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Top Choking Hazards For Babies and Toddlers

We recently went to a very popular restaurant for lunch and to my astonishment there were vending machines with gumballs and other small toys, right next to the jungle gym. This is a disaster waiting to happen!

Children under 3 are at the highest risk of choking because their airways are so small. Plus, chewing and swallowing is a lot more difficult for them. They also love to put foreign objects in their mouths. There is a cylindrical tool in the US used to measure toy parts that is the same size as a young child’s throat. If a toy part fits into this cylinder it’s a choking hazard and a warning label has to appear on the toy packaging. Therefore any object smaller than 3 cm wide is a choking hazard for small children.

WHAT IS A CHOKING HAZARD?

Any object that can get caught in a child’s throat and block the airway is a choking hazard.

TOP 10 HOUSEHOLD CHOKING HAZARDS

Once your baby starts to crawl and explore, choking hazards are all of a sudden everywhere.

  1. Coins
  2. Small caps of bottles e.g. juice and water bottles
  3. Small round batteries
  4. Jewellery
  5. Buttons
  6. Toys and toy parts
  7. Balloons (uninflated or popped)
  8. Garden pebbles
  9. Nails and screws
  10. Stationary e.g. staples, paper clips and pen lids

If you have older kids too, you should keep their toys separate and make sure they learn to pack their toys away.

There are countless more choking hazards. You should probably get down on your knees and have a look at your child’s eye level. How many more choking hazards can you find?

TOP 10 FOOD CHOKING HAZARDS

Hotdogs, grapes and popcorn are the top 3 causes of choking in children under the age of 3. Young children have a hard time chewing their food since they lack the proper dentition (canines for tearing and molars for grinding). They are still trying to coordinate chewing, and as a result, often just swallow their food whole. This makes smooth, slippery, round and hard foods especially dangerous.

The foods in the list below are not recommended for children under 4 years of age. The American Academy of Pediatrics (AAP) goes even further and recommends that hotdogs, grapes and popcorn not be given to children until they are at least 5 years old.

If you do however want to give your children some of these foods, then cut them in such a way that you change their round shape. Hotdogs should be cut lengthwise before slicing and skins of other sausages removed. Grapes and other round fruit should be cut into quarters.

  1. Whole grapes, cherry tomatoes and other round balls of fruit (blueberries are ok for toddlers as they are soft to chew)
  2. Hot dogs and other sausages
  3. Popcorn
  4. Tough, large pieces of meat
  5. Fruit pips and stones
  6. Nuts and seeds
  7. Hard round sweets and caramels
  8. Raw vegetables, especially carrots
  9. Marshmallows
  10. Chewing gum

BE CAREFUL

  • Children can trip and choke more easily if playing and eating at the same time. Your child should not walk, run or lie down while eating. Children should not be distracted whilst eating. They must sit upright and concentrate on what they are doing.
  • It is also not advisable to have your young child eat in their car seat whilst you’re driving. You might not even notice if they’re choking.
  • You should always supervise your child when they are eating.

It’s important that all parents and caregivers learn first aid for choking and CPR. There are many training academies that offer such courses around the country that are usually done over one day and will make you feel more confident when dealing with childhood emergencies.

RESOURCES

Altkorn, R. et al. (2008) Fatal and non-fatal food injuries among children (aged 0–14 years). International Journal of Pediatric Otorhinolaryngology, [online] 72 pp. 1041—1046. Available from: https://www.sciencedirect.com/science/article/pii/S0165587608001298 [Accessed 24 October 2018].

CDC (2018) Choking Hazards [online]. Available from: https://www.cdc.gov/nutrition/infantandtoddlernutrition/foods-and-drinks/choking-hazards.html [Accessed 24 October 2018].

Keep Your Swimming Pool Safe This Summer

South Africa has updated its pool safety regulations this year and now all private swimming pools not only need to be fenced off, but they also need to be fitted with either a pool cover or safety net when not in use. The new regulations form part of the SANS 10134 which is a SABS standard for the safeness of private swimming pools.

Lets take a look at the regulations and some additional measures that can be taken to safetyproof your swimming pool. No single safety measure is foolproof therefore its better to rather use as many as you can together.

