Children Rights and a Sample Study on Accidents in Children
Groups Aged 0-5 Years Old in the Light of Parents' Responsibilty in Turkey
- Omr Elcioglu * Sahin Aksoy** Tarők Gndz***
* Osmangazi University, Faculty of Medicine,
Department of Medical Ethics and History of Medicine, Eskisehir-TURKEY.
Assistant Professor.Ph D.
** Harran University, Faculty of Medicine,
Department of Medical Ethics and History of Medicine, Sanliurfa-TURKEY.
Associate Professor. MD, Ph D.
***Osmangazi University, Faculty of Medicine,
Department of Forensic Medicine, Eskisehir-TURKEY. Assistant Professor MD.
Corresponding Author: Assis.Prof
. Omr Elcioglu Ph D
Address: Osmangazi University, Faculty of Medicine,
Department of Medical Ethics and History of Medicine, Eskisehir, TURKEY
Eubios Journal of Asian and International Bioethics 13 (2003), 183-186.
Key Words: Childhood poisoning; Childhood accident; Child
The most frequent reasons of the accidents seen at
children at the ages of 0-5 who have a right to be cared and protected are
negligence and carelessness. In this study, judicial cases compiled from
children between 0-5 years of age, who had been injured due to severe family
negligence and were referred to the Osmangazi University Training, Practice and
Research Hospital between the dates of September 1999 and March 2001, were
examined. 40 of 113 cases (35%) were due to poisoning from drugs. The main
reasons for this were as follows the unawareness of children about the harm of
drugs, putting drugs in reach of children, and the easy access to drugs from
pharmacies without prescription. The recognition of international measures by
Turkish government on the approach to the problems imposed by the young age
population is a guarantee for the children rights. Our study implies that, as
suggested by other researchers, the investigation of measures to prevent
injuries due to negligence and the application of these measures will certainly
improve the welfare of the given society.
Children rights is a concept that considers the most special conditions
of children, the most helpless living beings of human kind. All rights
basically remind us of several liabilities and responsibilities (1). These
liabilities are mostly directed from strong to weak and adult to children.
Making a special emphasis on Children Rights besides Human Rights shall
not be taken as a discrimination for the benefit of entire humanity. This is
just owing to the unique state of this group. Article 25/2 of the Declaration
of Universal Human Rights states that "Maternity and childhood own the utmost
rights to receive special care and help,"(2) and that it has established the
base of international law in the modern world on this matter. According to
Article 27 in the Agreement Of Children Rights in Turkey, each child holds the
right to attain an adequate level of living standards in order to accomplish
his or her ideal physical, intellectual, psychological, moral and social
development. The responsibility of providing an adequate level of living
standards for the children is primarily rest on their parents. The rights on
avoiding bad conduct of behaviour, physically and emotionally, prohibiting
negligence in the household and evading inadequate care are listed among
protective. In fact, the dimensions of a concept related with child protection
is huge, and the topic is quite open to discussion.
Accidents have been the most frequent
reason of infant deaths and of the death of children younger than 5 years old
in the urban which makes the home accidents a problem as a whole with utmost
precedence (3). Swallowing toxic materials by accident is encountered mostly in
1-5 years old children. The incidence is mainly due to the natural curiosity of
the young children and the carelessness of adults by leaving drugs and
chemicals at the reach of children. Therefore, 92% of accidental poisoning
events occur in a typical home environment 4,5.
mostly seen accident at home is alkali and acid intoxication. Swallowing liquid
and solid alkaline substances orally may lead to severe oesophageal and gastric
damage due to perforation or narrowing. Sodium and potassium hydroxide,
cleansing powders, some detergents, dye extractors, and oven and toilet
cleaners are alkali materials that may cause poisoning. Acids are compounds
such as hydrochloric acid, which are widely used in cleaning metallic items and
toilets, liquids used for car batteries, and compounds applied against
corrosion such as hydrofluoric acid and oxalic acid 3,4.
are another frequently seen accidents at home. 15% of the burns are encountered
in young children under the age of 15. Burns are defined as fatal accidents at
home in the children group aged between 1-4. 6,7. Burns mostly occur
when children are left alone at home. The majority of burns are caused by
boiling water, hot milk and oil and are placed mainly at kitchens. Some of the
hot water burns occur in bathrooms and may be an indicator of an abuse. Burns
due to electricity occur especially at children under the age of 5 during the
usage of hair-dryer or by inserting objects into the electric sockets.
