Are FPCIs a source of increased risk for children? Results of a multicenter, experimental study comparing children's behaviour with FPCIs and toys

INTRODUCTION

Food Products Containing Inedibles (FPCIs) are believed to represent a source of higher choking risk in children. The aim of this study was to set up a controlled study, conducted on children aged 3-6 in a laboratory setting, in order to understand their behavior when interacting with FPCIs (with reference to mouthing activities, double nature recognition, and toy assembling ability).

METHOD

The experimental phase was divided into two sessions: a FPCI session and a Toy session, to which 247 children were randomly assigned. During these sessions children were observed in order to catch their mouthing activity according to the two types of objects available to them (FPCIs and Toys).

RESULTS

This study shows that: (a) children's behavior with respect to toys contained in FPCIs and toys presented alone is not significantly different; (b) children's ability to distinguish between the edible and non-edible part of the FPCI was very high; and (c) mouthing episodes of the inedible parts were negligible and comparable between FPCIs and toys presented alone. This strongly suggests that, with respect to choking risk, FPCIs are not per se distinguishable from toys containing small parts.

IMPACT ON INDUSTRY

Restrictions on the sale of FPCIs with small toys exist in the U.S. market. In Europe, FPCIs are allowed to be on sale, under the condition that, in case, they will follow the general regulatory requirements of small toys packaged and sold alone. In this case, they must provide age warnings and labels. Our findings do not justify the different attention that toys in FPCIs are at times afforded by regulators when compared to "stand alone" toys.

Resale of recalled children's products online: an examination of the world's largest yard sale

OBJECTIVE

To examine an online auction site for the presence and sale of children's products and toys previously recalled because of safety concerns.

METHODS

Targeted items were randomly selected from US Consumer Product Safety Commission (CPSC) press releases of recalled children's products dated 1992-2004. Auction listings from eBay were searched for the 150 targeted recalled items for 30 days. Item, seller, and buyer information were recorded from the auction listings.

RESULTS

190 auctions contained or were suspected to contain a recalled children's item from the target list. Most of the recalled items were listed for sale from addresses within the United States, with sellers from Canada, Australia, Great Britain, and Ireland also represented. On average, six bids were placed on each recalled item, with 70% of auctions eventuating in a sale.

CONCLUSIONS

Recalled children's products were found to be available for sale online and were sold most of the time, presenting a risk of injury to children. Although the CPSC is charged with notifying the public of recalled items, these results suggest that potentially hazardous products are recirculating online. A multi-front initiative to decrease the presence of hazards in online auctions is needed. This initiative should include increased manufacturer efforts to improve recall return rates, a requirement by online auction sites that sellers verify non-recall status before item posting, and parental checks of government recall websites before item purchase. Investigation of parental understanding and awareness of recalls and the potential risks associated with recall announcements is needed.

Severe retinal injuries from paintball projectiles

BACKGROUND

To determine the outcomes and circumstances of retinal injuries caused by blunt trauma from paintball pellet projectiles.

METHODS

Retrospective case series of all patients who presented with retinal injuries due to paintball-related trauma to 2 retina specialists in a clinical setting from 2004 to 2005. Patients were followed for a mean of 7.3 months, and retinal trauma was documented with retinal photographs and ocular coherence tomography as needed. Best corrected visual acuity (BCVA) was the main outcome measure.

RESULTS

Three eyes of 3 patients suffered severe retinal injuries after blunt trauma from a paintball pellet. Together, the 3 eyes demonstrated extensive retinal findings, including commotio retinae, choroidal rupture, and macular hole. BCVA at last follow-up ranged from 20/80 to hand motions.

INTERPRETATION

Our small case series indicates that retinal trauma from paintball injuries is not uncommon and results in severe long-term visual morbidity. The sale of paintball guns and pellets should be strictly prohibited for minors, and adults should be educated about the need for appropriate ocular protection and the potentially serious consequences of the use of these guns outside of commercial settings.

