Child Care - Providing Safe Environment

Child Care - Providing Safe Environment:

According to level of children's development, age, and capabilities, children are attracted toward certain hazardous environment, which may lead to accidental injuries. The steps should be taken to prevent such injuries by providing safe environment at home, school, and in the community.

Health education:

As a responsibility of nurses, it is important to help the parents and community to be aware of accidental injuries in children and their relation to the growth and development of their children. It should be stressed that children need the positive and clear instruction to protect themselves from the accidents. Provision of a safe environment is also important.

Poisoning:

Poisoning is a condition which occurs due to ingestion, inhalation or injection of injurious substance. Here the poisoning by ingestion in children is discussed. Poisoning is common in from 1 year of 4 years. It is an accident due to lack of supervision and carelessness of leaving poisonous material within the children's reach.

Common poisons may be cleansing agents, detergents, insecticides, sleeping pills, tranquilizers, paint solvent, kerosene, corrosives, cosmetics, and adulterated food.

Signs and symptoms:

1.     Gastrointestinal disturbances, such as anorexia, vomiting, diarrhoea, and abdominal pain are commonly seen.

2.     Respiratory problems: breathlessness, cyanosis, sternal retraction, and grunting.

3.     Circulatory problems should be checked for shock and collapse.

4.     Children may have convulsions or become unconscious.

5.     Children's mouth may have the smell or colour of ingested poisons such as, kerosene or organophosphurous compounds.

Treatment:

1.     Identification of poison is necessary to start appropriate treatment.

2.     Removal of poison: Vomiting is induced immediately, to prevent further absorption of poison. Ipecac syrup with water may be given for emetic effects.

Gastric Lavage (stomach wash - refer practicals): Gastric lavage is given to empty the stomach off poison.

Vomiting and gastric lavage are contraindicated, if a child is comatose, in severe shock, had corrosive poisoning, or has lost gag reflex to prevent aspiration. If a poisoning agent is mineral oil, the vomiting can cause aspiration, resulting into chemical pneumonitis. If a poison is a strong corrosive (acid or alkali), vomiting may further damage the injured tissues of the pharynx and oesophagus.

1.     Decontaminating stomach with activated charcoal helps to absorb many compounds. It is used within one hour of poisoning but after the patient is vomited.

2.     Dilution of a poison: Dilution of a poisoning agent is necessary when toxic substance cannot be removed such as corrosives.

Management:

1.     Place the patient in a semi prone position to facilitate drainage of secretions and prevent an aspiration.

2.     Maintain the patent airway. Administer oxygen if necessary.

3.     Check the vital signs and observe the patient for the signs of any changes in the symptoms. Maintain the normal body temperature.

4.     Give emotional support to the patient and parents. Nothing should be given by mouth.

5.     Monitor parental fluid intake and serum electrolytes.

Provide comfort measures to the patient.

Parental advice:

Parents should be explained about the measures to prevent poisoning in children as follows:

Instruct about proper storage of poisonous substances.

Explain to keep the poisonous material beyond the children's reach.

Instruct to put label on the container.

Poisonous substances should never be placed in a container used for the food, because the child may mistakenly ingest it.

Instruct to seek the medical advice when poisoning is suspected.