, and aggressive planned debridement and early skin coverage with the goal of preserving vital structures

23. Poisonings Poisoning is injury or death due to swallowing, inhaling, touching or injecting various drugs, chemicals, venoms or gases. Poisoning may be local (e.g., skin, eyes, or lungs) or systemic depending on the chemical and physical properties of the poison, its mechanism of action, and the route of exposure.

24. Common poisonings in children Kerosene Medicines Organophosphates Carbonmonoxide

25. Approach to poisoning ABC History taking Physical Examination Toxidrome recognition Decontamination Specific Antidotes Symptomatic and Supportive Care

26. Toxidrome These syndromes are usually best described by a combination of vital signs and clinically obvious end-organ manifestations. The signs that prove most clinically useful are those involving the- Central nervous system -(mental status); Ophthalmic system - (pupil size); Gastrointestinal system - (peristalsis); Dermatologic system: skin (dryness vs. diaphoresis) Mucous membranes- (moistness vs. dryness); Genitourinary system- (urinary retention vs. incontinence)

27. Toxidromes for cholinergics OPCs, carbamates , pilocarpine (DUMBELLS) D iarrhoea , diaphoresis U rination M iosis B radycardia , bronchorrhoea E mesis L acrimation L ethargic S alivation

28. Toxidromes for nicotinic (OPCs, carbamates ) – days of the week Monday – Mydriasis Tuesday – Tachycardia Wednesday – Weakness Thursday – Tremors Friday – Fasciculations Saturday – Seizures Sunday – Somnolence

29. Decontamination EYE DECONTAMINATION POSITION Affected eye should be down Wash with cold water for 15 to 20 mins . Recheck Repeat after 20 mins . If necessary Avoid rubbing Place sterile eye pad If infection, add broad-spectrum antibiotic eye ointment every two hours for 24 hours

30. Skin decontamination Shower/rapid wash with a bucket of water Look out for the toxic particles under the nails, groin, genitalia, behind the ears, hair Remove any contaminated clothing Repeat the procedure every ten minutes till the particles completely wash out

31. Gastric decontamination - Gastric emptying Gastric lavage Emesis Activated charcoal Whole bowel irrigation Gastric Emptying Time is an important consideration- preferably within 60mins of ingestion.

32. Activated charcoal use Dose 1g/kg; 6 to 8 hourly – Used for drugs with entero -hepatic and enteroenteric circulation such as : Carbamazepine Dapsone Digitoxin Diisopyramide Nadolol Phenobarbital Phenylbutazone Phenytoin Piroxicam Quinine • Salicylates • Sotalol Sustained release and enteric-coated medications • Theophylline

33. Supportive treatment Airway protection Oxygenation/ventilation Hemodynamic support Treatment of seizures Correction of temperature abnormalities Correction of metabolic derangements Treatment of arrhythmias

34. Common antidotes Antidote drug Oxygen Carbon monoxide Naloxone Opioids Methylene blue Methemoglobinemia Sodium nitrite Cyanide Deferoxamine Iron N- acetylcysteine Acetoaminophen

35. Common antidotes conts Antidote drugs Physostigmine Anti- cholinergics Atropine, Pralidoxime Organophosphates Flumazenil Benzodiazepines Glucagon Beta-blockers Bicarbonate TCA Vitamin K Coumadin anticoag . rodenticides Fomepizole ( Antizol ) Ethylene glycol, Methanol

36. Kerosene poisoning This is one of the commonest form of accidental poisoning seen in Nigeria   due common use of kerosene in house-hold and unsafe storage practices Aspiration pneumonitis is the most common manifestation of kerosene ingestion due to its low viscosity, high volatility, and low surface tension.

37. Kerosene ingestion Children who have ingested small amounts of kerosene and developed no symptoms of aspiration (choking, coughing, vomiting, and respiratory distress), normal oxygen saturation, or other features can be discharged after an observation period of 6 hours after ingestion and advised to attend hospital if symptoms develop

38. Kerosene poisoning contd Children with severe respiratory distress and hypoxemia unresponsive to supplemental oxygen and/or severe central nervous system involvement require early intubation and mechanical ventilation. Transfer to the pediatric intensive care unit (PICU) is required at this stage.

39. Kerosene poisoning contd Emesis, gastric lavage, and administration of activated charcoal are contraindicated due to risk of aspiration. There is no clear benefit of using corticosteroids or prophylactic antibiotics

40. References Kumar S, Kavitha TK, Angurana SK. Kerosene, Camphor, and Naphthalene Poisoning in Children. Indian J Crit Care Med 2019;23( Suppl 4):S278–S281.