Paintball: dermatologic injuries

The popularity of paintball as an extreme sport has gained momentum in recent years. Injuries related to paintball are growing as the number of participants increases. An increasing percentage of paintball-related injuries have occurred in noncommercial settings, such as backyards. We report distinctive follicular stippling and annular scars resulting from paintball injuries in 2 males. Dermatologists may encounter paintball-related injuries during routinely scheduled visits for acne or nevi surveillance. Patients should be verbally reminded to use protective gear to prevent injuries.

Bungee cord-induced corneal lacerations correcting for myopic astigmatism

We present a patient with a refractive error of -3.00 -0.25x150 in the right eye and -3.50 -1.50x170 in the left eye who experienced bungee-cord-related corneal lacerations in the left eye. Slitlamp examination revealed a large radial corneal laceration in the vertical meridian and several smaller lacerations in the periphery. Corneal topography showed more central flattening in the left eye than in the right eye. Posttraumatic visual acuity in the left eye was 20/20 with a -1.50 diopter corrective lens. Myopic correction was a surprising outcome of a traumatic corneal laceration that produced a radial-keratotomy-like effect.

Cap gun burns in children

AIM

To document the frequency of cap gun burns in children and identify strategies for prevention of this mechanism of injury.

METHODS

Retrospective case note review of children under 16 years of age treated at The Children's Hospital at Westmead between January 1999 and December 2004 with burns secondary to toy cap guns.

RESULTS

Five boys were treated over the 5-year study period. None was supervised at the time of injury and in three cases the caps appeared to explode with minimal handling. All burn wounds healed without operative intervention and only one child suffered permanent sequelae from the burn injury.

CONCLUSION

Cap gun burns appear a rare mechanism of burn injury not previously reported. Recently produced caps may be more susceptible to spontaneous explosion. Adequate adult supervision may have prevented some of the injuries. There appears be a need for greater awareness regarding the dangers of these toys.

Heelys and street gliders injuries: a new type of pediatric injury

OBJECTIVES

Our goals were to highlight an increasing trend in orthopedic injuries in children as a result of "heeling" or "street gliding," to describe injuries sustained by children using Heelys (HSL, Carrollton, TX) and Street Gliders (Glowgadgets Ltd, Bristol, United Kingdom), and to increase public awareness and prevent such injuries.

PATIENTS AND METHODS

We prospectively recorded the data of all roller shoes injuries referred to our department during the summer school holiday. Using a data-collection sheet, we recorded demographic data, type of injury, mechanism and place of injury, heeling or street-gliding experience, use of safety equipment, methods of treatment, and intention to continue heeling or street gliding after recovery from injury.

RESULTS

Over a 10-week period, 67 children suffered orthopedic injuries while using Heelys or Street Gliders. There were 56 girls and 11 boys with a mean age of 9.6 years. Upper limbs were the most common location of injury. Distal radius fractures were the most prevalent, followed by supracondylar fractures, elbow dislocations, and hand fractures. The majority of children suffered the injury while heeling or street gliding outdoors. Interestingly, 20% of the injuries happened while trying Heelys or Street Gliders for the first time, and 36% of the injuries occurred while learning (using 1-5 times) how to use them. None of the children used any sort of protective gear at the time of the injury. The majority of the injured children expressed their intention to continue heeling or street gliding after complete recovery from their injury.

CONCLUSIONS

Our study shows that the majority of children with injuries from heeling or street gliding are girls. We recommend close supervision of children using Heelys or Street Gliders during the steep learning curve and usage of protective gear at all times. These new types of injuries have a serious impact on child health and constitute a burden for the pediatric orthopedic service.

Orthopedic Trauma From Recreational All-Terrain Vehicle Use in Central Kentucky: A 6-Year Review

BACKGROUND

All-terrain vehicle (ATV) crashes and injuries have become an increasing concern for the medical community. After the expiration of federal guidelines in 1998, the United States Consumer Product Safety Commission has tracked an increasing incidence of usage and injury. This retrospective review of data from a Level I trauma center presents ATV crash-related injury prevalence, type, and location sustained in central Kentucky and compares the data with previous reports.

METHODS

Patient demographics, helmet and alcohol use, insurance type, injury type and location, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, Functional Independence Measure (FIM), duration of hospital stay, days in an intensive care unit (ICU), internal disposition, and discharge destination were analyzed among individuals who had sustained ATV crash-related injuries between January 1998 and December 2003.

