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Sea Creatures To Avoid At The Beach

I am really looking forward to taking my little one to the beach for the first time this year. Whilst the beach is great fun for any child there are a few sea creatures that can ruin a holiday.

If your child gets stung by one of these little guys try not to panic. Most stings cause nothing more than a localised skin reaction and a whole lot of pain. If your child is prone to allergic reactions there is a possibility they could however develop a severe allergic reaction and you will have to be on the lookout for this.

There are many dangerous marine animals but fortunately South Africa doesn’t have too many that your little ones will come across on the beaches and in rockpools. Below, I will describe how to manage the stings and bites of the most common sea creatures on South Africa’s shores.

  1. JELLYFISH

There are over 2000 different species of jellyfish and the toxins vary among them.

The nematocysts (cells inside the tentacles that release the toxin) from different species of jellyfish are either inhibited or stimulated to release more toxin depending on what first aid is applied which can make initial management challenging.

The jellyfish we encounter in South African waters are most commonly a relatively harmless type of box jellyfish. They most often only cause immediate pain, redness, tingling and itchiness.

How to treat jellyfish stings:

There is some debate as to how to treat jellyfish stings. Some suggest rinsing the wound in seawater others suggest vinegar or hot water and then there also seems to be some confusion about the order of steps. Based on a systematic review, which provides the best evidence, I have outlined the management of a jellyfish sting:

  1. Always provide Basic Life Support first. Don’t try remove any tentacles unless your child is responsive and stable.
  2. Flush the area with seawater to remove the tentacles that are stuck to the skin. You can use tweezers to gently remove tentacles whilst flushing. You can also use your hands provided you wear gloves. Don’t scrape away tentacles or rub with sand as the pressure will only release more toxin. Do not use fresh water as this causes more toxin to be released.
  3. Apply a paste of bicarb (50% bicarb of soda and 50% seawater) for several minutes and rinse off with seawater.
  4. Immerse the area in hot water (as hot as possible without burning the skin). Heat will help to reduce the pain. Apply for 30-90 minutes either in a hot shower, bath or by using heat packs.
  5. If heat has not helped the pain apply ice packs.
  6. Oral analgesics, anti-inflammatories and antihistamines are all effective.
  7. Monitor for a severe allergic reaction.

Jellyfish sting don’t’s:

Vinegar: I don’t recommend rinsing with vinegar. Vinegar is only effective for certain species of jellyfish and since it is very difficult to identify the species responsible for a sting I would avoid it. Vinegar can cause nematocysts to release more toxin causing significantly more pain.

Tweezers: Trying to remove stingers with tweezers or by scraping can also cause them to discharge more toxin. It is now recommended to avoid this.

  1. BLUEBOTTLE

The blue bottle, also known as the Pacific or Portuguese  man-o’-war, is very common along the coast of South Africa. Management of these stings is similar to that of the jellyfish sting described above.

  1. SEA URCHIN

These spikey creatures are like the hedgehogs of the sea and are commonly found in rock pools. If your little ones accidentally step on one or touch one, the urchin will shoot out some of their spines.

As with most sea creatures some are more poisonous than others, but most sea urchins cause nothing more than a painful puncture wound similar to that of a splinter. On the odd occasion there may be also be burning, swelling and numbess of the area that lasts a few hours.

What to do if your child comes into contact with a sea urchin:

  1. Remove all the spines with tweezers or your hands if large enough. Do this very carefully as the spines are fragile and can break easily.
  2. Stop any bleeding with firm pressure.
  3. Rinse the wound with salt water.
  4. Soak the wound in vinegar throughout the day or apply a cloth soaked in vinegar over the wound to dissolve any spines you were unable to remove.
  5. Follow with warm compresses to help with the pain and swelling.
  6. Analgesics and anti-inflammatories such as Ibuprofen.

If you don’t manage to remove the spines and they don’t fully disolve with vinegar they may need to be removed by a medical practitioner.

The spines would also have caused puncture wounds into the skin so its important to keep the area clean and watch out for any signs of infection.

  1. SEA ANEMONE

These beautiful creatures, which live in rock pools, can be very tempting for our kids and thankfully most of their stings are harmless.