SAFETY MEASURES

1. Swimming Pool Fence

According to the South Africa Bureau of standards (SABS) a fence must surround a body of water that holds more than 30 cm of water.

The fence gate must be self-closing and self-locking. The fence must be at least 1.2m high and sunk into the ground by at least 50cm. The vertical slats should be no more than 100mm apart.

Children should not be able to climb over or through the fence and should not be able to open the gates themselves.

2. Swimming Pool Cover

The SA safety standard also requires a swimming that holds more than 30cm of water to be covered by a cover or safety net. DIY installed nets are no longer allowed. An “accredited responsible party” must professionally install a cover and a cover is not approved if a child can unfasten it.

If your pool is small (less than 2.4m at the widest point) the cover must be able to hold the weight of one adult and one child. If you have a larger pool then the cover must hold the weight of two adults and one child in case the first adult falls into the pool during a rescue mission.

3. Swimming Pool Alarm

A swimming pool alarm is an additional safety measure you can have installed. Detectors with sensors that extend into the water are mounted onto the sides of the pool. You can also get free floating alarms. Waves form on the pool surface when a child comes into contact with the water, which triggers these alarms.

Aquawatch pool alarm

Lifebuoy alarm

 

 

 

 

 

You can also have a pool alarm installed on the swimming pool gate, which is activated when the gate is opened.

4. Swimming Pool Chemicals

Make sure all pool chemicals are locked away out of sight and out of reach. Children may mistakenly drink these and contact with the skin can cause chemical burns.

DO NOT FORGET

  • The same rules apply to water features and fishponds. Cover these with safety nets as children can drown in as little as 2.5cm of water.
  • It’s also a good idea to keep the pool brush or net nearby. The pole can be used to help someone in the water if needed.
  • Regularly inspect your safety measures. It’s not uncommon for dogs to chew the safety nets causing them to become lax and ineffective.
  • There are many different products and brands available. Make sure whatever you choose is SABS approved.

RESOURCES

Intemark (2018) Aquawatch Pool Alarms. [image] Available from: http://intemark.co.za/Aquawatch/ [Accessed 18 October 2018].

Lifebuoy (2018) Lifebuoy features. [image] Available from: https://www.lifebuoyalarm.com [Accessed 18 October 2018].

SABS (2015) The safeness of private swimming pools [online]. Available from: https://store.sabs.co.za/catalog/product/view/_ignore_category/1/id/218720/s/sans-10134-2008-ed-1-02/ [Accessed 18 October 2018].

Safepool (n.d.) Swimming pool by laws in South Africa [online]. Available from: http://safepool.co.za/swimming-pool-fence-by-laws-in-south-africa/ [Accessed 18 October 2018].

de Wet, P. (2018) These are the new safety standards for private swimming pools – and a fence is no longer good enough. Business Insider South Africa, [online] pp. https://www.businessinsider.co.za/private-swimming-pool-standard-sans-10134-mandatory-safety-net-to-prevent-drowning-2018-7 [Accessed 18 October 2018].

Drowning 101: Understanding The Biology

Drowning is the third leading cause of unintentional injury-related death worldwide. In SA, the number of drownings has increased significantly over the years, with drowning mortality highest in children under 15 years of age. Shockingly, South Africa has been ranked among the top 10 in an analysis of 60 countries for child drowning mortality.

LET’S TALK DEFINITIONS

In 2005, the World Health Organisation simplified matters, so the terms near-drowning, wet, dry, active, passive, silent and secondary drowning are no longer medically recognised.

Drowning: the process of undergoing respiratory impairment as a result of submersion or immersion in liquid. The outcome can either be fatal or nonfatal.

Submersion: when the airway is BELOW the surface of the liquid.

Immersion: when the airway is ABOVE the surface of the liquid.

Aspirate: when you breathe something foreign into the lungs.

Hypoxia: when not enough oxygen reaches the tissues in the body.

THE BIOLOGY OF DROWNING

The water enters the mouth. Once the water travels down and touches the larynx it triggers a reflex, which causes a laryngospasm. This is when the larynx closes up tightly, therefore no water can enter the lungs.

