Childhood Poisoning: By What and By Whom?
Dr Ellis KL Hon
Paediatric Intensive Care Unit,
Hong Kong Children Hospital
Dr Ellis KL Hon is the consultant intensivist at the Hong Kong Children’s Hospital, and Paediatrician at the Paediatric dermatology clinic, Prince of Wales Hospital. He is the clinical professor (Honorary) at the Department of Paediatrics and the Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong.
He received undergraduate medical education at the University of Western Australia. He is a Fellow of the American Academy of Pediatricians (FAAP) and Fellow of Critical Care Medicine (FCCM). He received his Doctor of Medicine (MD) at the Chinese University of Hong Kong.
He is the President of the Hong Kong Society of Paediatric Respirology and Allergy, Vice President of the Hong Kong Paediatric and Adolescent dermatology Society, Advisor of Hong Kong Institute of Allergy, Board of Directors and Research Committee of Asian Society of Pediatric Dermatology (ASPD), Scientific committee member of Pediatric Acute & Critical Care Medicine Asian Network (PACCMAN).
He has published nearly 400 peer-reviewed scientific papers, books and book chapters. He has performed extensive research on atopic diseases, traditional Chinese medicine and many paediatric critical care and health issues. He is particularly keen to promote health in children and their family and educate parents to dismiss a lot of myths and fallacies that hinder child health in Hong Kong.
He works well with many associate colleagues and residents, each being hard working and academically productive.
Accidents, injuries, and poisonings are important, but potentially avoidable, causes of mortality and morbidity in children. Injury is not synonymous with accident and is regarded by some as understandable, predictable, and preventable. It may be a sequela of a harmful or abusive act. In the literature, the term nonaccidental injury (NAI) is often equivalent to child abuse. NAI carries medicolegal consequences and must be used with caution. Injury is the leading cause of death and disability in children and adolescents. The causes of severe childhood injuries are heterogeneous. Cardiopulmonary or neurological/neurosurgical supports are often required. These injuries more commonly occur indoor and involve toddlers with underlying neurodevelopmental conditions.
Falls and head injury are common in children. Presentation varies according to the injury. Some patients with head trauma stabilize and other patients deteriorate. A patient may present with or without neurological deficit. Patients with concussion may have a history of unconsciousness, then normal arousal. Disturbance of vision and equilibrium may also occur. Common symptoms of head injury include coma, confusion, drowsiness, personality change, seizures, nausea and vomiting, headache and a lucid interval. Because brain injuries can be life-threatening, even people with apparently slight injuries, with no noticeable signs or complaints, require close observation.
Children are curious and like to explore their surroundings. Burns and scalds are a major cause of serious injury in children from newborn to 14 years old. Children under four years are most at risk due to their increased mobility and natural curiosity. A severe scald can be fatal or cause a serious injury and a long hospital stay. It may also require painful skin grafts and years of treatment and result in permanent scarring.
Submersion injury is less common in Hong Kong. Indoor submersion injury was associated with worse prognosis. All patients with GCS of 3 at ED and required intensive care support were either dead or incapacitated. Low GCS, pulselessness and intubation at the ED and seizures are also associated with adverse outcomes.
Childhood poisonings are common, but usually trivial, and infrequently necessitate intensive care unit (ICU) admissions. Life-threatening poisonings requiring ICU support can pose diagnostic difficulties and challenges to frontline medical officers at the emergency department. Children from all age groups can be affected. Prompt diagnosis is based on relevant history, careful clinical examination and a high index of suspicion in at-risk patients. The pupillary size and its reaction following treatment serves as an important diagnostic clue.
Filicide is the tragic crime of murdering one’s own child. These rare but tragic cases involved children of both sexes and all ages. Although psychosocial risk factors may be clues for interventions, the rarity of these incidents and the impulsiveness of the act make preventive measures virtually impossible in a city full of high-rise buildings.
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