What to do if your child has been stung by an anemone:

  1. Flush the area with seawater to remove as many stingers as you can.
  2. Immerse area in hot water for up to 90 minutes.
  3. Apply ice packs if heat does not help.
  4. Oral analgesics, anti-inflammatories and antihistamines.
  5. Monitor for a severe allergic reaction.

WHEN YOU NEED TO SEEK MEDICAL HELP:

  • Difficulty breathing
  • Confusion and/or loss of consciousness
  • Chest pain
  • Nausea and vomiting
  • Muscles cramps severe bleeding
  • Severe pain that won’t go away
  • Stings on a large surface area, the face, throat or genitalia
  • Signs of infection over the next few days: increased pain, redness, swelling, pus and/or fever

SIMPLE SAFETY TIPS

  • Look for any warning signs at the beach about jellyfish and other dangerous marine life in the area and AVOID.
  • If you find any jellyfish or blue bottles on the beach it’s likely there will be more floating around in the breakers. Rather avoid the water.
  • Never touch a jellyfish or blue bottle, even if it looks dead. The tentacles can still sting even if they aren’t attached to the body.
  • Invest in some good quality swim shoes. They can be worn in and out of the water. These have a rubber sole and will protect little feet from nasties they may step on, as well as the hot beach sand, which can burn.
  • Don’t forget that tetanus prophylaxis is important for any break in the skin. Refer to my previous blog for more information.

It’s important your kids respect the little animals they may come across at the beach. Teach your children to look but NOT touch. There are so many fun things to do at the beach so don’t let bluebottles and sea urchins scare you. Just keep an eye out and initiate immediate first aid to prevent a small injury from turning into something much bigger.

Keep on hand my on-the-go first aid MikiKit. It is compact and will fit perfectly into your beach bag https://www.oneaid.co.za/shop/

RESOURCES:

http://www.ambulance.nsw.gov.au/Media/docs/090730bluebottle-eee3bc83-ce7c-4281-a095-b427eb01e6d0-0.pdf

https://www.mdpi.com/1660-3397/14/7/127

https://www.merckmanuals.com/professional/injuries-poisoning/bites-and-stings/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3640396/

https://www.nsri.org.za/2012/02/how-jellyfish-sting/

https://www.racgp.org.au/afp/2015/januaryfebruary/marine-envenomations/

 

Baking With Your Little Ones; Safety and Tips to Taking Care of Thermal Burns

This weekend I plan on doing a little baking with my daughter. We are going to make cookies for her friends at playschool. My daughter loves getting involved in the kitchen which usually means I have to be super vigilent about keeping an eye on her.

I think the kitchen is the most dangerous room in the house. It’s the room with the most appliances, utensils and where most of us keep the cleaning materials. For our cookie making masterclass this weekend we will be using the oven for baking and this is why I am going to be talking a little more about thermal burns in children. Of course children can also sustain chemical and electrical burns in the kitchen but for this blog I will only be looking at thermal injuries.

Thermal burns can occur from hot liquids, hot solids or flames. According to the WHO, burns are the “fifth most common cause of non-fatal childhood injuries” worldwide. However in South Africa things are a little more frightening. In children 1 to 4 years of age, thermal injury is the second most common cause of mortality, with toddlers and boys being at highest risk.

CLASSIFICATION  OF BURNS

Burns are no longer classified as first, second or third degree and are currently being described according to the depth of the burn.

  1. Superficial thickness – This burn involves only the epidermis (the outermost layer of the skin). Here you will only notice a reddening of the skin.
  2. Partial thickness – This is further classified into superficial or deep partial thickness. This burn involves the entire epidermis and parts of the dermis.
    1. Superficial partial thickness: appears red with blisters and is very painful.
    2. Deep partial thickness: looks waxy white with some areas of red, wet and blistered. This depth of burn may be less painful.
  3. Full thickness – This burn involves the entire epidermis and the entire dermis. The skin looks white and leathery. There is no pain as the nerve endings in the skin have all been damaged. However, surrounding areas of partial thickness burns will be painful.
  4. Fourth degree – This is the deepest type of burn where there is damage to the structures underlying the skin such as the muscles and bones.

