Trampolining is more popular than ever, but it can also cause injuries, some of them very serious. Siba Prosad Paul, Torbay Hospital, Torquay, Joanna Barnden, University of Bristol, and Meridith Kane, Yeovil District Hospital, discuss what can be done to prevent them.
Ingestion and aspiration of foreign bodies are common reasons for children presenting to emergency departments. A significant proportion of such events are often unnoticed by the children's parents or carers. Emergency nurses should become suspicious of foreign body ingestion or aspiration if they see symptoms such as stridor, gagging, wheeze and difference in air entry on auscultation ( Hilliard et al 2003 , Paul et al 2010 ). If they suspect airway compromise, or bowel problems such as perforation or obstruction, the children concerned should be dealt with immediately. Definitive management for foreign body removal is generally available at tertiary centres and children should be transferred to specialist services as soon as possible after stabilisation ( McConnell 2013 ). Before discharge, their parents should be educated about possible signs of deterioration and advised about home-safety measures ( Paul and Wilkinson 2012 ).
Abusive head trauma (AHT) occurs due to an intentional abrupt impact and/or violent shaking leading to an injury to the skull or intracranial contents of a baby or child, usually younger than 2 years of age. Without impact, there may be no external signs of head trauma. It is the leading cause of mortality in children who have suffered intentional physical abuse. It is more likely to occur in very young children with an estimated prevalence of 1 per 3000 in infants under 6 months of age. Studies have highlighted that distressed and exhausted parents can sometimes shake their infant in desperation and parental education has been shown to decrease the incidence of AHT. Clinicians dealing with children who presents with traumatic brain injury (TBI) should always consider the possibility of AHT. AHT is classically characterized by a triad of signs; subdural hematoma, brain edema, and retinal hemorrhage, however, non-specific features may also be seen in clinical practice both acutely or subsequently. Certain neuroradiological findings (subdural hemorrhages, multiple interhemispheric convexity and posterior fossa hemorrhages, hypoxic-ischemic injury and cerebral edema) are suggestive of AHT in young children. Associated spinal injuries can be easily missed and it is important to investigate for this. This review article includes 2 illustrative case studies and gives a comprehensive overview of AHT in children which we hope will be useful for neurosurgeons in their clinical practice. Child protection is everyone's responsibility and is best achieved when different specialties and professionals work together.
A previously healthy 8-month-old boy presented to the emergency department with a 1-week history of chickenpox infection. His routine immunizations were up-to-date. His parents reported a high temperature (up to 39.5°C) in the preceding 48 hours and that he also had a mild cough, episodes of vomiting and loose stools. He had fed poorly in the 24 hours before presentation. Clinical assessment revealed a temperature of 36.7°C, heart rate 130/min, respiratory rate of 34/min and crusted chickenpox lesions. The infant was alert, smiling and playful, and systemic examination was otherwise unremarkable. He was admitted for monitoring of his fluid intake and temperature. As the infant continued to vomit intermittently in the 6 hours post admission, blood investigations were done and intravenous fluids were commenced. Laboratory investigations did not reveal biochemical evidence of dehydration, but they did show raised inflammatory markers: white blood cell count 24.8 × 109/litre, neutrophil count 19.8 × 109/litre and C-reactive protein 227mg/litre. In view of these results and the ongoing high fever, a chest X-ray was performed, revealing right upper lobe consolidation and collapse (Figure 1). Oral amoxicillin and flucloxacillin were started and oral feeding was successfully reestablished over the next 24 hours. He was discharged home after 48 hours, to complete a full 7-day course of oral antibiotics.
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