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Discuss about the Pediatric Safety Issues for Forensic and Legal Medicine.

Pediatric injury defined as physical damage of children from any sudden accident. Pediatric trauma emerges as one of the leading cause of morbidity and disability rate in developing countries like Saudi Arabia, USA, UK and third world countries. A significant number of cases in the emergency department of a pediatric division loaded with the cases where most of it explains the severity of the sudden accident. Countries such as Saudi Arabia where women have to take care of other family members, they are unable to take care of all offspring equally. Therefore, negligence of parents becomes a leading cause of high rate of morbidity and permanent impairment of organ in these countries. Since the anatomical development of the majority of children is undergrowth process, predominate cases are observed in the emergency department of pediatric division in the healthcare sector. With the minor injury, children younger than five years can experience permanent loss of organ or in a more severe situation die (Ryan et al. 2016). Statistical surveys and research literature provided the pieces of evidence of permanent paralysis, varying degree of disability and high morbidity rate in the emergency department of pediatric division (Price et al. 2015). However, the prevention of fall and injury of children younger than eight years require sound pediatric knowledge and intensive care according to the severity of the injury. Countries with low economic status, especially in rural area families are unable to treat their children in great facilities pediatric centers. Many severe cases remain untreated, and morbidity rate become extremely high. Therefore, this paper intends to focus on the injury that observed in children and cases received in the pediatric department. This paper will illustrate the leading causes of different pediatric injuries, their statistical surveys and safety measures taken by the pediatric department to prevent such injuries. 

Child injury now recognized as a global health problem that experienced by every developing country. The frequency of published articles and scientific databases reflects the clear picture of pediatric injury and the process of providing intensive care every year.  There has been tremendous growth in preventing those injuries in countries that have advanced technologies and superior infrastructure. In most of the scenario, the age between 1 to 14 years experiences an unintentional injury that either curable or permanently make them disable (Hildenbrand et al. 2015). A child who can sustain that traumatic injury eventually has to pay the significant cost regarding physical health along with mental health. The morbidity rate resulted from severe injury is high in those countries where medical expertise lack sound knowledge and intensive care. Poor infrastructures of health care centres also considered as the prime reason behind the high morbidity rate in developing countries (Kassam-Adams et al.). Therefore, studies about dealing with these injuries, their risk factors and possible consequences need a direction in planning the care procedure and implementation of appropriate care program. Injuries not only recognized in industrialized countries but also in oil-producing nations like Saudi Arabia. Eventually, hospital admission in the emergency department increases due to the high injury rate. Although, due to the intensive care provided by a nurse and medical experts discharge rate from the hospital also increases simultaneously. Within two years, the discharged rate in hospitals decreased by 30% (Al-Jadid  2013). The majority of the injury observed with boys than the girl in the emergency room. Approximately 69.9% of cases received by emergency departments are boys whereas only 30.1% of cases of injury received are girls (Edsberg et al. 2014). Most frequent cause of pediatric injury considered as poisoning, approximately 41% of the children showed by statistical evidence (Moghaddam et al.). Other common injuries frequently received by the emergency department of pediatrics are mostly suffocation, falls, drawings and burns in the age group less than five years. On the other hand, injury caused by road traffic or motor, vehicles accidents are spotted in the age group in between 5 to 9 years or 10 to 14 years (Alomar, Rouqi and Eldali  2016). Another official reason for these injuries is the low social, economic status of countries along with areas where technologies are extremely backdated. Most of the injuries are normal and do not require the assistance of high expertise, hospital staffs such as nurses can handle without difficulties, on the other hand, the intensive care needs in case of the motor vehicle injuries which leads to negative consequences such as fracture of bones and death.  

