Dr Jon Baker, an accident and emergency consultant at the Lister Hospital, in
Chelsea, West London, hates trampolines. A week or so ago he saw a
ten-year-old boy who had fallen on to the padded edging and ruptured his
spleen. If the boy hadn’t turned up at hospital with stomach pains, and had
his spleen removed, he would have died.
Most A&E doctors, especially those who deal with children, have their own
particular nightmare: some unnecessary hazard that brings too many sick and
injured little ones to their doors. For Dr Ian Morrison, a consultant at the
children’s A&E department at the Royal London Hospital, it’s
windows – surprising numbers of children fall out of them in the summer
months and end up with severe, sometimes fatal, head, chest and limb
injuries. And wheeled trainers – he’s seen too many bad fractures and deep
cuts as a result of these rollerskate-like shoes shooting a child forward
when they meant to stop.
But everyone who works in child A&E, without fail, will tell you about
burns. For one of the biggest threats to child health is the humble cuppa.
“Last week I treated a toddler who’d managed to pull a cup of coffee on top
of herself,” says Dr Baker. “She was in extreme pain, with burns all down
her face and front. Children’s skin is much thinner than ours, so a bad burn
often means they have to go to the burns unit and, like this child, have
plastic surgery.”
The problem, say all the consultants, could simply be avoided. Adults should
never put hot cups and saucepan handles within reach, or on tables and
cloths that can be pulled down, or pass cups to each other over children
rather than around them.
It doesn’t help that people do the daftest things to treat burns. Dr Morrison
says that it’s a regular occurrence for parents to put tooth-paste or butter
on burns to cool them. “Then we have the complicated process of getting it
out of the burn.” Both substances can make a burn worse; the best thing to
cool a burn is cold water (but not ice because it sticks to skin).
The human and financial cost of our oversights is enormous. Children’s
accidents cost the NHS about £200 million a year, with one severe bath-water
scald costing as much as £250,000 to treat.
Everyday things are unexpectedly hazadous
I’m talking to Dr Morrison in the cramped children’s A&E
department at the Royal London Hospital in the East End, as the waiting room
is beginning to fill with the postschool rush of parents bringing their
child in after a scrape at school. Early evenings and weekends are the
busiest times for child A&E departments, and holidays see a huge upturn
in road-traffic accident injuries. The Royal London’s A&E sees
34,000 children a year.
Beneath the Miffy rabbit frieze and colourful paintings by patients, there are
weary parents and children reacting in all possible ways to their injuries.
A toddler with a cut finger runs around screaming. An eight-year-old with a
bandage covering a bumped head looks bored as his parents try to explain why
he is there: “He was pushed over, in the playground . . . on purpose,” as if
that made a difference. The male nurse patiently takes notes. A boy with a
bloody bandage around his hand snuggles his mum.
As well as the hospital’s usual dusty stuffiness, there’s a pervading fug of
“if only”. If only I’d checked the water temperature in the bath; if only I
hadn’t left her alone for that minute. But the doctors and nurses try to
discourage that. Though most accidents they see are preventable, the A&E
staff are unremittingly charitable to parents. After all, as Dr Morrison
says, no one there expected to be meeting him when they got dressed that
morning. And it’s not that most of them did anything especially stupid; it’s
just that everyday things can turn out to be unexpectedly hazardous.
“Once an accident has happened, you can’t reverse it,” he says. “The main
thing is that parents become aware, for example, of some of the alterations
you can make to your kitchen or bathroom to reduce the likelihood of burns:
such as installing thermostatic taps” (see box, facing page).
Four-year-old John [not his real name] has just been ushered into the
emergency room. His dad is telling Dr Morrison about the gaping wound to the
side of his son’s right eye. John had come home from school, was running
around the front room, tripped, and hit his head against the corner of a
computer. Behind the curtain I can hear something more serious. A child
being put on oxygen, and a nurse explaining to the parents about the child’s
airways and how they have become blocked. Asthma attack.
Dr Morrison questions John’s father gently about how his son has been since
the injury, trying to assess the likelihood of concussion. John is more
interested in the Scooby-Doo poster above his head than his
condition, but his dad’s forced smile tightens when Dr Morrison tells him
that unfortunately there’ll be a scar whatever treatment he receives. The
face muscles loosen again when, with miraculous efficiency, the nurses close
the wound with paper sutures and medical glue, while a play therapist
distracts John with bubbles. When it’s all over, Dad euphorically tells me
how wonderful everyone in the department is, and how he’ll make sure he
moves his computer and everything else with sharp edges in his living room.
