A standardised protocol for the acute management of corrosive ingestion in children

Abstract

Oesophageal strictures developing after caustic ingestion in children are a serious problem, and several protocols to prevent stricture formation have been proposed. A prospective clinical trial was conducted for preventing strictures in caustic oesophageal burns in a single clinic, and the results are presented. All children with caustic ingestion who had oesophagoscopy for diagnosing the severity of the burn were included in the study. Eighty-one children were included in the series, with ages ranging between 3 months and 12 years. The patients were given nothing by mouth until oesophagoscopy. IV fluids, broad-spectrum antibiotics, ranitidine, and a single-dose steroid were given. Oral burns were positive in 66 patients. Oesophagoscopy revealed a normal oesophagus in nine patients, grade 1 burn in 24, grade 2a in 21, grade 2b in 23, grade 3a in two, and grade 3b in one. Patients with grade 1 and 2a burns were discharged after oesophagoscopy. Patients with grade 2b and all grade 3 burns were given nothing by mouth for a week except water when swallowing their saliva, and were fed via total parenteral nutrition. After the 1st week, if there was no problem with swallowing, liquid foods were introduced. No intraluminal tubes were used. At the end of the 3rd week, a barium meal was administered and an upper gastrointestinal series taken. Dilatation was performed at 2-week intervals for strictures, which developed in one grade 2a patient, six grade 2b patients, and the grade 3b patient. Only one of these patients is currently on an oesophageal dilatation program. Limiting oral intake and avoiding foreign bodies in the oesophagus seem to provide a good success rate; however, further prospective studies are needed to decrease the incidence of corrosive oesophageal strictures.

Characteristics of Children Who Ingested Corrosive Substances and Their Mothers’ Attitudes Toward Child-Rearing

“…16 So me of the re se arc hers ha ve scruti ni sed whet her the pa ren tal at ti tu des co uld ha ve a ro le in ca ses of in to xi ca ti on. 4,9,11 When the sco res that the mot hers of the chil dren re ce i ved from the PA RI sca le in our study (Tab le 1) we re com pa red to the sco res re ce i ved by the mot hers of chil dren who we re in vol ved in tra u ma tic ac ci dents in the study of Kaynar and Yıl dız, and mot hers of chil dren who we re in to xi ca ted by re a son of cor ro si ve subs tan ce in ges ti on in the study of Bu ke et al, si mi lar re sults we re ob ser ved. 1,16 The re was no sta tis ti cally sig ni fi cant re la tions hip bet we en the ages of the chil dren who inges ted cor ro si ve subs tan ces and the me an sco res the ir mot hers re ce i ved from the PA RI subs ca les (Tab le 2).…”

“…Se ve ral stu di es ha ve shown that in to xi ca ti on ca ses we re mostly pre va lent among boys. 4,5,9,15,17 Ka ya alp et al as so ci a ted boy-de pen dence among in to xi ca ti on ca ses with the fre e dom gi ven to boys in the so ci ety and the pa ren tal pres su re app li ed on the girls. 4 It was se en that the re was no statis ti cally sig ni fi cant re la ti ons hip bet we en the gen der of the chil dren who in ges ted cor ro si ve subs tan ces and the me an sco res the ir mot hers re ce i ved from the PA RI subs ca le (Tab le 3).…”

“…1,4 It has be en sta ted that, in or der to prevent the ca ses of in to xi ca ti on, it is im por tant to keep the se agents in loc ked cup bo ards, out of the re ach of chil dren and away from ref ri ge ra tors, ovens or pantry bo xes and to pre ser ve them in safe con ta i ners that may not be ope ned ea sily. 4,9 It is emp ha si sed that the ca ses of in to xi ca ti on are most fre qu ently ex pe ri en ced in chil dren of negli gent and une du ca ted fa mi li es. 4,[8][9][10][11] No sta tis ti cally sig ni fi cant re la ti ons hip was ob ser ved bet we en the edu ca ti on le vel of the mot hers of chil dren who inges ted cor ro si ve subs tan ces and the me an sco res they re ce i ved from the PA RI subs ca les (Tab le 4).…”

“…Num ber of in to xi ca ti on ca ses du e to in ges ti on of corro si ve subs tan ces in cre a se du e to il li te racy and lack of edu ca ti on and la unch of many new che mi cal subs tan ces in to the mar ket along with in dus tri al, techno lo gi cal and so ci o-eco no mic de ve lop ments. [6][7][8][9] The ma jor re a sons of in to xi ca ti on are ac ci dents and neg li gen ce of the pa rents. Most of the pa rents are una wa re of in to xi ca ti on ca ses.…”

“…The stu di es made in this fi eld in di ca te that ca ses of in to xi ca ti on mostly oc cur in the chil dren of pa rents who are irres pon sib le and who ha ve psycho-so ci al prob lems, and that po verty, fa mily prob lems, ha ving mul tiple chil dren, pa ren tal pres su re are among fac tors that in cre a se the pos si bi lity of in to xi ca ti on. 1,4,[8][9][10][11] Nur ses may, by edu ca ting the fa mi li es, ta ke on im por tant ro les in pre ven ting the ca ses of in to xica ti on. If the cha rac te ris tics of the chil dren who in gest cor ro si ve subs tan ces and the ir pa rents are known, the edu ca ti on can be mo re ef fec ti ve, and the num ber of in to xi ca ti on ca ses wo uld be sig ni ficantly dec re a sed.…”