Increased risk of unintentional injury in Autism spectrum individuals.
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As we all know children live in a world made by and for adults . Their developmental stages in physical, cognitive, psychological and social abilities that influence curiosity, perception, risk taking behaviour, judgement etc make them susceptible to injuries. The cognitive abilities of children are lesser than that of adults as their motor and nervous functions are still developing.
We know that Autism is a spectrum of disorders and only a few individuals in the spectrum are extremely coordinated in their fine motor control. There are a section of people who are less coordinated and need a full time care taker . This blog is intended towards caretakers of those individuals.
Lack of motor skills ,coordination and communication can manifest as not being able to catch oneself up to escape a danger as quickly as others, as in the case of a suffocating situation. High levels of epilepsy rate makes a spectrum individual more prone to accidents. The likelihood of developing epilepsy increases with age in people with spectrum disorders as many studies have shown.
Lack of social acceptance, camouflaging, and bullying are leading causes for intentional accidents and suicides among certain individuals.Drowning due to lack of life skills is one major cause of death among children since they have an affinity to play with water as it is quite calming for them.
Let's have a look at the factors that make the spectrum individuals more prone to injuries .
The medical fraternity is quite familiar with parents reporting spectrum children requiring medical attention due to injury accidents or poisoning. This usually is a result of comprehension issues, seizures asthma or sensory motor deficits. It is quite note worthy to analyse ,if lack of attention is the major cause which predisposes spectrum individuals to injury as a major fraction of them meet the criteria for ADHD as well. Hearing problems , Visual impairment ,delayed language development all contribute to the occurance of injury. Some of the individuals are hyperactive and more mobile coupled with lack of attention and a fraction of them shows self-injurious nature due to comorbidities too.
Reported injuries and accidents from parents.
* Ingestion of non edibles like coins ,cells ,plastic materials,detergents,silica etc
*Drinking kerosene,turpentine ,coloured cleaning liquids
*Eating medicines like thyroid hormones,anticonvulsants,tranquilizers,Resperidone,menstrual cramp pills,analgesics,oral contraceptives etc
*Drinking unprotected lab chemicals and corrosives from schools without proper labeling and storage facilities
*Ingestion of pesticides,rat poisons,organophosphorus compounds,mosquito repellents etc
*Breaking glass windows with bare hands
*Infants falling into semiautomatic washing machines as they love watching spinning..
*Touching high speed spinning objects like table fans or ceiling fans.
*Elopement or walking away from home to explore nature
*Drowing in water body or pool
*Peeping into wells and falling from heights due to lack of proprioception followed by fractures or death.
*Seizure related injuries
*Touching hot objects,boiled water/steam injuries
*Flushing objects down the sink or toilet.
The medical fraternity is quite familiar with parents reporting spectrum children requiring medical attention due to injury accidents or poisoning. This usually is a result of comprehension issues, seizures asthma or sensory motor deficits. It is quite note worthy to analyse ,if lack of attention is the major cause which predisposes spectrum individuals to injury as a major fraction of them meet the criteria for ADHD as well. Hearing problems , Visual impairment ,delayed language development all contribute to the occurance of injury. Some of the individuals are hyperactive and more mobile coupled with lack of attention and a fraction of them shows self-injurious nature due to comorbidities too.
Reported injuries and accidents from parents.
* Ingestion of non edibles like coins ,cells ,plastic materials,detergents,silica etc
*Drinking kerosene,turpentine ,coloured cleaning liquids
*Eating medicines like thyroid hormones,anticonvulsants,tranquilizers,Resperidone,menstrual cramp pills,analgesics,oral contraceptives etc
*Drinking unprotected lab chemicals and corrosives from schools without proper labeling and storage facilities
*Ingestion of pesticides,rat poisons,organophosphorus compounds,mosquito repellents etc
*Breaking glass windows with bare hands
*Infants falling into semiautomatic washing machines as they love watching spinning..
*Touching high speed spinning objects like table fans or ceiling fans.
*Elopement or walking away from home to explore nature
*Drowing in water body or pool
*Peeping into wells and falling from heights due to lack of proprioception followed by fractures or death.
*Seizure related injuries
*Touching hot objects,boiled water/steam injuries
*Flushing objects down the sink or toilet.
Disaster Preparedness Measures
Giving attention to an individual 24/7 is a herculean task. Majority of these accidents have happened in the presence of the parent or caregiver,though not all. Blaming the parents is no remedy for a problem.Instead, discussing on how ,we can be more cautious and have a prolonged life considering the accidents listed above is more important..
The discussion revealed:-
*Placing locks for doors and cabinets
*Labelling objects with danger sign
*Placing an alarm in the child's room and set a few rules for using them
*Eliminate the chances that will allow a child to climb and take something kept high.
*If the child has a wandering tendency,its always advisable to alert the neighbours and police
*Use safety locks to secure items that are unsafe for the individual.
*Visual labels,words,photos and stop signs are quite useful
*Always give safe PET items for use than metal items Eg :- forks
*Open bottles can be substituted by pump dispensers,as a measure to prevent swallowing the whole content of the bottle.
*Social stories of smoke detectors,fire extinguishers etc might help
*Use an ID bracelet for wanderes.
