My baby daughter, like a locust, is trying to eat the sitting room door. Now that she's teething, danger is everywhere. My older children's jumping beans resemble sweets, and in Tilly's chubby hands are potentially life threatening. I have dutifully had her jabbed against infectious diseases, only to be reminded by the Child Accident Prevention Trust last week that accidental injury is the biggest single cause of death in children. Launching a teaching resource on accident prevention for primary schools, Dr Tina Sajjanhar, a consultant paediatrician at Lewisham Hospital, London, warned that injuries cause the deaths of 500 children a year more than infections or genetically inherited diseases. Most of these accidents are preventable. Apart from road traffic accidents, children tend to be killed by falls from windows, drownings, burns and by swallowing poisons.
While cars, open windows, swimming pools and boiling water are rather obvious hazards, poisons are more subtle. They can pose as an adult's medicine, a household cleaning fluid or even mouthwash. A recent letter in the BMJ describes a three-year-old boy found collapsed at home by his mother. While waiting for an ambulance, she rather remarkably noticed that a bottle of mouthwash was missing from its usual place. The mouthwash contained 37 per cent alcohol (to kill, or at least confuse, bacteria). The alcohol made the boy's blood glucose level plummet and it took 10 hours for him to recover. "Mouthwashes," warn the letter's authors, Drs Tamsin Wade and Alison Gammon, of Stoke Mandeville Hospital in Buckinghamshire, "are usually highly palatable, brightly coloured, and readily available to young children. Manufacturers are not required to use child-proof containers."
When I worked in an accident and emergency department, children regularly came in having swallowed coins, which usually passed through without any trouble, as long as they didn't get stuck in the throat. I was once hugely relieved to see an anaesthetist sweep into casualty and scoop off a little girl who had got a tiny toy lodged in her windpipe. At that time, having no children, I was shocked to hear the child had been left to play on her own for a moment. "We went into the other room - it happened in a minute," the father said. To my shame I recall sternly lecturing them (as only a newly qualified, ignorant doctor can) on the dangers of leaving kids even for a second. Last night I found an easy-to-swallow 20p piece in Tilly's cot.
A survey of 3.8 million incidents of children swallowing things they shouldn't, published in the US journal Pediatrics, found that iron tablets were the single most frequent tablet taken by accident. A third of the unintentional poisonings also involved cosmetics and cleaning substances. Children were killed by mouthwashes containing alcohol and by nail varnish remover. Alkaline oven cleaners were also hazardous, in causing strictures of the oesophagus.
Dr Tina Sajjanhar has done her own survey at Lewisham Hospital's accident and emergency department. Her sample of 1,000 children also found that iron was the commonest cause of childhood poisoning. Iron can cause ulceration of the gut wall and can lead to internal bleeding, while absorbing a lot of it into the bloodstream can lead to kidney failure. The commonest scenario is for a toddler to take his pregnant mother's iron supplements. They look like nice red Smarties, and parents who might be vigilant about aspirin, may not realise iron's lethal potential. Other common admissions through the casualty department are children who have taken their grandparents' tablets. Paracetamol syrup is another favourite.
Essentially, children, particularly those under five, can swallow anything. Research papers tell of the effects on children of cleaning tablets for dentures (mild) and eating cigarette butts (common and can cause symptoms of nicotine rushes and vomiting).
There are a lot of qualified people working on how to stop children poisoning themselves. It's part of the remit of the government's Social Exclusion Unit to look at reducing accidental death in children.
While deaths from childhood injury are falling, there are steep social class gradients. Between 1981-1991 deaths from injury fell by 32 per cent in social class 1, compared with a fall of 2 per cent in social class 5. The social-class gradient for deaths due to injuries is steeper than for any other cause of death in childhood.