Full thickness and fourth degree burns almost always require surgical intervention and skin grafting. Some deep partial thickness burns may also require surgical management.

HOW TO TREAT A COOKING BURN

Act FAST: A child’s skin will burn much faster than adult skin.

The longer a burn remains open, the more likely it will get infected so get it covered as quickly as possible.

  1. Remove your child from the source of the burn.
  2. Remove any clothing near the affected area to expose the wound. Don’t try to remove anything that is stuck to the burn.
  3. Place affected area under cool running water for up to 20 minutes. Do this as soon as possible to prevent any further thermal injury.
  4. Pat dry gently with a clean cloth or gauze.
  5. You can now apply a burn gel if you have one (if you don’t have this proceed to the next step). This will help cool the wound but should only be used short-term. Remove after a few hours and wash away any excess gel left on the wound with cool running water, then gently pat area dry.
  6. Cover the wound loosely with a dry, sterile non-adherent dressing.

WHAT ABOUT BLISTERS?

It’s important to leave blisters alone. You can apply a burn gel over a blister. Just be careful when you rinse the wound of the gel once you remove it that you don’t rub too hard, as the skin on top is very thin. Cover the blistered wound with a dry dressing.

If the blister has popped the underlying skin is raw and exposed and at increased risk of infection. It is now even more important to keep the wound clean.  There is new evidence to suggest that you can now cover the wound with a wet dressing until it heals provided you regularly wash the area and keep the dressings clean.

You can read more in one of my previous blogs https://www.oneaid.co.za/picking-scabs-popping-blisters/

BUTTER, TOOTHPASTE AND TURMERIC

I have seen patients put all kinds of things on their burns. Superficial burns require nothing more than initial cooling, a dry dressing and some painkillers. If there are blisters you can manage the wound as described above. Applying home remedies can do more harm than good.

Antibiotic ointments for prophylaxis (prevention of infection) are an issue of debate. Many specialists don’t advocate their use as they can cause antibiotic resistance if the wound were to get infected. 

GO TO THE ER!

  • Any burn, regardless of depth, bigger than the palm of your child’s hand;
  • Any burn, regardless of size, deeper than a superficial partial thickness burn;
  • Any burn, regardless of size, involving the head and neck, hands, feet, groin and joints;
  • Circumferential burns of any size around the chest, abdomen or a limb; and/or
  • When there was a risk of inhalation burns

SAFEGUARD YOUR KITCHEN AGAINST BURNS

Burns are preventable!

  • Make sure appliances that contain hot liquids such as kettles and slow cookers as well as hotplates are kept out of reach.
  • Make sure that electrical cords of these appliances are also out of reach. Exploring children can pull on the cords as well as trip over them if they are lying on the floor. I read about an incident where a young child tripped over a cord pulling a slow cooker and all the hot contents over her. She sustained serious full thickness burns over most of her body.
  • Use the furthest burner on the stovetop and keep pot handles turned away towards the back.
  • Don’t mix hot liquids in a blender as the contents can explode out onto whoever is standing nearby.
  • Be careful of long hair and loose clothing, which can catch on fire.
  • Keep paper towels, dishcloths and oven mitts away from the stovetop as they can catch on fire.
  • Keep chemicals and other flammables such as paraffin locked away at all times https://www.oneaid.co.za/10-essential-tips-to-prevent-poisoning-in-your-home/
  • If you have little children running around you should never take your eye off the kitchen if you still have something cooking.

Cooking with your kids can be so much fun. It’s hands on and a great form of ‘messy play’. It’s also a great way to get your children to explore new flavours. I find that if my daughter has been involved in the prepping of her meal she is much more likely to eat it. Next time why don’t you let your toddler better their motor skills by cracking open some eggs or measuring out some flour.

