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Are Essential Oils Safe For Children?

South Africa has joined the new oil boom and you can now readily find doTERRA and Young Living essential oils on our shores. With all the apparent “positive” effects these oils are having and especially since I am seeing so many parents use these oils on their children, I decided to do a little research, because for me, it’s all in the evidence.

WHAT ARE ESSENTIAL OILS?

Essential oils (EO) are not a new thing, they have been around for years. These oils are extracted from flowers, herbs and other plants and used to promote physical and emotional wellbeing.

Many pharmaceutical drugs used today are actually derived from plant sources. Drugs such as digoxin, quinine, morphine, codeine and aspirin all find their origins in plants. So it only makes sense to assume that essential oils must be effective against some medical conditions too.

IF IT’S NATURAL IT MUST BE SAFE?

Just because it’s natural does not always mean it is safe. Some of the most poisonous toxins in the world are found in plants – think belladonna and oleander.

Children have different absorption, distribution, metabolism and excretion of substances compared to adults. They also have immature body systems, which all make them more sensitive to the side effects of essential oils, regardless of how ‘natural’ a substance may be. There are also some children who are more sensitive than others because they are more allergy-prone.

There are, of course, other concerns with essential oils. Concerns about carcinogenicity, mutagenicity and toxicity to the fetus in pregnant women and also what effects certain oils have on breastfed infants.

IT’S ALL IN THE RESEARCH

Using essential oils in low concentrations and inhaling their vapours is usually safe for most people. But when it comes to our little ones we can never be too safe. There is very little research available on the benefits of essential oils and even less on how these oils affect babies and children.

While aromatherapy has been practiced for centuries in various cultures, it has not yet been properly evaluated for medical effectiveness. Most of the research that has been done has not been done on human subjects and those that have been done on adults are poor quality.

While we can argue that there is some evidence to show that essential oils improve physical and emotional wellbeing, I have reason to be concerned with the drug-like claims some people make about these oils. Essential oils should NOT replace scientifically proven effective (and safe) medical treatments for medical conditions.

SPECIAL CONSIDERATIONS WHEN USING ESSENTIAL OILS IN CHILDREN

  1. Essential oils are not a replacement for medical care.
  2. According to the American Association of Naturopathic Physicians, essential oils should not be used in babies younger than three months old.
  3. Children and babies should NEVER take essential oils orally.
  4. Always make sure you use a pure essential oil. Don’t use ones that are premixed with alcohol or other synthetic fragrances, as these can irritate the skin.
  5. Never apply an essential oil directly onto your child (and even your own) skin. Always mix it with a carrier oil such as coconut or grapeseed oil. You should probably ask a distributor about the difference between linoleic and oleic acids. Oils high in oleic acid are not recommended for sensitive skins prone to conditions such as eczema.
  6. Always dilute essential oils. Follow the recommended dilution ratios. If you are buying your EO from a distributor they should be able to give these to you.
  7. Diffusing oils is generally safer than applying them to the skin. If you are going to be using a diffuser, pay attention to your child’s reaction. Sometimes the oil particles enter the airways and can cause irritation especially if your little one has a reactive airway.
  8. If your child develops a rash or skin irritation, headaches, nausea and/or vomiting, coughing, wheezing or difficulty breathing, stop using the essential oils immediately and contact your healthcare provider.
  9. Do a patch test first to see if the oil causes irritation. Rub the oil into a small part of the forearm and wait 24 hours. If you notice any redness, swelling or a rash develop do not use this oil.
  10. Do not apply essential oils topically to children with sensitive skin, eczema or other chronic skin conditions as this can cause aggravation.

Remember as with all medications in your home, keep them out of sight and out of reach of your children because many essential oils are extremely toxic in overdose. Accidental poisoning with essential oils in children is becoming increasingly more common, since most essential oils smell nice. Children are also more likely to choke on these oils because of their bitter taste. This will send these oil particles straight into the lungs and cause aspiration pneumonia, which can be fatal.

All this being said, I am not anti-essential oils. In fact, I have seen some benefits of their regular and correct usage in my own household. However, what I am against is when parents claim that essential oils can prevent or treat medical conditions. Essential oils are prescribed to help promote wellbeing. Promote meaning to support and not cure.

Since there is no solid evidence that essential oils are safe and effective in children, major organisations such as the American Academy of Pediatrics (AAP) do not recommend using them at all in children. My advice to parents is to use them as directed, as you would administer prescribed medication to a child. Not all oils can be used on children and some can only be used on children over a certain age. Do your homework. Natural does not equate to safe, so please always be mindful.

