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Contexte Conscient·e·s des difficultés engendrées par la pandémie de COVID-19 pour de nombreuses familles ayant des enfants de 6 ans ou moins, l’étude se focalise sur trois contextes de vulnérabilités familiales : familles monoparentales, avec enfants ayant des difficultés développementales et celles en situation de pauvreté. Méthode Un questionnaire, composé de 69 questions, a été transmis, au niveau national durant le premier confinement (du 17 mars au 10 mai 2020). Parmi l’échantillon d’étude (n = 490), 36 foyers sont monoparentaux et 93 familles ont un enfant présentant des difficultés développementales. De novembre 2020 à juin 2021, une approche qualitative complémentaire a été menée pour atteindre les publics les plus pauvres (n = 23). Résultats La méthodologie mixte adoptée permet de relever des modalités du vécu qui rassemblent les familles dans les trois contextes (relations intrafamiliales davantage renforcées et investissement des mesures de protection, par exemple), et d’autres qui apparaissent plus spécifiques : pression ressentie et besoin d’informations pour les foyers monoparentaux et avec enfants à difficultés développementales, charge liée à l’école à la maison pour les foyers monoparentaux et les plus pauvres, isolement social pour les foyers monoparentaux, difficultés à maintenir le budget alimentaire antérieur pour les plus pauvres. Conclusion Les diverses pressions ressenties, les conditions de logement (avec ou sans espaces extérieurs) et de travail, la crainte d’être malades, les sentiments négatifs, etc. doivent inciter les pouvoirs publics à mettre en œuvre des dispositifs de soutien psychologique, notamment pour les foyers les plus vulnérables afin que n’adviennent pas des problèmes de santé physique et/ou psychique ultérieurs voire des symptômes post-traumatiques des parents et de leurs enfants.

The first containment of the Sars-Cov2 pandemic had the potential to generate posttraumatic stress (PTS) symptoms in children. Objective The main objective of the study was to determine the prevalence of PTS symptoms within 6 weeks of the end of lockdown, in children contained between March 17, 2020 and May 11, 2020 in France. Material and Methods This was a French prospective cross-sectional study between May 15 and July 2, 2020 conducted via telephone survey. Parents of children aged between 8 and 15 years were eligible. The invitation to participate was proposed through social networks (Instagram and Facebook), various local and national media, and by e-mail to the staff of our University Hospital Center. The PTS symptoms were assessed using the CRIES-13. A score of 30 and over has been confirmed as the cut-off for screening cases. Results During the study period, 379 children (male, n = 207) were included, their mean age was 10.8±2.1 years. Symptoms of PTSD were identified in 17% of the children (girls 20.5%, boys 13.5%). These children were younger (p = 0.04), lacked access to a private outdoor space (p

International audience; Outline : 1. Expected psychological consequences today and in the future ; 2. More marked clusters of inequality ; 3. Violence and tragedies ; 4. Forgoing medical care and follow-up ; 5. Daily routine at-risk ; 6. Adolescents in difficulty ; 7. From a crisis, additional proof of a global finding from child health professionals.

La fiebre es una reaccion inespecifica de defensa del organismo como respuesta a la accion de diferentes agentes desencadenantes denominados pirogenos exogenos. La fiebre es una senal de alarma. La hipertermia es una elevacion de la temperatura central por encima de los 38 °C. Para medir la temperatura en el lactante menor de 2 anos, la via rectal sigue siendo la recomendada (no asi en el recien nacido, en el que se recomienda la via axilar), con un termometro electronico o de galio. Entre los 2 y los 5 anos de edad, la medicion rectal sigue estando indicada, pero las vias timpanica y axilar tambien son aceptables para la deteccion de un episodio febril, que, en caso de ser positivo, debe comprobarse por via rectal. A partir de la edad de 5 anos, esta indicada la via oral, aunque las consideraciones sobre las mediciones timpanicas o axilares son las mismas. Para una medicion o seguimiento detallado, la via de referencia es la rectal, aunque segun el estado del paciente, tambien puede estar indicado un procedimiento invasivo. La fiebre constituye un motivo frecuente de consulta en la medicina privada y en los servicios de urgencia. Suele generar inquietud, a menudo proporcional al valor de la temperatura e inversamente proporcional a la edad. Esta inquietud, a su vez, conduce a una automedicacion generalizada o a la prescripcion de antipireticos e incluso de antibioticos, cuando solo se deberia prescribir un medicamento, como el paracetamol, para aliviar el malestar del nino y no para bajar el valor de la temperatura. Existen varios criterios que, aislados o asociados (edad, duracion de la fiebre, tolerabilidad, antecedentes, estado vacunal), orientan sobre la necesidad de realizar pruebas complementarias. El desafio consiste en identificar una posible infeccion bacteriana grave en un nino que, como unico sintoma, presenta fiebre. Se han estudiado y validado diversas escalas clinicas y biologicas para definir a los ninos de bajo riesgo. En la actualidad, estan en curso estudios sobre combinaciones de proteinas de la inflamacion o de acidos ribonucleicos proinflamatorios para facilitar el diagnostico de las infecciones virales o bacterianas.

Las exposiciones domesticas accidentales a toxicos son muy frecuentes en los ninos pequenos menores de 6 anos, con un pico alrededor de los 2-3 anos. Las intoxicaciones suponen un porcentaje pequeno, pero aumentan con la edad y segun las caracteristicas de algunas moleculas o productos. La distribucion de los distintos toxicos implicados (farmacos, productos domesticos, productos fitosanitarios, plantas) varia segun el grupo de edad implicado. Los fallecimientos de origen toxico son infrecuentes. La mortalidad aumenta con la edad y con algunas moleculas (opiaceos sobre todo). La orientacion diagnostica, terapeutica y el seguimiento son mas faciles cuando se conoce la causa de la intoxicacion (presencia de un testigo). Por el contrario, para sospechar una causa toxica ante la presencia de sintomas que no tienen otras etiologias evidentes se deben conocer los principales toxindromes con el fin de solicitar analisis toxicologicos dirigidos y no realizar una deteccion sistematica amplia, que a menudo es inadecuada y cuya negatividad no descarta obligatoriamente la hipotesis toxica. Sospechar un origen toxico con la suficiente precocidad en la evolucion de los sintomas es un autentico reto, en la medida en que cualquier retraso a la hora de utilizar un antidoto (si este existe) supone una perdida de posibilidades de mejoria del paciente. Los principales cuadros clinicos en los que se debe sospechar una causa toxica son: cualquier sintoma neurologico aislado no febril inexplicado (coma, convulsiones, ataxia, hipotonia, etc.), sincopes repetidos inexplicados, perturbaciones metabolicas sin causa evidente (hipoglucemia, acidosis, hipopotasemia, etc.), arritmias, un fallecimiento inesperado (muestras para analisis posteriores, analisis capilar). Es necesaria una vigilancia continua, porque hay nuevas moleculas, productos (capsulas de detergente) o sustancias (liquido de cigarrillo electronico, cannabinoides de sintesis) que pueden originar una intoxicacion. Muchas intoxicaciones podrian evitarse, sobre todo colocando los productos fuera del alcance de los ninos (en un lugar alto dotado de un sistema de cierre) y manteniendolos en un envase adecuado.