RESOURCES:

https://consumer.healthday.com/general-health-information-16/burn-health-news-87/kitchen-cooking-burns-a-real-danger-for-kids-713976.html

http://www.firechildren.org/index2.asp?include=fireburns.htm&catID=4

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3187951/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3500004/

http://www.who.int/news-room/fact-sheets/detail/burns

https://www.westerncape.gov.za/general-publication/national-burns-week-2016

How To Keep Your Children Safe In The Sun

1. SUNSCREEN, SUNSCREEN AND MORE SUNSCREEN!

I cannot stress this enough. The damage that causes skin cancer in adulthood can start in childhood. Every child needs sunscreen, regardless of skin tone. Melanin is a pigment found in the skin that absorbs UV rays. The darker the skin, the more melanin there is, therefore the more UV rays are absorbed. This simply means that the skin will take longer to burn BUT it will burn.

How does sunscreen work?

Most sunscreens contain organic and inorganic chemicals. The inorganic chemicals act as a physical barrier and don’t get absorbed into the skin. These are known as physical sunscreens and work by reflecting UV rays, which is what used to make sunblock look white on the skin. Modern day sunblock no longer leaves this white residue on the skin.

The organic chemicals actually absorb UV rays, much like melanin, and then disperse the energy as heat. These chemicals get absorbed into the skin and are known as chemical sunscreens. 

What is the difference between UVA and UVB rays?

 UVB rays are the main cause of redness of the skin and sunburn. These rays damage the superficial layers of the skin.

UVA rays penetrate deeper into the skin and cause the tanned look by increasing the amount of melanin in the skin. This is a how the skin protects itself from further damage. There is no way to tell how much UVA damage the skin has endured. 

How to choose the right sunscreen?

It does not matter if you use a lotion, cream, gel, spray or stick. They are all equally effective. What is important is that you apply a sunscreen with at least an SPF 30.

To get the most protection, you need a broad-spectrum sunscreen. This means the sunscreen must protect against UVA and UVB rays. No sunscreen can block 100 percent of UVB rays; SPF 15 blocks 93 percent of UVB rays, SPF 30 blocks out 97% and SPF 50 blocks 98%.

Using a water-resistant sunscreen is probably a better idea especially if your little ones are running around sweating a lot or swimming.

What is SPF?

Sun protection factor (SPF) is a measure of how long a sunscreen will protect you before you burn. SPF is a measure of UVB rays only.

So how does the factor in SPF work? If you normally burn after 20 minutes (without sunblock) and you apply an SPF 15 it will take 15 times longer to burn. This means that you should theoretically be protected for 5 hours (20 x 15 = 300/60 = 5 hours) If you use an SPF 30 then it should take 30 times longer and therefore 10 hours before you burn. However, it is impossible to expect a sunscreen to be effective for 5 hours never mind 10 so the SPF model is not 100% fail proof.

How common is sunscreen allergy?

It is uncommon to have an allergy to sunscreen. If there is a real allergy towards a sunblock it is usually towards one of the organic chemicals found in the cream. It’s a good idea to test the sunblock out first on a small area of the skin to see if an allergy will occur, before applying sunblock to the whole body. Sunscreens for sensitive skin are readily available. Physical sunscreens are not known to cause allergies. Make sure to check the label so you know what you are getting.

Sunscreen everywhere!

Be sure to put sunscreen on all exposed areas. Don’t forget the tops of the feet, back of the hands, the ears, back of the neck, hairline, lips and nose.

Reapply often!

Remember to apply sunscreen 20-30 minutes before going out into the sun. All sunscreens, regardless of strength, need to be reapplied every 2 hours. Reapply more frequently if swimming and/or sweating a lot. Sand and water also reflects more light so your children will burn more easily when at the beach, swimming or playing water sports. Remember, no sunscreen is waterproof.

2. COVER UP

You should never rely on sunscreen alone to keep your children safe from the harmful UV rays. There are other additional measures you can take to protect your children from the sun and heat. Have your children wear loose cotton clothing so that they don’t overheat and avoid sheer fabrics as UV rays can penetrate these.

Clothing that contains Ultraviolet Protection Factor (UPF) is becoming more readily available. UPF fabric is very tightly woven and uses dyes that disrupt UV light, which prevents the penetration of both UVA and UVB rays. Look for UPF clothing with a rating of 50+. Don’t forget about hats. Wide brimmed hats are better as they also protect the ears and back of the neck.

