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Paediatricians working in child protection are regularly faced with diagnostic difficulties when children present with signs and symptoms that could have an accidental, non-accidental or medical cause. As part of a review of the evidence behind two such signs, oronasal haemorrhage and hypernatraemia, a market-research survey was commissioned to explore parents’ awareness of the potential seriousness of blood loss from the mouth or nose and of a salt overdose.
Oronasal haemorrhage is rare in children under 2 years who present to accident and emergency units,1 and blood coming from the nose or mouth of a baby or infant is alarming and may signify or herald serious illness. Table salt is routinely used in domestic food preparation, creating a risk of accidental overdose particularly in children. Our prior hypotheses were that parents would seek immediate medical help if they observed oronasal bleeding that did not have an obvious accidental cause but may not be aware of the relatively small quantities of salt that are toxic to children.
The British Market Research Bureau (BMRB) surveyed by telephone 320 adults who were parents of a child under the age of 5 years. Questions were in a multiple choice format. In response to the question, “If you found fresh or clotted blood around the nose or mouth of your 2-month-old baby when he or she woke from their afternoon sleep, what would you do?” 53% (169/320) indicated that they would call the GP immediately, 41% (130/320) would take their baby to casualty; 4% (12/320) would tell a nurse or health visitor next time they called, 1% would go to the GP the following day, 1% would take no action and 1% would do none of these and 0.5% (1) did not know. Overall, 300 (94%) parents indicated they would seek immediate medical attention for their child.
In response to the question, “What do you think is the minimum number of level teaspoons of salt, consumed in one day, that could kill a 1-year-old child?” 30% (95/320) thought half a teaspoon; 29% (94/320) thought two teaspoons; 19% (62/320) thought five teaspoons; 6% (18/320) thought 10 teaspoons; and 2% (7/320) thought 20 teaspoons. Twelve percent of respondents (37/320) did not know, and 2% (6/320) agreed with none of these options. The results indicate that parents have very varied preconceptions of the lethal dose of salt, with many, but not all, considering relatively small doses to be dangerous. The correct answer to this question is that the minimum dose needed to kill a 1-year-old child lies somewhere between two and five teaspoons.
Competing interests: None.
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