What I’m witnessing – burns, bumps, falls – is the bread and butter of
paediatric casualty departments. Playgrounds and car doors cause a lot of
broken wrists and crushed fingers, Neil Fletcher, a senior nurse in the
department for eight years, tells me. Hot irons, hot drinks and hot taps are
the main causes of burns. And a surprising number of babies come in having
fallen off the bed; mums don’t expect them to roll. “We do get children with
severe asthma attacks and for them, the problem is often that they have an
attack, reach for the inhaler, and it has run out. So I’d advise parents
always to keep on top of their refills.”
“It’s 90 per cent about communication”
What most parents want from A&E, Dr Morrison says, is not treatment but
reassurance. This applies particularly to the thousands who turn up to them
every year, not because their child has had an accident, but because they
have a high temperature. The most common cause of an unnecessary visit to A&E?
The common cold. It causes a fever in younger children.
He doesn’t blame parents for coming when they’re worried about something
trivial because GPs, and services such as NHS Direct, do not always have the
time to explain the condition, or to observe a child over an hour or so to
see whether they improve or not with medication.
“About 90 per cent of what we do is communication,” says Dr Morrison.
“Reassuring people that most of the things that go wrong with children get
better by themselves. About a quarter of the people who come here have first
been to another form of healthcare, and when I ask them why they come here
they say they weren’t given a full enough assessment.”
Many people find it hard to get past the GP’s receptionist, he says, and NHS
Direct has a tendency to make sensible parents worry more by advising them
to play safe by visiting a casualty department.
Watching the painstaking medical detective work of Dr Morrison and Nurse
Fletcher, their detailed explanations of what’s wrong, and when to worry,
it’s no wonder so many people turn up again and again, whatever the problem.
For all of us, says Fletcher, there’s a general rule about reassurance: “It’s
about looking at your child. If you have a happy, smiling child, just don’t
worry.”
To keep your kid out of A&E
DO . . .
Check grandparents’ houses for hazards before visiting; they aren’t
child-proofed, and most incidents of bleach or tablet-swallowing occur when
visiting friends and relatives.
Install thermostatic taps, available from B&Q and Homebase, in your
bathroom to reduce the chance of burns.
Check windows. Locks that limit how much they can be opened are a good idea.
Check you have asthma inhaler refills.
DON’T . . .
Leave hot tea or coffee unattended near children, or hold it near them.
Ever drive them anywhere without the correct car seat and seat belt.
Leave stairs ungated if you have a toddler.
Let them get on a bike without a helmet.
Emergency numbers
1m under15s go to A&E every year after accidents in the home
67,000 children’s accidents occur in the kitchen each year
58,000 children’s accidents happen on the stairs a year
44% of all children’s accidents involve falls
10 children die every year as a result of falls from windows, balconies
and stairs
2,500 children attend A&E each year as a result of bath-water scalding
Sources: Office for National Statistics and Home Accident Surveillance
System
"58,000 children’s accidents happen on the stairs a year"
So what part of Germany are you from?
Andrew Milner, Yokohama, Japan
The forgotten art form that Mike Poulson refers to is "spare the rod and spoil the child". The mamby-pamby social state which virtually criminalises parents for chastising their children physically, is the root cause. An odd clip round the ear never did my generation any harm.
But here is the answer - a loosely rolled up newspaper whacked across the bottom or back of the legs - makes a lot of noise - no pain, but a fright - one of the most successful ways of training children and dogs without inflicting physical pain.
The stupid statement "wait till your father gets home..." which I heard too many times, is so idiotic - punishment must be psychologically associated with the crime - ie - on the spot.
And of course these infernal parental-evading playgroups don't help - the child then has a conflict between what the parents say is right and what the playgroup says.
Dr John, Kuala Lumpur, Malaysia
I'd have to agree with Mike
educating instead of eliminating the hazards is what is necessary.
Elimination just brings up a weird sort of curiosity meaning accidents will happen when you're not around
besides it'll help keep your sanity knowing your kid KNOWS what not to do instead of going
"No you can NOT go to visit Ben's house because I don't know if the stairs in his house have skid proof edges"
jks, Quetta, Pakistan
Also wrap your little ones in cotton wool and don't let them out of the cardboard box.
Yes, you should avoid the genuine safety hazards like pan handles sticking out, or unguarded fires and the like. But it should not be necessary to 'childproof' a house. Either your own or grandparents. Children should be educated from a very young age not to consume unconsumables and not to stick things into anything. And if you can't trust them not to do as they are told it is your job to watch them and teach them the error of their ways. It's a forgotten art form called 'bringing your children up'. They need to develop haxard awareness before they go out into the grown-up world which is not idiot-proofed.
Mike Poulsen, Reading, Berkshire