Poisoning is also a cause accidents at home. Dermal application of
substances for agriculture protection, eating disinfected fruits and
vegetables, and wearing contaminated clothes may cause poisoning8.
Like many countries CO poison ranks highly as followed by suicide or any other
fatal accidents at home in Turkey. The reason for seeing the poisoning cases in
the home environment is due to using CO generating devices at home, and
sleeping in rooms which are heated with such substances.
"Rights To Health" As Found In The 'Agreement Of
phrase 'Children Rights' were first announced in the 'Geneva Declaration Of
Children Rights', which was approved at the General Committee of the Nations
Assembly dated September 26, 1924. The information that children were mostly
effected group from the World War-I stimulated the idea that it was extremely
necessary to pay maximum attention to the entire children on earth by
emphasizing their rights for being protected from any kind of negligence and
misuse. The second important stage regarding to Children Rights in the
international level was the 'Declaration Of Children Rights' that had been
approved and announced at the General Assembly of the United Unions dated
October 18, 1959.
agreement related with Children Rights signed by the Republic Of Turkey at the
date of September 14 , 1990 and verified after some drawbacks were placed in
Articles 17, 29 and 30 by the Turkish Great National Assembly at December 9,
1994 and after then was converted to an internal legislation of law by the
Act/No.4058 and was eventually published at the Official Gazette dated January
27 1995/No. 22184. By signing and activating the Agreement of Turkish
Children's Rights, Turkey has accepted to approach the problems imposed by the
children's population with universal criteria.
Turkish Code Of Civil Law took the opinion "the most ideal state of raising a
child would be with his or her mother and father" as a starting point. This
condition had been openly determined in Article 262 and 272 of the Code Of
Civil Law. Therefore the legal regulation that holds parents primarily
responsible to raise the child with proper physical, psychological and
intellectual support seems adequate.
Accidents at the 0-5 age group commonly occurs as a result
of carelessness and negligence. While 'carelessness' refers performing an
action that should not be performed, 'incautious behaviour' indicates failing
to avoid a dangerous state that can be avoided. 'Forgetfulness' is also
accepted as an incautious behaviour. "Unconcerned mood"
(Negligence/Indifference) is carrying out a work with deficient or not to
fulfill a duty while there was a possibility to do so. 'Faulty attitude' also
indicates disregardful manner to an obligation that a legal regularity burden.
'Negligence' signifies failure of performing an obligation of the person whom
is responsible to look after a child. Negligence can be also defined as failure
to display a minimum attention in order to provide an optimum term of lifestyle
or failure to fulfil provisions for optimum nutrition, clothing, medical care,
and emotional needs. In crimes related with unconcerned mood, the individual
may foresee the consequences of the foresaid action and would not desire such a
result to happen but may appear helpless in preventing the action.
Parental Tasks Towards The Child
are valued elements that cannot be abandoned in view of the spiritual dimension
of the family. Therefore, children are described to complete the cultural
structure of a family, and ultimately to bring joy and happiness to family
members as well as to the relatives. For that in the institutional Turkish
family structure, children are accepted as 'ones that must exist'.
Guardianship has a dual meaning in Turkish code of family law ; While the first
meaning includes the parents with the right of power to administer the personal
wealth and possessions of the child, the second meaning covers the duties and
responsibilities of the parents against the child9. Therefore, the
word 'legal guardianship' comprises not only the authority but also the duties
have various tasks such as looking after and raising the child and , educating
the child both for moral and intellectual development. These missions are
clearly stated in Turkish Code of Civil Law, Article 264.
