Most children who sustain burns recover without significant disability; however, burns remain the third leading cause of injury-related deaths in children ages 1 to 9. Estimation of morbidity is difficult to ascertain from databases. Physical scarring and emotional impact of disfiguring burns are longterm consequences of burn injuries.
About 92% of burns occur in the home. Prevention is possible by using smoke and fire alarms, having identifiable escape routes and a fire extinguisher, and reducing hot water temperature to 49°C (120°F). Immersion full-thickness burns develop after 1 second at 70°C (158°F), after 5 seconds at 60°C (140°F), after 30 seconds at 54.5°C (130°F), and after 10 minutes at 49°C (120°F).
The most common agents ingested by young children include cosmetics, personal care products, analgesics, and cleaning solutions. Fatal childhood poisonings are commonly caused by analgesics, antihistamines, sedative/hypnotics, and fumes/ gases/vapors.
More than 2 million human exposures are called in to poison control centers in the United States each year. More than half of all exposures are in children (63% in 2010) with a male predominance in children under 13, but a female predominance in adolescence. Most ingestions in young children are unintentional, with intentional ingestions becoming more common in children 13 and older. Most ingestions occur at home (91%) and are single substance (90%).
Any child who presents with unexplained symptoms including altered mental status, seizure, cardiovascular compromise, or metabolic abnormality should be considered to have ingested a poison until proven otherwise. A history and physical examination by someone who understands the signs and symptoms of various ingestions often provide sufficient clues to distinguish between toxic ingestion and organic disease (Table 45-1). Determination of all substances that the child was exposed to, type of medication, amount of medication, and time of exposure is crucial in directing interventions. Available data often are incomplete or inaccurate, requiring a careful physical examination and laboratory approach. A complete physical examination, including vital signs, is necessary. Certain complexes of symptoms and signs are relatively specific to a given class of drugs (toxidrome) (Table 45-2).
A poisoned child can exhibit any one of six basic clinical patterns: coma, toxicity, metabolic acidosis, heart rhythm aberrations, gastrointestinal symptoms, and seizures.
Coma is perhaps the most striking symptom of a poison ingestion, but it also may be seen as a result of several other causes including trauma, a cerebrovascular accident, asphyxia, or meningitis. A careful history and clinical examination are needed to distinguish among these alternatives.
Hydrocarbon ingestion occasionally may result in systemic toxicity, but more often it leads to pulmonary toxicity. Hydrocarbons with low viscosity, low surface tension, and high volatility pose the greatest risk of producing aspiration pneumonia; however, when swallowed, they pose no risk unless emesis is induced. Emesis or lavage should not be initiated in a child who has ingested volatile hydrocarbons.
Caustic ingestions may cause dysphagia, epigastric pain, oral mucosal burns, and low-grade fever. Patients with esophageal lesions may have no oral burns or may have significant signs and symptoms. Treatment depends on the agent ingested and the presence or absence of esophageal injury. Alkali agents may be solid, granular, or liquid. Liquid agents are tasteless and produce full-thickness liquefaction necrosis of the esophagus or oropharynx. When the esophageal lesions heal, strictures form. Ingestion of these agents also creates a long-term risk of esophageal carcinoma. Treatment includes antibiotics if there are signs of infection and dilation of late-forming (2 to 3 weeks later) strictures.