Public Release: 

Recovery position may curb hospital admission rate of unconscious kids

But many parents don't put child in this position and carry out potentially dangerous maneuvers instead

BMJ

Putting a young child in the recovery position after s/he has lost consciousness may help curb the hospital admission rate for this indication, but this manoeuvre is rarely carried out, indicates research published in Archives of Disease in Childhood.

The evidence suggests that around 15% of children will have lost consciousness before they reach the end of their teen years.

The recovery position entails laying the child on his/her side, mouth facing downwards, but with chin up, and locking their arms and legs to keep them stable. This position helps to keep the airway open and drain it of fluid.

To find out how caregivers respond when a child passes out, the researchers assessed what 533 parents did when this happened.

The children, who were aged between 0 and 18 years, had either passed out within the preceding 24 hours or were unconscious when they arrived at one of 11 children's emergency care departments across Europe between July and September 2014.

Parents were asked how they had responded, including whether they had called emergency services, given their child medicines, put their child in the recovery position, or had used other manoeuvres to try and rouse him/her.

If they had used other manoeuvres, parents were asked what these were, and where they had learnt to do them, while the emergency care doctors in these cases were asked whether these actions had been potentially harmful.

The average age of the children was 3 years, and one in five had an underlying condition, the most common of which was epilepsy (7.4%). Almost half had passed out on at least one other previous occasion.

The length of time the child was unconscious ranged from 2 to 20 minutes. Half the children had blacked out following a seizure, while almost one in four (22.4%) had lost consciousness because of a sudden drop in blood pressure and heart rate (vasovagal syncope), which is often triggered by stress.

Parents had called the emergency services in only around half of the cases. In around one in four cases (145; 26%) they had placed their child in the recovery position. In 25 cases, they had given their child prescribed drugs - mostly anti-epileptics.

But in over half of cases (293; 53%), parents had carried out other manoeuvres, which the emergency care doctor regarded as potentially dangerous in 95 (17%). In 91 of these cases the child had been shaken.

Around a third of children under the age of 12 months (25/82; 30.5%) were shaken, and in 18 of these cases, this was judged to have been potentially dangerous. Shaking infants under the age of a year can lead to severe brain damage.

Other tactics parents used included putting water on the face, and slapping or blowing on the face.

Three quarters of the parents who put their child in the recovery position had been taught this on first aid courses, or by a doctor. The potentially dangerous manoeuvres had primarily been learnt from family members or the media.

Over half the children (56%) were admitted to hospital and the remainder were discharged after seeing a doctor. Six of the children died while in hospital.

Children who had passed out made up 0.55% of the caseload in emergency care. And analysis showed that putting the child in the recovery position was associated with a 28% overall lowered risk of hospital admission.

For children under the age of 2 years, this risk was 10 times lower, irrespective of other influential factors, such as length of black-out and a diagnosis of seizures.

On the other hand, manoeuvres deemed to be potentially dangerous were associated with a more than doubling in risk of hospital admission.

The researchers admit that they only looked at children admitted to emergency care, and therefore their study sample may not reflect the range of children who lose consciousness.

But they conclude: "Our study showed that the [recovery position] may reduce the hospital admission rate of children [who have passed out], but often is not performed.

"Campaigns aimed at increasing the knowledge and skills of adults to deliver safe, effective first aid to children, and specifically those highlighting the importance of using the [recovery position] should be promoted," they write.

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