Resume Les convulsions de l’enfant sont un symptome frequent et toujours mal vecu par les parents. L’objectif de cette etude etait de connaitre les representations parentales actuelles de ces convulsions afin d’ameliorer l’accueil, la prise en charge et les explications dispensees aux familles. Methodes Au moyen d’une approche anthropologique, nous avons analyse 28 entretiens enregistres de 37 parents pour une premiere crise convulsive chez leur enfant admis entre novembre 2007 et aout 2008 au service des urgences pediatriques. Resultats Le vecu de la crise etait douloureux, par le souvenir d’un corps a l’allure terrifiante et la perception d’une mort imminente. Les interpretations physiopathologiques des parents etaient souvent erronees, tres peu evoquaient la possibilite d’un phenomene d’origine cerebrale, rendant les conduites de secourisme inadaptees. La signification attribuee par les parents aux mots « convulsion » et « epilepsie » renvoyait de facon assez juste a l’expression clinique du phenomene mais beaucoup avouaient ne pas connaitre le terme ou du moins sa signification. De nombreuses etudes deja anciennes ont rapporte cette impression de mort imminente de l’enfant de meme que les conduites inadaptees. A notre connaissance, cette etude est la premiere a envisager les representations singulieres exprimees par les parents autour du phenomene convulsif, permettant de relever un faible niveau de connaissances autour de ce symptome. Des representations historiques persistaient (exces d’humeur, coleres, menstruations, possession). Conclusion Apprehender ces representations parentales parait indispensable pour ameliorer la prise en charge des familles hospitalisees pour ce symptome. Ce travail a permis l’elaboration en 2010 d’un atelier educatif specifique actuellement tres apprecie des parents.

Unintentional pediatric female genital trauma is frequent in the daily practice of emergency wards. However, scientific data are rare in the literature, leading to variability in their management. The aim of this study was to evaluate our practice in order to obtain epidemiological data and define clinical guidelines.We conducted a retrospective study from March 2013 to January 2015 and identified all emergency visits for this pathology. Data were extracted from the patients' charts and a statistical analysis was performed.One hundred and eighteen patients were admitted during the study period, with an average age of 5.9years. Straddle injuries accounted for 73 % of the injury mechanisms. Most wounds involved the majora and minora labia. Sixty-five patients did not require stitches (55.9 %); 29 patients were examined with MeopaSurgical exploration under general anesthesia should be proposed for all unintentional female genital trauma unless the patient is older than 8 and allows complete examination at the emergency department consultation.

Children's hallucinations pose the dual challenge of diagnosing a possible medical emergency and a possible psychiatric disorder.The main objective was to analyze the causes of such hallucinations in children presenting to a pediatric emergency department.We conducted a single-center, observational, retrospective study including all children aged less than 15 years experiencing hallucinations and admitted to our tertiary level pediatric emergency department between 1 January 2007 and 31 December 2015. The data collected were demographic; medical: previous medical or psychiatric history, current medications, associated clinical or psychiatric symptoms, type and character of hallucinations, length and recurrence of hallucinatory phenomena; and other biological, radiological and neurological explorations.Sixty-eight patients were included (29 boys). The mean age was 9.1±3 years (range, 2-14 years and 10 months; median, 9.2 years). Admissions were seasonal with a bimodal distribution (a peak during springtime and another one during fall). Hallucinations were mainly visual (90%), acute (77%) and complex (63%). Visual hallucinations were associated with other types of hallucinations: auditory (n=17), somatosensory (n=7). Fifteen children had a psychiatric history and had already experienced hallucinatory phenomena (93%). Among 47 patients (69%), these hallucinations were associated with other symptoms: agitation (41%), headaches (28%), hyperthermia (21%) and negative symptoms of the schizophrenia spectrum (15%). On admission, 20 patients (29%) had one or more treatments under way (34 drugs, 41% known for hallucinogenic adverse effects). Neurological explorations were undertaken in half of the cases. Toxicological analysis prescribed in 19 children was positive in five cases (26%). Fifty-three percent of patients were hospitalized and 51 children received a specialized follow-up (by a neurologist and/or a psychiatrist). A nonpsychiatric origin of these hallucinations was diagnosed in 29 patients (43%): neurological causes (n=10), infectious diseases (n=10), intoxications (n=5) and a medication side effect (n=4).Hallucinations with a suspected underlying psychiatric cause differed on several factors: chronic duration (p=0.02), an onset after 10 years of age (p=0.004), previous identical episodes (p=0.014) and a parental psychiatric history (p=0.036), auditory hallucinations (p=0.0009), absence of fever (p=0.005), headaches (p=0.036) and the presence of negative symptoms of the schizophrenic spectrum (p=0.02).

Objectif Evaluer le personnel infirmier sur leurs capacites a mettre oeuvre les gestes d’urgence et de reanimation devant une urgence vitale pediatrique.