RESULTS

Patients were primarily male (85.4%), white (98%), resided in a rural county (85.1%), and relied on commercial insurance (36.2%) or self-pay (31.4%) for medical expenses. Alcohol use before injury was documented for 25% and 85.5% were not wearing a helmet. Rollover was the primary ATV crash mechanism (63.3%) and 52.1% of patients lost consciousness. Of 707 total injuries, 319 (45.1%) were fractures or dislocations with the spine (26%), ribs (24.1%), clavicle (6%), radius-ulna (5.3%), and tibia-fibula (4.7%) being the most common locations. Admitted patients were hospitalized for 8.1+/-12.7 days (range=0-127 days), 42% were transferred to the standard care ward, 28.2% spent 8.4+/-7.7 days (range=1-34 days) in the ICU, and 18.6% were taken directly to the operating room. At discharge 78.2% of patients went home, 12.8% were transferred to a rehabilitation facility, 4.8% died, and 3.2% were transferred to another hospital. Patients who never lost consciousness or who were discharged to home had lower ISSs and greater composite and component GCS and FIM scores.

CONCLUSION

Almost half of all patients sustained one fracture or joint dislocation with the spine being the most prevalent location. Injury severity, the low number referred to rehabilitation facilities, and predominantly rural residence locations suggests that many may not be accessing needed healthcare services. Prospective longitudinal outcome studies are needed to assess patient functional independence, quality of life, and health care system effectiveness.

Ocular findings following trauma from paintball sports

PURPOSE

To raise awareness of potential significant ocular damage and visual loss secondary to paintballs in those not wearing ocular protection and to report high incidence of chorioretinitis sclopetaria from paintball contusion.

METHODS

We reviewed cases of eye injury presenting to a single institution from 2000 to 2005. Those cases in which the injury was attributed to paintballs were identified and evaluated to determine ocular findings and visual prognosis.

RESULTS

Ocular paintball injuries occurred in eight male subjects and one female subject (nine eyes) with an average age of 16 years (range, 11-26). None had ocular protection at the time of ocular injury. On initial examination, vitreous haemorrhage was present in six eyes (67%), maculopathy, hyphema, cataract, and commotio retinae were each present in four eyes (44%). Two eyes suffered retinal detachment and one eye an optic nerve avulsion. Chorioretinitis sclopetaria occurred in four eyes (44%). The final visual acuity was > or =20/40 in three eyes, 20/50 to 20/150 in two eyes, and < or =20/200 in four eyes.

CONCLUSION

Injuries owing to paintballs can result in severe ocular damage and visual loss. Increased awareness and need for proper ocular protection should be emphasized by ophthalmologists. Chorioretinitis sclopetaria occurs with a high frequency and its presence should be recognized, as its management is different from retinal tear or detachment.

Cerebral infarct secondary to traumatic carotid artery dissection

Internal carotid artery dissection is an important cause of ischemic stroke in children and young patients. Children presenting with gross neurological abnormalities after blunt trauma to the head or neck should be considered to have sustained injury to the carotid arteries until proven otherwise. Treatment options include observation, anticoagulation and endovascular stenting, and aggressive surgical repair of the carotid artery injury. We present the case of a 7-year-old boy who had a dissection of his right internal carotid artery after a dangerous position of head upside down from a water slide.

Intestinal perforation caused by magnetic toys

Accidental ingestion of foreign bodies is a common problem in children, but ingestion of magnets is rare. When multiple magnets are ingested, they may attract each other through the intestinal walls, causing pressure necrosis, perforation, fistula formation, or intestinal obstruction; as has been reported in 13 cases in the past 10 years. We report the fifth case in the literature of intestinal perforation and fistula caused by the ingestion of 2 small magnetic pieces of a toy by a 3-year-old boy. We find it necessary that sanitary authorities give more information to parents and physicians about the potential risks of these magnetic toys.

