Gene Rider

PREVENTION AND MANAGEMENT OF AERODIGESTIVE FOREIGN BODY INJURIES IN CHILDHOOD

Pediatricians have a critical role in the evaluation of children who experience a choking episode and foreign body injury. Familiarity with important symptoms and signs improves diagnostic skills and complements radiographic evaluation. Further reduction in injury prevention is assisted by parental education and avoidance of objects and foods that produce the greatest risk. Design modifications of toys and other products for childrens use is the next important step in this safety process.

Pediatric button battery injuries: 2013 task force update

Over the last 10 years, there has been a dramatic rise in the incidence of severe injuries involving children who ingest button batteries. Injury can occur rapidly and children can be asymptomatic or demonstrate non-specific symptoms until catastrophic injuries develop over a period of hours or days. Smaller size ingested button batteries will often pass without clinical sequellae; however, batteries 20mm and larger can more easily lodge in the esophagus causing significant damage. In some cases, the battery can erode into the aorta resulting in massive hemorrhage and death. To mitigate against the continued rise in life-threatening injuries, a national Button Battery Task Force was assembled to pursue a multi-faceted approach to injury prevention. This task force includes representatives from medicine, public health, industry, poison control, and government. A recent expert panel discussion at the 2013 American Broncho-Esophagological Association (ABEA) Meeting provided an update on the activities of the task force and is highlighted in this paper.

Fatal and non-fatal food injuries among children (aged 0–14 years)

OBJECTIVE To identify and characterize food items with high risk of airway obstruction in children younger than 15 years. METHODS This retrospective study collected injury data from 1989 to 1998 for 26 pediatric hospitals in the United States and Canada. Aspiration, choking, ingestion, and insertion injuries due to food items were analyzed. The data included 1429 infants and children. Results were compared with fatality data published by the American Association of Pediatrics in 1984. RESULTS The 10 food objects with the highest frequency for both injuries and fatalities were identified. Peanuts caused the highest frequency of injury, and hot dogs were most often associated with fatal outcomes. The severity of respiratory distress prior to hospital evaluation varied for different foods. Age younger than 3 years was the highest-risk factor. Key characteristics such as bite size, shape, and texture were analyzed and found to demonstrate relationships with severity of clinical outcomes. CONCLUSIONS Children younger than 3 years remain at greatest risk of food injury and death. We found that hard, round foods with high elasticity or lubricity properties, or both, pose a significant level of risk. Consideration of the key characteristics of the most hazardous foods may greatly decrease airway obstruction injuries. Food safety education can help pediatricians and parents select, process, and supervise appropriate foods for children younger than 3 years to make them safer for this highest-risk population.

Development of the Small Parts Cylinder: Lessons Learned†

Objectives/Hypothesis: The Consumer Product Safety Commission mandates federal child choking prevention standards in the United States. Consumer Product Safety Commission utilizes the small parts cylinder (SPC), a 31.75‐mm inside‐diameter cylinder with a slanted bottom and depth ranging from 25.4 to 57.1 mm. The SPC was developed with very limited clinical data, and the effectiveness of the SPC remains controversial. Small parts ingestions remain among the most common causes of injury and fatality to preschool children. This study reviews the history, medical basis, and effectiveness of the SPC and provides recommendations for prevention of choking and airway fatalities.

Human factors project: development of computer models of anatomy as an aid to risk management

Behavioral studies and reports in the pediatric medical literature suggest that children, particularly those younger than 4 years, frequently place foreign objects such as toys and small parts of consumer products in their mouths, nasal cavities and ear canals. These actions not infrequently lead to injury or death. Accurate models of the anatomical areas most often severely injured by foreign body impaction (oral cavity, orbit, ear canal and nasal passages) would greatly facilitate assessment of the risks of impaction. Because models of these anatomic regions in children of the ages when they are most at risk are not widely available, Intertek Testing Services, Risk Analysis and Management (ITS RAM), in association with faculty at the University of Pittsburgh and the Pittsburgh Supercomputing Center at Carnegie Mellon University, developed computerized models of these anatomical areas of interest in children at the critical stages of child development. Computer models were also developed of proposed or existing products and of objects represented in the ITS RAM Small Parts Aspiration and Ingestion Database (comprised of data from 17 childrens hospitals) and fatality data from the Consumer Product Safety Commission. The computer models of products and computer anatomical models can be used to assess the possible hazards inherent in the product designs and to communicate the risks associated with product designs to manufacturers and marketing groups.