Since the lungs are no longer getting air, the brain starts to lose oxygen which eventually causes this reflex to stop. The larynx then relaxes and water enters the lungs. If death occurred before water entered the lungs it was called dry drowning and when water entered it was wet drowning. Dry drownings are actually very rare.

Once water is in the lung the body absorbs it into the bloodstream. It is uncommon for the amount of water to exceed the rate of absorption because people who are conscious won’t actually breathe in that much water and when they become unconscious they are no longer actively breathing.

Surfactant

The lungs are made up of lots of little sacs called alveoli. These sacs are lined with a substance called surfactant. Surfactant keeps these sacs open so that air can enter them.

When water mixes with surfactant it no longer does its job and the alveoli collapse. With all these sacs collapsing the blood cells cannot absorb any oxygen. They then start to look elsewhere for oxygen and begin to flood areas of the lung where the alveoli are still open (this is known as shunting). Because of these high pressures, fluid starts to leak out of the blood and into the lungs. This then causes pulmonary oedema and is what used to be referred to as secondary drowning.

Eventually, because of the decreasing oxygen in the blood, you lose consciousness. Your brain will then continue to be without oxygen and the duration of this is the most important determinant of outcome.

DELAYED DROWNING

This is what many parents are afraid of will happen to their children. Delayed drowning happens when your child aspirates some water whilst swimming and develops symptoms much later after the incident. Usually you are not even aware of this and your child may not even tell you they had any problems in the water.

Physiologically speaking delayed drowning is the same as secondary drowning. The water that was breathed in causes enough alveoli to collapse to result in shunting and pulmonary oedema.

It’s important to know that there has never been a medically documented case where someone who had a drowning incident, experienced no symptoms at first but later deteriorated and died. Usually someone who has aspirated water will have some symptoms right after which will either get better or worse within a few hours. If your child has had any problems in the water you should watch them for the next 1-2 days. If any respiratory symptoms develop you should take them straight to the emergency room.

Signs and symptoms to watch out for:

  • Coughing
  • Shortness of breath
  • Difficulty breathing
  • Chest pain
  • Unusually tired
  • Pale skin
  • Vomiting

Remember… NEVER leave your children unsupervised around water. A child can drown in as little as 2.5 cm of water.

RESOURCES

van Beeck, E.F. et al. (2005) A new definition of drowning: towards documentation and prevention of a global public health problem. Bulletin of World Health Organization, [online]. Available from: https://www.scielosp.org/pdf/bwho/2005.v83n11/853-856/en [Accessed: 11 October 2018].

Hawkins, S.C., Sempsrott, J. & Schmidt, A. (2017) Drowning in a Sea of Misinformation: Dry Drowning and Secondary Drowning. Emergency Medicine News [online]. Available from: https://journals.lww.com/em-news/blog/PhotographED/Pages/post.aspx?PostID=247 [Accessed: 11 October 2018].

High, P. (2016) Immersion submersion and drowning Available from: https://derangedphysiology.com/main/required-reading/trauma-burns-and-drowning/Chapter%204.0.7/immersion-submersion-and-drowning [Accessed: 11 October 2018].

Saunders, C.J., Sewduth, D. & Naidoo, N. (2018) Keeping our heads above water: A systematic review of fatal drowning in South Africa. SAMJ, [online] 108 (1), pp. 61-68. Available from: http://www.scielo.org.za/pdf/samj/v108n1/17.pdf [Accessed: 11 October 2018].

WHO (2018) Violence and Injury Prevention. [online]. Available from: http://www.who.int/violence_injury_prevention/other_injury/drowning/en/ [Accessed: 11 October 2018].

A Bump To The Head: When Should You Worry?

I have attended to many children in the ER who have taken a tumble. In the US, falls account for around half the injury-related ER visits in children under 5 years of age. Most of these falls involve furniture such as changing mats, high chairs, baby walkers and beds.

Parents are almost always concerned about head injuries. Majority of head injuries from a fall are usually minor.