If the skin needs protecting so do the eyes. Whilst Sunglasses these days are much more of a fashion statement they are actually very important in protecting eyes against UV rays. UV rays can cause a number of eye problems later in life such as cataracts, retinal damage, pterygium formation and skin cancer of the eyelids. Short-term exposure can also burn the cornea, which is extremely painful and causes blurred vision. I have seen various sunglasses that are available for children. When buying sunglasses make sure though that they protect against both UVA and UVB rays.

6. NEWBORNS AND YOUNG CHILDREN 

Babies younger than 6 months should be kept out of the direct sunlight. The skin is thinner and the melanin is not properly developed. If this is not possible, use a sunscreen that contains either zinc oxide or titanium dioxide only (a physical barrier cream only). These are less likely to irritate your baby’s sensitive skin, as they do not get absorbed. Still, make sure that you keep them out of the sun during the harmful peak hours mentioned below.

4. STAY HYDRATED

Prevent heat-related illnesses such as heat cramps, exhaustion and stroke. Make sure your children drink plenty of fluids before and during outdoor activities in hot weather. Thirst is a late sign of dehydration.

 5. OPT FOR SHADE

 Your children should try stay in the shade during dangerous peak times, 11am – 3pm, when UVB rays are the strongest. Kids should also take regular breaks from the sun and go into the shade to cool down and prevent overheating.

6. CLOUDY, OVERCAST WEATHER

This is a common problem. One thinks because there is no visible sun the clouds offer protection but in fact the clouds only manage to filter a small percentage of UV rays. Children can still get sunburnt when it is cloudy. Even though you may not be able to see the sun, the sun’s UV rays still reach the earth.

7. SET AN EXAMPLE

Make sure you always wear sunscreen and sunglasses. Let your kids help rub it in on your shoulders. Avoid tanning and limit your time in the sun so that your children can learn correct behaviours from you.

I know that some of these tips may seem obvious but I continue to see children playing outdoors without any sunscreen or sunhats. In a climate like what we have in South Africa we need to be more aware of the dangers the sun and heat create for our little ones.

RESOURCES

https://www.cdc.gov/cancer/skin/basic_info/children.htm

https://www.preventblindness.org/how-can-uv-rays-damage-your-eyes

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].

7 Tips To Keep Your Sleeping Baby Safe

I’m sure many of you have heard of SIDS, which is also known as cot death. SIDS is defined as the sudden unexpected death of an infant, which appears to happen during sleep, where the death can’t be explained even after an autopsy.

In the developed world, SIDS and suffocation are the most common cause of sudden unexpected infant deaths (an infant is a child under 1 year of age). Unfortunately, in South Africa, we don’t know the stats since most infants that die unexpectedly don’t undergo routine autopsies to identify cause of death.

You all probably know that back sleeping is the safest for your baby, but there are other additional ways you can reduce the risk of SIDS and other sleep-related causes of death. I have put together some tips in which to create a safe sleep environment for your baby from birth up until 1 year of age.

1. POSITION

Always place your baby to sleep on his or her back, for night sleeps AND naps. There is no evidence to prove that your baby is more like to choke if he or she vomits or regurgitates in this position, compared to a baby that sleeps in any other position. Placing your baby to sleep on their side is also not recommended, unless indicated for medical reasons by your practitioner.

Once your baby starts to roll, continue to place them to sleep on their backs but do not drive yourself mad by constantly repositioning them if they do roll over in their sleep. Once babies have mastered the art of rolling they can roll themselves right out of trouble if their breathing becomes difficult.

It’s important to also talk a little bit about flat head syndrome (plagiocephaly). Back sleeping is associated with this condition. Babies’ skulls are soft and constant pressure on the same spot can cause the head to change shape. You can avoid this deformity by repositioning your baby’s head to face opposite sides with each sleep.

2. SURFACE

Your baby should sleep on a firm flat surface. Not a soft surface like a couch, pillow or blanket. Babies should not sleep in car seats, baby swings and carriers either (this is not back sleeping). If your baby does fall asleep in one of these, it’s better to place them flat in their cot or bassinet as soon as possible. I spoke about recline angle and heads blocking airways in my post about car seat safety.

