A Safe Home Environment for Our Children

We feel home is the safest place for children. But it depends on how safe we keep our home environment for them. Sometimes, without us realizing it, our homes could be unsafe for our kids especially when it comes to unintentional poisoning. Children are by nature inquisitive and sometimes end up consuming stuff out of curiosity. Every year, there are many cases of poisoning with reports of children having consumed household products accidentally. There are many possible sources of accidental poisoning pediatricians come across – kerosene, neem oil, eucalyptus oil, camphor, mosquito repellent, naphthalene balls, perfumes, hand sanitizers, detergent liquid/powder, battery acid, bleaching agents, dish washing soap, toilet cleaner, rodenticide, etc.

“All things are poison and nothing is without poison, only the dose permits something not to be poisonous.” – Paracelsus

Apart from household items, we also see conditions of drug overdose – most common are paracetamol, iron, cough remedies, antihypertensives, diabetic medications and sleeping pills.

There are some situations where children accidentally ingest or choke on materials like coins, button batteries, magnets, sharps, small headphone earbuds and safety pins, which are more challenging to manage as they either block the airway or settle in the gastrointestinal tract and injure it.

Most of these “accidental” ingestions are preventable.

Let’s see briefly about various situations of accidental ingestions, their consequences, management and how to prevent them.

1. Corrosives:

Source:

Cleansing agents like dishwashing liquids, toilet cleaners, etc.

Harmful Effects:

They can harm the airways, eyes and the lining of the food pipe.

Symptoms:

Inflammation and burning sensation in the lips, mouth ulcers, eye redness and airway injury leading to blockage in the food pipe or gastric perforation.

Treatment:

No lavage or charcoal can be given. There is no specific antidote. Local disinfection can be done.

2. Hydrocarbons:

Source:

Petrol, lamp oil, etc.

Harmful Effects:

Flammable and can be breathed in easily.

Symptoms:

Breathing symptoms (cough, fast breathing, etc.) due to chemical injury caused to the lungs.

Management:

Only respiratory support. No washing, no charcoal, no specific antidote.

3. Alcohols, Perfumes and Mouthwashes:

Source:

Liquids like hand sanitizers that contain alcohol.

Harmful Effects:

Initially, irritation at the area through which it enters the body. Later, can lead to acid accumulation in the body.

Symptoms:

Nausea, vomiting, fall in the level of sensorium, low sugar and visual toxicity.

Treatment:

No washing, charcoal and hemodialysis if early. Antidote available.

4. Naphthalene:

Source:

Naphthalene balls, deodorants and dyes.

Harmful Effects:

Breathing in naphthalene vapors can cause respiratory toxicity while ingested naphthalene is toxic to blood.

Symptoms:

Various respiratory symptoms like cough, sneezing, etc. and low O2 level are shown by pulse-oximeter.

Treatment:

The child has to be observed for a week as there can be a delayed manifestation of toxicity; no specific antidote available.

5. Camphorated Oils:

Source:

Perfumes, ointments and sprays for pain relief and inhalation medication.

Symptoms:

Intense local irritation based on the route of entry at skin, eyes, GI and respiratory tract. They can irritate the brain and cause convulsions (fits).

Management:

Symptomatic treatment, controlling fits.

6. Paracetamol Overdose:

Toxicity occurs if the dose exceeds 100 mg/kg/day.

It causes gastric and liver injury and can even lead to liver failure.

Symptoms:

Nausea, vomiting, abdomen pain and decrease in sensorium.

Management:

Gastric lavage, charcoal administration and antidote.

7. Iron Tablets/Syrup Overdose:

It can cause severe gastric injury initially. Later, can affect the functioning of the liver and heart.

Symptoms:

Abdomen pain, vomiting, diarrhea and black stools.

Management:

Gastric lavage; charcoal doesn’t work. Antidote administration.

What Do We Do at the Emergency Department During Poisoning/Accidental Ingestion Scenarios?

Decontamination Methods:

• Irrigation with water (skin, eyes).
• Gastric lavage wherein we give aliquots of saline to clean the stomach.
• Activated charcoal administration – charcoal takes up the toxic material in the small intestine and prevents it from entering circulation.
• Whole bowel irrigation which is a method to remove the toxic material by giving laxatives.