Pediatric injury because of falling and preventive measures

In the age group of fewer than five years most commonly experiences the injury because of falling from higher places. In most of the scenario, home is the place where the majority of the damage occurred due to lack of supervision or during playing with older siblings. In countries such as Saudi Arabia due to enlargement of families, mothers are unable to take care of the child since they have responsibilities of nourishment of other children (Grivna, Eid and Abu-zidam, 2013). Pieces of evidence from research journals and statistics also stated climbing, jumping, running and walking to explore the environment as a reason to fall (Al-Anazi, 2013). Majority of fall are non-fatal and children older than five years ended up having small cuts or bruises and fracture. Non-fatal falls are the significant burden on health care centers as the majority of nonfatal falls also raises question on the safety of children at home and prevention procedure of pediatric department. Children younger than five years mostly fall due to playing in the garden, changing of cribs, baby walkers, mats, bunk bed and that does not confirms the standard height for an infant (Mileva-Seitz et al. 2017). A fatal injury such as Deaths tends to observe in cases where a significant portion of brain damaged because of falling due to negligence. Infants younger than five years in low economic countries are at higher risk where the damages are beyond repair. Risks identified significantly in case of boys as they tend to more advantageous and keen to explore places beyond their capabilities. Children are at substantial risk of fall due to single parenthood, overcrowding of families, young maternal age, and superficial knowledge about care, low income and destabilized mental health and inequity in access of health care facilities (Mychasiuk et al., 2015). Therefore, as a preventive measure redesigning of nursery products such as cribs, bunk beds, cots should be recommended. Falling also prevented by taking care of the child and checking whether infants are going near the places with tremendous heights and whether they are running from slippery floors or long wet foot wears (Thomas et al.2016). When the pediatric department receives such cases in order to prevent falling it should be recommended to secure and supervise all the children with belts, use adequate lights and camera to monitoring the status of children. Besides, it should be recommended to nurses to be present within reach of patients and educate the family of patients about safety measures. Necessary items such as water, health drinks and another food item should be present within range to prevent the fall.

Pediatric injury due to chocking and suffocation

Chocking and suffocation are an essential cause of unintentional injuries and ranked as one of the leading cause of injuries in infants and toddler.  Approximately 40% of the damage estimated every year is from accidental choking and suffocating (AlBuhairan et al. 2015) Suffocation and chocking more likely observed in infant or toddler during swallowing any fluids or during sleeping. In families with overcrowded family members, siblings tend to take care of their younger siblings, and they feed infants inappropriate foods. Children cannot chew food effectively, and chewing mechanism is underdeveloped. Foods are having bones of fish, raw carrots, long slice of hot dog sometimes swallowed by a toddler and leads to choking vigorously (Borrie et al. 2015). They cannot also eliminate the episode of chocking. However, suffocation and chocking injuries are preventable, every year approximately 110 children treated with the excellent assistance in the emergency department. Sometimes toddler also suffocated due to sleeping habits and blocking of airways. Although the prevention rate is high in this case, statistical surveys represent a significant morbidity rate due to anoxic brain injury and oesophagal perforation (Rimensberger et al. 2015). The tendency of asphyxia also occurs in an age in between 1 to 14 due to enclosed space or trapped in old toy box and trunk of the car (Tamilarasu and Kumaravel 2017). Strangulation mostly occurs by curtains where interference of respiratory tract where neck or heads vigorously entrapped. Strangulation mainly leads to fatal injuries about 38% according to statistical surveys (Martin et al. 2014). Non-food items also predominately considered as one of the reasons why toddler admitted in the emergency department. Round and smooth objects are especially hazardous to keep near infants. Few toddlers tend to put random toys, coins into the mouth that leads to chocking. Swallowing coins are most of common causes department received every year (Denny, Hodges and Smith  2015). Lack of proper supervision and advanced treatment subsequently increases the chances of death. In order to prevent choking and suffocation, placing infants on the back should be recommended. It should be advised to clear stuffed toys and blanket to eliminate the chocking tendencies. It should be recommended to hospital authority to monitor the food habits of patients and nurses present to attend to the patient. It is the responsibility of hospital staffs and family members to supervise the pieces of food chewed by a toddler. When infants admitted to hospitals, hospital staffs should educate parents about the prevention of choking and strangulation. Clearing airways should be recommended and using plastic bags; other hazardous chocking materials should be reduced. It is also recommended to examine the breathing capabilities of a toddler to avoid further chocking.