Resume Objectif Decrire la semiologie et l’evolution de la grippe A (H1N1)v dans une population d’enfants consultant aux urgences. Methodes L’enquete multicentrique prospective a eu lieu du 1er octobre 2009 au 31 decembre 2009. Les enfants ayant une polymerase chain reaction (PCR) Grippe A (H1N1)v positive ont ete inclus dans cette etude. La semiologie, les antecedents, le devenir, la prescription d’un traitement antiviral et la survenue de complications ont ete recueillis. La duree de la fievre et de la toux a ete recueillie par un entretien telephonique a j8. Les donnees etaient analysees selon l’existence ou non d’un facteur de risque (FDR). Resultats Quatre cent soixante-six enfants ont ete inclus. L’âge median etait de 4 ans (1j–17,5 ans). Le FDR le plus frequent etait l’asthme. Il n’y avait pas de difference pour l’âge ni pour la frequence des complications (31 et 28 %, p > 0,05) entre les groupes avec (n = 208) et sans FDR (n = 258). Les complications ont ete principalement respiratoires (17 %) et la decompensation d’un FDR preexistant. Les nourrissons âges de moins de 3 mois n’avaient pas plus de complications que les enfants plus âges. Les enfants avec FDR, apres exclusion des enfants âges de moins de 3 mois, n’ont pas ete plus souvent hospitalises que les enfants sans FDR. Dix-sept enfants (3,6 %) ont ete admis en reanimation. La duree de la fievre (3,8 j) et celle de la toux (6,3 j) ne differaient pas que les enfants aient ou non recu de l’oseltamivir. Conclusion Les nourrissons âges de moins de 3 mois ne semblent pas etre un groupe a risque. La prescription d’oseltamivir n’a pas diminue la duree des symptomes.

Resume Nous rapportons le cas d'une hypercalcemie majeure chez un nourrisson de 4 mois, liee a une intoxication a la vitamine D. Observation Ce garcon âge de 4 mois, d'origine turque, a ete admis pour anorexie, asthenie, hypotonie, constipation et somnolence. L'examen clinique a confirme l'hypotonie majeure, objective une deshydratation intracellulaire moderee et une polyurie avec leucocyturie. Les constantes hemodynamiques etaient normales. Le bilan electrolytique sanguin a mis en evidence une hypercalcemie a 4,28 mmol/l, controlee a 4,55 mmol/l. L'intervalle QT corrige etait court a l'electrocardiogramme (ECG) et egal a 0,34 ms. L'enfant a ete transfere en reanimation devant l'aggravation des signes neurologiques. Une seance d'hemodialyse a ete realisee en raison de l'aggravation clinique, des anomalies de l'ECG et la valeur de la calcemie. Une hyperhydratation, des diuretiques de l'anse a forte dose et des perfusions de pamidronate de sodium ont complete la prise en charge therapeutique. Le bilan etiologique hormonal, radiologique, echographique et cardiologique associe a la reprise de l'interrogatoire parental a permis de conclure a une intoxication a la vitamine D par apports journaliers excessifs sans possibilite de determination exacte de la quantite totale administree. L'evolution a ete compliquee d'une nephrocalcinose sans retentissement fonctionnel renal, d'une thrombose iliaque sur catheter de dialyse, l'evolution neurologique a ete favorable a 3 mois. Commentaires La hantise de survenue d'un rachitisme, notamment dans les familles turques, peut conduire certains parents a administrer des quantites massives de vitamine D, certaines galeniques fortement dosees etant accessibles a l'achat par Internet. Chez un nourrisson presentant des troubles digestifs avec vomissements, constipation, associes a des troubles neurologiques (lethargie, hypotonie) et une hypercalcemie ; une intoxication a la vitamine D sera envisagee en l'absence d'une cause tumorale, hormonale ou malformative (syndrome de Williams-Beuren). L'utilisation de biphosphonates en complement d'une hyperhydratation, de diuretiques de l'anse permet souvent la correction de l'hypercalcemie. La nephrocalcinose n'est pas systematique et est souvent associee a une intoxication chronique, les troubles cardiovasculaires sont plus frequents lors d'intoxication a dose massive sur des durees courtes, les troubles du rythme graves sont rares chez l'enfant dans ce contexte.

Tracheal injuries are a rare but potentially lethal entity, most particularly in pediatrics. While standardized management allows quick therapeutic decisions in adults, based on the results of the initial bronchoscopy, the use of diagnostic exams remains unclear during childhood. We describe the case of a 6-year-old patient with a posterior tracheal wall injury due to a car accident, which was managed without tracheal endoscopy. Based on our experience and on a literature review, we suggest clarifying the management of tracheal injury in children, defining the place of computerized tomodensitometry and endoscopy in the decision process.

We report a case of a pseudo encephalitis presentation of pediatric intoxication - Case report - A 7 year-old girl was admitted to our pediatric emergency unit after she developed sudden agitation, visual and tactile hallucinations. She was febrile (38.3 °C). She had not experienced any recent head trauma, infection or toxic ingestion; she did not take any medication for ADD. Her physical exam revealed tachycardia, normal pupils, reflexes and normal plantar responses. Laboratory investigations (complete blood count, basic metabolic panel, plasma lactate level, ammonia level) produced normal results. Lumbar puncture and computed tomography of the brain were normal. A serum and urine drug screening (benzodiazepines, barbiturates, cocaine, cannabis, amphetamines, methadone, ethanol) was negative. An electroencephalogram, performed during an episode of hallucinations, was compatible with benzodiazepine intoxication. A larger toxic detection by liquid chromatography/diode array detector (LC-DAD) detected promethazine and its metabolites. Symptoms lasted 20 h and she finally said she drank syrup from an over-the-counter cough suppressant medication. Comments - Anticholinergic syndrome is not well recognized or evoked in children presenting hallucinations. Promethazine is still present in several over-the-counter medications, alone or in combination with acetaminophen, carbocisteine or opiates. CONCLUSION: Medications containing promethazine should not be prescribed in children. Such intoxication can mimic encephalitis. Language: en

Brucellosis is an overlooked infection of widespread geographic distribution. This disease is rarely evoked when assessing unexplained pediatric fever, and only 20-30 cases (children and adults) are confirmed per year. Risk factors for contracting brucellosis are exposure to bodily fluids and consumption of unpasteurized dairy products from infected animals. Most cases of brucellosis are associated with traveling to or importing contaminated goods from endemic areas. Here, we report a case of brucellosis in a 16-month-old patient hospitalized for an acute febrile illness in a French general pediatric ward. An antibiotic regimen of rifampicin and co-trimoxazole given over 6 weeks led to successful cure without relapse. The child had eaten a cake made from unpasteurized goat's milk and imported from Oran, a region in Algeria. His mother had consumed the same cake and was hospitalized for brucellosis 15 days later. Clinicians should suspect brucellosis when encountering febrile patients who have traveled to endemic areas, been exposed to body fluids or products of abortion of farm animals, or consumed unpasteurized products.

