Amina Khambalia

Risk factors for unintentional injuries due to falls in children aged 0-6 years: a systematic review.

Objective: To identify risk factors for unintentional injuries due to falls in children aged 0–6 years. Design: A systematic review of the literature. Methods: Electronic databases from 1966 to March 2005 were comprehensively searched to identify empirical research that evaluated risk factors for unintentional injuries due to falls in children aged 0–6 years and included a comparison group. Results: 14 studies met the inclusion criteria. Studies varied by the type of fall injury that was considered (ie, bunk bed, stairway, playground or infant walker) and with respect to the quality of evidence. In general, major risk factors for the incidence or severity of injuries due to falls in children included age of the child, sex, height of the fall, type of surface, mechanism (dropped, stairway or using a walker), setting (day care v home care) and socioeconomic status. Conclusion: Despite a high burden, few controlled studies have examined the risk and protective factors for injuries due to falls in children aged 0–6 years. The only study to examine falls from a population health perspective suggests that age, sex and poverty are independent risk factors for injuries due to falls in children.

Clinical and Laboratory Assessment of Dehydration Severity in Children With Acute Gastroenteritis

Objective. To evaluate clinical and laboratory assessment of dehydration severity in children, 1 to 36 months, with acute gastroenteritis. Study design. Clinical and laboratory measures and weight change following rehydration were collected for enrolled children. Setting. Pediatric emergency department. Results. Likelihood ratio (LR+) and 95% confidence interval (CI): for a clinical score of 0, the LR+ was 2.2 (95% CI = 0.9-5.3); for a clinical score of 1 to 4, the LR+ was 1.3 (95% CI = 0.90-1.74); for a clinical score of 5 to 8, the LR+ was 5.2 (95% CI = 2.2-12.8); for a venous pH <7.32, the LR+ was 7.2 (95% CI = 2.4-21.9); and for serum bicarbonate <18 mmol/L, the LR+ was 11.6 (95% CI = 3.5-38.0). Conclusion. Clinicians may find it useful to incorporate the Clinical Dehydration Scale and laboratory measures into clinical decision-making algorithms to assess dehydration severity in children with acute gastroenteritis.

Peer and Adult Companion Helmet Use Is Associated With Bicycle Helmet Use by Children

Objective. To examine whether the helmet status of riding companions (child or adult) influences helmet use by children (5–14 years). Methods. This study is part of a larger prospective observational survey that was conducted in a defined urban region of Toronto, Canada (1990–1997, 1999, and 2001). Trained observers collected data on children who were riding bicycles in April through October each year. Observation sites included school yards, parks, major intersections, and residential streets. Results. Of the 2094 children who were observed riding a bicycle, 50% were riding alone, 36% were riding with at least 1 child companion, and 14% were riding with at least 1 adult companion. Compared with riding alone, children were less likely to wear a helmet when riding with nonhelmeted child companions (relative risk [RR]: 0.29; 95% confidence interval [CI]: 0.22–0.38) and were more than twice as likely to wear a helmet when riding with either helmeted child (RR: 2.18; 95% CI: 1.97–2.42) or adult companions (RR: 2.67; 95% CI: 2.44–2.93). Compared with children who were riding with nonhelmeted child companions, children were more likely to wear a helmet when riding with nonhelmeted adults (RR: 3.93; 95% CI: 2.86–5.40), helmeted adults (RR: 9.18; 95% CI: 7.04–11.98), or helmeted children (RR: 7.49; 95% CI: 5.72–9.82). Adjusted analyses showed no difference between companion helmet status and helmet use by children before and after legislation. Conclusions. Helmeted and nonhelmeted adult riding companions were positively associated with child helmet use. The association between child riding companions and child helmet use was positive for helmeted child riding companions and negative for nonhelmeted child riding companions. Efforts need to be made toward improving adult helmet use and childrens perceptions and attitudes toward helmet use.

Periconceptional Iron and Folate Status Is Inadequate among Married, Nulliparous Women in Rural Bangladesh

Recent evidence suggests that poor fetal growth is associated with preconception anemia and first trimester iron deficiency. Periconceptional iron and folate supplementation may improve the effectiveness of iron supplementation programs during pregnancy by treating preexisting anemia, building iron stores, and reducing risk of neural tube defects. Our objective in this study was to describe the iron and folate status of married, nulliparous women in rural Bangladesh from March to May 2007. Of 272 women, 37% were anemic (hemoglobin <120 g/L), 13% were folate deficient (plasma folate <or=10 nmol/L), 15% were iron deficient (plasma ferritin <12 microg/L or tranferrin receptor >4.4 mg/L), 11% were iron deficient and anemic, and 81% were estimated to have <500 mg of iron stores. Risk of anemia was 4 times greater among nonstudents than students (95% CI: 1.23, 14.69), twice as likely among women with a previous miscarriage compared with those who had never been pregnant (95% CI: 1.04, 5.47), and 6 times greater among iron-deficient compared to iron-replete women (95% CI: 2.76, 11.81). Adolescents (<or=19 y) had lower mean plasma ferritin concentration (38.3 +/- SD vs. 49.1 +/- SD microg/L; P = 0.004) and body iron stores [3.4 +/- 5.2 mg/kg vs. 4.3 +/- 5.6 mg/kg (0.06 +/- 0.09 mmol/kg vs. 0.08 +/- 0.10 mmol/kg); P = 0.006] compared with adults. An unacceptably high percentage of nulliparous women in rural Bangladesh have inadequate iron and folate status. As they enter pregnancy, more than one-third will be anemic, >80% will have inadequate iron stores, and more than one-tenth will be folate deficient. Further research is needed on risk factors of poor nutritional status before the start of a womans childbearing years.