RESOURCES

https://www.healthline.com/health/parenting/essential-oils-for-babies#TOC_TITLE_HDR_1

https://healthywa.wa.gov.au/Articles/A_E/Essential-oils

https://parenting.nytimes.com/childrens-health/essential-oils-safe

https://pediatrics.aappublications.org/content/112/Supplement_1/240.abstract

https://www.poison.org/articles/2014-jun/essential-oils

Gas or Wood? How To Safely Keep Warm This Winter.

We are now well into winter and definitely feeling the chill! South African homes are not well equipped to withstand the cold and we have to resort to various heating appliances to stay warm during winter. This is why structural fires and carbon monoxide poisoning are so common during the winter months. Below, I outline some safety tips on keeping warm in the home.

WHEN USING A GAS HEATER

  1. Always make sure the gas heater and especially the cylinder is completely turned off before going to bed or leaving the house.

  2. Always keep the room well ventilated to avoid carbon monoxide (CO) build up.

  3. Do not use outdoor gas heaters indoors, as they may produce more CO.

  4. Make sure all components of the heater are well maintained. Ensure the gas bottle is safely secured with no leaks.

  5. Natural gas is odourless. In order to identify leaks more easily manufacturers add chemicals to give it that distinctive rotten eggs smell.  If you smell gas in your home turn off the gas cylinder and do not use an electric fan to try and remove the gas.

  6. When switching your gas heater on always start by first turning on a match or lighter and then opening the gas supply. When switching the heater off always turn the gas cylinder off first.

  7. Never move a gas heater whilst in use.

  8. Do not place anything on or over the heater, such as damp laundry items. This can result in a fire. Do not ever sit on a gas heater either as it could fall over.

  9. Do not use flammable liquids and/or aerosols near a gas heater. Do not use a gas heater in a room that has recently been painted.

  10. Make sure to keep all flammable items a safe one-metre away.

  11. Have smoke and CO detectors installed and test them regularly.

  12. Always keep a fire extinguisher in your home.

 

WHEN USING A FIREPLACE 

  1. Keep a window slightly open.  This will help prevent the room filling up with smelly smoke. It also prevents the build up of carbon monoxide (CO).

  2. Make sure the damper of your chimney is open so that the smoke can leave the house. Only close the damper once the fire is completely extinguished.

  3. Use dry wood and not wet or green wood. Wet and green wood cause more smoke.

  4. Clean out any ash from the previous fire. Thick layers of ash restrict the air supply to the fire and cause more smoke. 

  5. Use smaller pieces of wood because these create less smoke.

  6. Remember to have your chimney cleaned once a year before the winter season. Animal nests and excess soot can block the escape of smoke.

  7. Never leave a fire in the fireplace unattended. Always make sure it is completely extinguished before going to bed and/or leaving the house.

  8. Make sure the area around the fireplace is clear of potentially flammable items such as books, curtains and furniture. Keep a safe one-metre distance.

  9. Keep fireplace tools and accessories such as firelighters, matches and lighters out of a child’s reach.

  10. Use safety screens so your children can’t get burnt by hot flying embers or by touching the hot glass of a closed fireplace.

  11. Have smoke and CO detectors installed in your house and test them regularly.

  12. Always keep a fire extinguisher in your home!

CARBON MONOXIDE POISONING

It may seem counter-productive to keep a window open when you are trying to keep your home warm, but this is extremely important if you are burning a fuel, such as gas, paraffin, coal or wood to generate heat.

Carbon monoxide (CO) is a colourless and odourless gas produced by the incomplete combustion of these carbon-containing fuels. When there is too much CO in the air your body replaces the oxygen attached to red blood cells in the blood, with carbon monoxide. This is because the affinity between haemaglobin (Hb) (in the red blood cells) and carbon monoxide is much stronger than the affinity between Hb and oxygen. This can be extremely dangerous and lead to hypoxia, irreversible brain damage and eventually death.

Symptoms of carbon monoxide poisoning include:

  • Tiredness
  • Shortness of breath
  • Headache
  • Dizziness
  • Nausea or vomiting
  • Weakness
  • Confusion
  • Loss of consciousness

If carbon monoxide poisoning is suspected you need to move the victim into fresh air, either by opening all the doors and windows or getting the person outside. This will allow some oxygen to start displacing the carbon monoxide. Definitive management is however in hospital with high flow 100% oxygen so you need to call an ambulance right away.

ELECTRIC HEATERS

Some of you may have electric heaters in your homes. These are safer than using gas and fire but still not 100% safe. Electric heaters use a lot of electricity so they can easily overload circuits and cause power failures or fires.