Quantitative risk analysis

Problem. Each year, unsafe consumer products are involved in millions of injuries and thousands of fatalities around the world. There is a need to quantitatively assess the risks to consumers posed by all types of consumer products. Objective. Quantitative Risk Analysis (QRA) is a scientific methodology that was developed to quantitatively demonstrate the potential risk associated with any given consumer product. QRA is based on the Risk Equation which is Risk = Hazard X Exposure. Methods. Key factors affecting Risk were studied. Factors impacting Hazard include Design Defects, Manufacturing Defects, and Foreseeable Use. Factors impacting Exposure include Product Quantity in distribution, Product Durability, Caregiver Vigilance, and Product Accessibility. Monte Carlo Simulation methods were utilized to generate estimates of product-related risk. Results. The Kinder Egg is used as an example and the QRA results for this product in the North American market are presented. Conclusion. QRA results can do the following: 1.) Determine if a design meets desired or necessary safety expectations 2.) Allow one to understand which components of a given design can be modified to ensure the greatest improvements in the safety of a given product 3.) Guide the development of product safety specifications and requirements and 4.) Determine if a recall is warranted. QRA can benefit risk managers and others by allowing them to identify the critical factors influencing the risks posed by consumer products in the global marketplace.

Prevention of Accidental Childhood Strangulation a Clinical Study

Accidental Strangulation is a preventable problem, and there is limited scientific understanding of its mechanism in children. If the amount of external pressure that occludes the airway can be determined, design changes may be made to allow for production of household objects that would break apart at safe pressure levels. A force gauge was applied to the suprahyoid region in 90 children under standardized anesthesia. Three blinded observers performed the study. The anesthesiologist maintained the airway and used a stethoscope to auscultate for breath sounds and monitor the CO2 curves to evaluate obstruction. The recorder noted the numbers from the gauge. A single observer applied the force gauge. Age was the most significant variable in occluding the airway. Obstruction appears to occur at the level of the larynx. Increased knowledge regarding the external pressure required for airway occlusion would allow for the design and manufacture of products with a reduced potential for accidental strangulation.

Framework model of product risk assessment

Risk assessment has been a vital tool in the consumer product safety arena. However, the challenges have been to ensure scientific and robust assessments and to eliminate diverging risk results. Back in year 2005, EuroSafe took the initiative and orchestrated a working group (WG) on risk assessment (EuroSafe WGRA). The WG includes subject experts from regulatory bodies and industry. In the past 2 years the WG has devoted itself to vigorous research in the harmonisation of nomenclatures and the identification of basic principles of non-food consumer product risk assessment. More importantly, it has undertaken the groundbreaking work of the establishment of a risk assessment framework model. The framework model took a step-by-step approach to exemplifying a disciplined thought process: defining the objective, hazard identification and characterisation, exposure assessment, risk characterisation, risk evaluation, risk reduction and residual risk communication. The model is enriched with information source inventories and resource recommendations that can be consulted to develop practical risk assessment methods.

Prevention of accidental childhood strangulation: where is the site of obstruction?

BACKGROUND Accidental strangulation is a preventable problem with limited scientific understanding in children. Childrens clothing and household furniture have the potential to cause strangulation. Localizing the site of obstruction would provide understanding and insight to preventing this unfortunate event. METHODS While undergoing the application of pressure to the submental and suprahyoid region in eight patients flexible endoscopy was performed to evaluate the location of obstruction. RESULTS Submental pressure occluded the nasopharynx and oropharynx. Suprahyoid pressure occluded the larynx. CONCLUSIONS In suspension strangulation, airway obstruction appears to occur at the level of the larynx involving the epiglottis and the arytenoids. Increased knowledge regarding site of airway occlusion may help to decrease the hazard of accidental strangulation.

Frequency of caregiver supervision of young children during play

Unintentional injury is one of the most significant threats to children’s health worldwide. The 2nd UNICEF Innocenti Report Card (UNICEF 2001) reveals (overwhelmingly unintentional) injury as the leading cause of child deaths in all developed nations, accounting for approximately 40% of all deaths in children aged 1 to 14 years. Caregiver supervision is a principal contributor to childhood injury prevention and caregivers in many countries have identified a need for more information on hazard identification and reduction (Vincenten et al. 2005). To help understand caregiver practices, this study examines the self-reported supervision of caregivers with at least one child under 6 years of age, focusing on frequency of supervision in four play scenarios: playing outside, alone, with a playmate of similar age and with an older sibling or playmate.