About 10 - 12% of the nearly 400 children who seek treatment everyday at the Children's Emergency at KK Women's and Children's Hospital do so for childhood injuries. Childhood injuries are largely preventable if caregivers are more aware of child safety issues, and exercise caution in the day-to-day care of their children.
Childhood injuries can be serious and fatal. The common causes of death include those due to Road Traffic Accidents, Unintentional Drownings and Falls from height. Countless other children suffer temporary or permanent physical pain or disabilities due to childhood injuries everyday. Such events are also heart-breaking for their caregivers.
It is useful to keep a First Aid box at home. Readily prepared ones are available at the pharmacies. However, if you find these too costly, you can also easily assemble a kit yourself. Some suggested materials for the First Aid Box would include:
You may want to add on common medications like Paracetamol for fever and aches, and diarrhoea and flu medications. Ensure that you know the correct dosage and use for these medications for your child. What is good for an adult may not be beneficial for a young child. Check with your doctor or the pharmacists when in doubt.
Remember to keep the First Aid box out of reach of your children.
The following is a brief summary of first aid treatment for mishaps which children commonly encounter. It is important that caregivers remain calm and know the appropriate line of action to take during such emergencies. In some instances, this may be life saving. In many cases, the injured child will be more reassured if his caregiver remains calm.
Wash the abrasion with soap and water. Then clean the wound again with antiseptic solution. Cover with a dry non-stick dressing. The dressing should be changed only after 3-4 days because removing the dressing daily will pull off the healing tissue and delay wound healing. You may have to wrap the affected limb in a plastic bag to prevent the dressing from getting wet during bathing.
Superficial scratches or cuts may be treated with simple dressing like in abrasions. Steristrips are especially useful to bring together the cut edges of a superficial cut.
If the cut is large or deep, then a wound repair by suturing or by tissue glue would be necessary. Your family physician may be able to cope with repairing the wound if it is not too deep and if your child is cooperative. However, deeper wounds or a struggling fretful child may require the expertise of the Accident and Emergency physician. Sometimes, a light sedation may be given to calm a fretful, struggling child.
The initial bleeding may seem terrifying, but rest assured that most wounds, even the large wounds, can have the bleeding controlled by simply applying pressure on the wound with your hands or by a pressure bandage. Applying a tourniquet is unnecessary and is in fact dangerous.
If the child's clothes catches fire, immediately roll him tightly into a blanket or rug to smother the flames. This can be potentially life-saving.
A small, superficial scald may be treated by immersing the affected part in cold water or placing it under a running tap to ease the pain, then cleaning it with antiseptic solution like chlorhexidine. The wound is then covered with a non-adhesive dry dressing. Do not remove the skin flaps if a blister breaks down. Do not apply ointments, and other traditional remedies like powder, toothpaste or jelly to the wound. Pain relief may be given in the form of children's paracetamol in the appropriate dosage.
Anything more than a superficial trivial scald will require medical attention. A child with a significant burn or scald should be wrapped in a clean sheet and blanket and brought immediately to the Accident and Emergency Department. You can also use the kitchen transparent cling wrap to cover the affected part before bringing the child to hospital. This is to prevent the child from the danger of losing excessive body fluid from the oozing at the burnt skin areas. If the clothes are heavily contaminated by a chemical, remove them and flush the affected area copiously with tap water. Children who have significant burns of more than 5 - 10 % of their body surface area, or burns affecting vital areas like the face, may require admission to hospital.
Potential complications which may occur include hypotensive shock from the excessive loss of body fluids, wound infections and lung complications in the case of concomitant smoke inhalation.
Children commonly sustain limb fractures after a fall. Upper limb fractures are more common than lower limb fractures. Common situations include a fall from the monkey bar in the playground, during a football game, or while jumping off a table. The fractured limb may be obviously deformed and swollen, or the child may simply present with pain in the affected limb after a fall. Children's bones are often more pliable, and they may sustain only partial fractures through the bone shaft (greenstick fractures). This may not be apparent unless an X-ray is taken.
Hence, in cases of suspected fractures, it may not be wise to seek treatment by a traditional Chinese physician (sinseh) without first having an X-ray done, because any further massage and manipulation may be painful and cause more deformities.
Remember to splint the affected limb with a simple wooden splint and triangular bandage. Do not give your child anything to eat or drink until he has been attended to by the Accident & Emergency physician. This is because the child may require anaesthesia for emergency surgery to fix the fracture. Simple, undisplaced fractures may be treated easily on an outpatient basis by manipulation and reduction, and then applying a plaster cast. Further orthopaedic specialist outpatient clinic follow-up would be required to ensure that the fracture heals well.