Snippets
* Nirmala, special educator(Chennai) and parent of a 21 year old in the spectrum, revealed her experiences of encountering spectrum children drinking kerosene kept in a mineral water bottle. She explained that safety is an abstract concept and that it should be categorised and taught. Road safety and kitchen safety can be taught first hand if possible. She observed that, contrary to the belief that social stories help , some children may not escape danger when met in real life even after learning safety through social stories.This could be due to lack of proper comprehension, communication difficulties, sensory issues, attention-deficits etc. It could be also due to the reaction time required for the spectrum individuals to respond.
* Nirmala, special educator(Chennai) and parent of a 21 year old in the spectrum, revealed her experiences of encountering spectrum children drinking kerosene kept in a mineral water bottle. She explained that safety is an abstract concept and that it should be categorised and taught. Road safety and kitchen safety can be taught first hand if possible. She observed that, contrary to the belief that social stories help , some children may not escape danger when met in real life even after learning safety through social stories.This could be due to lack of proper comprehension, communication difficulties, sensory issues, attention-deficits etc. It could be also due to the reaction time required for the spectrum individuals to respond.
*Vinay Badam ,parent suggested to teach contact numbers in the form of rhymes as some children easily learn that way.He also expressed his fear and concern,using tracking devices like GPS watches,for strangers harming the kids to acquire the devices.
*Sheba Luiz,special educator,Kochi, pointed out that ,accidents can happen to anyone at anytime."As parents, we need to be prepared for it and also train our children in basic first aid.In case of accidental ingestion of poison/drugs, giving activated charcoal helps (except for thinners and corrosives). Activated charcoal keeps swallowed drugs and poison from being absorbed from the gut to the bloodstream. It is a highly effective treatment for many poisons. Remember to give it within an hour of ingestion. Keeping a packet or two of activated charcoal at home will come in handy in case of an emergency.
First aid - showing the children how to wash the wound with soap and water, how to put the medicine, cover the wound with cotton and keeping it in place with a micropore tape. Labeling the contents in the first aid box and if necessary put small pictures or drawings of each one’s use.
Use calamine lotion in case of heat rash.
Keeping the gas valve closed is another important thing to remember and do. Keeping water and a jar of healthy snacks on the dinner table and keep the kitchen cabinets and door under lock and key.
Keep all the keys (including car/two wheeler) safely."
First aid - showing the children how to wash the wound with soap and water, how to put the medicine, cover the wound with cotton and keeping it in place with a micropore tape. Labeling the contents in the first aid box and if necessary put small pictures or drawings of each one’s use.
Use calamine lotion in case of heat rash.
Keeping the gas valve closed is another important thing to remember and do. Keeping water and a jar of healthy snacks on the dinner table and keep the kitchen cabinets and door under lock and key.
Keep all the keys (including car/two wheeler) safely."
*Dr Gayathri,Paediatrician, Kochi, suggested to use ID badges,teaching contact numbers and teaching to type in the case of nonverbal kids who have wandering habit.
* Dr Rafeeq Ali, Otolaryngologist (ENT) ,Malappuram, expressed that though ingestion of a few drops of kerosene won't cause much harm,there are chances of development of mild inhalational chemical pneumonia after a few weeks.This points out that the quantity of chemicals that is for immediate access and use should be bare minimum. He also cautioned all parents to be more beware of drug ingestion as they are concentrated sources of chemicals compared to diluted household liquids which are less likely to be consumed in larger amounts. He also added that dilution, gastric aspiration and antidotes are the management strategies for poisoning.
*Anju Varghese, Senior Speech Language Pathologist, Renai Medicity Hospital ,stated the relevance of conducting awareness programs for parents of special needs children on child safety in their homes. She pointed out the relevance of teaching the "do's and don'ts" in an age appropriate language, backed up with reinforcements whenever necessary. She advised the parents to always remain prepared and equipped to face any emergency situations.
*Dr Susan Mary Zachariah,Senior specialist,Developmental Paediatrician,AsterMedCity suggested that care should be taken while storing kerosene or other corrosives, because there are higher chances for them to be mistaken for juices or cool drinks. It should be stored away from the individuals reach, locked up in cupboards. In the case of ingestion of kerosene or other corrosives she warned, "not to induce vomiting" as it may increase the chances of aspiration causing pneumonia and worsen the condition.She advised to run the child to the nearest hospital in the case of consumption of any poison.
Everyone accepted that "Prevention is better than Cure".
*Dr.Reeba Ann Daniel, Paediatric Registrar,KIMS, Thiruvananthapuram pointed out the relevance of using chemical free ,natural products as in the case of toothpastes. She stated that accidentally swallowing toothpaste for a long time may lead to fluorosis and white lines in the teeth. She advised to use fluoride free toothpaste for small children.
Contributors
Gina Vijayakumar
Catherine Figarado
Litty George
Jayalakshmi K.R
Prashanthi Vankamamidi.
Children always have a curious interest to know how things work. But it is noteworthy that the curiousness is coupled with an unawareness of dangerous conditions. Hence, it is the responsibility of our society to help all with special preference to spectrum individuals.
To conclude, the discussion has further scope for extension with reference to school/therapy centre safety.
"Safety should never be a priority,it should be a precondition"
Thanking all...
Swapna Jose Luke
Images used are royalty free
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