Two Minutes on The Changing Table. What a Parent Needs to Know About Children’s Trauma

Pediatrician Svetlana Valiullina speaks about dangerous wardrobes, ice slides and walks on abandoned buildings.
Alena Kork | 12 September 2020
Two Minutes on The Changing Table. What a Parent Needs to Know About Children’s Trauma

Mom left the baby on the changing table for a couple of minutes, and he fell. A three-year-old child dropped the TV on himself. A 10-year-old boy braked unsuccessfully on a bicycle and suffered a ruptured spleen. A 14-year-old teenager climbed onto the roof of an electric train to shoot an extreme video, could not stay on a moving carriage and received a severe head injury. Traumatologists have hundreds of such stories.

 

Svetlana Valiullina, pediatrician, first deputy director of the Research Institute of Emergency Pediatric Surgery and Traumatology, chief children’s rehabilitation therapist in Moscow, told Pravmir what injuries children of different ages can get and why parents cannot relax if there are babies in the house.

Dysplastic Children and Special Trauma

– How often do babies get injured? Usually parents take special care of them, how does it happen that babies are injured?

Svetlana Valiullina

– More than 3.5 million children in Russia are injured every year. Household injury prevails: about 450 thousand children are hospitalized from home and from the outside. Among those hospitalized, 3-5% are children with severe trauma requiring long-term treatment and multi-stage rehabilitation. Among severe childhood injuries, more than half are injuries after road accidents, followed by falling out of windows, riding down slides, diving, injuries on motorcycles, mopeds and others.

All childhood injuries, of course, happen through the fault of adults: due to oversight, inattention. No one can be calm when there is a small child in the house. Although the baby should fall, gain experience, get his scratches and bumps. The question is how and where he will fall, how hard he will hit.

Children have a reduced sense of responsibility, they do not understand the consequences of their actions, this should always be remembered. And not only kids, but also teenagers. A 16-year-old girl came to us, she quarreled with her boyfriend, sat on the fifth floor window and jumped down.

I thought I would only break an arm or a leg, and he would look after me,” she said afterwards. And, of course, she broke not an arm or a leg, but her back. And spinal injuries often turn into disability for life.

Therefore, if looking after children is important, then it is more important to have mutual trust and warm contacts with teenagers.

– Can we say that recently there have been more injuries due to screen addiction? The child is playing while the mother is looking into the phone.

– We did not study this issue specially and do not have such data. And it doesn’t matter what the parents are distracted by. The child can be left in the room for only five minutes and he turns something over. The kids need to be constantly watched, we remind parents about this all the time.

– What injuries usually occur in children under one year old?

– Falls from changing tables, sofas, beds, strollers, high chairs. Parents underestimate that a child can roll over at the age of up to three months, and it is impossible to leave him unattended even for a couple of minutes.

We have heard such stories, a mother says: “He does not roll over yet, how could he fall?” We cannot hope that since the child does not yet know how to roll over, then he is safe.

– In young children, the head outweighs the body. Are these falls dangerous for the brain in the first place? Why is it dangerous, what is the threat?

– The head of children under one year old occupies a fourth of the body. And if a child falls from a height, then usually falls head down. Older children may unsuccessfully slide off the couch and fall onto their backs, but this is less common.

Why is it dangerous? In children, all organs grow, which means that they are strongly supplied with blood, their vessels are still malleable. And in children, the brain does not yet occupy the entire cranium, it moves inside it. And with any blows, sudden movements, the brain can hit the skull, which can lead to bruises and hemorrhages.

You know, even falling off the couch can lead to death, especially if the child has an undiagnosed vascular pathology. This is rare, of course, but it happens. In other words, any fall can end in disaster and have irreversible consequences.

– It can have the negative consequences for development, study as well, can’t it?

– Anything can happen. Young children have thin bones of the skull, it is easily injured. But at the same time, the injury itself can be tolerated easily. The child can recover quickly and will not show any neurological symptoms. This quick recovery is a feature of childhood, by the way.

But the trauma can manifest itself later, at school age: the child can’t catch up with classmates, does not understand, reads slowly, his attention is reduced, in a word, various cognitive problems appear. Headaches recur. Or, on the contrary, the child is disinhibited, hyperactive, different symptoms, up to aggression and mental disorders can take place.

Each area of ​​the brain is responsible for certain functions of the body. Depending on the damage to any zone, there will be certain consequences. It is important to remember: any blow to the head can lead to irreversible consequences, so you shouldn’t neglect them, it is better for parents to immediately consult a doctor.

– Does it mean that fractures of the arms and legs are not so dangerous against this background? Do they heal faster in children?

– Usually it takes 3-4 weeks. But because of the plaster, stiffness in the joints, a decrease in muscle mass can occur, then the limb will have to be trained. The injury can be complex – comminuted, or a helical fracture, with displacement.

Another point is that children grow very quickly, bones are stretched, and muscles and ligaments do not keep pace with them. And such dysplastic children have some peculiarities in the nature of injury and subsequent recovery.

– Do falls from slings happen?

