20 May 2008

Shopping carts can kill

From shopping carts to lawn mowers, from escalators to ice-skating rinks, small children face a host of health hazards.

That's the conclusion of a series of four studies in the August issue of Pediatrics.

"We live in a world that has been designed by adults primarily for the convenience of adults, and the safety of children is often not thought of," said lead researcher Dr Gary Smith, director of the Centre for Injury Research and Policy at Nationwide Children's Hospital in Ohio. "That's why we have incompatibilities in the environment between children and everything from different types of consumer products to activities that put them at increased risk."

Kids should be strapped in
According to the first study, more than 20 000 children were treated in US emergency rooms for shopping cart-related injuries in 2005. About 3 percent of these children had to be admitted to a hospital, primarily because they weren't properly strapped in. Some deaths have even been reported.

Smith remembers one patient, about 3 or 4 years old, who was rushed to the emergency department with half his body paralysed and breathing that stopped periodically. Those are classic signs of herniation, when pressure builds inside the skull and forces the brain out through the base of the skull.

"He was minutes away from dying," said Smith, adding that he started paying attention to the problems posed by shopping carts and realised doctors were seeing one to two injuries a month resulting from seemingly routine trips to the grocery store.

Preventive measures do help
But simple preventive steps appear to help. When greeters posted at store entrances encouraged the use of child restraints (and gave out $2 coupons), correct use increased from 15 percent to 49 percent. The study involved children aged 5 and younger.

"The good news is that with a modest intervention, we were able to increase restraint use significantly and that's something stores should consider doing," Smith said. "The bad news is we were only able to increase it up to 50 percent, so half the kids are still being transported without appropriate restraint use."

"Even in the face of a pretty strong intervention, there were still 50 percent of the children unrestrained or improperly restrained," said Susan Cox, director of trauma services at Rady Children's Hospital and Health Centre in San Diego. "It certainly reinforces my conviction that parental and/or child education cannot be relied on as the only approach to injury prevention."

Another avenue for improvement would be differently designed carts that seat children closer to the floor and offer "passive protection," meaning the parent or caregiver does not have to do anything to ensure the child's safety. The study authors also called for stricter tip-over performance standards.

"Shopping cart design must be looked at," Cox said.

Lawn mowers take heavy toll
A second study in the journal found that an average of 9 400 children, 20 years old and younger, are treated in hospital emergency departments each year for lawn mower related injuries. One quarter of these children are younger than 5, and more than three-quarters (78 percent) are boys. The injuries include burns, fractures and even amputations.

"This is a wake-up call," said Dr Jonathan Groner, an associate professor of surgery at Ohio State University College of Medicine and Public Health, who was not involved with the research. "Lawn mowers are probably the most dangerous tool people have in their garage. The blade spins more than 100 miles per hour. We see horrible, devastating, mangling injuries."

Injuries occur when kids operate the mower, or ride on a parent's lap and fall off, into the blade, or when parents back up over a child. And these injuries are made worse by bacteria in grass that infect the wound, Groner said.

Many lawn mower injuries could be prevented by installing a more effective "no-mow-in-reverse" option, Smith said. Right now, an override button is too easily triggered. The override button should be positioned behind the operator's seat, Smith said. "Then they [parents] physically have to turn around and look behind them," he said. "I have personally taken care of kids who have lost a leg. It's the same story every time. We know what the problem is. We know how to fix it."

Escalators also carry risks
Other studies found that the most common escalator-related injury among children was a fall, followed by entrapment. Cuts were the most common injury linked to escalators. About 2 000 children are injured each year on one of 33 000 escalators in the United States; most of the children are younger than 5, the researchers found.

The study authors recommend that the gap between escalator steps and the sidewall be reduced. Also, young children should not be transported on a stroller while on an escalator.

The final study found that children are more likely to suffer head and facial injuries when ice skating than when roller-skating or in-line skating. Children should wear helmets and wrist guards when engaging in any of these activities but especially ice-skating, the researchers said. – (HealthDayNews)