You should never plug in more than one electrical device into the same outlet as the heater to prevent overheating and overloading. To prevent electric shocks electric heaters should not be used in rooms where moisture builds up such as bathrooms and kitchens. There is also a fire risk if flammable items such as fabric come into contact with electric heaters that have hot elements and the electric bar heaters pose an additional burn risk.

Whatever heating methods you use this winter none of them are guaranteed safe, so remember to take the necessary precautions. It is important that you teach your children about fire safety from a young age. If your little ones do get thermal burns from poking fires and other heating elements follow the principles of first aid.

To find out more about management of thermal burns you can read my previous post: https://www.oneaid.co.za/baking-with-your-little-ones-safety-and-tips-to-taking-care-of-thermal-burns/. It is also recommended that you develop a fire escape plan and make sure your children know how to safely get out of the house in the event of a fire.

RESOURCES

https://www.betterhealth.vic.gov.au/health/healthyliving/gas-heating-health-and-safety-issues

https://www.healthychildren.org/English/safety-prevention/all-around/Pages/Fire-Safety.aspx

https://www.nhs.uk/conditions/carbon-monoxide-poisoning/ https://riseandshine.childrensnational.org/how-to-protect-children-around-fireplaces/

When Your Child Eats A Silica Gel Sachet

I’m sure many of you are familiar with those little sachets you find in almost anything these days.  The ones with the massive “DO NOT EAT” all over them. I have seen my fair share of hysterical parents bring their kids into the ER with a history of having swallowed the contents. But are these sachets really that dangerous?

These little sachets contain silica gel, which is silicon dioxide (Si02). The sachet does not actually contain a gel but rather small beads. Silica is a desiccant, which means it absorbs water. It has millions of small pores that hold moisture and can absorb up to 40% of its weight, which is why you find it in products that would otherwise spoil from excess moisture.

IS SILICA TOXIC?

Silica gel is chemically inert and considered to be non-toxic. Silica gel packets contain less than 5g of silica gel. If this tiny amount is ingested, it basically passes through the digestive tract without being absorbed or digested.

While this means that the contents of these sachets are harmless, it would be quite unpleasant if these are handled or swallowed. The mouth, gums and tongue would become parched, and if the contents were swallowed and not spat out, this would result in a few self-limiting side effects. Most notably, dry throat, eyes and mucous membranes in the nose, together with stomach discomfort and depending on the amount swallowed, nausea, vomiting and constipation. If the sachet was opened and the contents handled, it can also dry out and irritate the skin.

FIRST AID FIRST

If you think your child has played with silica gel, practice the principles of first aid. Anywhere the silica has come in contact, will be irritated. Wash whatever parts of the skin have been in contact with the silica and moisturise afterwards. If the eye has been touched, then rinse with running water for up to 15 minutes. If the contents were swallowed the best thing you can do is offer continuous sips of water to relieve the stomach distress. Do not give anything to induce vomiting! You don’t want the silica to be inhaled, because it can cause a very irritating cough and shortness of breath. The symptoms of silica ingestion are self-limiting, meaning that eventually, they will go away on their own.

IF SILICA IS NON-TOXIC WHAT IS THE BIG DEAL?

The biggest concern with these sachets is choking. These tiny beads are a choking hazard for small children. Unfortunately, additives, such as moisture indicators, are also sometimes added to the silica which can then make it toxic.

WHAT ARE MOISTURE INDICATORS?

Some silica gel sachets have moisture indicators. These indicator sachets are available in different colours depending on the type of indicator used. You may also find some sachets which contain a mixture of both indicator and non-indicator beads. The blue “indicator” silica gel is the more common one you may find. The blue comes from either cobalt dioxide, methyl violet or some other toxic substance that gets added to the silica. These substances change colour when wet and therefore are a good indicator of a saturated silica gel sachet. Cobalt dioxide, in particular, is a known carcinogen and also affects fertility. The FDA is busy banning this additive altogether, and thankfully, these indicator sachets are not commonly found in consumer products. If your child does, however, come into contact with one of these, you should seek immediate medical assistance.

Always remember to discard these sachets immediately after opening your products. Given the uncertainty of the composition of some of these silica sachets, practice the principles of first aid and keep an eye out for any unusual signs and symptoms whenever your child comes into contact with silica. If there is any concern, head straight to your nearest emergency room and don’t forget to take the sachet with you so that the contents can be tested.