It is suspected that elementary school age children engage in "the choking game" or other asphyxial practices, but the prevalence is unknown.This study was conducted to determine the prevalence among 2nd and 3rd graders.Twenty-five schools in a region in Southeastern France were sampled on the following criteria: school size, rural/urban location, underprivileged neighborhood or not, and private/public school. Second and third grade classes were randomly sampled in each school. Another sample of 25 schools was selected in case a school refused to participate. A self-administered questionnaire, previously validated in two nonsampled schools, was administered in selected classes by the pediatrician leading the project.A total of 1125 questionnaires were distributed and 95% were completed. The mean (SD) age of children was 8.3 (0.7) years. Forty percent of children reported they had already played choking games. Among all the declared players (n=401), the male to female ratio was 1.4; 13% of them played this game every day or several times a day (91% were male). This prevalence varied between schools (16-75%) and games and was significantly higher among children schooled in underprivileged neighborhoods. Seventy-six percent of non-players and 48% of players were aware of the potential life-threatening risk.The mean prevalence in elementary school (40%) appears to be higher compared to middle and high schools (5-10%). Motivation differs in elementary school children compared to older children and teenagers. Prevention of choking games should start at elementary school and determinants leading to the continuation of such practices from elementary school to high school need to be explored.

Resume Les intoxications aigues chez l'enfant necessitant une prise en charge en unite de reanimation pediatrique (URP) restent rares. Le caractere « dynamique » de l'intoxication, avec la possibilite d'une symptomatologie differee ou retardee explique l'importance d'une surveillance (generalement

Un enfant âge de 11 ans consultait aux urgences pediatriques pour des douleurs abdominales febriles evoluant depuis 24 heures. Aucun antecedent medical ou chirurgical n’existait, aucun contage dans l’entourage proche ni la notion d’un voyage recent. Les douleurs insomniantes avaient debute la veille au soir. La derniere selle etait non glairo-sanglante. Les douleurs contrariaient les activites et ne cedaient pas sous paracetamol. A l’admission, les constantes etaient les suivantes : temperature 38 °C, pouls 117/min, tension arterielle 130/70 mmHg. L’examen clinique retrouvait un abdomen globalement douloureux sans defense. Les bruits hydro aeriques etaient presents. Le reste de l’examen etait normal. L’echographie et le scanner abdominal montraient la presence d’une adenolymphite avec ileite terminale, la presence d’un appendice sain. Le bilan biologique objectivait : une CReactive Proteine (CRP) egale a 63mg/l, leucocytes 17 700 elements/mm [83 % de polynucleaires neutrophiles (PNN)], hemoglobine et plaquettes normales. Le retour a domicile etait autorise sous traitement symptomatique (AINS, paracetamol, antispasmodique). La persistance du tableau douloureux febrile justifiait sa readmission 48 heures plus tard. La douleur predominait alors en fosse iliaque droite avec une defense nette. Le reste de l’examen etait inchange. Une nouvelle echographie objectivait une ileite terminale et de volumineuses adenopathies (diametre non precise) avec infiltration de la graisse mesenterique. La CRP etait egale a 100 mg/l, leucocytes 11 100 elements/ mm (72 % PNN), valeurs de l’hemoglobine et des plaquettes normales. Le ionogramme sanguin, les enzymes hepatiques et pancreatiques etaient normaux, la coproculture et la serologie yersiniose etaient demandees a cette seconde consultation. Une antibiotherapie intraveineuse par cephalosporine de 3 generation etait debutee (ceftriaxone 50mg/kg/ j) associee a des antalgiques et antipyretiques. L’apyrexie et l’amelioration des douleurs etaient obtenues en 48 heures ainsi qu’une decroissance de la CRP a 65 mg/l. La sortie etait autorisee sous Bactrim (sulfamethoxazole 30 mg/kg/j et trimethoprime a 6mg/kg/j) pour 7 jours dans l’hypothese d’une ileite bacterienne. La coproculture etait negative pour Yersinia, Shigella, Campylobacter, Clostridium difficile, Salmonelle ou Escherichia coli enteropathogene. Prelevee lors du second passage aux urgences, la serologie, Yersinia enterolitica etait negative et la serologie Yersinia pseudotuberculosis faiblement positive (taux a 16). Un nouvel interrogatoire authentifiait la notion de contact avec des rongeurs au domicile. Un controle serologique 10 jours plus tard confirmait la seroconversion a Yersinia pseudotuberculosis (taux a 64). Le patient etait alors asymptomatique et son bilan biologique normalise (CRP a 3.5 mg/l).

We present a neonate with a cervicofacial haemangioma complicated by the Kasabach-Merritt syndrome, respiratory distress due to airway compression and high-output heart failure. This haemangioma and intravascular disseminated coagulation, treated initially by aspirin, ticlopidine and corticosteroids, required more invasive treatment with superselective embolisation and interferon alpha-2a. The clinical outcome was good.

Resume Objectif Determiner les avantages et les inconvenients de la voie intraosseuse (VIO) pour la reanimation de l'enfant. Type d'etude Analyse retrospective, non comparative, d'abords vasculaires par VIO effectues entre janvier 1994 et juin 1998. Patients Quarante et un enfants necessitant un acces vasculaire immediat en medecine prehospitaliere (Smur), dans les services des urgences et de reanimation. Methodes La VIO etait etablie par des pediatres au niveau du tibia avec des trocarts type Mallarme en 1994 et ceux de Cook Critical Care® ulterieurement. Resultats Au total, 46 VIO ont ete placees chez 41 enfants d'âge median 18 mois (extremes: 8 jours–9 ans). Les principales pathologies indiquant le recours a la VIO ont ete les noyades, les accidents de la voie publique et les arrets cardiorespiratoires. Les complications ont consiste en une ponction articulaire et neuf extravasations souscutanees, imposant dans cinq cas l'etablissement d'une VIO a l'autre membre. Conclusion La VIO est une voie d'acces vasculaire facile a mettre en place, sure et efficace. Elle doit s'imposer dans les urgences, quand les autres techniques ne permettent pas l'obtention d'un acces vasculaire dans les cinq premieres minutes.

