Keeping children safe at home during the MCO period

Be especially alert about what your child is doing during this MCO period. — Filepic

A one-and-a-half-year-old girl was brought into the hospital's emergency department near midnight after ingesting almost a whole bottle of salbutamol (used to treat asthma). She saw the “cough” medicine being given to her sister, then later stood on a chair and reached for the medication kept in a cabinet.

This was the third accidental drug ingestion in five days. Previously, a three-year-old boy who is possibly on the autism spectrum took his uncle's pill for a chronic infection that had been left on a table. A two-year-old boy with global developmental delay picked up a bottle of loosely capped eucalyptus oil and it splashed over his face; he turned cyanotic (blue in the face), accompanied by rapid breathing and drowsiness and soon developed pneumonitis (inflammation of the lung tissue because of inhalation).

Accidents like these seem to have become by-products of the movement control order (MCO) that has been imposed to curb the Covid-19 outbreak. We are unsure of how many accidents of this nature have occurred in the country, especially now that we know people are avoiding emergency departments and clinics.

But they would not come as a surprise to any medical professional. We know that accidents at home – including accidental ingestion of drugs and poisons – are common among young children.

During the past month of the MCO period, children who are normally cared for in a preschool or nursery or by a babysitter have been forced to remain home and are potentially less supervised – especially if parents have to work from home. The safety of this vulnerable group may be neglected.

We don’t know when exactly the MCO will be lifted so this situation could continue for some time. As such, it would be good to learn strategies on child injury prevention.

Preventive measures

> Do not take medicine in front of children because children will learn and copy what you do.

> Keep all alcohol, drugs and poisons out of sight. Store all medicines (and button batteries) in a locked space that is high up – remember, children are good at climbing to reach for things they are curious about.

> Do not store medicines in handbags.

> Only buy medications that are packaged as pellets in a foil strip or in bottles with a safety cap. Medicines should no longer be sold loose in plastic bags. Do not remove tablet/capsule pellets from their foil packaging or re-bottle them in an easy-to-open bottle or plastic bag. These measures will minimise the harm caused in case the children do get hold of the medicines – rather than being able to swallow a handful, they would have to peel the tablets/capsules out one by one.

> Most medicines can be stored at room temperature so they do not need to be kept in a fridge where children can access them; discard any unfinished syrup medicines – they should not be kept for future use.

> Do not keep cleaning agents such as detergents, dishwashing soap or antiseptics under the kitchen sink or in unlocked cupboards.

> Keep cleaning agents in their original containers with the product labels intact; do not re-bottle them in mineral water or soda bottles – even adults can make mistakes and drink them accidentally.

> Store all other poisonous products such as gasoline, pesticides, or paints properly in a locked store in the garden/workplace that children cannot access.

> Only allow your child to play with toys suitable for his age and repair any broken toys or replace them to prevent choking on parts.

> Do not scatter small objects such as coins, buttons, beads about – keep them away from young children.

How to know you child may have ingested a drug or posion

Drug/poison ingestion can mimic general illness in children, which includes vomiting, difficulty in breathing and drowsiness. There may be redness around the mouth and/or lips, stains on clothing, or breath that smells like chemicals.

If the child or his siblings report the accident, do not disregard them. Be alert for clues such as empty pill bottles or packages, scattered pills, or an open toy with its battery missing.

What to do in case of drug/poison ingestion

> Get more adults to help.

> Remember “DR ABC”: Danger removal, check for child's Response, and assess the Airway, Breathing and Circulation.

> Remove the child from any further danger, such as anything remaining in the child's mouth or contaminated clothing (do wash your hands if it is a poison).

> If the skin is involved, rinse the skin for 15 to 20 minutes in a shower or with a hose. If the eyes are involved, gently flush the eyes with lukewarm water for 20 minutes.

> Check for the child's response. If he seems well, remain calm and take him to seek medical attention immediately.

> If the child vomits, turn his head to the side to prevent choking.

> If the child is unresponsive or has the following signs, ensure someone is calling for an ambulance: drowsy or unconscious, difficulty breathing or has stopped breathing, uncontrollably restless or agitated, has seizures or fits.

> If the child shows no signs of life – ie, he is not moving, breathing or coughing – begin cardiopulmonary resuscitation (CPR) and continue until the ambulance or more help arrives. (During this MCO period, when you have some free time at home, learning CPR techniques from a reliable online source is worthwhile.)

> Try to provide the doctor or ambulance officer with an accurate time the child may have ingested the drugs or chemicals (or button batteries). Bring along the original bottle or medicine package even if they are empty.

> Make sure you know and can communicate these details: The child's age and weight and his general health condition (ie, is he on any long-term medication).

What you shouldn’t do

Do not take any of the following actions – they are useless and could cause more harm:

> Do not induce vomiting.

> Do not insert metal objects/fingers into the mouth if the child is having a seizure.

> Do not pinch the philtrum or heels attempting to wake up the child.

> If the child is otherwise looking well, take him to the nearest clinic as soon as possible. Do not try to perform any traditional remedy at home, which causes further delay in medical treatment.

> Do not blame or punish the child or his siblings – it is vital to remain calm, as a scared parent and child will only lead to more harm, such as accidents on the road to the hospital/clinic.

Spend this MCO period wisely at home with your children. Identify potential dangers in the home and teach children about them.

PROF DR TOH TECK HOCK & AARON TOH AW ZIEN

Note: Dr Toh is a consultant paediatrician and adjunct professor at a university in Sibu, Sarawak, and Aaron Toh is a first year medical student