Trends in fall injuries associated with children's outdoor climbing frames

Falls from publicly owned climbing equipment are often cited as the major cause of injury on children's outdoor playgrounds and have been the focus of substantial interventions in the UK since the early 1980s. Analysis of national data on falls from climbing frames for 1988 to 2002 shows that the main discernible trend during this period is an increase in the occurrence of injuries to the lower arm. Whether this is attributable to a behavioural response to some of the interventions, or to some other factor, is unknown.

Superhero-related injuries in paediatrics: a case series

Five cases of serious injuries to children wearing superhero costumes, involving extreme risk-taking behaviour, are presented here. Although children have always displayed behaviour seemingly unwise to the adult eye, the advent of superhero role models can give unrealistic expectations to the child, which may lead to serious injury. The children we saw have all had to contemplate on their way to hospital that they do not in fact possess superpowers. The inbuilt injury protection which some costumes possess is also discussed.

Not fun in the sun: playground safety in a heatwave

Two patients with severe palmar burns sustained from hot playground equipment during a heatwave are presented here, with a review of the management of palmar burn injuries.

Fractures in New Zealand elementary school settings

BACKGROUND

There is a need for greater international understanding of student safety in schools. This New Zealand study investigated the causes and school location of fractures sustained by students attending elementary school, with special emphasis on the types of fractures sustained following falls from playground equipment of various heights.

METHODS

Over a 1-year period, 76 participating schools (with a combined roll of over 25,000 students) completed a questionnaire about the nature and circumstances of student fractures sustained during regular school hours.

RESULTS

Some 118 students sustained a total of 131 fractures. Injuries from playground equipment were no more frequent than those from general activities at school, and most were sustained in falls from heights less than 59 inches. Most fractures were to the upper limbs. Fractures were found to vary by gender and school size.

CONCLUSIONS

The results are discussed in terms of the conditions and policies present in local schools, and the tension that exists in maintaining safety while offering appropriate challenges to students. Improvements in school safety may be more likely to result from a greater focus on the way that students interact at school, rather than on modifications to playground equipment.

Use of the ICECI and ICD-10 E-Coding structures to evaluate causes of head injury and concussion from sport and recreation participation in a school population

The purpose of this study was to identify the most common causes of head injury and associated symptoms of concussion in a population of school children (n=1,372,979). Using standardized injury report forms, we identified the mechanisms of head injury associated with various sports/recreation activities and assessed each injury for the presence of concussion symptoms. Head injury reports (n=7,765) were coded using the WHO's ICECI and ICD-10 E-codes. 1,338 Cases reported symptoms of concussion. The majority of head injuries occurred during School Free-Play/Recess (59.8%). Combative Sports and Wheeled Non-Motored Sports were the activities most often associated with concussion symptoms (rate of concussion (RC): 48.3% and 44.4%, respectively, p<0.001). School Free-Play/Recess and Physical Education Classes were significantly less likely to have head injuries associated with concussion (RC: 16.0%, p<0.001, and 12.4%, p=0.034, respectively). The most common causes of head injury were (1) Struck by an Object (24.9%) and (2) Falling on the Same Level (22.8%). Falling from a Transport was the only etiological code significantly associated with concussion symptoms after head injury (RC: 28.7%, p<.001). Results were similar when using the two coding structures in combination. Prevention efforts should focus on activities where children are moving at high speeds since these are more likely to cause a concussion when a head injury occurs.

Incidence of trampoline related pediatric fractures in a large district general hospital in the United Kingdom: lessons to be learnt

AIM

To test the observation that the incidence of trampoline related pediatric fractures is increasing-both nationally and in a large district general hospital.

METHOD

A retrospective analysis was undertaken of patient records establishing mechanism of injury of pediatric fractures over three consecutive summers from 2000-03. Theatre records of fractures treated operatively were used as the initial data source.

RESULTS

A statistically significant increase in trampoline related injuries was discovered. This reflects the rising incidence of injuries from national data and furthermore corresponds to the growing popularity of domestic use trampolines in the UK.

CONCLUSION

The incidence of injuries is increasing. There are lessons to be learnt from existing work from countries where trampoline prevalence has been greater for longer. The authors recommend various safety measures that may reduce children's injuries.