RESOURCES

https://www.productip.com/uploads/CClip_519_SilicaGel_20130827_v1.pdf

https://www.illinoispoisoncenter.org/my-child-ate-Silica-Gel

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3493316/

 

Keeping Your Children Safe During Bath time

I’m sure many of you will agree that bath time is loads of fun for our kids. Whilst the bathroom is a fun place, it can also be a scary place with a number of dangerous hazards such as the drowning, burns and poisoning.

It’s important that you are always in the bathroom with your children before, during and after bath time. Drowning is a major cause of death in children under five years. According to the Consumer Products Safety Commision in the United States, 80% of the 87 children, under five years who drown at home each year, have drowned in the bathtub. Young children are top heavy and can slip suddenly and drown in very little water. Infants and toddlers also don’t have the upper body and core strength to lift themselves up if that slip under the water.

HOW TO RUN A BATH

  • Keep your child away from the bath until the water is the right temperature.
  • The safe temperature of bath water should be between 37oC and 38oC (36OC for a newborn). Children have thinner skin than adults so they can burn much more quickly. Even if the bath feels warm to you it may be hot to your little one. Your plumber can also set the thermostat of your geyser to a maximum of 50oC.
  • Always fill your bath with cold water first. Your child could put his hand or foot in the water before the bath is ready and get burnt. If you have a mixer tap, run hot and cold together but start with the cold and slowly increase the amount of hot.
  • Run cold water through the tap before your child gets into the bath to cool the tap and prevent them from getting burnt if they touch it.
  • If you have a mixer tap, point the lever on the cold setting when you are finished running the bath to ensure the hot water does not get accidentally turned on in the bath.
  • Do not overfill the bath. Fill the bath water to just over your little one’s knees.

HOW TO HAVE A S-A-F-E BATH

S: Supervision is key! Always supervise babies, toddlers and children less than six years in the bath and when you run the water. Never leave an older child to supervise.
A: Arrange everything you will need for bath time in advance for e.g. towel, soap, shampoo, nappy, clean clothes and any medications.
F: Feel the water with your elbow first. It should feel warm but not hot. You can also use a water thermometer. Remember to swirl the water around to ensure an even temperature with no hot pockets.
E: Empty the bath as soon as bath time is over.

SLIPS, TRIPS & FALLS

Slips, trips and falls in the bathtub and shower are a common cause of injury in young children and according to statistics more common than tub drownings.

Use a non-slip mat in the bath. If you are using a bath seat or ring, your child will still need to be supervised. A bath seat is not a safety device. These seats are actually associated with an increasing number of reported drownings. This is because the device gives parents a false sense of security and they are therefore more likely to leave their baby alone in the bath.

Infants should be bathed in the bathroom basin or a smaller infant bathtub. This way they can’t roll over or ever be completely covered by the water.

Wipe up any splashes before your kids get out the bath so that nobody, including you, can slip and hit their head. As your kids get older you should also teach them to remain seated in the bath and not to stand up and jump.

Be sure to keep a MiniKit in your bathroom for peace of mind. Each kit contains a range of thoughtfully selected first aid items geared towards common childhood injuries. You can purchase one here: https://www.oneaid.co.za/product/minikit/

WHEN CAN YOU STOP SUPERVISING YOUR CHILD IN THE BATH?

This is a difficult question to answer as children mature at different ages. Since most children who drown in bathtubs are under the age of five, the general consensus is children under the age of six should never be allowed to bath alone and even those over six should be closely monitored. Even if your child knows how to swim you should never be too far away.

OTHER BATHROOM HAZARDS

Toilet: luckily my daughter has never been interested in exploring the toilet bowl but I have had moms tell me how their child likes to play with the water in the toilet. Keep the toilet lids closed at all times and if your little one is particularly curious install a toilet-lid lock.

Appliances: make sure any electrical appliances in the bathroom are unplugged and out of reach when your child is having a bath. Regular plug sockets may actually not be fitted in bathrooms for safety reasons so rather keep extension cords out.

Medicines: many of us keep medication in the bathroom. Make sure they are all locked away, out of sight and out of reach.

Dangerous items: make sure you keep cosmetics, razor blades, nail scissors, cleaning products and other dangerous items away.

Don’t get distracted during bath time. Keep your phone on silent or rather keep it out of the bathroom and join in on the fun. You could also try having a shower with your child instead for some extra fun. My daughter loves this and the best part is that I manage to get cleaned up as well freeing up some time later in the evening for something else. Just make sure you get a slip-proof mat for the shower first.