International audience

Intussusceptions in infants and children are a medical and surgical emergency. A seasonal pattern, with fall and winter predominance, is usually taught in medical schools, but in France the epidemiological characteristics of intussusceptions are not clearly described.We conducted a retrospective study concerning children with idiopathic ileocolic intussusceptions admitted and treated at our institution (Emergency Department and Pediatric Surgery Department, Toulouse University Hospital) between January 2002 and December 2011. The main purpose was to evaluate the seasonality of intussusceptions. We describe the sex ratio, age of occurrence, rate of recurrence, and rate of failed enema reduction.A total of 306 idiopathic ileocolic intussusceptions (280 patients) were included over a 10-year period with an average of 31 cases per year [21-42]. No seasonal pattern of intussusceptions or fall/winter predominance was shown (P=0.6) in the cumulative number of monthly cases: 24% of the intussusceptions occurred during fall, 21% during winter, 29% during spring, and 27% during summer. There were two peaks: April (35 cases over 10 years) and June (34 cases). The mean age was 18.7 months [2.3-159.4]: 19.5 months [3-159.4] in boys and 14.8 months [2.3-77.5] for girls (P=0.02). Two peaks were shown: one between six and nine months, the other one between 18 and 21 months. Male children had a higher incidence than female children: the sex ratio was 2:1, with 65.4% boys and 34.6% girls (P=0.0003), with an increasing sex ratio for older children. The recurrence rate was 8.2% among all (26 recurrences): 10.1% in boys and 4.9% in girls (P=0.08). The rate of surgery after failed enema reduction was 7.5% (21/280 children). There was no case of recurrence after operation.These results were consistent with previous reports. We did not show any seasonal pattern of idiopathic ileocolic intussusceptions in our patients. A new survey of childhood intussusceptions would be relevant to confirm these results and would make it possible to modify academic teachings about seasonality in intussusceptions.

New concentrated laundry pods, available on the European market for approximately 10 years, are associated with more severe intoxications compared to classic laundry detergents.To compare symptoms and severity after exposure to classic laundry detergents and new laundry pods in a pediatric population.Retrospective study conducted between 1st January 2002 and 30th June 2013 including all laundry detergent exposure patients admitted to our tertiary level pediatric emergency unit. Collected data were age, sex, date, time and location of exposure, type of product (powder, liquid, tablets, pods), estimated ingested quantity, time of admission, clinical symptoms, severity, complications, and progression.Descriptive analysis: eighty-nine children were included. The mean age was 2.1 ± 1.5 years (range, 36 days to 10 years), 65% of patients were aged less than 2 years. The male:female ratio was 1.5 (males, 60%). After exposure, 57% of children were symptomatic and most frequently developed digestive symptoms (75%). Comparative analysis: compared to classic laundry detergent, children exposed to laundry pods were more symptomatic (96% versus 51%, P0.0001), had more digestive signs (P=0.003), more frequently had bronchospasm (P=0.02), had a higher risk of ocular lesions (P=0.04), and exposure was more severe (poisoning severity score grade 2, 92% versus 59%, P0.0001).Laundry pod toxicity is more severe. The chemical composition of laundry pods has a higher concentration of surfactants and ethoxylated alcohols; they have a higher viscosity and hydrotropic power. The addition of water seems to modify the alkalinity, which explains the severity of ENT, gastric, and corneal lesions.The declaration to national poison centers of these intoxications should be pursued by emergency pediatricians, physicians, and pediatric intensivists. Family physicians can encourage parents to declare adverse effects to the National Consumer Product Safety Commission. Parents need to be better informed of the risk of laundry pods and strictly keep this type of product out of the reach of children. Given that it took 7 years after the first warning by the French poison centers to obtain safety recommendations for manufacturers, it is important to maintain pressure on companies to obtain the necessary modification of the physicochemical properties and child-resistant packaging.

Introduction Les intoxications accidentelles aux champignons representent plusieurs centaines de cas chaque annee en France. Ils font l’objet d’une surveillance par les centres antipoison et de toxicovigilance. L’objectif de ce travail etait de decrire les intoxications ayant motive un recours aux urgences. Methodes L’enquete permanente sur les accidents de la vie courante (EPAC) enregistre de facon exhaustive les recours aux urgences pour accidents de la vie courante (AcVC) dans 10 hopitaux metropolitains. Ce recueil porte sur la personne accidentee, les caracteristiques de l’AcVC, les lesions et parties lesees et la prise en charge. Les intoxications aux champignons ont ete selectionnees dans la base EPAC 2004–2014 et decrites par saisonnalite, âge, sexe et prise en charge. Resultats Parmi les 1 272 015 AcVC de la base, 382 (30 pour 100 000 AcVC) intoxications aux champignons ont ete identifiees. Elles ont ete plus frequentes les annees 2010 et 2011 (43 et 46 pour 100 000) et entre les mois d’aout et d’octobre (77 pour 100 000). Elles concernaient autant les hommes que les femmes (sex-ratio 1,01) et touchaient particulierement les 45–64 ans (68 pour 100 000). Une hospitalisation a ete necessaire dans 24 % des cas. La duree d’hospitalisation etait de 3 jours et plus dans 5 % des cas. Discussion Selon les informations disponibles dans la base EPAC 2004–2014, les recours aux urgences pour intoxication aux champignons sont peu frequents, survenant a la fin de l’ete et au debut de l’automne, touchant plus souvent les 45–64 ans. Ils peuvent etre graves puisqu’ils entrainent deux fois plus d’hospitalisations que les autres AcVC.

