Children Rights and a Sample Study on Accidents in Children Groups Aged 0-5 Years Old in the Light of Parents' Responsibilty in Turkey

- OmŸr Elcioglu * Sahin Aksoy** Tarõk GŸndŸz***

* 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 . OmŸr Elcioglu Ph D

Address: Osmangazi University, Faculty of Medicine, Department of Medical Ethics and History of Medicine, Eskisehir, TURKEY

E-mail: elcioglu@ogu.edu.tr

Eubios Journal of Asian and International Bioethics 13 (2003), 183-186.
Key Words: Childhood poisoning; Childhood accident; Child abuse


Abstract

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.

 

Introduction

   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.

            Another 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.

   Burns 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 Children Rights'

   The 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.

   An 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.

   The 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

   Children 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'.

   Legal 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 and responsibilities.

   Parents 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 children.

   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.

 

Objectives

   From 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.

   In this 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.

 

Methods

            Judicial 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 investigated.

   In 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 country.


Results

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)

   The 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).

   91 (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).

   102 (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

Gender

 N

 %n
Boys

 65

 57.5
Girls

 48

 42.5
Total

 113

 100
 

Table 2 : Distribution of types of events according to gender

Type of event

 Girls

 Boys
n

 %

 n

 %
Food poisoning

4

 8.3

 3

 4.6
Drug intoxication

16

 33.3

 24

 36.9
Intoxication with drugs administered to animals

 2

 4.2

 7

 10.8
Cleaning materials

 8

 16.7

 9

 13.8
Dye solvents

    5

 10.4

   8

 12.3
Stoves  and natural gases

    2

   4.2

   4

 6.2
Burns

 7

 14.6

 4

 6.2
Bumps and falls

 1

 2.1

 1

 1.5
Falling into water canals

1

 2.1

 3

 4.6
No information

 -

 -

 1

 1.5
Animal bites

-

 -

 1

 1.5
Cuts

2

 4.2

 -

 -
Total          

48

  

 65

  
 

Table 3: Intervention performed (N=113)

Intervention

n

 %
Hospitalized

 91

 80.5
Outpatient

 18

15.9
Abandoned due to request from family

2

 1.8
Follow-up due to observation

 2

 1.8
 

Table 4: Distribution of events according to results. (N=113)

Result

 n

 %
Discharge of hospitalized  patients after improvement

 102

 90.3
Patients whom were sent home after first intervention + Prescription arrangement

 4

3.5
Excitus

 2

 1.8
Patients discharged upon request of the family

 5

 4.4
 

Discussion and Conclusion

   This 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 children.

   Among 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.

   Among 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.

   Burns 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.

   The most 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 intoxication.

   The most 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.

   One of 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.

   A 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;

            The lack of information available in files suggested that the research which will be done in this field should be a prospective rather than retrospective.

            Standard 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.

-          Owing to the fact that children may reach everywhere, even though drugs and chemicals are stored in cupboards , they must be kept tightly locked.

-          In 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.

-          Disinfectant materials, detergents, anti-freezers, accumulator liquids and similar substances must be stored in their original packages.

-          Natural cotton, synthetic and acrylic threads that may suddenly ignite must be keep not of the reach of children .

-          Young 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 reach.

-          Children should play with 'safe toys' under adult supervision.

-          Adult surveillance and monitoring must be provided in the bathrooms and kitchens, and safety and security precautions must be maintained.

-          Safety 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.

-          Lakes, 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.

 

References

1-Kingdom E. Birthrights: Equal or special? Morgan D,Lee R, editors. Birthrights. Routledge, London 1990.

2-Robertson AH, MerrilsJG. Human rights in the world. Manchester University press. Manchester.1990.

3-Dart RC, Rumork BH. Poisining . in HayWW, Hayward AR, Lewin JM, Sondheimer MJ editors. Current pediatric diagnosis &treatment. A Simon &schuster comp. Stamford, Connecticut, 1999:290-315.

4-Rudolph AM, Kamei RK. Rudolph's fundamental of pediatrics. A Simon &SchusterComp. Stamford, Connecticut, 1998:334-357.

5-KrugSE. The acutely ill or injured child. In Behrman RE, Kliegman RM,editors. Nelson essentials of pediatrics. Third Ed. WB Saunders, Philadelphia,Connecticut, 1998: 103-112.

6-Levejoy FH Jr. Corrosive injury of the esophagus in children: Failure of corticosteroid treatment reemphasizes prevention. New England Journal of Medicine, 1990: 323:668.

7-Behrman RE, Kliegman RE, Nelson EW, Vaughan CW. Burn injures.Nelson textbook of pediatrics. Forth ed. WB Saunders, Philadelphia, Pennsylvania.1992:233.

8-Leonard IB, Injuries and poisining.Dworkin PH, editors. Pediatrics.Harwal Publising Comp, Malvern, Pennsylvania.1992:25-42.

9-Hancõ H.Hekimin yasal sorumluluklarõ: Tõbbi hukuk.(Legal responsibility of physician: Medical law) Egem yayõncõlõk .İzmir(in Turkish).

10-Petridou E, PolychronopoulouA, Kauri N, Karpatios T, KaussouriM, Messaritakos Y et al.Unintential childhood poisining in Athens: a mirror of consumerism J.Toxicol Clin Toxicol 1997; 35 (6):669-77.

11-Ellias PJ, Ruizde Tamiro Bravo M, Esteban Ibarz JA, Albo Losado J.Severe caustic esophagitis in childhood. An Esp Pediatr. 1997;47(6): 597-83.

12-Fieldman KW, Schaller RT, Feldman JA, Mc Millan M.Tap water scald burnsin children. Pediatrics. 1978; 62(1): 1-7.

13-Klauber MR,Barret-Connor E, Hofstetter CR, Micik SH.A population -based study of non fetal childhood injures.Prev.Med.1986; 15(2):139-49.

14-O'neill JA. Advancesin management of pediatric trauma. Am J Surg. 2000;18(5):365-69.

15-Meiers S, Baerg J. Farm accident in children eleven years of experiences. J Pediatr surg .2001; 36(5): 726-9.

16-Snajder M, Chevallier B, Leroux G, Bruneau C, Yacoubovitch J, Auvert B. Frequency of childhood injuries: First result of the Bolougne- Billancourt registry. Rev Epidemiol Sante Republique. 2001 ; 49(2):125-134.

17-Klassen TP, Mackay JM, Moher . Community based in injury prevention intervention. Future Child . 2000; 10(1):83-110.

18-Zuckermen BS, Dubu JD.developmental approach to injury prevention Pediatr Clin North Am. 1985 ; 32(1): 17-29.

19-Gulotta CS, Finney JW. Intervention models for mothers and children at risk for injuries. Clin Child Fam Psychol Rev. 2000, 3(1): 25-36.

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