By Dr. Mohamed Izham Mohamed Ibrahim
The Sun, October 3, 1995
IN SO-CALLED "DEVELOPED" countries, accidents are the primary cause of death in children after the first year of birth. One of the commonest accidents referred to hospitals is poisoning.
It is reported that 10,000 children are admitted to hospitals in England and Wales each year due to poisoning. In the United States, 600 children die from poisoning and 600,000 are successfully treated for it each year. One study estimates that about 6% of all children aged one to four years in an area in New York take poisons.
The commonest poisons taken by children are tranquillising and sedative drugs, salicylates, contraceptive pills, ferrous sulphate, cleaning agents, pesticides, disinfectants, berries, laxatives and petroleum derivatives. There are at least 300,000 different noxious household products which can pose potential dangers to children. With regard to the storage of poisons, carelessness and ignorance on the part of the parents are two significant factors.
In a Swedish study of homes containing one-to-two year-old children, it was found that chemicals were accessible to children in 93% of homes.
Children most often come into contact with potentially dangerous products when they are left on their own or are not closely observed. Accidental poisonings are unintentional and therefore preventable. Children living within a disrupted family structure, or having a disturbed parent-child relationship, or children with parents who are drug or alcohol abusers, are at a greater risk of poisoning. Family friction can seriously affect the mind of the growing child.
Prevention, therefore, needs the assessment of the potential interactions among the victim (child), the environment, and the poison. Hazards within the infant's reach and in the path of the crawler, the toddler, and the climber should be removed.
Poisoning in homes have become very common. Thus, the responsibility to educate children to help prevent ingestion, inhalation, or spillage of toxic products should be borne by both parents and health practitioners.
In fact, in some communities, the parents themselves need to be informed of their roles in preventing poisoning at home. Physicians and pharmacists should routinely integrate poison prevention education into the normal procedures of paediatric care.
Parents or guardians and children should be made aware of potential toxicologic dangers to children at each stage of development up to the five-year-old groups(see table).
Relevant features of the psychological development of a child such as the need for love and security, the desire to practise new skills, the ego and negativism, habit formation, and imitativeness can be associated with accidental poisonings in children.
Children must therefore be prevented from reaching poisons. Children who are allowed to do exactly as they want are liable to become involved in poisoning.
Poisoning prevention needs forethought, time and discipline: forethought - to think of and become sensitive to possible dangers to children; time - to watch them; and discipline - so that they learn how far they can go. Mild, consistent, logical discipline is as necessary to a child's sense of security as it is to his life.
| Toxicologic Dangers By Age And Development Abilities | |
|---|---|
 6 months |
Infant can hold bottle with both hands and feed |
| 8 months |
Self Crawling |
| 10-11 months |
Pulls self to standing position and walks with support |
| 12-15 months |
Walks independently, opens doors, drinks from cup |
| 12 months-3 years |
The toddler--period of greatest risk of poisoning. Gets into closets, drawers, reaches to tabletops, stoves,counters. Oral exploration |
| 18 months |
Mimics adult chores |
| 21 months |
Climb stairs |
| 3-5 years |
The creative climber - devises ingenious ways of getting to high places |
The importance of education in poisoning prevention has not received sufficient emphasis. This includes the immediate cessation of all dangerous practices that might lead to accidental poisoning.
However, it does not include over-protection, which prevents children from experimenting and which gives them an exaggerated and distorted concept of danger. The average child of 20 months can be taught some degree of caution. They can usually be trained to keep away from the place where hazardous household products are kept.
The children should be given positive instructions; he should be told the right and wrong way of doing things.
The do's and don'ts in children poisoning
The following do's and don'ts are steps required to prevent poisoning in children. If practised, they would prevent morbidity and mortality among our children.
- Remember that the older child may pick up poisonous materials and give them to his younger brother.
- Wherever possible, cleaning agents, drugs and certainly pesticides should be locked in a cupboard that is not easy to reach and the key should be removed.
- Never leave medicines in the child's bedroom.
- Destroy all unused or expired medicines by flushing them down the toilet.
- Never take or give a medicine to a child without first looking at it and reading the label.
- Do not let the child see you take a medicine; a child is liable to imitate.
- Refer to the medicine as medicine and not a plaything or sweets.
- Never store dangerous products on the food shelves.
- Always keep medication and poisons in their original containers and not in fruit juice or milk bottles.
- Make sure medicine bought is in a child-proof container.
- Never let a child see you hide a poison. It is a challenge for him to find it.
- Wax crayons are dangerous; they should not be given to a small child who may eat them.
- Colours must be fast. Home decoration with lead paint must be avoided, for a child may bite the paintwork.
- Anticipate that 50% of children who has swallowed a poison will repeat again within a year.
The writer is a lecturer specialising in Social Pharmacy, and is currently an associate researcher in the National Poison Centre.