Minor head trauma is frequent among infants and leads to numerous visits to emergency departments for neurological assessment to evaluate the value of cerebral CT scan with the risk for traumatic brain injuries (TBI).To analyze the epidemiological characteristics of nonwalking infants admitted after falling at home and to analyze associated factors for skull fractures and TBI.Between January 2007 and December 2011, all children aged 9 months or younger and admitted after a home fall to the pediatric emergency unit of a tertiary children's hospital were included. The data collected were age, sex, weight and height, body mass index; geographic origin, referral or direct admission, mode of transportation; month, day and time of admission; causes of the fall, alleged fall height, presence of an eyewitness, type of landing surface; Glasgow Coma Scale (GCS) score, application of the head trauma protocol, location and type of injuries, cerebral CT scan results, length of hospital stay, progression, and neglect or abuse situations.DESCRIPTIVE ANALYSIS: within the study period, 1910 infants were included. Fifty-four percent of children were aged less than 6 months with a slight male prevalence (52%). Falls from parental bed and infant carriers accounted for the most frequent fall circumstances. GCS score on admission was equal to 14 or 15 in 99% of cases. A cerebral CT scan was performed in 34% of children and detected 104 skull fractures and 55 TBI. Infants aged less than 1 month had the highest rate of TBI (8.5%). Eleven percent of patients were hospitalized. A situation of abuse was identified in 51 infants (3%). UNIVARIATE ANALYSIS: Male children and infants aged less than 3 months had a higher risk of skull fractures (P = 0.03 and P = 0.0003, respectively). In the TBI group, children were younger (3.8 ± 2.6 months versus 5.4 ± 2.5 months, P0.0001), fell from a higher height (90.2 ± 29.5 cm versus 70.9 ± 28.7 cm, P0.0001), were more often admitted on a weekend or day off, and had more skull fractures (54% versus 6%, P0.001). MULTIVARIATE ANALYSIS: all variables showing P0.2 in the univariate analysis were entered into the model. In the final model, three variables continued to be associated with a risk of TBI: being referred by a physician (OR 4.6 [2.2-9.6], P0.0001), being younger than 3 months old (OR 3.1 [1.7-5.7], P = 0.0002), falling from a height greater than 90 cm (OR 3.1 [1.7-5.6], P = 0.0002).Before walking acquisition, children are particularly vulnerable and have the highest rate of TBI after a vertical fall. In this age group, the rate of abuse is also higher. Given this double risk, numerous cerebral CT scans are performed (35-40% of the target population). This protocol, however, leads to a low proportion of detected TBI (10%) compared to the high number of CT scans and an additional risk of irradiation.As no validated predictive score exists and pending the contribution of the S-100B protein assay, the identification of infants at high risk for TBI and justifying neuroimaging is based on the search for predisposing factors and circumstances.

Because meningitis symptoms are not very specific under the age of 18 months, lumbar puncture (LP) was widely recommended in children presenting a febrile seizure (FS). Recent retrospective studies have challenged this age criterion. In 2011, the American Academy of Pediatrics updated its guidelines for the first episode of simple FS: LP is indicated if signs suggestive of meningitis are present and remains "an option" in case of prior antibiotic treatment or between the age of 6 and 12 months if the child is not properly vaccinated against Haemophilus and Streptococcus pneumoniae. Because the meningitis epidemiology and the vaccination coverage are different, the objective of this study was to evaluate whether these new guidelines were applicable in France.Between 2009 and 2010, we conducted a retrospective single-center study including 157 children aged less than 18 months admitted to the pediatric emergency department (Children's Hospital, Toulouse, France) for their first febrile seizure. The data collected were: type of seizure, knowledge of prior antibiotic treatment, neurological status, signs of central nervous system infection, and biological results (LP, blood cultures).Lumbar puncture was performed in 40% of cases (n=63). The diagnosis of meningitis/encephalitis was selected in eight cases: three cases of viral meningitis, three bacterial meningitis (Streptococcus pneumoniae), and two non-herpetic viral encephalitis. The incidence of bacterial meningitis in our study was 1.9%. The risk of serious infection, bacterial meningitis or encephalitis, was increased when there was a complex FS (14% versus 0% with a simple FS, P=0.06). The presence of other suggestive clinical symptoms was strongly associated with a risk of bacterial meningitis/encephalitis (36% in case of clinical orientation versus 0% in the absence of such signs, P0.001).All severe clinical presentations were associated with complex FS (prolonged, focal, and/or repeated seizures) and the presence of other suggestive clinical signs (impaired consciousness lasting longer than 1h after the seizure, septic aspect, behavior disorders, hypotonia, bulging fontanel, neck stiffness, petechial purpura). The risk of bacterial meningitis or encephalitis associated with a simple FS and followed by a strictly normal clinical examination is extremely low.After a simple febrile seizure without any other suggestive signs of meningitis, systematic lumbar puncture is not necessary even in children younger than 18 months. LP remains absolutely indicated if clinical symptoms concentrate on central nervous system infection and should be discussed in case of complex seizures, prior antibiotic treatment, or incomplete vaccination.

Numerous infants wear teething necklaces, a quack remedy with a real risk of strangulation or aspiration of small beads.Evaluate parental perceptions and beliefs about the use of teething necklaces and analyze parental knowledge about the associated dangers.Between March and July 2011, in three different pediatric units of a tertiary children's hospital and a general hospital in Toulouse and Montauban (southwest France), voluntary parents were invited to be interviewed about their child wearing a teething necklace. The interviews were conducted following an anthropological approach: they were recorded and then fully transcribed and analyzed. Parents were informed that the conversation was recorded.During the study period, 48 children were eligible. Eleven families refused to participate, 29 parents were interviewed face to face. The children's mean age was 14 years ± 7 months, the male:female ratio was equal to 0.8 (12 boys, 15 girls). The mean age of children when necklace wearing was started was equal to 4 ± 2 months. The mean mother's age was 31 ± 5 years and 33 ± 4 years for fathers. The parents' religion was mostly Catholic (60%). Teething necklaces were mainly made of amber (n=23). Sales information about the risks associated with the necklaces was for the most part absent (92%). The most frequent positive parental perceptions were analgesic properties and a soothing remedy (73%); a birth accessory and memory (64%); an esthetic accessory (60%); a protective amulet (60%); and an alternative or additional element to other traditional therapeutics (55%). The negative parental perceptions (n=4) were an unnecessary accessory, costume jewelry, a pure commercial abuse of a popular belief, a dangerous item with a risk of strangulation, and the absence of proof of its efficacy.Although parents concede that teeth eruption is benign, they fear its related symptoms. To a natural phenomenon a natural response: they use a necklace to satisfy the analogy. The parental approach of this usage is consistent with accessorizing the child to protect and help them during a difficult stage. When informed of the danger of strangulation, numerous families preferred to continue this practice; their irrational fear of seeing their child suffer surpassed their fear of the risk of strangulation.Putting necklaces on young children is dangerous. This risk must be diffused by all professionals working with small children in order to stop any publicity or sale of this ineffective product implicated in infant deaths by strangulation.