RESOURCES

https://www.aappublications.org/news/2015/11/11/PPBath111115

https://medlineplus.gov/ency/patientinstructions/000154.htm

http://www.ncbi.nlm.nih.gov/pubmed/19596735

https://pediatrics.aappublications.org/content/124/2/541.long

https://pediatrics.aappublications.org/content/100/4/e1.long?utm_source=TrendMD&utm_medium=TrendMD&utm_campaign=Pediatrics_TrendMD_0

Tips For Choosing The Right High Chair

Before going out and buying a high chair it’s important to know the safety requirements. A US study found that more than 9 400 children, aging three years and younger, were treated each year for high chair related injuries in emergency rooms from 2003 to 2010. That’s one child every hour!

Nearly all of these injuries were as a result of a fall where the child either climbed in or out of the chair or stood in it. Majority of the injuries seen were head injuries (37%) then bumps and bruises (33%) followed by lacerations (19%). Most of us use our high chairs in the dining room or kitchen where the flooring is usually hard, so you can imagine the impact this has on a small brain.

This has prompted the US to update their safety standards (unfortunately there are no available statistics for South Africa). From mid-2019 all high chairs in the US will have to have a passive crotch restraint and a three-point restraint system, which means there has to be a fixed post that sits between a child’s legs and restraints that are fixed to the high chair in three different places. They found that children were able to slip out the bottom of a high chair and hope a fixed post will prevent this.

High chairs are not recommended for children younger than 6 months of age. A child is only ready for a chair once they have good head and neck control and are able to sit up on their own. If one is used too early a child could experience positional asphyxia. You may however, be able to start a little sooner with a reclining high chair (see my previous blog, ‘How safe is your car seat?’). https://www.oneaid.co.za/how-safe-is-your-car-seat/

CHOOSING THE RIGHT HIGH CHAIR

Framework: choose a high chair that is sturdy. Put some weight on it and see if it squeaks, deforms or moves or collapses.

Gaps: make sure there are no gaps your child can slip out of. Also check for gaps that little fingers can get caught in.

Harness: choose a high chair with either a three-point or five-point harness that includes a crotch strap or a post. The restraint should go over the shoulders, around the waist and if a five-point harness then between the legs.  

Wide base: a high chair becomes top heavy when your child is in. Choosing a chair with a wide base will make it more stable so that it does not tip easily.

Wheels: if you choose a high chair with wheels, make sure they can be locked when the chair is in use.

Folding locks: if the high chair folds check that the locks work well enough so that the chair cannot fall or collapse when in use.

Joints: choose a high chair with metal joints. These are stronger than plastic, which can crack after time.

Safety standards: make sure the high chair meets current safety standards and has been approved by an international safety authority.

BOOSTER SEATS AND HOOK-ON SEATS

Please be careful when you use these chairs. If not used correctly these seats can be dangerous.

Hook-on seat: These chairs are mounted directly onto a table and should only be used once your baby has good head and neck control and can sit upright. The mounts must be slip resistant and because this seat carries the entire weight of your baby the table has to be strong so that it does not tip over.

Booster seat: These seats are attached to normals chair by straps to raise a child’s height. They are usually used when a child has outgrown the high chair but is not quite tall enough to sit at the table unaided. They should also have straps to keep your child in the seat.

KEEPING YOUR CHILD SAFE IN A HIGH CHAIR

  • Never leave your child unsupervised when they are in a high chair.
  • Always use the safety straps when your child sits in the chair, even if only for a few minutes. The tray is not a restraint.
  • If the chair folds, make sure it is locked each time you set the chair up.
  • If the chair has wheels, make sure they are locked each time you set the chair up.
  • Never allow your child to stand in the high chair.
  • Do not place the high chair near a counter or table. Your child may be able to push against the surface and cause the chair to tip over.
  • Don’t allow older children to climb or play on the high chair while another child is seated in it because it could tip over.
  • Position the high chair at its lowest possible height if this is adjustable.
  • Make sure potential hazards such as hot food, drink and sharp cutlery are out of reach.

When choosing a high chair opt for an age-appropriate one with plenty of safety features. It’s also important to check often for recalls once you have purchased your chair. High chairs are commonly recalled because of their safety issues. Recent recalls include the Skip Hop Tuo convertible high chair and the Graco Table2Table 6-in-1. You can check http://www.recalls.gov to see if your high chair has been recalled.

RESOURCES

https://journals.sagepub.com/doi/abs/10.1177/0009922813510599

http:// https://www.nationwidechildrens.org/newsroom/news-releases/2013/12/new-study-finds-24-children-a-day-are-treated-in-us-emergency-departments-for-high-chair-related

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

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].

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].

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