|Posted by Naveen Kini on April 5, 2012 at 12:45 PM|
This blog entry is prompted by a tragic incident that occurred the other day. A 7 month old child was brought into the outpatient clinic by the frantic grandfather, saying that he found the child unconscious in the house. The child had been crawling around the house just a little while back, and had been fed about an hour ago. Immediate CPR (Cardio-Pulmonary Resuscitation) was started, and the child was shifted to the PICU, where the heart beat was revived and child was put on a ventilator. An X-Ray showed a small part of a toy stuck in the throat and larynx of the child, which was the reason for the breathing difficulty and collapse. Unfortunately too long a period had elapsed between collapse and revival, as a result of which the child had suffered irreparable brain damage.
Such tragic events bring to the forefront the utmost importance of awareness about preventive measures, and the knowledge of what needs to be done in an emergency situation. I would like to highlight a few of the measures that all parents and caregivers should know and practice.
1. An infant habitually mouths whatever object it gets hold of. It is the child's way of getting to know the look and feel of the new exciting world around it. Therefore the first and most important precaution is that any object within reach of the child should be bigger than the diameter of the child's mouth.
2. No object with sharp and irregular edges should be available to the infant.
3. The same applies to breakable items, or toys with small, detachable parts.
4. Only items which can be easily and thoroughly cleaned can be given to the infant. As a corollary, the most easily cleanable, soft, non-detachable harmless item that the child can mouth is its own finger!
5. A steady and sturdy crib, with barriers of at least 1.5 to 2 feet on all sides, is the only safe place where you can leave an infant who is turning over and trying to stand. The next best place is the floor.
6. Make sure you put away the medicine bottles, measuring cups etc. after administering the daily medicines.
7. The practice of giving the car key, the pen from your pocket, your necklace, a chocolate etc. to a crying child should be strongly discouraged, as they are all potential choking hazards, and sources of contamination and food poisoning.
8. Force-feeding an un-interested child to complete the bowl of cereal that you have prepared, is a potential risk for vomiting and aspiration of the feed into the lungs.
9. Keep hot milk or water in spill-proof flasks, and not in open containers that can be toppled by the infant. The practice of keeping the infant on your lap while drinking coffee and other hot beverages is to be strictly avoided.
In the unfortunate occurrence of a mishap or accident, the immediate first-aid measures provided to the child will go a long way in ensuring a favourable outcome, and preventing any permanent damage. In most countries, the presence of trained paramedical personnel, and efficient emergency services, take some burden off the parent's shoulders. In India, it is prudent to be forewarned and forearmed. Some of the measures are highlighted below.
A. All parents, grandparents and caregivers should be familiar with the basics of CPR (Cardio-Pulmonary Resuscitation), and resuscitation of a choking infant and child. Brief videos for each of the above are available on my Facebook page
The same videos are also available as a downloadable application for Apple (iPhone) and Android phones under the name CPR.Choking
If possible, attend basic life support classes, which are conducted from time to time in the major hospitals, where you can practice the manoeuvres on mannequins, or plastic dummies. In fact, if a sufficient number of people are interested, a class can be arranged in the clinic itself.
B. Mark out the location of the nearest hospital having a Pediatric Intensive Care Unit (PICU), and memorise the nearest route to the same.
C. Visit the hospital before hand, and find out the exact location of the PICU, or in some hospitals Emergency or Casualty departments, so that when needed, vital time is not wasted searching for the same.
D. In the event of an emergency, take the child straight to the PICU, and not to any nearby hospital or clinic. It is the best equipped place to handle any emergency, and the only place where trained staff and doctors are available round the clock.
E. In a child with a pre-existing medical problem, keep all records handy in a place where you can easily find them. Keep a detailed list of all the medications the child is currently on, and of drug allergies, if any.
F. Enrol the support of a neighbour, friend or relative who is available nearby most of the time, especially in the case of parents whose places of work are far away from home.
G. Inform the school authorities too of any medical conditions in the child, and give them the address and contact numbers of the hospital you would like them to take the child to, in the case of any emergency.
H. Lastly, and most importantly, do not panic. Vital time is lost, and more harm than good comes out of tackling situations in a haphazard, illogical way.
This article is dedicated to the memory of Ankur, and also to his parents, who even when struggling to deal with such a grave personal tragedy, insisted that I write about the same in my blog, so that other parents may never have to face what they have faced.