In addition to floppy heads its important to realise that a baby’s head is very large compared to their body. So if you elevate the head too much the airway can also become obstructed.

 

What happens to the airway when the head is elevated

 

3. BEDDING

It’s hard to avoid decorating your little one’s room when there are so many gorgeous accessories available. Just remember to remove all loose items from their beds before naps and bedtime. Such items are a potential entrapment, strangulation and suffocation hazard. Pillows, blankets, stuffed animals and even cot bumpers should not be in your baby’s bed whilst they sleep. There is no evidence to even prove that cot bumpers actually do prevent injury and infants don’t need pillows.

Please also be aware of mobiles. Depending on how high your mobile is your little one may be able to reach for it, as he or she gets older. Then the strings and other components could become a choking and/or strangulation risk.

4. LOCATION

This tip is debatable since there is mixed evidence in the literature. The American Academy of Pediatrics (AAP) recommends that your baby share your room but not your bed. This recommendation was introduced after many infants who co-shared died by either becoming trapped in the bedding or smothered by a parent.

Interestingly in African and Asian countries, this has not been seen. These countries, where co-sharing is the norm, actually have lower rates of sleep-related infant deaths than Western countries. Researchers suggest that co-sharing is actually protective because infants who sleep next to their parents are constantly stimulated. This stimulation keeps them in a more aroused state so they spend less time in deep sleep and are therefore at a lower risk of stopping breathing.

5. TEMPERATURE 

Your baby should not get too hot in their sleep. Dress your baby in only ONE extra layer than you would comfortably wear. A sleep sack is a safe option. No blankets please!

The room temperature should also be kept comfortable. Most baby monitors have a built in temperature function but if yours doesn’t, keep an indoor thermometer in the room and don’t let the temperature go higher than 22o Celsius.

6. PACIFIER

It has been shown that a pacifier reduces the risk of SIDS. You can try giving your baby a pacifier but only once breastfeeding has been well established (if you choose to breastfeed). The nipple can confuse your baby if given too early and you may then have problems with latching.

Remove dummy chains or strings before giving your baby a pacifier to sleep. Also, don’t stress if the dummy falls out during sleep (it most probably will), you don’t need to replace it.

Don’t force a dummy. It’s ok if your baby doesn’t like it, not all babies do.

7. FURNITURE

Now take a step back and look around your baby’s room. Make sure all electrical cables, window blind cords and any other potentially hazardous items within arms reach from the cot are removed.

Looking after our babies is a lot of work and we always need to be on call and think 2 steps ahead. But now that your little one is sleeping SAFELY, go and put your feet up and have a cup of coffee… or maybe go take a nap yourself!

RESOURCES

Cadematori, M.E., Piranian, M.A., Skrzypek, P.A. & Pron, A.M. (2016) Caregiver Compliance With Safe Sleep Guidelines. Newborn & Infant Nursing Reviews, [online] 16, pp. 122–125. Available from: https://www.sciencedirect.com/science/article/pii/S152733691630054X [Accessed: 26 September 2018].

Kibel, M.A., Molteno, C.D. & De Decker, R. (2005) Cot death controversies. Cot death. SAMJ, [online] 95 (11). Available from: http://www.samj.org.za/index.php/samj/article/viewFile/1881/1202 [Accessed: 26 September 2018].

Koren, A., Reece, S.M., Kahn-D’angelo, L. & Medeiros, D. (2009) Parental Information and Behaviors and Provider Practices Related to Tummy Time and Back to Sleep. Journal of Pediatric Health Care, [online] 24 (4), pp. 222-230. DOI: 10.1016/j.pedhc.2009.05.002 [Accessed 26 September 2018].

Miller, L.C., Johnson, A., Duggan, L. & Behm, M. (2011) Consequences of the “Back to Sleep” Program in Infants. Journal of Pediatric Nursing, [online] 26, pp. 364-368. Available from: https://0-ac-els–cdn-com.innopac.wits.ac.za/S0882596309002930/1-s2.0-S0882596309002930-main.pdf?_tid=dccfa213-e0d1-4850-beeb-18fd49b69dd5&acdnat=1537520788_cb816c0abb2f56d365e5a1b195a3ca24 [Accessed 26 September 2018].

