Recovery position in children decreases hospital admissions

By Bianca Nogrady
Using the recovery position for children who have lost consciousness can significantly decrease the likelihood of them being admitted to hospital, a European study has found.

The prospective study of 553 consecutive children (aged 0 to 18 years) presenting with loss of consciousness at paediatric emergency departments found that children who had been placed in the recovery position by their caregiver were 72% less likely to be admitted to hospital than those who had not been placed in the recovery position.

The study also found generally low awareness of the recovery position, with only around one in four caregivers using it when the child lost consciousness, according to the study findings published online in Archives of Disease in Childhood.

The most common cause of the loss of consciousness episode was febrile seizures (26.6%), followed by nonfebrile seizures (23.7%) and vasovagal syncope (22.4%).

Caregivers who did not use the recovery position reported trying to shake the child, putting water on the child’s face, slapping or blowing on the child’s face, or even using chest compressions. The authors found that around 17% of these procedures were potentially dangerous. Furthermore, these more dangerous manoeuvres were independently associated with a twofold increase in the risk of admission to hospital.

The recovery position was more likely to be used with older children, those with a chronic epileptic disease and a history of loss of consciousness, those in whom the final diagnosis was a seizure, and those presenting with a loss of consciousness for two minutes or longer or with abnormal movements.

‘The [recovery position] is a simple manoeuvre which is commonly recommended in first aid for all unconscious people, in order to protect the airway against aspiration, which is a recognised cause of death in patients with epilepsy,’ the authors wrote. ‘Many studies have already indicated the lack of knowledge of parents about first aid in children, but only two studies, which focused on febrile seizures in young children, have evaluated the parents’ ability to put the child into the [recovery position].’

Commenting on the study, paediatric emergency physician Dr Fiona Thomson said although the use of the recovery position was second nature for emergency physicians and ambulance staff, there was a need for more awareness in the general community.

‘It helps to avoid complications from aspiration or pneumonia – often that can be a secondary insult after the initial reason for the patient losing consciousness. If you can prevent that, it will have a significant flow-on effect in terms of reducing complications, so it’s a good public health message,’ said Dr Thomson, Senior Staff Specialist in paediatric emergency medicine at the Lady Cilento Children’s Hospital in Brisbane.

Dr Thomson suggested a public health campaign similar to the recent awareness-raising efforts around the risk of button batteries could help increase use of the recovery position.
Arch Dis Child 2016; doi: 10.1136/archdischild-2015-308857.

Picture credit: © Lukaves/Depositphotos.