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A Nossa Equipa

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Quiet, peaceful and secluded. Caustic soda is found in some household cleaning products, e. Alkali burns penetrate deeper in the skin when compared to thermal or acid burns.

Histórias Para Acordar (Em Portuguese do Brasil)

This type of tissue injury comprises three factors: intense cellular dehydration; saponification of fat, leading to the loss of thermal insulation; and enzyme protein inactivation and binding with alkali, resulting in a chemical reaction that releases heat and further aggravates the initial injury 6 , Severity of tissue damage is directly related to substance type, amount, and concentration, as well as to the duration of contact with skin.

Alkali burns can have acute or chronic complications, or even permanent sequelae Chemical burns in children are primarily accidental. In the literature, only two case reports of exposure to caustic soda as a result of children maltreatment were found 11 , The rare frequency of injuries caused by caustic soda, on the one hand, and the extent and depth of the injury reported in this study, on the other, were the main reasons behind the emergency team's suspicion of sexual abuse.

It was considered unlikely that the mere contact with a cleaning product, as reported by the mother, would have been able to cause the injury found.

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In general, controversy between the type of injury observed and the causative mechanism reported by parents is one of the indicators justifying suspicion of violence, and requires a thorough evaluation to clarify the circumstances leading to injury Whenever there is the possibility that the injury may have been intentional, professionals have to deal with other issues - in the present report, suspicion of sexual abuse and the possibility of negligent supervision of the child. In both situations, the healthcare team has to go beyond merely clinical aspects to clarify and understand the social, cultural, and emotional background of the families seeking assistance.

This approach requires, on the part of healthcare professionals, personal availability for an attentive listening and some degree of experience in handling difficult cases calmly, not scaring or accusing the family. Professionals dealing with these situations also need to clarify the circumstances that have caused the injury, find out who takes care of the child, and whether this care is appropriate for his or her age and development.

It is also useful to learn about the environment where the family lives, whether other accidents have already occurred, whether there has been a delay in seeking care, and whether the child behaves and interacts appropriately with the caregiver These data will make it possible to assess the level of risk to which the child may be exposed and will help decide on how to manage the case, e. It is worth mentioning that notification should be made even in cases of suspicion whenever it is not possible to involve other professionals.

Fatores de risco para consultas em pronto-socorro por crianças asmáticas no Sul do Brasil

Because the emergency department is an important route of admission to the health system, professionals working in this setting should be able to develop positive rapport with guardians, so as to help increase adherence to the follow-up treatment proposed after discharge. Outpatient follow-up is a way of ensuring child protection, as it allows long-term monitoring of the case.

For instance, it allows to analyze the bond between child and parents, the family characteristics, and new health problems that may emerge. Finally, follow-up is a way of providing guidance to parents regarding the prevention of accidents and maltreatment. Neglect is a very common type of violence against children worldwide. According to the Brazilian Ministry of Health, neglect is a disregard for the welfare, safety, affection, or education of children or adolescents, or the parents' refusal to follow guidance regarding the immunization schedule, drug treatments, and educational and preventative guidelines The chronicity and recurrence of these acts are important aspects to be taken into consideration when determining the presence of neglect.

As for the case reported here, social family history, family ties, and previous care of the child indicated that she was receiving adequate care and that the accident was the result of an isolated oversight.

A Princesa Rosa - Historinhas para Acordar

During outpatient follow-up, the mother argued that she usually closed the bedroom door whenshe and her daughter slept in the afternoon, but she had forgotten to do so that day. The outpatient team focused on advising the mother to require family help in the care of the child and increase accident prevention measures.

A História da Vida

Over six months after the accident, adherence to follow-up was good, and no complications were observed. In order to promote the safety of infants aged between one and two years, it is important to advise parents to keep sharp objects, or objects that can be swallowed, out of children's reach; to use protection devices to prevent falls on stairs or from windows; to use edge and corner protectors on furniture; to use a gate or other obstacle to prevent access to the kitchen door and keep the bathroom door closed; to use special child seats in the car, always in the back seat; and to store cleaning products and medicines in locked, high cabinets The present case deserves the attention of healthcare professionals because it underscores the importance of accident prevention, a topic that should be consistently emphasized in the follow-up of children and adolescents and adapted according to the stages of the child's development and the family's way of living.

Health teams should be prepared to consider violence as a differential diagnosis whenever necessary and should know how to clarify suspicions in a welcoming manner, not to undermine either the care process itself or the relationship with the family. National Center for Biotechnology Information , U.

Journal List Rev Paul Pediatr v. Rev Paul Pediatr. Paula Marques C. Author information Article notes Copyright and License information Disclaimer. Received Sep 2; Accepted Nov Copyright notice. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

COMMENTS: Accidents and violence are frequent causes of physical injuries in children, and the differential diagnosis between them can be a challenge for healthcare workers, especially in rare clinical conditions involving patients who cannot speak for themselves. Keywords: sodium hydroxide, accident prevention, chemical accidents, accidents, home, sexual violence, negligence, child.

Introduction External causes of morbidity and mortality i. Case description A month-old female was brought by her mother to the emergency department of the hospital. Open in a separate window.


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