Christmas Offerings Alice in Blunderland |
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Charles Lutwidge Dodgson was a single, reticent, non-practising
Anglican clergyman who lectured in mathematics at Christ Church
College, Oxford, in the 19th century. Today he is remembered as the
author of Alice's Adventures in Wonderland, published under
the pseudonym Lewis Carroll.
Alice's exploits in this book could well serve as a reminder of the various dangers which confront children in Australia today. Here are some of them. Falls You will recall that Alice fell down a rabbit hole -- towards "the Antipathies". Antipathy to taking appropriate steps to make our environment safer represents one of the greatest dangers to our children. Falls are one of the most common causes of injury to children. Almost 85 Australian children a week are admitted to hospital following falls from play equipment, amounting to around 4400 a year. Allowing for a 14% hospitalisation rate, this would give a total figure of about 31 000 children presenting to hospital emergency departments each year, or around 600 per week. Despite the extraordinary length of Alice's fall she was "not a bit hurt", as she landed "upon a heap of dry leaves". Kidsafe recommends that soft fall surfaces, such as bark chips, under playground equipment should be 30 cm thick. Alice illustrates to the owners of playgrounds the good sense in taking this precaution. Poisons Soon after the fall, Alice came across a bottle marked "DRINK ME". She did look to see if it was also marked "poison", but, in the absence of any such warning, she drank its contents. The lesson here is to ensure that noxious substances are clearly marked as such and are stored in a safe manner, preferably in a child-resistant cabinet. It is estimated that each week some 54 children under the age of five years are admitted to Australian hospitals (2800 per year) for treatment of poisoning with medicines. Alice was considerably diminished by the drink -- not altogether unlike adults who consume too much alcohol. However, as is common with children, she did not learn quickly from her mistakes and then unquestioningly swallowed a small cake marked "EAT ME". As with adults who consume quantities of cake, she then became very large. She began to cry "gallons of tears" and soon found herself in a pool of tears. Anguish The word "tears" brings with it thoughts of misery and sadness. These feelings abound among the parents and friends of injured children and, although often overlooked, are nevertheless very significant. Drowning Alice's immediate predicament was that she might drown. In the period 1994-1998, 1277 people drowned in Australia, of which 356 were children under 15 years of age and 281 under 5 years. Among children under 5 years, 130 drowned in swimming pools and 54 in the bath1 -- drowning is still the leading cause of injury deaths in this age group. Continuous surveillance by adults of young children near water is mandatory if this toll is to be reduced. Choking Alice didn't drown and escaped from the pool of tears. She then took part in a "Caucus-race". Everybody won. Alice distributed "comfits" (sugar-coated lollies) to the winners. When eating the comfits "the small ones choked and had to be patted on the back". Young children, particularly those under about four years of age who have not yet produced their molar teeth, are at risk of choking on hard foods such as uncooked pieces of carrot, apple or nuts. About 500 children are admitted to Australian hospitals each year for treatment of choking, of which about 14 die. In 60% of children under 5 years of age, inhaled food is the cause of choking. Lacerations Next, Alice found herself in a home which proved too small for her. She reached out and, in so doing, accidentally caused a rabbit to fall into a glass-topped cucumber frame. Broken glass is another major hazard to children. Many children present to hospital emergency departments (particularly in summer) with cut feet after stepping on broken glass. Alice frequently had trouble with doors in her adventures. The doors tended to be either too large or too small. Children also have trouble with doors and may from time to time try to run through a closed glass door, with potentially serious consequences. About 2800 Australian children are treated in the emergency departments of hospitals each year for cutting or piercing injuries. This equates to about 54 a week. Thousands more are treated in emergency departments and general practitioners' surgeries. Smoking Alice didn't smoke, but in her wanderings she did come across a caterpillar who was hooked on a hookah. It's just as well Alice didn't have asthmatic tendencies, as passive smoking is now a recognised danger. Bites and stings When asked to recite a poem, Alice could not remember "How doth the little busy bee". We can remind her that the sting is in the tail -- a bit like this narrative. European wasps as well as bees pose a danger to children eating outside during summer. The use of drinking straws is a simple measure to reduce the likelihood of a sting in or around the mouth. Hallucinogens Alice took the advice of the smoking caterpillar and ate some mushrooms. Fungi are hard to classify unless you're an expert, and Alice took a definite risk here. She could well have needed medical attention. Missiles Alice continued to wander and before long came to the Duchess's domicile. The Duchess ran a chaotic household. Alice was lucky not to be hit by flying crockery or by other airborne kitchen utensils. Many children are not so fortunate. Of greater concern to Alice, and this is to her credit, was the Duchess's potentially lethal practice of shaking her baby, which eventually turned into a pig. Our worry is that a shaken baby may turn into a damaged individual requiring lifelong medical and nursing support. Statistics Alice began conversing with a cat. You will recall the Cheshire cat -- it tended to fade away, but not entirely. Statistics for childhood injury are not dissimilar. Around 1979, when Kidsafe (then known as the "Child Accident Prevention Foundation of Australia") began, more than two Australian children died each day as a result of accidents. (This includes all types of accidents other than injury resulting from child abuse. Since then, the toll has slightly more than halved but, like the cat, has not entirely disappeared.) There are still at least 300 Australian children killed each year through accidents. Heavy metal poisoning After talking to the fading cat, Alice went to a tea party for refreshment, but unfortunately the party was hosted by a Mad Hatter. Hatters were traditionally mad, owing to their intimate association with mercury-treated pelts. Today's children may also be at risk of heavy metal poisoning, for example from living in areas where the level of lead in the environment is high. Scalds The Mad Hatter endeavoured to awaken the sleeping Dormouse by pouring "a little hot tea upon its nose". This stupid behaviour cannot be condoned, yet throughout
Australia hundreds of domestic water-heaters deliver excessively
hot water from taps accessible to young children. Water at 50 Education After leaving the party, Alice met with the Gryphon and the Mock Turtle. The latter was keen on education. So is Kidsafe. The porpoise of this presentation is to encourage all who read it to do something positive to improve the safety of Australian children. On an average day in Australia, it is likely that about 5000 children will need medical care because of injury. Some 1500 children will come to hospital because of unintentional injury, 100 will be admitted and one will die.1,2 The financial cost of this injury and death is in the order of $1.5 billion a year.3 Since 1979, the death rate due to child injury (allowing for growth in population) has fallen by nearly 60%. This reduction means that almost 5000 Australian children are alive today who would not have been if the injury death rate had stayed the same. However, there is no room for complacency. For every 100 child injury deaths in Australia there are only 75 in England and Wales.4
Brian J Fotheringham
Acknowledgement: I wish to thank Mr Ian Scott, Director of Research and Policy at Kidsafe National Office, Melbourne, for his kind assistance in the preparation of this paper, including supplying most of the reference material.
©MJA 2000
Readers may print a single copy for personal use. No further reproduction or distribution of the articles should proceed without the permission of the publisher. For permission, contact the Australasian Medical Publishing Company. Journalists are welcome to write news stories based on what they read here, but should acknowledge their source as "an article published on the Internet by The Medical Journal of Australia <http://www.mja.com.au>". <URL: http://www.mja.com.au/> © 2000 Medical Journal of Australia. We appreciate your comments. |
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C takes
minutes to scald human skin and yet is sufficiently hot for most
household purposes. Water over 60