How Safe Is Your Car Seat?

We all know how long it can take for a child to fall asleep. So when you reach your destination and your little one has finally fallen asleep you couldn’t feel more relieved. You wouldn’t dream of disturbing them by removing him or her from the car seat. Instead you do what is the most convenient, and move your child from your car into a pram chassis or straight into your home without ever moving them from the car seat.

Whilst car seats have saved many lives, they do have some hidden dangers. A study in 2015 found that out of all the sitting and carrying devices for young children, car seats were responsible for the most number of deaths. Hypoxia and suffocation from either poor positioning in the car seat or strangulation by the straps and buckles was the cause of death in all these cases.

HYPOXIA

This is when there is a loss of oxygen in the blood which reduces the amount of oxygen reaching the tissues. When there is an extreme loss of oxygen a child will suffocate.

The developing brain is very sensitive to a decrease in oxygen. Loss of oxygen can cause brain injury and result in a range of developmental problems as well as seizures.

POSITIONING

The position of your car seat is important. The Recline Angle of a rear-facing car seat is critical and an angle between 30-45o from the vertical is recommended. A recline angle more than 45o offers very little protection in the event of a crash.

A newborn or young infant’s head is heavy and the neck muscles are weak. If the recline angle becomes less and the car seat more upright, the head will flop down and obstruct the airway. A newborn should therefore be positioned in the lowest possible position, which still offers crash protection. As babies grow their neck muscles get stronger and the angle of the car seat can become more upright since their head and neck control improves.

 

The recline angle of a rear-facing car

 

A number of studies have looked at the level of oxygen in an infant’s blood whilst in their car seat. A level of oxygen less than 90% is considered dangerous. It was shown that children’s oxygen levels dropped as far down to 83.7% when in incorrectly positioned car seats. The authors also found that the longer the child remained in the car seat the lower the oxygen level would drop.

Another study found that a child in a correctly placed rear-facing car seat is still at risk of suffocation. The vibration produced by a car could cause newborns and young children’s head and shoulders to fall forward, despite correct use of the straps and buckles. This risk was also similar for both term and preterm infants.

Some specialists recommended that young babies spend no more than 30 minutes to an hour in a car seat at a time. If a long journey is unavoidable it may be wise for someone to sit in the back with your child to keep an eye out.

STRAPS AND BUCKLES

Always make sure your child is properly securely in a car seat. If the straps are too loose a child can easily slip or even wriggle down far enough to become strangled by the straps. If the child falls lower down in the seat the child may also suffocate from an obstructed airway if the head falls onto the chest.

NEVER

  • Never place your baby in a car seat on a soft surface such as a bed or couch. This type of surface could cause the recline angle to change resulting in your child’s head falling forward and obstructing the airway.
  • Never loosen or unbuckle any straps if you do decide to keep your baby in a car seat outside of the car. A child can wriggle and slip down far enough to be strangled by the straps and even fall out of the car seat altogether.
  • Never leave an infant or young child unsupervised in a car seat if they are asleep or even if they are awake.
  • Never place your baby in a car seat on an elevated surface such as a table. A baby can wriggle enough to cause the seat to move and fall off the surface.
  • Never place your baby in a car seat on the floor without looking at the recline angle. Some car seats may become more upright when placed on the floor.

Always make sure your car seat is installed correctly. Most car seats come with a built-in indicator that allows you to see if the seat is installed at the proper angle.

Read the manual carefully and if in doubt contact the local manufacturer or distributor. You can also contact Julie at Precious Cargo (www.preciouscargo.co.za) to book a professional car seat installation.

RESOURCES

Arya, R., Williams, G. and Kilonback, A. et al. (2017) Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle. Arch Dis Child Fetal Neonatal Ed, [online] 102, pp. 136-141. Available from: https://fn.bmj.com/content/fetalneonatal/102/2/F136.full.pdf [Accessed 13 September 2018].