41. Child labor and child abuse Dr Akhiwu Helen Department of Paediatrics JUTH MBBS, MSc clinical epidemiology, FMCPaed

42. Child labor The international labor organization defined it as work that deprives children of their childhood, their potential and their dignity, and that is harmful to physical and mental development. It refers to work that: is mentally, physically, socially or morally dangerous and harmful to children; interferes with their schooling by: depriving them of the opportunity to attend school; 

43. Child labor contd obliging them to leave school prematurely; or requiring them to attempt to combine school attendance with excessively long and heavy work. Whether or not particular forms of “work” can be called “child labour ” depends on the child’s age, the type and hours of work performed, the conditions under which it is performed and the objectives pursued by individual countries

44. Pictorial presentation of legal working hours

45. Why child labor occurs Poverty Lack of access to quality education Conflicts and mass migration Death or loss of a primary care giver cultural acceptance of children working from a young age national debt, unemployment/inability to cope, street life and single parents' families Polygamy Lack of family planning

46. Consequences of child labour  death extreme bodily mental harm Slavery sexual or economic exploitation. it cuts children off from schooling and health care

47. In Nigeria Child labor in Nigeria is the employment of children under the age of 18 in a manner that restricts or prevents them from basic education and development. There about 160 million child workers in the world and Nigeria has about 15 million child workers World day against child labor is June 12.

48. In Nigeria The Child Rights Act of 2003 defines acts that constitute child labor and also stipulates some penalties for defaulters. According to the Act, any person or group of persons: who subjects a child to any form of exploitative or forced labor; who employs a child to work in a capacity other than domestic or light agricultural and horticultural work as a family member; who asks a child to carry, lift or move heavy items which could pose negative effects on the child’s social, physical, moral, spiritual, and mental development; who employs a child as a domestic help outside the child’s family environment or home;

49. In Nigeria who employs a child in an industrial undertaking other than required and duly supervised technical work in schools or other approved institutions; is deemed guilty of child labor in Nigeria and liable for conviction and imprisonment for 5 years or the payment of a fine not exceeding ₦500,000 (five hundred thousand Naira) Depending on the gravity of the crime, the defaulter can be made to serve the term and also pay the fine.

50. How to eliminate child labor in Nigeria create public awareness and mobilize support in societies against hazardous and exploitive child labor; and Increase the capacity of community teams to identify vulnerable families and prevent exploitive child labor.   Accessible Education for All. A child's place is in the school where they can receive proper education and use it to build a promising future in the society, they live in. Share your Resources. Make the Government Responsible

51. Child abuse Any act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation"; or "An act or failure to act which presents an imminent risk of serious harm."

52. Types of child abuse Physical abuse Sexual abuse Emotional abuse / Psychological abuse Neglect

53. Physical child abuse  is an injury resulting from physical aggression. Even if the injury was not intended, the act is considered physical abuse. The injury from physical child abuse may be the result of: Beating, slapping, or hitting. Pushing, shaking, kicking, or throwing. Pinching, biting, choking, or hair-pulling. Burning with cigarettes, scalding water, or other hot objects. Severe physical punishment.

54. Sexual abuse of a child  is any sexual act between an adult and a child, including penetration, intercourse, incest, rape, oral sex, and sodomy. Other examples include: Fondling - Touching or kissing a child's genitals, making a child fondle an adult's genitals. Violations of bodily privacy - Forcing a child to undress, spying on a child in the bathroom or bedroom. Exposing children to adult sexuality - Performing sexual acts in front of a child, exposing genitals, telling "dirty" stories, showing pornography to a child. Commercial exploitation - Sexual exploitation through child prostitution or child pornography.

55. Emotional child abuse  is any  attitude, behavior, or failure to act that interferes with a child's mental health or social development . It can range from a simple verbal insult to an extreme form of punishment. Emotional abuse is almost always present when another form of abuse is found. Surprisingly, emotional abuse can have more long-lasting negative psychiatric effects than either physical abuse or sexual abuse. Other names for emotional abuse are: Verbal abuse Mental abuse Psychological maltreatment or psychological abuse

56. Child Neglect  is a very common type of child abuse. neglect is a type of child abuse that is an act of omission - of not doing something. neglect is a pattern of failing to provide for a child's basic needs. A single act of neglect might not be considered child abuse, but repeated neglect is definitely child abuse. There are three basic types of neglect; physical neglect, educational neglect, and emotional neglect.

57. Types of child neglect Physical Neglect- Failure to provide food, clothing appropriate for the weather, supervision, a home that is hygienic and safe, and/or medical care, as needed. Educational Neglect- Failure to enroll a school-age child in school or to provide necessary special education. This includes allowing excessive absences from school. Emotional Neglect- Failure to provide emotional support, love, and affection. This includes neglect of the child's emotional needs and failure to provide psychological care, as needed.