Children under one who fall are more likely to sustain head injuries regardless of the height from which they fall. Whereas older children are more prone to extremity fractures. This is because an infant’s head is much larger than the rest of their body. As a child grows, their head mass becomes more proportional and they develop upper body strength, which enables them to brace falls with their arms or legs.

WHEN TO SEE A DOCTOR

If your child is awake, alert and behaving normally after a bump to the head with no other signs and symptoms then he or she will most likely be fine and you don’t have to rush to hospital right away. It’s a good idea to observe your child for 1-2 days afterwards, since symptoms of a brain injury may present late.

Seek Medical Attention:

  • For any bump to the head in an infant;
  • If your child has lost consciousness, even if brief;
  • If your child has any signs and symptoms of a concussion (see below);
  • If your child is inconsolable;
  • If your child is vomiting;
  • If your child is difficult to wake;
  • If your child has a seizure; and/or
  • If you suspect a broken bone.

If your child has had a bad fall and you suspect a neck injury DO NOT move your child. Call an ambulance right away! Always trust your gut. If you are unsure rather head straight to your nearest emergency room.

CONCUSSION

A concussion is a brain injury caused by a blow to the head. The signs and symptoms may be vague and may even take a few days to develop. It’s important to know that not all concussions cause a loss of consciousness.

Concussions can be more difficult to diagnose in children, as they are not as vocal about their symptoms. Children older than 2 years will show more behavioural symptoms.

Signs & symptoms will therefore depend on age and include but are not limited to:

  • Irritable and fussy;
  • Unusually sleepy;
  • Crying more than usual;
  • Change in appetite;
  • Nausea and/or vomiting;
  • Lack of interest in play;
  • Headache;
  • Confusion;
  • Child is unsteady on his or her feet;
  • Sensitivity to light and noise;
  • Blurred or double vision;
  • Dizziness;
  • Unusual speech e.g.: slow or slurred;
  • Poor concentration and memory; and/or
  • Problems with co-ordination.

DIAGNOSING A CONCUSSION        

The doctor will do a thorough evaluation. A CT scan and MRI cannot diagnose a concussion. A CT scan will however, most likely be ordered to exclude a brain bleed or skull fracture depending on the mechanism of injury and presenting symptoms.

The majority of falls in children are caused by modifiable factors and are therefore preventable. It’s impossible to bubble wrap our kids and we shouldn’t have to. Falls and tumbles can teach our children valuable lessons, but we can spend time baby proofing our homes and being more cautious to prevent serious injury. Remember to always buckle your baby in their high chair and never leave him or her unattended on a changing mat, not even for a second – it takes seconds for an accident to happen.

RESOURCES

Burrows, P. et al. (2015) Head injury from falls in children younger than 6 years of age. Arch Dis Child, [online] 100 (11), pp. 1032-1037. Available from: https://0-www-ncbi-nlm-nih-gov.innopac.wits.ac.za/pmc/articles/PMC4680174/ [Accessed 3 October 2018].

CDC (2017) Traumatic Brain Injury & Concussion [online]. Available from: https://www.cdc.gov/traumaticbraininjury/symptoms.html [Accessed 3 october 2018].

Chaudhary, S. et al. (2018) Pediatric falls ages 0–4: understanding demographics, mechanisms, and injury severities. Inj Epidemiol, [online] 5 (suppl 1). Available from: https://0-www-ncbi-nlm-nih-gov.innopac.wits.ac.za/pmc/articles/PMC5893510/ [Accessed 3 October 2018].

Kendrick, D. et al. (2015) Risk and Protective Factors for Falls From Furniture in Young Children Multicenter Case-Control Study. JAMA Pediatr, [online] 169 (2), pp. 145-153. Available from: https://jamanetwork.com/journals/jamapediatrics/fullarticle/1939058 [Accessed 3 October 2018].

Samuel, N. et al. (2015) Falls in young children with minor head injury: A prospective analysis of injury mechanisms. Brain Injury, [online] 29 (7-8), pp. 946-950. Available from: https://0-www-tandfonline-com.innopac.wits.ac.za/doi/full/10.3109/02699052.2015.1017005 [Accessed 3 October 2018].

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