Batra, E.K., Midgett, J.D. and Rachel Y. Moon (2015) Hazards Associated with Sitting and Carrying Devices for Children Two Years and Younger. The Journal of Pediatrics, [online] 167, pp. 183-187. Available from: http://dx.doi.org/10.1016/j.jpeds.2015.03.044 [Accessed 13 September 2018].

CPSBestPractice (2018). Rear-facing restraint recline angle. [image] Available at: https://sites.google.com/a/umich.edu/cpsbestpraci/resources/rear-facing-child-restraints [Accessed 14 Sep. 2018].

NHS (2016) Warning over babies sleeping in car seats. [online] Available from: https://www.nhs.uk/news/pregnancy-and-child/warning-over-babies-sleeping-in-car-seats/ [Accessed 13 September 2018].

Rholdon, R. (2017) Understanding the Risks Sitting and Carrying Devices Pose to Safe Infant Sleep. Nursing for Women’s Health, [online] 21 (3), pp. 225-230. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28599744 [Accessed 13 September 2018].

The Dangers of Party Balloons

We recently celebrated my daughter’s two-year birthday and, of course, decorated the house with balloons. No children’s birthday party is complete without balloons and although they are very popular with kids, they can also be extremely dangerous. Which is why I wanted to do a post on the potential dangers of balloons:

CHOKING HAZARD

Children can choke on balloons if they breathe them in whilst trying to blow them up. This happens when a child takes in a deep breath before inflating the balloon and accidently sucks the balloon back into his or her mouth. A child can also choke if they swallow deflated balloons or pieces of popped balloons they may chew on. If a balloon pops in a child’s face the child can also inhale the balloon pieces as they fly through the air.

Latex is a dangerous material to choke on as it can fit tightly in the throat and cause a complete airway obstruction very quickly. Whilst foil balloons are usually blown up with helium they can also become a choking hazard if deflated balloons or broken pieces are swallowed. There was a widely reported incident in 2016, where a three-year-old suffocated after putting the foil balloon over her head.

BURSTING HAZARD

Balloons can pop without warning. They can pop if children play with them roughly or if little children chew on them. Poor quality balloons can also pop more easily even if they aren’t being rough-handled. Children can also trip over balloon strings and fall onto the balloons popping them. If balloons pop near a child’s face they can cause serious damage to the eyes as well as cuts to the face.

STRANGULATION HAZARD

This may be an overlooked hazard. The colourful strings and ribbons that are tied to balloons can become a strangulation hazard as children become tangled.

ALWAYS KEEP IN MIND

  • Keep uninflated balloons away from children
  • Do not let children blow up balloons
  • Inflated balloons should be kept out of reach of children
  • Children should never play with inflated balloons
  • Always supervise children when inflated balloons are around
  • Throw away deflated and popped balloons immediately
  • Throw away balloon strings immediately when balloons deflate and pop

In the United States the Child Safety Protection Act requires a warning to be placed on any latex balloon or toy containing a latex balloon. This warning states that children under eight years of age are at risk of choking or suffocating on uninflated or broken balloons. Similarly, in the EU, children under the age of eight are actually legally banned from blowing up balloons without adult supervision.

However, children as old as 10 years have been found, on autopsy, to have suffocated from a balloon, which makes it difficult to define what age is actually safe for kids to handle balloons.

I think its important to stress to your kids that party balloons are not toys. They are purely for decoration and should always be properly secured and disposed of after use.

RESOURCES

CPSC (2012) CPSC Warns Consumers of Suffocation Danger Associated with Children’s Balloons. [online] Available from: https://www.cpsc.gov/s3fs-public/5087.pdf [Accessed 6 September 2018].

Francis, P.J. & Chisholm, I. H. (1998) Ocular trauma from party balloons. British Journal of Opthalmology, [online] 82 (2). Available from: https://bjo.bmj.com/content/82/2/203.1 [Accessed 6 September 2018].

Meel, B.L (1998) An Accidental Suffocation by a Rubber Balloon. Medicine, Science and the Law, [online] 38 (1), pp. 81-82. Available from: https://doi.org/10.1177/002580249803800113 [Accessed 6 September 2018].

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