Pediatric burn injuries are categories as one of the primary the reason of death where it affects millions of children every year. Burning further classified depending on the area of the burning and depth of burning. Injuries that cover most of the city of anatomy require manifestation by a multidisciplinary team and intensive therapeutic measures. Nearly all the burn injuries that tend to occur observed in infants less than five. Since infants have poor immunity power and recovery potentials, probabilities of sepsis and secondary diseases are exceptionally high. Most of the infants’ experiences burning injuries in a small portion of their body due to playing with crackers or other firing agents and do not require the assistance of medical expertise. Negligence of parents also holds a significant impact on the cases that the pediatric department receives. In many cases working women unable to take care of child as they have to balance work and households. Therefore, other members of family or babysitters incline to take care of infants and due to inattention infant tend to get injuries that can be major and minor. However, a minority of cases received by departments involves intense burning due to child abuse or vulnerabilities towards external hazardous factors. The statistical pieces of evidence represent approximately 3% of the cases where highly specialized centers and highly superior multidisciplinary team. Every day about two children dies from the burning injuries where 300 patients are admitted to the emergency room every day (Alqahtani 2018). Hot liquid, steam water and flame from the fire are most common causes of burning. After burning as a immediate response, vasoactive mediators and inflammatory markers and hormones are released. In subsequent stages, local and systematic capillary leak and eventually protein loss, internal oedema takes place. Immediate after injury, the drug binding centres become impaired and require intensive care. Therefore, the initial management of burning needs superior oxygenation, ventilation and a clear airway. To prevent burns in infants it should be recommended to focus on the well being of the child, especially when they are unable to make a rational decision for their immature actions.  Parents should be more attentive to their child in terms of their playing habits, their playing objects, their tendency to go near flames and their curiosity for exploring new things (Alomar, AlRouqi and Eldali 2016). When the pediatric department receives such cases, it should be recommended to monitor direct lungs injury and systematic toxicity (Al-Zahrani 2018). It should be recommended to the hospital department of intensive care to provide proper set up for oxygenation and ventilation; nurses should attentive towards patients. It should be advised to hospital staffs to clean the area of burning with soap or water, clear the fluid from blisters and apply the antimicrobial ointments. Minor burns generally do not require dressing, but significant burning cases need dressing time to time.

Home and surrounding environments are uncertain places where most of the toddler experience unintentional poisoning and subsequent death. Since, infants have a tendency of exploring objects without knowledge, in developing countries every year calls are made to poison the controlling division of the pediatric department. Intentional poisoning is uncommon but rare. In the house premises, most infants experience poisoning from household objects and natural objects in their surroundings. Global report of WHO shows the acute poisoning mostly observed in infants less than 15 years. Approximately 13% of children die because of unintentional poisoning in-between age group of 1 to 4 (Saleem et al. 2015). Morbidity rate also high in countries where economic status in low and they lack the expertise to lack to handle such cases. Rate of admission in hospital is too high in advanced nations. Moreover, time of discharge from the hospital also require longer time. However, families with low income are not able to afford the high-cost treatment of severe poisoning. Sometimes doctors may be unable to address the prime reason and interpret poisoning as other diseases. In that case, wrong medication increases the morbidity rate every year. Most common type of poisoning detected in children is fluid poisoning, which rapidly absorbed in the bowel and secures to prevent as well. Second common type of poisoning observed in a toddler is food poisoning, mostly due to poor immunity or wrong food habits. Parents sometimes leave infants to eat on their own; as a result, they ended up eating unusual objects that lead to poisoning. Sometimes, this will might lead to mild allergy, but in rare cases, it is fatal. Another leading cause of injuries from poisoning is drug poisoning, where most of the drug poisoning predominately observed in paracetamol and N- cysteine poisoning. It also depends on the immunity power of infants. When the interval is lengthy, chances of survival are high. If infants ingest drugs in stable for, onset reaction is slower than fluid poisoning. Subsequently, more time is available for neutralising poison and save the life. Very rare poisoning categories as fatal are snakebite and insect bite. Due to lack of expertise and sound knowledge, a significant number of failed cases observed as doctors were unable to address the reason behind poisoning and provide medication according to poisoning. Therefore, in order to prevent the injury and death from poisoning, it is recommended to parents to take account of objects that toddler put their mouth and also the food habits. When pediatric departments receive these kinds of cases, it should be recommended to hospital management to use substances such as acetic acid to reduce the toxicity of the poison (Alanazi, Al-Jeraisy and Salam 2016). Lowering of toxicity level also requires the involvement of ethanol or spirit. The antidote of that substance prescribe by hospital sometimes help to save many lives, but the degree of effectiveness varies with individuals. In countries like Saudi Arabia, UK, USA they manufacture paracetamol with the additional components of methionine to balance the overdose of paracetamol (Bakhaidar et al. 2015). Poison control division of pediatric department is the leading reason behind lower morbidity rate. It should be recommended to the hospital management to decontaminate the premises for poisoning patients It should be advised to discordant cloths as toxic waste, maintain oxygenation and ventilation. It should be recommended to medical experts to prescribe the medicines such as thiamine, naloxone and glucose to prevent further consequences.