– Of course, theoretically, this is possible, and parents always need to be on the alert. But I don’t remember such cases. These devices are quite safe and useful for the child: the baby feels close contact with the mother, feels her smell, protection.

– Can the carry cot be dangerous? For example, a child is carried in such a carry cot, and he receives craniocerebral injuries from impacts on corners, stairs, he can be pinched by the door. How often does this happen?

– Yes, there are such children admitted here. Carry cots often break, and parents do not always immediately pay attention to this. It happens that the parent put the child in the carry cot without checking it, and it broke in his arms, the child fell. Hitting the corners of doors or jambs also happens, mainly due to inattention.

An attentive parent carries the carry cot in front of him to see the baby and control every step.

– How often do children get stuck between the bars of the bed with their heads? And with their feet?

– Usually children get stuck with their feet and it happens quite often. If the child has been in this position for a long time, edema and soreness may occur. Fractures occur less often, there should still be a mechanical shock, it is hard to break one’s own leg.

Children get stuck with their heads in the rods of the crib less often, but sometimes they wedge their heads in the fences in the garden plot. This can cause asphyxiation, suffocation.

In the baby’s crib, soft sides will protect, such protection is useful in general: when the child learns to get up, he will hit the soft when falling. And of course, you need to monitor the child on the garden plot.

Children Often Drop Cabinets on Themselves

– Do falls from windows happen both inside the apartment and into the outside world? Are there any falls from the first floor? Parents are relaxed, they say, children on the first floor are not in danger, but this is not so. What are the risks of falling from windows?

– Children mostly fall out. The window always attracts attention, it you bring a child of any age to the window, whether he is three months old or a year old, he will always be interested in what is happening there.

We are faced with the fact that parents themselves begin to put their children on the windows: he is still breastfeeding, and already standing at the window. We have had so many cases when 9-10-month-old children fell out of the windows. All of them were put on the windows by their parents.

There are often sofas and armchairs near the windows, from which the child can easily climb onto the window. Children who know how to walk bring the stools and chairs to the windows and climb onto the windowsills. Parents believe in mosquito nets, but this is an imaginary protection, it does not support the child’s weight and is not fixed in any way.

Each country resolves this issue in its own way. In America, a child will not be discharged from a maternity hospital if there are no bars installed on the windows of the house above the first floor. The Germans install locking devices. In England, children do not fall out of windows at all, their windows are designed in such a way that they do not swing open.

Russia does not yet have such a state program, but we, together with Leonid Mikhailovich Roshal and the Presidential Commissioner for Children’s Rights Anna Kuznetsova, are working on it. After all, even simple protective devices can save a child’s life and improve the quality of life in a family.

– Sometimes we come across stories in the media of how children fell from a great height and did not receive any injuries. Why? Is it a feature of the child’s body?

– Yes, we call them “children with wings”, even children who fell from the 13th floor were brought to us.

Parents told how they rush down in shock, and the child sits on the ground and plays.

These are inexplicable things from the point of view of medicine, you should not be guided by them.

But it happens that a child fell from his height and received a severe head injury incompatible with life.

– What harm and injury can dynamic gymnastics cause? What exercises do you consider the most dangerous?

– With any sudden movement, the brain inside the child’s skull will move. After rough throwing upwards, they brought to us babies with the most powerful bruises, that is, the brain was injured inside the skull from impacts on the cranium during the throwing up.

As for the arms and legs, in young children, neither the ligamentous, nor the muscular apparatus, nor the bone structure are properly formed: the child has a growing organism. And you can quickly injure a child’s arm and leg with such dynamic gymnastics.

With the child, you need to do gymnastics, swimming, but very carefully, without jerking, smoothly.

– Is it safe to hold the child upside down?

– It is usual for an infant to be upside down, because the child in the belly turns, but spends most of the time with his legs up and head down. Therefore, children often love this exercise.

But I repeat: it is important to avoid any sharp body movements, there should be no jerks, tosses, sharp swinging from side to side. Everything should be very smooth.

– At what age do falls from stairs in duplex apartments and houses usually happen? Probably they happen when children already know how to walk and master the world with their feet, don’t they?

– They happen, but not often. Parents mostly monitor the stairs, put partitions. Cases of children falling head over heels down the stairs are rare. When children still walk unstably at the age of a year or two just falls from a height usually happen.

– Are the pinched fingers also more typical for the “age of researchers”? Can they lead to serious consequences up to amputation?

– The child grows up and shows curiosity about everything he sees, puts his hands everywhere. All pediatricians emphasize: when a child begins to walk, you need to monitor him especially carefully. All doors must be fitted with stops.

Children came to us not only with completely broken, but also torn off fingers. Sometimes it came to amputation. There are many such cases: a child approached the car with the doors ajar, while adults were busy talking, the child pinched his fingers.

– How often do children drop heavy things on themselves? Can a child really drop a wardrobe on himself? Do I need to screw the furniture if there is a baby in the house?

– Such stories often happen, too. Large objects not attached to the wall are potentially hazardous. Here is my advice: in a home with small children, furniture should be attached to the walls.