We report a paediatric case of survival following severe hydrogen sulfide (H2S) gas intoxication. A 13-year-old boy was found submerged to the neck in a manure tank. He was hypothermic, unresponsive with bilateral mydriasis, and had poor oxygen saturation. After intubation, he was transferred to the paediatric intensive care unit of a tertiary care children's hospital. He developed acute respiratory distress syndrome (ARDS) requiring high frequency percussive ventilation. Cardiac evaluation was significant for myocardial infarction and left ventricular function impairment. He completely recovered from the respiratory and cardiac failure. Neurological examinations showed abnormal signals on MRI in the semi-oval center and in the frontal cortex. Follow-up detected partial impairment of axonal fibers of the right external popliteal sciatic nerve. Paediatric cases of survival after H2S intoxication have been rarely reported. Such exposures can evolve to severe ARDS and benefit from high frequency percussive ventilation. Hypothermia and other metabolic abnormalities are now better explained thanks to actual knowledge about endogenous H2S function. Lessons learned from paediatric accidents should result in better information about this threat for farmers and families living in houses with septic tanks, reducing the risk to their own and their children's safety.

Resume But Analyser sur un echantillon de soignants et de parents l’appreciation du tarif d’examens complementaires courants. Patients et methodes Le questionnaire portait sur la valeur en euros d’une consultation de jour et de nuit aux urgences, d’une analyse de sang, d’urines, d’un electrocardiogramme (ECG), d’une radiographie pulmonaire (RP) et de l’abdomen, d’une echographie abdominale, d’une endoscopie digestive haute, d’une tomodensitometrie (TDM) et d’une imagerie par resonance magnetique (IRM) cerebrales sans anesthesie, la pose d’un plâtre du bras, d’une suture de plaie superficielle. Resultats Les reponses de 185 soignants et de 187 parents ont ete analysees et comparees. Moins de 25 % de la population donnait une reponse approchant la realite avec un risque d’erreur de plus ou moins 30 %. Parents et soignants surestimaient les couts, parents et auxiliaires de puericulture surestimaient plus que les autres. Les examens de radiologie etaient les plus surestimes ; par exemple, l’ecart moyen a la valeur attendue d’un scanner ou d’une IRM cerebrale sans anesthesie etait respectivement egal a 850 ± 1100 % et 370 ± 590 %. Commentaires Inscrit dans la culture collective et devenu une exigence, le droit a la sante a un cout. Ce cout est souvent surestime par soignants et population generale. Conclusion L’acces a l’information sur les couts necessite une education de la population et les medecins devraient beneficier d’une formation a la maitrise des depenses sans glisser vers des rapports de subordination entre sante et economie qui conduiraient a des attitudes de renonciation a des examens voire d’exclusion sur le seul pretexte de leur cout.

Pediatric seizures are a common symptom, especially when associated with fever. This phenomenon is still shocking and traumatic for parents. The study analyzed current parental perceptions of seizures in order to improve the quality of management, care, and explanations provided to families at our emergency unit.Using an anthropological approach, we analyzed 28 interviews of 37 parents whose child was admitted to our pediatric emergency unit between November 2007 and August 2008 due to a first seizure.The parental experience of the crisis was marked by upsetting memories of a "scary"-looking body and the perception of imminent death. Parental interpretations of the pathophysiology of the event were often wrong; very few mentioned the possibility of its cerebral origin, leading to inappropriate rescue attempts (e.g., giving CPR). The meaning attributed by parents to the word "seizure" and "epilepsy" usually referred to an exact clinical description of the phenomenon, but many admitted being unfamiliar with the term or at least its origin. Many studies have found the expectation of imminent death as well as inappropriate behaviors. This is the first study to consider interpretations expressed by parents around the convulsive phenomenon and to confirm a low level of knowledge of the symptom. Some historical interpretations persisted (e.g., the influence of excessive mood, anger, menstruation, demonic possession).Understanding and integrating these parental interpretations seems essential to improving care for families who first experience this symptom. This study motivated the implementation of a special educational workshop on seizures in 2010.

We report a paediatric case of survival following severe hydrogen sulfide (H2S) gas intoxication. A 13-year-old boy was found submerged to the neck in a manure tank. He was hypothermic, unresponsive with bilateral mydriasis, and had poor oxygen saturation. After intubation, he was transferred to the paediatric intensive care unit of a tertiary care children's hospital. He developed acute respiratory distress syndrome (ARDS) requiring high frequency percussive ventilation. Cardiac evaluation was significant for myocardial infarction and left ventricular function impairment. He completely recovered from the respiratory and cardiac failure. Neurological examinations showed abnormal signals on MRI in the semi-oval center and in the frontal cortex. Follow-up detected partial impairment of axonal fibers of the right external popliteal sciatic nerve. Paediatric cases of survival after H2S intoxication have been rarely reported. Such exposures can evolve to severe ARDS and benefit from high frequency percussive ventilation. Hypothermia and other metabolic abnormalities are now better explained thanks to actual knowledge about endogenous H2S function. Lessons learned from paediatric accidents should result in better information about this threat for farmers and families living in houses with septic tanks, reducing the risk to their own and their children's safety.