Wounds endured in motor vehicle activity crashes are the driving cause of passing among children in countries such as Saudi Arabia. Studies show that children more than five years usually experience the motor vehicles. Injuries in infants are worse than similar kinds of damage observed in adults. As consequences, they face brain injuries and late-appearing problem related to psychology. Monitoring of these injuries is essential as with age it will give rise to neurological disorders. Many cases provide the potential pieces of evidence that toddler sitting in the front seat of the vehicle leads to injury beyond treatment. Sometimes school bus collided with other car leads to mass injury of infants or children more than ten years. Sitting positions, not using seat belts also consider as one of the reason that they experience trauma. Thirty-five per cent of the infants younger than two years seated in centre sear of the second row, therefore, they face vigorous injury and death. Mostly injuries due to sitting in front seat observed in children in between four to seven. Another factor arises from pieces of evidence, many teenagers with driving license drive car without informing their parents. Since, they lack the sense of driving, frequency of facing motor vehicle crash and injury increases every year exponentially. Drunk driving also leads to significant injuries. Many parents would drive the car while they are driving, in that case, if accidents happened, due to lower immunity infants mostly affected by it. In most of the scenario frontal lobe become defective, and some cases show spot death. To prevent such vehicle-related injuries, it should be recommended to keep a toddler in the back seat as long as possible. Toddler less than 1 or2 years should be carefully placed in rare facing seats. It should recommend not driving while drinking, instead drives carefully so that accidents by motor vehicle can be avoided.

Other injuries also considered as pediatric injuries but mostly they are mild and non-fatal. Many children tend to play barefoot, especially football in the ground. Therefore, mostly the damage that they face is nail prick injury. Countries such as Saudi Arabia encourages the vigorous physical injuries especially boys. Consequently, they experience the trauma of injury. Drowning in water is another leading cause of facing injury in younger age. Many other causes of damage can be prevented easily if parents and other members of family incline to take care of the infants carefully.

Conclusion

Thus, from above it can be concluded that pediatric injury is one of the leading cause of death in different countries. Negligence of parents and lack of appropriate knowledge is the prime reason behind these injuries, and high morbidity rate observed in all countries especially Saudi Arabia where most women are homemakers and have huge families. Most of the injuries can be successfully prevented by developing strategies to increase the educational system and knowledge in order to educate parents, medical experts and other staffs who handle these kinds of injury in the pediatric department. Medical experts also can organise a session where they directly able to talk to parents, know their emotional narrative, personal experiences related to injuries and give them the outline of injuries along with possible consequences of trauma. Many healthcare centres can promote how to prevent it by developing health care programme every year. They also encourage knowledge through social media, organising peer events, distributing peer events. More pediatric care centre built to avoid the morbidity rate and permanent impairment. The government of countries also plays a crucial role in preventing these kinds of fatal and non-fatal injuries. Government legislate rules to avoid injuries, also make health care policies to prevent such injuries. The government of the country also can make plans for the negligence of parents and hospital authorities to manage the severe loss of life. Safeties of infants are important, as they are not able to take care of themselves. By providing attention, nourishment and proper health benefits, the incidence of pediatric injury can be reduced.

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