58. Signs of child abuse Withdrawal from friends or usual activities Changes in behavior — such as aggression, anger, hostility or hyperactivity — or changes in school performance Depression, anxiety or unusual fears, or a sudden loss of self-confidence Sleep problems and nightmares Frequent absences from school Rebellious or defiant behavior Self-harm or attempts at suicide

59. Signs of physical abuse Unexplained injuries, such as bruises, broken bones (fractures) or burns Injuries that don't match the given explanation Injuries that aren't compatible with the child's developmental ability

60. Signs of emotional abuse Delayed or inappropriate emotional development Loss of self-confidence or self-esteem Social withdrawal or a loss of interest or enthusiasm Depression Avoidance of certain situations, such as refusing to go to school or ride the bus Appears to desperately seek affection A decrease in school performance or loss of interest in school Loss of previously acquired developmental skills

61. Signs of sexual abuse Sexual behavior or knowledge that's inappropriate for the child's age Pregnancy or a sexually transmitted infection Genital or anal pain, bleeding, or injury Statements by the child that he or she was sexually abused Inappropriate sexual behavior with other children

62. Signs of neglect Poor growth Excessive weight with medical complications that are not being adequately addressed Poor personal cleanliness Lack of clothing or supplies to meet physical needs Hoarding or stealing food Poor record of school attendance Lack of appropriate attention for medical, dental or psychological problems or lack of necessary follow-up care

63. Risk factor for abuse A history of being abused or neglected as a child Physical or mental illness, such as depression or post-traumatic stress disorder (PTSD) Family crisis or stress, including domestic violence and other marital conflicts, or single parenting A child in the family who is developmentally or physically disabled Financial stress, unemployment or poverty Social or extended family isolation Poor understanding of child development and parenting skills Alcohol, drugs or other substance abuse

64. Consequences of abuse Premature death Physical disabilities Learning disabilities Substance abuse Illegal or violent behavior Abuse of others Withdrawal Suicide attempts or self-injury High-risk sexual behaviors or teen pregnancy Problems in school or not finishing high school Limited social and relationship skills

65. Consequences of abuse contd Low self-esteem Difficulty establishing or maintaining relationships Challenges with trust An unhealthy view of parenthood Inability to cope with stress and frustrations An acceptance that violence is a normal part of relationships Eating disorders Personality disorders Behavior disorders Depression Anxiety disorders Post-traumatic stress disorder (PTSD) Trouble sleeping (insomnia) and nightmares Attachment disorders

66. How to prevent child abuse Be a nurturing parent Help a friend, relative or neighbor Help yourself Know what to do if your baby cries Get involved in developing the services needed to meet the needs of children and families Look into parenting resources and help develop resources if needed Promote child abuse prevention programs at school Monitor your child's television and video viewing as violent images can harm young children Report suspected child abuse or child neglect

67. References https://www.ilo.org/ipec/facts/lang--en/index.htm#:~:text=The%20term%20%E2%80%9Cchild%20labour%E2%80%9D%20is,harmful%20to%20children%3B%20and%2For https://www.thebalancemoney.com/thmb/Fe3DlVJoSxvU2CH7kaM4uICPPXo=/750x0/filters:no_upscale():max_bytes(150000):strip_icc():format(webp)/hours-teens-are-legally-allowed-to-work-2063912_Final-b52618287bb54b7395ceb74967a1ac54.png

68. References https://www.dictionary.com/browse/accident https://www.protex.ai/glossary/accident-prevention#:~:text=Accident%20prevention%20refers%20to%20the,or%20to%20lessen%20its%20severity . https://thenewageparents.com/common-accidents-in-children/ https://medlineplus.gov/ency/article/000048.htm https://www.emergencyphysicians.org/article/health--safety-tips/choking--heimlich-manuever .

69. References contd https://www.vinmec.com/en/news/health-news/first-aid-for-drowning-what-you-need-to-know/?link_type=related_posts https://emedicine.medscape.com/article/772753-treatment#d15 https://emedicine.medscape.com/article/433682-treatment https://nhsrcindia.org/sites/default/files/2022-11/Emergency%20Care%20for%20MO-%20General%20Approach%20to%20Poison%20Management.pdf

70. https://www.dol.gov/agencies/ilab/eliminating-worst-forms-child-labor-west-africa-strengthening-sub-regional#:~:text=Create%20public%20awareness%20and%20mobilize,and%20prevent%20exploitive%20child%20labor . https://womenimpactingnigeria.org/5-ways-to-eliminate-child-labour-in-nigeria/ https://www.mayoclinic.org/diseases-conditions/child-abuse/symptoms-causes/syc-20370864

71. References https://www.eclt.org/en/news/child-labour-causes https://proguide.ng/punishment-for-child-labour-in-nigeria/#:~:text=who%20employs%20a%20child%20in,%E2%82%A6500%2C000%20(five%20hundred%20thousand https://www.vanguardngr.com/2023/03/over-160m-children-actively-engaged-in-child-labour-globally-ilo .

72. https://en.wikipedia.org/wiki/Child_labour_in_Nigeria#:~:text=Child%20labour%20in%20Nigeria%20is,from%20basic%20education%20and%20development . https://www.childwelfare.gov/topics/can/defining/ Tracy, N. (2021, December 17). Types of Child Abuse, HealthyPlace . Retrieved on 2023, July 31 from https://www.healthyplace.com/abuse/child-abuse-information/types-child-abuse

73. References contd https://www.qld.gov.au/community/getting-support-health-social-issue/support-victims-abuse/child-abuse/child-abuse-causes Tracy, N. (2021, December 17). Child Abuse Prevention: How to Stop Child Abuse, HealthyPlace . Retrieved on 2023, July 31 from https://www.healthyplace.com/abuse/child-abuse-information/child-abuse-prevention-how-to-stop-child-abuse