Adder bites and their progression to severe envenomations are more frequent in children than in adults.To describe the clinical, biological, and therapeutic characteristics of children bitten by adders and to identify risk factors associated with severe envenomations corresponding to grades II and III of the Audebert et al. classification (Toxicon 1992).A retrospective study was conducted between 2001 and 2009 in the pediatric emergency department of a tertiary children's hospital. The data collected were: age and sex of children; day and time of admission; day, time, and circumstances of the accident; snake identification; bite location; envenomation severity based on the Audebert et al. classification; presence of fang marks; prehospital care; use of specific immunotherapy (Viperfav(®)), associated treatments; length of stay; orientation, progression, and any complications.Fifty-eight children were included (43 boys, 15 girls). The mean age was 7.8 ± 4.1 years (range, 1.8-15 years). Bites occurred more often between 12:00 pm and 6:00 pm (62%), and were most often located in the lower extremities (77%). The classification of envenomation was: 83% low grade (grade 0, absence of envenomation, fang marks present; grade I, minor envenomation) and 17% high grade (grades II and III, moderate and severe envenomations). All high-grade envenomations received specific immunotherapy (Viperfav(®) F(ab')(2) fragments against Vipera aspis, Vipera berus, and Vipera ammodytes). The mean time from bite to Viperfav(®) injection was 23 ± 11 h (range, 8-36 h). Being bitten on the upper extremities (p0.001), during the afternoon (p = 0.025), feeling an immediate violent pain (p = 0.037), and high initial glycemia (p = 0.016) were associated with a significant risk of progressing to high-grade envenomation. There was no significant correlation between age, gender, and upper extremity bite. In the final model of the multivariate statistical analysis, three factors remained associated with this risk: bite location in the upper extremities (relative risk [RR] = 60.5 [3.5-1040[; p = 0.005), immediate violent pain (RR = 21.5 [1.3-364.5[; p = 0.03), and female gender (RR = 17.5 [0.9-320.3[; p = 0.053).A certain number of criteria seem related with a more significant risk of progression to high-grade envenomation following an adder bite. These results need to be studied on a larger cohort of patients. Bites to the upper extremities should be handled with caution because of the association with more severe envenomation.

To analyze the accuracy of estimates made by medical staff and parents regarding fees for consultations and frequently prescribed medical exams.The questionnaire focused on the value in euros for the following: day and night consultation in the pediatric emergency department, blood and urine analysis, electrocardiogram, chest and abdominal x-ray, abdominal ultrasound, upper digestive endoscopy, CT scan, cerebral MRI (without anesthesia), an arm cast, and superficial wound repair. Medical staff belonged to different units of the childrens' hospital. The parents interviewed had consulted at the pediatric emergency unit. Neither of the two investigators was familiar with the fee structure. To avoid inducing a gradation in estimates, questions were asked with no pre-established order. To limit the possibility of participants discussing the questionnaire with their colleagues or searching for the real value, all medical staff members were assessed within a 48-h period.The responses of 185 medical employees (23 pediatricians, 28 interns, 81 nurses, 45 childcare assistants, seven nurse supervisors) and 187 parents were analyzed and compared. Less than 25% of the population gave an answer with an accepted error of ± 30%. Parents and hospital staff overestimated costs, parents and childcare assistants overestimated more than other medical employees. Radiological exams were the most overestimated procedures with the largest proportion of the average deviation from normal value: CT scan 850 ± 1100%, cerebral MRI 370 ± 590%, abdominal x-ray 240 ± 390%, and chest x-ray 190 ± 320%.Part of our societal culture and now a requirement, the right to healthcare has a cost. This cost is often overestimated by caregivers and the general population.Global understanding of the costs related to medical care requires educating the population and medical professionals. Medical staff should be informed of the real costs of treatment to enable them to manage unnecessary costs. There is a balance between justifying the costs of essential medical treatment and not using economic constraints as a pretext for denial of treatment.

Les urgences pediatriques requierent des besoins et competences specifiques differents des urgences adultes, plus sensiblement face a des urgences vitales. Ces urgences devraient etre accueillies en salle d’accueil d’urgences vitales (SAUV). A partir des recommandations francaises publiees en 2004, nous avons evalue les capacites des services d’accueil des urgences (SAU) francais a la prise en charge des urgences vitales de l’enfant. Questionnaire issu des recommandations francaises concernant la gestion d’une SAUV pediatrique adresse a 300 SAU. Evaluation de l’effectif medecin et sa formation, recours a un pediatre, admissions pediatriques en SAUV, disponibilite du materiel recommande, de protocoles pediatriques. Les reponses de 100 centres ont ete analysees. Les SAU n’etaient pas en conformite en matiere de lits de SAUV dans 39 % des cas. Le recours a un pediatre H24 etait impossible dans 23 % des etablissements. Le pourcentage de formation en SAU non pediatriques (SAUNP) etait egal a 16,6 ± 17,7 %. Le materiel de reanimation respiratoire etait complet dans 75 % des SAU et des SAU pediatriques (SAUP), de reanimation cardiocirculatoire complet dans 82 % des SAU, 91 % des SAUP, des protocoles pediatriques disponibles dans 51 % des SAUNP. Une moindre disponibilite de l’equipement cardiocirculatoire et l’absence de pediatre disponible H24 etaient significativement associees avec un nombre annuel de passages pediatriques inferieur a 7 000. Toute deficience des besoins specifiques a la gestion de ces urgences vitales entraine une mise en danger des enfants. Tout doit etre mis en oeuvre pour favoriser acquisition et maintien des ressources recommandees.

The clinical manifestations and outcome of infants and children with confirmed 2009 H1N1 influenza in emergency departments is described.We conducted a prospective multicenter case series involving children with symptoms of influenza-like illness in whom 2009 H1N1 influenza was diagnosed on reverse-transcriptase polymerase chain reaction assay on a nasopharyngeal swab or nasal aspirates and who were admitted to the ED of four university pediatric hospitals. The following data were collected: age, gender, preexisting chronic conditions (PECs) associated with a high risk for influenza-related complications, clinical symptoms, outcome, antiviral treatment, and complications. We recorded length of cough and fever during a phone-call on day 8.Between 1st October and 31st December 2009, 466 children were included. Their median age was 4 years (range, 1 day to 17 years). The median time to consultation was 24h. Of these 466 infants and children, 55 were aged less than three months and 153 had one or more PECs. Asthma was the most frequent condition. Children at risk and children without risk did not differ for complications (28% vs 31%, P0.05). Respiratory complications (17%) and decompensations of preexisting disease were the most frequent. Infants aged less than three months did not have more complications than infants without PECs. At-risk infants and children were more frequently hospitalized (P0.02) and the duration of the pediatric ward stay was longer (P0.02). This was true only for children aged less than three months. Of the hospitalized children, 17 (9%) were admitted to an ICU. Duration of fever (3.8 days) and duration of cough (6.3 days) did not differ according to whether or not children received oseltamivir.Infants younger than three months of age are not a group at risk for influenza-related complications. Oseltamivir did not reduce duration of symptoms in this population.

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