Gas fireplace contact burns in young children.

Contact burns from domestic appliances are common in young children. Recently, gas fireplaces have been recognized as a potential cause of contact burns in young children. We sought to quantify the frequency of gas fireplace contact burns in young children, to identify the etiology of contact, to describe the clinical presentation, and to describe clinical outcomes. Children with gas fireplace contact burn injuries presenting to The Hospital for Sick Children in Toronto (1999-2002) were identified using three data sources: the Canadian Hospitals Injury Reporting and Prevention Program Database, the Burn Unit Registry, and the Rehabilitation Services Database. Demographic, clinical, and outcomes data were collected on all children. During the 4-year study period, 27 children presented to the hospital because of a gas fireplace contact burn (approximately 9% of all contact burns). The median age of the children was 14 months (range, 8-36 months), with 16 boys (59%). Most children were burned in their own home. With regard to etiology, 10 children (37%) lost their balance near the fireplace, 2 (7%) walked too close to the glass front, and 8 (30%) touched the glass front out of curiosity. Almost half (44%) of the children burned the palms and digits of both hands. The median total burn surface area was 1% (range, 0.2-2.5%). In total, 30% of children were admitted to hospital, and 11% required skin grafts. All children had full wound closure after 4 to 43 days. Given the etiology of these burns (loss of balance or curiosity), passive prevention, such as barriers or changes in the composition of glass panels, may be the most effective approach to combat them.

COMMUNITY PAEDIATRICIANS' COUNSELING PATTERNS AND KNOWLEDGE OF RECOMMENDATIONS RELATING TO CHILD RESTRAINT USE IN MOTOR VEHICLES

Background: Road traffic injury is the leading cause of death among Canadian children and youth. Transport Canada recommends four types of child restraint depending on the size of the child, and recent studies have demonstrated the effectiveness of recommended restraint use. Objectives: To determine community paediatricians’ knowledge of Transport Canada recommendations for child restraint use in vehicles, and to examine paediatricians’ counseling patterns in relation to child passenger safety. Methods: A mailed questionnaire survey of all community paediatricians affiliated with the Hospital for Sick Children, Toronto was conducted. A 16 item questionnaire gathered information on knowledge of Transport Canada recommendations for child restraint use, general counseling patterns in relation to child passenger safety, and demographic information. Results: In total, 60 community paediatricians in active practice were identified. Of these, 48 (80%) responded to the mailed questionnaire. Almost all paediatricians (92%) correctly identified the recommended weight for transition to a forward-facing car seat, whereas fewer paediatricians (63%) correctly identified the recommended weight for transition to a booster seat from a forward-facing car seat, and only one third of paediatricians correctly identified the recommended weight for transition from a booster seat to a seat belt. Conclusion: Community paediatricians’ knowledge of Transport Canada recommendations for child restraint use in vehicles is incomplete. There is a need for such recommendations to be better disseminated to paediatricians and parents so that information on child restraint use is delivered in a clear and consistent manner.

Office-Based Intervention to Reduce Bottle Use Among Toddlers: TARGet Kids! Pragmatic, Randomized Trial

OBJECTIVE: The goal was to determine whether an office-based, educational intervention for parents of 9-month-old children could reduce bottle use and iron depletion at 2 years of age. METHODS: Between January 2006 and 2007, 251 healthy, 9-month-old infants attending a routine health maintenance visit were assigned randomly to intervention or control groups. Parents in the intervention group were introduced to a 1-week protocol to wean their children from the bottle. Iron depletion (ferritin levels of <10 μg/L) and bottle use at 2 years were assessed. RESULTS: A total of 201 children were monitored to 2 years of age (follow-up rate: 81%). Rates of iron depletion (10 [10%] of 102 children vs 13 [13%] of 99 children; P = .42) and milk consumption of >16 oz (16 [16%] of 102 children vs 17 [17%] of 99 children; P = .7) were not significantly different between the 2 groups at 2 years of age. However, children in the intervention group started using a cup 3 months earlier (9 vs 12 months; P = .001), were weaned from the bottle 4 months earlier (12 vs 16 months; P = .004), and were more than one-half as likely to be using a bottle at 2 years of age (15 [15%] of 102 children vs 39 [40%] of 99 children; P = .0004). CONCLUSIONS: This simple intervention administered during a health maintenance visit did not result in a decrease in iron depletion at 2 years of age but did result in a 60% reduction in prolonged bottle use.