Last February, four children fell into unprotected wells, three died. A wall collapsed on a child killing him. Two children rolled a concrete ‘hume’ pipe with a third child inside it -it hit a tree and broke killing the latter. Last September eight-year-old Harshika died of Paracetamol poisoning. A child drowned after falling off a bridge where the fence had perished. In a German zoo, a child climbed a fence and jumped into the bear cage. She survived, but had serious injuries.
Such tragedies, reported in the newspapers are due to lack of parental supervision and civic-mindedness of the public, and also to the indifference of authorities.
In all countries, ‘injuries’ are the leading cause of hospital admissions. In 2004, accidents killed over 950,000 children in the world. According to the ‘World Report on Child Injury Prevention’, children live in a world designed for adults, and because their body contours and behaviour are different they are more prone to injury. “Children’s curiosity and drive to explore their world are not matched by the capacity to understand danger.
|The poisonous Kaneru plant
They have a natural instinct to crawl, climb, slide down the stair-way railing, squeeze through balustrades and swing on the gate. They fall from heights because their climbing ability exceeds their balancing and reasoning ability.
The grasping and drinking functions that develop early promote poisoning. They lack knowledge and skill to manage the road environment and they are not easily seen by drivers. Their skin burns more deeply and quickly.”
The toddler who crawls to an unprotected well is thrilled by his own reflection. Children are fascinated by flames and would love to strike a match and hold it on to the curtain. Like us, they are eager to have a dip in a river or a pool. So, is it any wonder that accidents kill so many playful kids, and are the parents not responsible in most such cases?
Most accidents are preventable and all states have a responsibility towards child injury prevention (See box). It lies with different sections of the fabric of civil society such as health, law and education authorities, motor industry and the media, but a parent’s responsibility to protect his/her own children is even greater.
We lock our car and house when we get out, but are we observant enough in a swimming pool or on the road when we are with them? In the USA, 39% of kids who drown do so in swimming pools where lack of parental supervision is apparent. All should remember that the feeling of guilt and the sorrow attached to the loss of a child by an accident through neglect last a life time! This article contains observations on accidents and tips for their prevention.
Road traffic accidents:
|A cooker guard
This is the world’s most neglected public health issue, as over 262,000 children die on the roads annually; in 2007, 2334 people had died in this manner or over six every day. Yet, road safety has not received enough attention for two reasons. One is the lack of awareness about its great importance, and the other is that it belongs to many different sections with no leader to coordinate and address the problem as a whole!
There are many causes of road accidents such as speeding, drunk driving, sleepiness, fatigue, haste, lack of proper training, worry, defects like poor vision, wilful breaking of traffic rules, defective roads and defective vehicles. Lifelong disabilities, huge costs of medical care and rehabilitation, legal and vehicular repair costs, loss of income are some of the direct consequences of road accidents.
Tips for prevention:
- Do not drive fast.
- Do not drink and drive.
- Avoid driving when there is fatigue and sleepiness.
- Always use seat belts and helmets.
- Avoid using cell phones while driving.
- Do not wear dark clothes in the night if you have to cross the road.
- Use child restraints when carrying little children in vehicles.
- Cross only at pedestrian crossings; otherwise you run a risk to life and a fine by Police.
- Do not try to get off or get into a moving vehicle.
- Do not walk along the railway line and do not try to ‘beat the train’ at level crossings.
- Be cautious when reversing your car at home; children have been run over by parents!
- Motor cyclists should use lights during day time too.
In developing countries falls are the most common cause of injury among children, and the third leading cause of fatal injuries after road traffic accidents and drowning. Most falls among children occur at home. Baby walkers have caused falls and now their use is not recommended.
Tip for prevention:
- Climbing is a part of normal development of a child and it should be allowed. What is needed is supervision. Ensure that there are protective railings.
Burns and scalds:
Burns cause 300,000 annual deaths out of which 96,000 are children, with millions of disabilities and disfigurements. In Sri Lanka, 10,000 are admitted to government hospitals every year, and severe scarring with blindness and loss of many fingers are not uncommon.