According to the 'Agreement Of Children's Right' Article 6, every child
owns the fundamental right to live. States are obliged to guarantee the life
and growth of a child. Article 18 of the Agreement Of Children's Right lists
the responsibilities of the parents. Both mother and father carry shared
responsibilities on children while they are brought up. According to the Code
Of Civil Law, Articles 262-264, it has been emphasized that a family
environment is accepted as the most convenient media in order to raise
Compliance to Article 24 of the Agreement, children possess the right to
achieve the most advanced standard level of health care and medical aid.
Governmental authorities pay attention on issues related with basic and
preventive health care so to reduce the numbers of infant death, and obtain
international collaboration that would support and promote effective healthcare
services, without allowing deprivation of any child.
time to time during any period of life, human beings may encounter with
unexpected events that they have no control of These events may affect the
bio-psychological function of the child and the family. Individuals may undergo
multiple arcades of losses such as disabilities, and injuries due to diseases.
However the impact of traumatic events in children differs from adults.
study, accidents in children at the age group 0-5 were due to adult negligence.
The children's rights to health in Turkey at the scope of the 'Agreement of
Children Rights', the parent's duties and obligations toward the child were
investigated, and necessary precautions shall be emphasized.
cases compiled from children between 0-5 years of age who had been injured due
to severe family negligence referred to the Osmangazi University Training,
Practice and Research Hospital between the dates of September 1999 and March
2001, were included in the scope of the study. It was determined that patients
had applied to our clinic from the Central Province of Eskişehir and other
neighbouring cities. Files of cases that were obtained from archives with file
numbers, indicating cases obtained from the records of the hospital police were
studied retrospectively. The gender, age and type of application of patients
the type of interference, and the results obtained from the study were
search of patients' files, all efforts were paid to benefit in maximal level
from the available data. However, the information was not available in the
files regarding to socio-demographic features of the children and the families,
attitudes against accidents , and social and psychological support provided to
the children and the families. It is also known that social and psychological
support services are not well established in governmental organizations in the
65 (57.5%) of the cases were boys and 48 (42.5%) were girls.
30 (26.7%) of the cases were 2 years old and 28 (24.7%) were 3. 68 (60.2%) of
the patients were referred to our hospital after receiving their first
intervention from other clinics. However, 45 (39.8%) of them had applied to our
hospital directly (Table 1)
present study indicates a high level of drug intoxication among children aged
between 0-5. It was determined that 16 of the girls (33.3%) and 24 of the boys
(53.6%) had been referred to our hospital due to intoxication with drugs used
in human beings. Oral administration of corrosive substances was listed in the
second row. The third row consists of referrals due to events of burns in 7
girls (14.6%) and digestion of dye solvents in 8 boys (12.3%) (Table 2).
(80.5%) of the patients were treated after hospitalisation 2 patients (1.8%)
were taken under observation and the remaining 2 (1.8%) had been discharged
from the hospital upon request from their parents (Table 3).
(90.3%) of the patients were discharged from the hospital after receiving
necessary medical intervention while 2 (1.8%) had deceased (Table 4).
Table I: Distribution of cases according to gender
Table 2 : Distribution of types of events according to
Table 3: Intervention performed (N=113)
Type of event
Intoxication with drugs administered to animals
Bumps and falls
Falling into water canals
Table 4: Distribution of events according to results.
Abandoned due to request from family
Follow-up due to observation
Discussion and Conclusion
study was carried out on 113 patients, and it was clearly observed that the
most frequent type of poisoning had occurred by drugs. The main reason for such
a condition relays on the fact that the young children are unaware of the
dangers of the hazardous substances, and the drugs are kept at reach of
our patients, the drugs that led to poisoning were various medical preparations
that were easily available at pharmacies and sold without prescription, and
abundantly existed in everywhere 5 . 30 (26.5%) of the patients were
included in the 2 years old group.