Children often drop cabinets on themselves. If there are shelves in the closet, children perceive them as a ladder, try to climb in and bring down the entire closet on themselves. And if the closet remains standing, then the shelves can fall on the child along with all the contents.

Here we also include “television trauma”. A child is always interested in TV because of moving pictures. The child steps on the bottom shelf of the cabinet and knocks over this cabinet with the TV. This is usually a very serious injury, several times a year we meet children with broken faces and injuries to the skull. Our oral and maxillofacial surgeons work wonders at times.

Therefore, if there is a baby in the house, we recommend hanging the TV on the wall.

– Slides in playgrounds are often traumatic due to sharp bends and differences in height. Is it possible to get spinal injuries, severe bruises of the tailbone on such slides?

– It is possible, usually after such unsuccessful rolls there is an uncomplicated compression fracture of the spine or coccyx. Slides with serpentines are also dangerous, a small child can be thrown out by centrifugal force. But this rarely happens if the slide is designed correctly.

– What are the dangers of ice slides?

– Winter is coming, and the donut tubes season begins. This is a very dangerous game, you should ride on donut tubes only in places that are suitable for this. Parents must learn this rule by heart.

The main danger of a donut tube is uncontrollability. If a child is carried on a donut tube on a tree or a post, he cannot slow down or turn. From a sharp impact on a tree, you can be disabled or die. With a sharp descent, the child may not be able to stay in the tube and may be thrown out of it, which also threatens with severe cranial injuries and fractures.

Ice skids or sleds are not so scary, they are more controllable. And donut tubes can be dangerous at home too. We had a case: children were jumping on a cheesecake in the house, it was torn. The 20-month-old child was thrown to the ceiling by the air stream and fell to the stone floor, seriously injured.

He flies on the Steering Wheel, Getting Hit on the Liver

– Trampolines are the favorite summer entertainment. What age children are most often injured and how do they get injuries?

– How can a child live without jumping? Jumping is not very useful for adults, because their joints are not as they used to be. And children love to jump, although jumping from a height can lead to a depressed fracture of the spine, with unsuccessful jumps, you can land on your back and damage it.

Trampolines usually cause injuries if a lot of children gather at the same time. Most children today are dysplastic, their bones grow faster than muscles with ligaments. Due to the fact that the ligamentous apparatus does not keep up with the bones, there may be fractures. On trampolines, uncomplicated compression fractures of the spine usually occur, vertebrae are displaced, sometimes children knock out teeth, not to mention abrasions, bruises and sprains.

Often, children are injured when the trampoline is folded. Usually such cases are made public, they have a public resonance. A loose trampoline can be knocked over by the wind. The trampoline must have a side surface, otherwise the child may be thrown onto the asphalt.

– What kind of dangerous and not very dangerous injuries can bicycles and rollers lead to?

– With the onset of warmth, many such children are brought to us. Falling from a bicycle, children often get head injuries, break their arms and legs.

But abdominal injuries often happen, too. With sudden braking, the child flies on the steering wheel, receiving blows to the liver, spleen and kidneys. From strong blows, these organs can not only be injured, but also tear, sometimes the spleen or kidney has to be removed.

Therefore, fans of bicycles, scooters, balance bikes need to ride wearing a helmet, knee pads and special vests.

– What other street injuries are there?

– Children not only fall off the swing, but can also suffocate by entangling their heads in the ropes of the swing. Sometimes children on swings and playgrounds get caught in scarves, which also leads to suffocation. Children and adolescents suffer from road accidents and fights.

– Many teenagers, in an effort to gain views and collect likes, post extreme videos – jumping on the roofs of electric trains, adventures in abandoned buildings. Can we say that there are more such cases now?

– There have always been fans of extreme sports, but today there are especially many of them because of social networks.

In order to post a photo on the web and get approval, teens risk their lives. And sometimes there is simply not enough adrenaline.

Children take selfies both on high-rise objects and on moving trains. And electric trains mean not only speed, but also high-voltage wires. We have two such hook-up friends now. A teenager on the train gets an electric shock, he falls and breaks his neck.

Teenagers love to dive in unsuitable places, getting injured in the cervical spine. There are also sports injuries. It is good that recently, among children practicing sambo in sections and at competitions, a fighting technique with a coup and falling on the head was banned. Sambo wrestlers often came to us previously.

Teenagers get injured on scooters, get into traffic accidents and come to us with serious injuries. Recently, a girl was hit by a drunk driver at 11 pm on a forest road. What was she doing alone in the woods at such a time?

– For what symptoms do you need to call an ambulance or go to the emergency room?

– In all, of course, if there was an injury. Better to come and exclude everything, rather than suffer the consequences later. If a child hits his head, back, faints, his breath stops, if there is swelling in his arms or legs, if the child cannot stand upright, falls over, then it is imperative to consult a doctor immediately.

I would also like to note: parents should not only be attentive to children, they should teach them to fall correctly, to group. Traumatologists and rehabilitation therapists can also teach this. We also need government prevention programs.

In Japan, there are many such videos with a 25th frame embedded. What they see is deposited in the subconscious, and people correctly group their bodies when they fall. This can be learned at any age.

Translated by Alyona Malafeeva

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