Over 350 die annually and 25-30% were caused by unsafe bottle lamps some years ago, but it is less now. Successful strategies are very rare in developing countries; one exception is the ‘Safe Bottle Lamp Project’ of Sri Lanka that has won four global awards.
Tips for prevention:
- Do not pour kerosene to burning lamps, hang lamps on a wall or allow children to handle them
- Do not let children pull kettles and dishes. Have a railing on the cooker top.
- When preparing baby’s bath, pour cold water first and then hot water.
- When using LP gas, use thick ‘rat proof’ tubing and check tubing and regulator once a month. Keep windows open for 5-6 minutes before lighting the cooker,
- When clothes catch fire, put the person down and roll him or cover with a thick cloth (‘stop, fall and roll’)
- First aid is vital. Soon after extinguishing flames, pour cold water on the burnt area for 20 minutes to prevent further damage to tissues by the retained heat. Do not apply iced water or anything else on the burnt area, and do not break blisters.
Drowning is the second leading cause of death in children across the globe with an annual death toll of 175,000, and it ranks first for children under five years. Some non-fatal drowning victims survive with long lasting physical, emotional and financial consequences. In Sri Lanka around 1,100 people drown every year and many are young people. It is tragic that some drown while trying to save others.
In developing countries, people drown while bathing in unsafe places in rivers, tanks and in the sea. Some toddlers drown in abandoned pits, unprotected wells, and in bath tubs and basins at home.
Principles of drowning prevention:
- Prevent the unexpected fall into water, such as to unprotected wells.
- Prevent drowning of those who get into water by warning them about unsafe bathing spots and alcohol.
- Rescue those who get into difficulty while in water.
- Give first aid when indicated, after rescuing them.
Specific strategies for drowning prevention:
- Remove the hazards
- Drain unnecessary accumulations of water
- Prohibit bathing in unsafe areas
- Fence swimming pools, wells and ditches
Protect those at risk
- Do swimming training
- Educate parents about supervision
- Educate public how to rescue others
Increase community awareness
- Legislate against drinking near bodies of water
- Identify the hazards
- Develop safety plans for floods and tsunamis
- Use safety flags in beaches
Counter the damage
Cardio Pulmonary Resuscitation (CPR): If the person has stopped breathing, immediate mouth to mouth respiration (‘kiss of life’) by bystanders is critical.
In other countries, dogs have mauled and killed children, while here the problem is rabies following the bites. In either case, avoidance of bites is vital. However friendly the pet dog is, never leave a child alone with it. Usually, the dogs snarl briefly before biting, yet a small child may not notice this danger signal..
Code of behaviour to avoid dog bites:
- Before petting a dog, let it sniff you; they sniff as a means of communication.
- Do not run past dogs; they like to chase moving objects.
- Do not try to outrun a dog; they run faster than humans.
- Remain calm if a dog approaches; screaming may incite predatory behaviour.
- Do not let small children hug a dog; they may regard infants as intruders.
- Avoid direct eye contact; it may be interpreted as aggression.
- Do not try to stop two fighting dogs; they snap at anything that is near.
- If attacked, stand still with feet together; dogs tend to attack extremities.
- If attacked while lying, stand up. If not possible, keep face down and cover the ears with hands.
(Quoted from ‘World Report on Child Injury Prevention’)
In case of bites, wash the wounds well with soap and water and take the child to a hospital on the same day. The doctor knows what to do. Rabies is fatal; so do not go to quacks after a bite. Over 55,000 people in the world and around 50 in Sri Lanka die of rabies every year.
There are 125,000 deaths from snake bites annually in the world. Our death toll is 125 to 150. Snakes bite only when they are provoked or cornered; they like to avoid a confrontation and slither away except black mambas and king cobras who like to safeguard their territory.
The poisonous snakes in Sri Lanka are Russel’s viper, cobra, common krait, Ceylon krait, hump nosed viper and saw scaled viper.
Tips to avoid bites
- When you see a snake, avoid it. It is more scared of you than you are of it; so let it get away.
- Wear boots when working in farmlands and walking on footpaths
- Use a torch in the night
- Do not put your hand into cavities in tree trunks, under shrubs etc
- Do not try to attack or catch snakes
What to do after a bite:
A snake bite is a dire emergency. The bitten person must start proper treatment as soon as possible. Medicines that are universally accepted as effective must be given and some have to be given as injections.
