Regulatory and Educational Initiatives to Prevent Food Choking Injuries in Children: An Overview of the Current Approaches.

Choking injuries are one of the major causes of death among children ages 0-3, and most of these injuries are related to food. This work provides an overview of the current recommendations for food choking prevention and educational targets as a basis for developing a unified common set of knowledge for primary prevention policies development. Guidelines published by professional membership organizations and national governments in the English language were considered. All of these guidelines provide lists of hazardous food items and recommendations for food preparation to minimize choking hazard. Together with recommendations for food preparation, also recommendations aimed at stakeholders (food manufacturers, health care providers, and public authorities) are provided, underlining that this severe public health problem should be further addressed by adopting integrated public health interventions. Our overview stressed the importance of developing educational and primary prevention policies to sensitize adult supervisors and to regulate dangerous food products in the market.

'H-type' tracheoesophageal fistula in an infant: A case report.

Congenital isolated 'H-type' tracheoesophageal fistula (TOF) is a rare disorder which is difficult to diagnose. Clinical presentation is characterised by a triad consisting of paroxysmal coughing and cyanosis during feeds; recurrent chest infections and failure to thrive; and abdominal distention secondary to gaseous loading of the bowel. It is often difficult to diagnose 'H-type' TOF because the continuity of the oesophagus is not interrupted. The diagnosis is often missed or delayed, leading to complications such as chronic lung disease and failure to thrive.

Traumatic chylothorax in a young child: Case report and management.

INTRODUCTION: A chylothorax is an uncommon feature of paediatric chest trauma. CASE REPORT: We report a case of traumatic chylothorax following blunt chest trauma in an eight year-old girl with polytrauma after being hit by a motor vehicle. She was initially found to have a bilateral frontal skull fracture extending into the left parietal area, pulmonary contusions, left posterior rib fractures, left clavicular fracture and a degloving injury of her left foot. On the fifth day of her admission she developed progressive dyspnoea with signs of a pleural effusion, which was confirmed radiologically and drained by tube thoracostomy. Biochemical analysis confirmed chylothorax, which was managed conservatively with a fat free diet. The chest tube was removed after it stopped draining over 20 mL per 12 hours and she made a full recovery. DISCUSSION: Initial management of chylothorax is conservative with tube thoracostomy drainage and fat free diet. Traumatic chylothroax is a rare complication following chest trauma and can take days to develop and to become clinically apparent. It is therefore important to be vigilant for potential late complications in blunt chest trauma in children, especially if there are extensive rib fractures, a sign of major transmission of force to the thorax.

INTRODUCTION: Un chylothorax est une caractéristique clinique peu fréquente des traumatisme du thorax chez l'enfant. OBSERVATION: Nous signalons un cas de chylothorax traumatique suite à un traumatisme du thorax contondant chez une fillette de huit ans souffrant d'un polytraumatisme après avoir été percutée par un véhicule motorisé. Elle a d'abord été diagnostiquée avec une fracture frontale bilatérale du crâne s'étendant à la zone du pariétal gauche, des contusions pulmonaires, des fractures de la cage thoracique au niveau postérieur gauche, une fracture de la clavicule gauche et un dégantage du pied gauche. Au cinquième jour de son admission, elle a développé une dyspnée progressive avec des signes d'effusion pleurale, confirmée par radiologie, et drainée par tube de thoracostomie. Les analyses biochimiques ont confirmé un chylothorax, géré de manière conventionnelle par un régime sans matières grasses. Le drain thoracique a été retiré une fois le drainage passé à moins de 20 millilitres toutes les 12 heures et elle s'est totalement rétablie. DISCUSSION: La gestion initiale du chylothorax est conventionnelle, avec un drainage par tube de thoracostomie et un régime alimentaire sans matières grasses. Le chylothorax est une complication rare des traumatismes du thorax et peut mettre plusieurs jours à se développer et à apparaître cliniquement. Par conséquent, il est important de rester vigilant afin de détecter d'éventuelles complications tardives en cas de traumatisme du thorax contondant chez les enfants, notamment en cas de fractures graves de la cage thoracique, un signe de transmission de force majeure au niveau thoracique.

Pediatric trauma care in Africa: the evolution and challenges.

Childhood trauma is one of the major health problems in the world. Although pediatric trauma is a global phenomenon in low- and middle-income countries, sub-Saharan countries are disproportionally affected. We reviewed the available literature relevant to pediatric trauma in Africa using the MEDLINE database, local libraries, and personal contacts. A critical review of all cited sources was performed with an emphasis on the progress made over the past decades as well as the ongoing challenges in the prevention and management of childhood trauma. After discussing the epidemiology and spectrum of pediatric trauma, we focus on the way forward to reduce the burden of childhood injuries and improve the management and outcome of injured children in Africa.

Evaluation of pain incidence and pain management in a South African paediatric trauma unit.

OBJECTIVES. To evaluate pain incidence and pain management in a South African paediatric trauma unit, and to compare the usefulness of 5 different assessment tools. DESIGN. A prospective observational study, using the Numerical Rating Scale for pain (NRS pain), Numerical Rating Scale for anxiety (NRS anxiety), the Alder Hey Triage Pain Score (AHTPS), the COMFORT behaviour scale and the Touch Visual Pain Scale (TVPS). All patients were assessed at admission; those who were hospitalised were again assessed every 3 hours until discharge. RESULTS. A total of 165 patients, with a mean age of 5.3 years (range 0 - 13), were included. NRS scores were indicative of moderate to severe pain in 13.3% of the patients, and no pain in 24% at admission. Two-thirds of the patients received no analgesics; for them, NRS pain, AHTPS and TVP scores were lower than the scores for the other children. CONCLUSION. Pain and anxiety incidences in this paediatric trauma unit are relatively low. Implementation of a standard pain assessment tool in the emergency department triage system can improve pain management. The AHTPS is the most promising for use in non-Western settings.