Baby walkers (BWs) continue to be a frequent cause of head injuries in young children. A random sample survey of 240 families with children aged 2-6 years revealed a use rate of baby walkers of 55%. Of the children using baby walkers 20% were found to have suffered a BW-related accident. In a retrospective study we reviewed 172 case reports of infants who suffered a BW-related injury between January 1990 and June 1993. We observed 19 skull fractures, 23 concussions of the brain and 125 contusions and lacerations of the head including 4 teeth luxations and 3 fractures or distortions of the upper extremity. BW-related injuries represent the third most common mode of injury in children aged 7-14 months. We conclude that despite previous warnings BW still represent a frequent cause of severe head injuries in young children. We recommend a general ban on the sale and manufacture of BWs.
In order to establish guidelines for highchair accident prevention we investigated causes, mode and complications of highchair accidents by the following methods: The charts of 103 children attending our Accident & Emergency department for highchair related injuries were studied retrospectively. Questionnaires were sent to the parents to obtain detailed information about the mode of accident. They were also asked to suggest preventive measures. In addition, a random sample survey was performed with 163 families inquiring about the rate of highchair use and the incidence of highchair related accidents. Of the 103 infants, 15.5% had sustained a skull fracture, 13.6% a brain concussion, 2.0% limb fractures and 68.9% a simple contusion of the head or lacerations to the scalp or face. The questionnaires were fully completed by 61.2% of parents. Every second family reported that their infant had tried to stand up in the highchair before falling off (only one child had been wearing a restraint). In a further 14.3% of accidents the highchair tipped over. Eighty-seven percent of parents would appreciate a pre-installation of restraints, 54.0% requested more informative instructions for users, and 33.3% asked for products with better stability. The random sample survey revealed a highchair use rate of 92%; 18% of families used highchairs equipped with restraints, and 6% reported highchair accidents sustained by their children. We conclude that most highchair accidents occur when unrestrained infants try to stand up. Pre-installed child restraints, better manuals for users and increased highchair stability should be recommended as promising accident prevention strategies.
Twelve infants operated upon for choledochal cyst (CC) are reviewed with emphasis on the operative technique of biliary tract reconstruction, incidence of cholangitis, postoperative hypergastrinemia, biliary excretion, and upper gastrointestinal (GI) motility in a follow-up of 24 to 35 months. In 7 patients biliary reconstruction was performed with a Roux-en-Y hepaticojejunostomy (HJ), and in 5 with a hepaticoantrostomy (HAST). In the HJ group 4 patients had recurrent episodes of cholangitis and intermittent diarrhea and serum gastrin levels were significantly elevated in 5. Hepatobiliary scintigraphy showed unobstructed excretion of labelled bile through bile ducts into the Roux-en-Y loop, but with significantly delayed emptying of bile into the distal jejunum in all patients. Gastric emptying and upper intestinal passage were normal. In the HAST group no episode of cholangitis occurred and serum gastrin levels were within the normal range. Scintigraphically, hepatobiliary excretion, and duodenojejunal passage of labelled bile was normal, except in 1 patient who developed a postoperative stenosis of the left hepatic duct. Upper GI contrast studies demonstrated normal gastric emptying without reflux into the biliary system. These results suggest that biliary reconstruction with HAST can be performed safely with a low incidence of complications HAST offers a more physiologic method of biliary reconstruction after resection of a CC that allows bile to drain directly into the duodenum.
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