Vehicular Entrapment and Heat Stroke in Three children: Is it a Form of Child Neglect?

Did Child Neglect Cause Severe Injuries in Nine Children?: Case series from a regional hospital in Oman

Child abuse and neglect (CAN) is a global phenomenon that takes many forms, with child neglect being the most common. CAN comprises serious incidents with medicolegal implications for the caregivers. The recognition of CAN is still in its early stages in Middle Eastern cultures, including in Oman, where parental authority over children is traditionally sacrosanct. This case series presents nine serious incidents from a regional hospital in Oman from 2020-2021 that appear to fulfil the definition of child neglect. All cases were diagnosed by the Suspected Child Abuse and Neglect (SCAN) team. This article provides evidence that child neglect exists in Oman and has resulted in the death of some children while causing significant physical, psychological and social sequelae in others. It also addresses risk factors and provides recommendations for management. Furthermore, the experience of the SCAN team and limitations of the current Child Protection Services in Oman are highlighted.

The Emergence of Child Protection Capacities in Oman: Lessons learned

Child maltreatment (CM) is the abuse and neglect of children under the age of 18 years. Many types of CM lead to actual or potential harm to the child's health. It is a widespread phenomenon and is well reported in Western countries in contrast with the Gulf countries. Reports documenting CM in Oman are now available; therefore, this review aimed to provide an overview of the state and patterns of CM in Oman. It also addresses the current child protection services (CPS) in Oman and the sociocultural constraints. All English-language relevant medical literature about CM in Oman that were published before January 2020 were included. This review can serve as a basic reference in the field of CM in Oman and should help to identify lacunas in the current CPS as well as provide guidance in the establishment of a more effective one.

Assessing parental awareness and attitudes toward leaving children unattended inside locked cars and the risk of vehicular heat strokes

Background

Vehicular heat stroke is considered as one of the preventable causes of non-crash, vehicle-related deaths among children. The prevalence of parents and caregivers leaving children unattended in enclosed vehicles is non-negligible.

Objective

This paper aims to assess parents’ knowledge and beliefs about vehicular heat strokes among children in addition to the prevalence and associated factors of leaving children inside locked cars.

Methods

A cross-sectional study was carried out at King Abdullah Specialist Children’s Hospital in Riyadh. Two hundred nine parents completed a self-administered questionnaire addressing vehicular heat strokes.

Results

Among the participants, 24.88% have left at least one of their children unattended inside locked cars during a sunny day; 78.85% of parents have heard about accidental deaths secondary to leaving children in locked vehicles. When assessing parental knowledge of increased sensitivity to heat in infants/children, 81.34% of them knew the correct information. Older age (P = .0150), less paternal education (P = .0157), and increased number of children (P = .0020) were associated with increased incidences of leaving children unattended in enclosed cars.

Conclusion

Considering the high temperatures in the Gulf region, the prevalence of vehicular heat stroke secondary to locking children inside vehicles is nontrivial. Awareness programs for parents and caregivers are strongly encouraged.

Child Maltreatment Prevention Readiness Assessment in Oman

Objectives

This study aimed to evaluate Oman’s readiness for implementing large-scale child maltreatment prevention (CMP) programmes.

Methods

This cross-sectional study was conducted between May and August 2016 in Oman. Participants, referred to as key informants, were individuals with influence and decision-making powers over CMP. The multidimensional Readiness Assessment for the Prevention of Child Maltreatment tool, developed by the World Health Organization with the help of collaborators from middle- and low-income countries, was used to assess 10 dimensions of readiness, each with a maximum score of 10.

Results

A total of 49 participants were included in this study (response rate = 98%). The mean total score for the 10 dimensions was 50.17 out of 100 possible points. The participants showed high mean readiness scores on legislation, mandates and policies (9.08) followed by knowledge of CMP (7.55), institutional resources and links (6.12), willingness to address the problem (5.35), informal social resources (5.15) and current programme implementation and evaluation (5.10). Participants had low scores in readiness in association with human and technical resources (2.44), attitudes towards CMP (2.90), scientific data on CMP (3.06) and material resources (3.46).

Conclusion

The results of this study indicate that Oman has a moderate level of readiness to implement large-scale evidence-based prevention programmes against child maltreatment; however, several dimensions still need to be strengthened. It is important to develop a national strategy that outlines a framework for organising and prioritising efforts towards CMP.

Evaluating the impact of solar radiation on pediatric heat balance within enclosed, hot vehicles

Pediatric deaths due to children being left in hot cars remain a significant yet preventable public health concern. The current study aims to demonstrate the influence of vehicle type, time of day, and solar exposure (sun or shade) on the energy balance and core temperature (T_c) of a hypothetical two-year old boy left in a vehicle on a hot day. Cabin temperatures and relative humidity were collected within six enclosed vehicles under sun or full shade in Tempe, Arizona. These variables and radiation estimates were used to estimate the human energy balance and final T_c across 76 measurement cycles lasting approximately 60minutes. Interior temperatures averaged 39.5°C and 47.6°C in the shade and sun, respectively, at steady-state. Based on the specific heat of a human body, the average T_c after 60 minutes in shaded or sun-exposed vehicles was estimated to reach 38.2±0.29°C and 39.1±0.41°C, respectively, with a significantly higher final T_c in sun-exposed vehicles across all days and in the shaded minivan. Extrapolation to 2 hours is estimated to result in heat injury in the sun. Results demonstrate the influence of radiation on a child's thermal balance in a hot and dry environment. In real-world situations, it is critical to acknowledge variability between children, the starting car environment, and climate (e.g., humid versus dry), and that a child left in any vehicle car can experience potentially lethal core temperatures if forgotten, as shown by vehicular heat stroke statistics. Findings may improve public messaging and reinforce the need for policy action and technological adoption to prevent injury and death.

Certification of Vehicular Hyperthermia Deaths in the Pediatric Population

The investigation of vehicular hyperthermia deaths in infants and children requires coordination between the autopsy, clinical history, and scene investigation. Unfortunately, autopsy findings can be limited or nonspecific, clinical history may be unavailable, and details concerning ambient temperature and vehicular temperature may be vague. In cases where hyperthermia is established as the cause of death, the certification of manner of death can be challenging and inconsistent among medical examiners. This article provides an overview of vehicular hyperthermia deaths and the certification of cause and manner of death in these cases.

Child Maltreatment: Types and effects: Series of six cases from a university hospital in Oman

Child maltreatment (CM) is common worldwide, and can take many forms. It may even endanger the child's life, especially when younger children are the victims. CM affects the child's quality of life and consequently leads to long term issues to be dealt with by the child, family and community. This case series discusses six children who have been subjected to CM, and diagnosed by the child protection team of the departments of Child Health and Behavioural Medicine at Sultan Qaboos University Hospital (SQUH), Oman. The aim of this case series is to increase the level of awareness of CM among Oman's medical professionals and to highlight the difficulties encountered in diagnosing and providing optimal care for these children. Although treatment is provided in Oman's health care system, it is clear that there are gaps in the existing system which affect the quality of child protection services provided to the children and their families.