Further, certain types of therapy can be given only in hospitals. So take the victim there soon after giving first aid described below.
- Allay anxiety by reassuring him.
- Let the patient lie still on a bed with bitten limb below heart level; movement quickens the spread of venom in the blood stream.
- Wash the wound well with soap and water.
- Give two tablets of Paracetamol, but nothing else. Do not let him inhale oils and ‘nasna’.
- Do not cut, scrape or suck the wound.
- Do not apply a tourniquet. They do a lot more harm than good, such as causing gangrene.
- Do not apply anything.
- Do not be misled; ‘Snake stones’ do not work.
- Do not be misled by stories about ‘Top Snakebite Specialists’.
- Take the victim to a hospital soon.
Poisoning kills 300,000 people globally every year. It is the fourth leading cause of death in children below 14 years after roads accidents, burns and drowning.
As we have many chemicals and drugs at home and may also have poisonous plants in the neighbourhood, we have to be very vigilant. Kaduru, Aththana, Kaneru, Endaru, Olinda Hondala and Niyangala, are the poisonous plants in Sri Lanka.
Paracetamol and kerosene are two common agents causing poisoning. Some drug manufacturers now use child proof closures for bottles of medicine that require two actions, such as first pressing and then turning the lid down. Children are attracted to bright colours. It is sad that most household agents like detergents are sold in bright containers.
Principles on prevention-
- Removal of the agent. E.g.: Removal of trees with poisonous fruits.
- Reduction of toxicity. E.g. : Use of safer (but more costly) pesticides.
- Reduction of the attractiveness of the container.
- Altering the taste by adding bittering agents to household products.
- Packaging using child resistant closures.
- Reduction of access to poison
- Education of parents.
Tips for prevention-
- Keep all chemical agents beyond the reach of children, in a locked cupboard.
- Do not keep kerosene etc in empty drink bottles.
- Warn children not to drink off any bottle they see, and not to eat fruits and yams of unknown plants.
- If a poison is ingested, take the child to a doctor with the left- overs in the container.
- If a poison gets into eyes or skin, wash immediately.
- Getting the child to vomit may be beneficial or harmful, depending on the agent. Hence it is safer not to get him to do so.
- Lightning activity over Sri Lanka shows peaks during March-April and October-November. Over 60 die annually from lightning strikes. This is what to do to escape injury from lightning:
- Seek shelter immediately in a building. If not possible, get away from tall trees, telephone wires and poles. If you are part of a group, spread out. Squat and put your head between you knees.
- Do not touch metal objects.
- Do not bathe, wash dishes, or handle wet objects. If you are in water, get out.
- Avoid using the telephone. Unplug the phone and other appliances.
- Do not take cover in a rock face and cave mouths etc.
These are rare in children as few children are engaged in occupations.
Wasp and hornet attacks:
Dozens of people who visit Sigiriya are stung by hornets. Rarely does a person die from these bites, but such tragedies are actually due to allergy to the poison.
Tips to avoid stinging
- Get a professional to destroy any hornets’ nests at home; do not try to burn them.
- Keep fruits at home covered. Destroy over ripe fruits.
- Pluck fruits early from trees in the garden.
When going to places like Sigiriya -
- Avoid strong perfumes.
- Avoid wearing clothes of very dark colours.
- Wear clothes to cover head and body.
- Those with a history of allergy should wear a notice to that effect on the neck and carry some anti-histamine tablets.
The writer is a member of the National Committee for Prevention of Injuries. His Safe Bottle Lamp project to prevent burns has won international recognition. See www.safebottlelamp.org.
Principles of injury prevention:
(1) Supervision: This is vital.
(2) Having standards, E.g. for nursery equipment.
(4) Enforcements of legislation.
(5) Product modifications: E.g. safe kerosene lamps.
(6) Environmental modification: E.g. Fencing of
(7) Promotion of safety devices: E.g. seat belts
and cycle helmets.
(8) Educational and skills Development:
E.g. water safety instructions.