Intoxication is seen more frequently in boys than in girls. According to
a similar study carried out by Petridou et al, it has been stated that the
events of poisoning were encountered mostly during the second year of life and
more frequently in boys 10.
factors of intoxication, the administration of corrosive substances follows the
accidental swallowing of drugs. Girls displayed a higher incidence of using
such substances. Our findings were also compatible with findings of another
study published in 1997 suggesting that the best therapy for accidents that had
occurred in children between 0-5 years of age due to carelessness and
improvident manner is to provide sufficient precautions 11.
are frequently seen in children who are new toddlers. As it has been described
in the literature, adult negligence and curiosity of the child may cause such
type of accidents 12. According to our findings obtained from the
study, 7 (14.6%) of the girls and 4 (6.2%) of the boys who had been referred to
our hospital were burned by boiling milk, soup and other liquids which had
flipped over them, or by sudden ignition of pyjamas or clothes after playing
with matches. 7-17% of all type of hot water burns would require medical care
in hospitals. However, according to our findings obtained from the study,
children with burns were hospitalized at longer periods when compared with
other accidents 13.
hazardous substance that is inhaled by accident is CO. Especially inhalation of
CO during winter season due to burning stoves or water heaters in bathrooms may
cause dangerous conditions. According to findings obtained from our study, 6
children (together with their families) were referred to our hospital due to CO
frequent types of accidents encountered are 'falls'. These type of accidents
usually occur when the child is climbing the stairs or when he or she tries to
reach or stretch out for an object from high shelves. Additionally, falls can
occur when then a child is on the playground or riding a bicycle. 6 of our
patients (5.3%) had applied to the hospital due to falls. As it has been stated
in various studies, cranial traumas due to falls are very frequent in this age
group, and would require medical follow-up. Traumas are still considered as
important factors that cause death of children 14,15.
every 6 cases which were evaluated under the topic of 'Strikes' and 'Falls' had
occurred after falling out from a tractor. According to the literature, among
the accidents that had occurred in farms the falls from tractors and
agriculture machinery were ranked at the first row and were frequently seen in
boys Our findings were compatible with the study carried out in Canada 16.
recording system related with children accident must be generated and widened
throughout the country. Generating adequate records shall establish the basic
ground in order to designate the foresaid precautions with priority. Events of
poisoning may display regional differences related with accidents occurred in
the 0-5 age groups of children, but intoxication due to inattention and
improvident behaviour leading to poisoning by drugs, insecticide and pesticide
substances, corrosive agents and deficient information related with burns and
food intoxication especially with mushrooms and plants ranks the first row in
Turkey. As it is seen the majority of these accidents occur from preventable
events, however they may very well lead to severe morbidity and mortality.
There are some precautions that may help to prevent those unpleasant and
unhealthy occasions which are;
lack of information available in files suggested that the research which will
be done in this field should be a prospective rather than retrospective.
forms can be prepared for patient files that comprise information on
socio-demographic features as well as information regarding to families
'attitudes . It is also urgently targeted that social and psychological support
are provided to families in these kind of cases.
to the fact that children may reach everywhere, even though drugs and chemicals
are stored in cupboards , they must be kept tightly locked.
order to avoid intoxication of children, packages of drugs must be carefully
re-designed and utmost care must be displayed in order not to distract
children's attention and store drugs with locked stoppers.
materials, detergents, anti-freezers, accumulator liquids and similar
substances must be stored in their original packages.
cotton, synthetic and acrylic threads that may suddenly ignite must be keep not
of the reach of children .
children should never be left alone at homes, and household items such as
matches that may lead to fire must be strictly prohibited and kept out of their
should play with 'safe toys' under adult supervision.
surveillance and monitoring must be provided in the bathrooms and kitchens, and
safety and security precautions must be maintained.
helmets must be worn during bicycle ride ,and adult supervision must be
provided while running, climbing and bicycling activities of the 0-5 years old
groups of children in order to maintain environmental safety. 17.
ponds, swimming pools, streams, rivers and bathtubs are very dangerous sources
for young children especially, for toddlers and children who cannot swim.
Strict adult supervision must be provided in such areas.
Paediatricians must inform mothers and fathers about home accidents
and their prevention and also provide continuous information related with
subjects that includes topics of miscellaneous activities 18.
It is particularly essential to provide consultancy services
for inexperienced, young mothers on child accidents and their prevention 19.
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Discharge of hospitalized patients after improvement
Patients whom were sent home after first intervention +
Patients discharged upon request of the family
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