This occurs commonly when little fingers are caught at the door hinges or when doors are slammed onto them. Rarely, it occurs when children poke their fingers into household appliances. Frequently, Steristrip dressing may be done to reposition the wound. Partial or complete finger amputation or a severely crushed finger may require emergency microsurgery.
This is a common injury in children caused by a sudden pull on the child's arm, like when parents swing them in play, or tug at them to prevent them from falling. The head of the radius, one of the forearm bones, becomes dislocated. The child will complain of pain and refuse to use the arm. This pain can easily be reduced by the A&E doctor.
Head injury is one of the commonest injuries occurring in children. About 50% of children who seek treatment in the Children's Emergency for injuries sustained head injuries. More than 80% of head injuries in young children occur at home. Common situations include falls from being left unattended on an adult bed, falls from chairs and tables and falls related to the use of baby walkers and sarong cradles.
Most head injuries do not cause complications but sometimes children may have skull fractures and internal brain injuries which can potentially be serious. About 20% of the patients seen in the Children's Emergency for head injuries require treatment by specialists from the Paediatric Neurosurgery Department.
You should bring your child to see the doctor if he sustains a head injury. Drowsiness, unconsciousness, vomiting or bleeding from the ears or nose are especially serious symptoms and signs of head injury..
Sometimes, children inevitably swallow fish bones. They may complain of pain in the throat only a few hours after the event. Immediate medical attention should be sought. Bring your child to the A&E department where an X-ray will be done, and special instruments will be used to look into the throat for the fish bone.
Children may accidentally inhale food when they laugh or talk as they eat, or when they eat while lying down. Young children are still not able to coordinate their swallowing mechanism well. The commonest food item being inhaled is the peanut. Never allow your young child (3 years and below) to eat or play with peanuts.
Inhaled objects or food can cause partial or complete obstruction of the windpipe. Urgent medical attention is necessary. If your infant turns blue or becomes unconscious soon after choking, call for help. Meanwhile turn him prone on your lap and firmly apply 4 backblows on the back in the area between the shoulder blades to attempt to dislodge the inhaled object.
Older children who turn blue or become unconscious may be treated with urgency in the same way as for an adult. Use the Heimlich manoeuvre to dislodge the inhaled object from the windpipe. This procedure can be life-saving.
If your child has taken, or is suspected to have ingested, something poisonous, seek medical attention immediately. Do not attempt to give him any home remedy or antidote, or attempt to gag him with your fingers. If he becomes unconscious, call for the ambulance, and place him on his abdomen, so that if he vomits, he will not inhale the vomitus and aspirate from it.
Even if your child appears well initially, do not waste time in attempting to observe your child at home. This is because some medicines or poisons do not manifest the effects until several hours after they have been ingested. These are considered as "time-bombs". One common example is paracetamol poisoning. If your child swallows an excessive amount of paracetamol, he may appear well in the first few hours, but may suffer from severe liver and kidney complications if left untreated.
Bring the poison in its container to the doctor as well. Your doctor may find it helpful to refer to the actual constituents in the household chemical which your child may have ingested.
Particles like sand or dirt that get into the eyes may be removed easily by irrigating the eye copiously with clean tap water using an eye dropper. Do not use a handkerchief to rub the eye surface. Clumsy efforts to remove the particles may cause more harm than good.
Penetrating eye injuries or chemical burns to the eye will require immediate medical attention at the A&E. For chemical substances accidentally splashed into the eye, the immediate action to take is to hold the child's face upwards under a running tap for 5 minutes.
Attempts to remove objects inserted into the small orifices of the nostrils or the ears will most likely result in their being pushed further in. Seek medical attention immediately. Fine instrument forceps will be required to remove all these foreign bodies. In uncooperative, struggling children, this may even have to be done under general anaesthesia. Common items which have been removed from children's nostrils and ears include peas, beans, coloured beads, pencil lead, pen caps and the small parts of toys.
When an injury occurs, the most important rule to remember is to remain calm. An anxious parent will only make the child more fretful. Administer basic first aid, and identify the potentially life threatening injuries, so that you can seek medical attention early. Have a list of the important emergency phone numbers ready for easy reference.
You can go to your family doctor for minor injuries. The Children's Emergency attends to children with significant injuries like lacerations requiring wound repair, fractures, head injuries, accidental ingestions or poisoning, burns, near drowning, and major or multiple trauma such as those caused by road traffic accidents.
Once the acute situation is over, evaluate the circumstances leading to the mishap to identify any preventable cause for the injury. Modify your home environment to ensure that it is child safe. Teach your child the relevant safety precautions so that he can learn from the experience.