The poisonous substances can be removed from the gastrointestinal tract before they get absorbed into the blood circulation by the above methods. To derive the maximum benefit from gastric lavage, it has to be done within 1 hour of ingestion and its use is doubtful after that. So, always bring the child to the hospital within 1 hour of ingestion of any toxic substance.

Enhancement of Removal of Toxic Substance from Blood:

• Make the urine more alkaline by giving medicines (if the toxic substance has an acid property).
• Dialysis

Antidote to Specific Toxins:

It’s available only for certain toxic substances like paracetamol, iron, some sleeping pills and antihypertensive medications. So, it’s always necessary to bring the medicine or toxin to the hospital, with the pack or container.

Foreign Body in Airway or Wind Pipe or Stomach

Foreign Body in Airway:

Symptoms of Severe Airway Obstruction:

Universal choking sign, unable to cry or speak, weak or no cough, high pitched noise while trying to breathe in and change of skin colour to blue.

Management:

This is an emergency situation to be treated immediately. There are two techniques to relieve choking. Abdominal thrusts (in adults & children), back slap & chest thrust (in < 1 year old or small kids whom we can easily lift with a single hand). But these techniques can remove the foreign body only from the upper airway (up to voice box). The links to see videos of these techniques are given below.

First aid for Choking:

Adult – https://youtu.be/6E9AXXRdkfE
Children – https://youtu.be/etyEWWEtbqI
Infant – https://youtu.be/Lx_AE-UNwmY

Foreign Body in Windpipe:

Sometimes, the foreign body passes down to the trachea (windpipe) or bronchus (smaller airways) crossing the upper airway. This can be seen in chest x-ray if the material is radio opaque. It has to be removed using bronchoscopy by a pulmonologist. If not removed at the right time, it can block the airways and lead to collapse of the lung or can act as focus for infection. We usually see peanuts, beads and vegetable matter blocking smaller airways leading to lung infection.

Foreign Body in Food Pipe/Stomach:

Management depends on the nature of the material swallowed and its location in the gastrointestinal tract. Button batteries, magnets, sharp objects, coins and other blunt materials are what we commonly see in the gastrointestinal tract. X-rays help in most of the cases to know the location of the foreign body. In the case of a button battery, it can injure the food pipe by releasing chemicals, so it has to be removed endoscopically as early as possible.

Coins and blunt objects have a chance of spontaneous clearance if they are in the stomach and small in size (< 2.5 cm in diameter, < 6 cm in length).

Preventing Accidental Ingestion and Poisoning

• Often, parents refer to medicines as chocolates to make children swallow them without a fuss. This practice should be avoided.
• Always give medicines in a specified dose and frequency as advised by the doctor. Along with paracetamol, try other modalities (tepid sponging) to control fever. Don’t depend only on paracetamol and overdose it.
• Check medicines routinely and discard expired ones.
• Do not use soft drink bottles to store other liquids like petrol.

Choosing the Right Play Things

• Check age rating on the cover before buying a toy.
• The toy should not have parts that are easy to remove.
• Any small items like marbles are best avoided.
• Make sure stuffed toys are washed regularly.
• Buy non-toxic colouring materials.
• Make sure the paint on play things does not contain lead.
• Large toys which can’t be swallowed are preferable.
• The battery casing in toys should be closed tight.
• Toys should not break easily.
• Walkers are best avoided.

Making Homes Safe

• Balconies and staircases should be barricaded to prevent toddlers’ entry.
• Balcony walls should be high and the child should not have access of any kind to climb the wall. Balcony grills should be closely spaced and should also be designed in such a way that children will be unable to climb it.
• Windows should have grills with openings no bigger than 4 inches.
• Sturdy furniture that cannot be pushed easily is advisable. Any sharp edge that can hurt the child should be covered. Child proofing drawers and cabinets will prevent children from hurting their fingers.
• Baby cots should not have any kind of foothold (to prevent babies from climbing them). Locks in the cot railing should be secure. The bars in the cot should be checked so that the baby’s head is not trapped in between. The height too should be adequate to prevent the baby from falling out.
• Door locks should be placed over 4 feet so that the child does not lock himself or family members in rooms.
• Any kind of tool should be safely locked away.
• It is best to keep the bathroom and kitchen locked when not in use.

Parents’ Role if Child Is Injured

Knowledge of basic first aid is essential. Get to know the hospitals which offer 24-hour emergency care in your area so that you know what to do if at all your child needs to be taken for emergency care.

Images Courtesy – kidsafesa.com.au