Childhood injury prevention, drowning and burns
Childhood injuries: patterns by age, drowning prevention and rescue, burn and scald emergency care, road safety and injury-prevention counselling.
- Injury is the leading threat to children after infancy: hundreds of thousands of children die each year from injuries or violence, and for every death many more are hospitalised or live with lasting disability. [1]
- Drowning kills about 300 000 people worldwide each year; children under five account for nearly a quarter of those deaths, and it is the third leading cause of death in children aged 5 to 14 years. [2]
- Burns and scalds kill about 163 000 people worldwide each year from fire, heat and hot substances, including about 35 600 children under 15, and non-fatal burns bring pain, scarring and prolonged treatment. [3]
- Road traffic injuries are the leading cause of death for children and young adults aged 5 to 29 years, and 92% of road deaths occur in low- and middle-income countries. [4]
- Almost all of these injuries are predictable and preventable: fences around water, smoke alarms and thermostatic taps, car seats and helmets, and active supervision stop far more deaths than emergency care ever can. [6][4] [5]
- Emergency care at the scene saves lives: cool a thermal burn with running water (around 20 minutes), and in a drowning start rescue breathing and CPR early because the problem is lack of oxygen, not the heart. [7][5]
By the end of this page you should be able to:
- Describe the main patterns of unintentional injury at each stage of childhood, and explain why they change with development.
- Outline the chain of survival for drowning, and the key steps in safe rescue and resuscitation.
- Give correct emergency care for a thermal, chemical or electrical burn, and state which burns need urgent hospital care.
- List the evidence-based measures that prevent drowning, burns, road traffic injury, falls and poisoning in children.
- Provide practical, age-appropriate injury-prevention counselling to families.
- Adapt injury prevention to low-resource settings and recognise safeguarding concerns.
- Identify the guidelines behind your advice and their editions.
DefinitionUnintentional injury
Physical harm to a child caused by an external agent or circumstance rather than by disease. It includes road traffic crashes, drowning, burns and scalds, falls, poisoning, suffocation, cuts and sports injuries. The word "accident" is best avoided, because most injuries are predictable and preventable, not random. [6]
Injury begins to matter from about the first birthday, and contributes more and more to death and disability until the person reaches adulthood. [1] Mechanisms change with age, but the commonest worldwide are road traffic injuries, drowning, burns, falls and poisoning. [1]
Globally there are about 300 000 drowning deaths and about 163 000 deaths from fire, heat and hot substances each year. [2][3] Children and young people aged 0 to 29 years account for 57% of all drowning deaths, and the highest drowning rates are in children aged 0 to 4 years. [2] Children under five account for nearly a quarter of all drowning deaths. [2]
Drowning is the fourth leading cause of death in children aged 1 to 4 years and the third leading cause of death in children aged 5 to 14 years. [2] Nearly all drowning (more than 90%) is considered preventable. [5] About 35 600 deaths from fire, heat and hot substances occur in children under 15 each year, which is 22% of that global total. [3] About two thirds of those deaths occur in the African and South-East Asia regions. [3]
Road traffic injuries cause about 1.16 million deaths each year worldwide and are the leading cause of death in children and young adults aged 5 to 29 years. [4] Males are about three times more likely to die in road crashes than females. [4] More than 90% of road deaths occur in low- and middle-income countries. [4]
World Health Organization
The WHO World Report on Child Injury Prevention (2008) and the WHO fact sheets on drowning (2026), burns (2026) and road traffic injuries (2026) provide the global figures used here. Regional figures differ: drowning rates are highest in the WHO Eastern Mediterranean Region for children under 5, and over half of global drowning occurs in the WHO Western Pacific and South-East Asia Regions. [1][2]
The hazards a child meets depend on what they can do. Match the advice to the child's stage.
| Age group | Usual mechanisms | Main hazards | Prevention focus |
|---|---|---|---|
| Infants (under 1 year) | Falls, suffocation, scalds | Hot drinks, baths, changing tables, stairs | Supervision, safe sleep, water temperature, never leave alone near water |
| Toddlers (1 to 3 years) | Falls, burns/scalds, poisoning, drowning | Climbing, cupboards, kettles, buckets, ponds | Locked storage, gates, thermostatic taps, pool fencing, hand holding near roads |
| Preschool (3 to 5 years) | Road traffic, falls, burns, drowning | Roads, play equipment, kitchens, hot surfaces | Car seats or boosters, helmets, supervision on roads, smoke alarms |
| School age (5 to 12 years) | Road traffic, sports, falls, drowning | Bicycles, streets, playgrounds, lakes | Helmets, pedestrian skills, safe routes, swimming and water safety skills |
| Adolescents (13 to 18 years) | Road traffic, falls, drowning, self-harm | Driving, alcohol, water, machinery, firearms (where present) | Seat belts, helmet use, no drink-driving, swimming with others, mental-health support |
A useful counselling frame: children under 5 are generally more vulnerable to injuries in the home, and children over 11 are more vulnerable to road injuries. [6] Boys are more likely than girls to drown and to be killed on the roads. [2][4]
Drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid. [2] It has three outcomes: death, morbidity (survival with disability), and no morbidity. [2] Impairment starts within seconds of the airway entering the water; the person cannot call for help because the instinctive drowning response prioritises breathing over waving or shouting. [5]
About 300 000 people die from drowning worldwide each year, including about 236 000 according to the American Heart Association estimate; the difference reflects different data sources. [2][5] Children aged 0 to 4 years have the highest drowning rates per population, and children and young adults aged 0 to 29 years account for 57% of all drowning deaths. [2]
Risk factors include age under five; interaction with water without active adult supervision; being male; poverty and daily exposure to ponds, rivers, lakes, open wells and water containers; climate extremes such as floods; and unsafe water transport. [2] Drowning death rates are more than three times higher in low- and middle-income countries than in high-income countries, and 92% of drowning deaths occur in low- and middle-income countries. [2]
Drowning: from recognition to resuscitation
- Recognise distressThe person may be silent, vertical in the water, struggling to keep the face above water; they cannot wave or call. Ask for help and note the location.
- Call for helpActivate emergency services. Tell someone to bring rescue equipment and an AED.
- Question: Can the person be reached safely without entering the water?
Yes, from land or poolside
- Reach, throw, don't goExtend a pole, rope or clothing; throw a flotation device; talk the person to safety. Never jump in if you are not trained.
No, water entry needed
- Only trained rescuersUse approved rescue equipment and personal flotation. Avoid becoming a second victim.
- Provide flotationKeep the person's airway above water until removal.
- Remove from waterRemove as soon as it is safe; prefer a near-horizontal position with the head above the body and the airway open if the person is in shock or likely cardiac arrest; a more vertical position if the person is conscious and breathing.
- Assess breathingLook, listen and feel for up to 10 seconds; pulses are hard to feel accurately, so if the person is unresponsive with abnormal or absent breathing, start CPR.
- Question: Is the person breathing normally?
Yes
- Recovery positionPlace in the recovery position, keep warm, give oxygen if available, and transport to hospital for observation.
No
- Start rescue breathingTrained rescuers may give in-water rescue breathing if it is safe. Begin CPR with breaths and compressions as soon as possible: AHA allows initiating with breathing (A-B-C) or compressions (C-A-B).
- Give oxygen and ventilateCardiac arrest after drowning is usually due to severe hypoxaemia, so ventilation matters as much as compressions. Use 100% oxygen when available.
- AED after CPR startsApply an AED once removed from the water; do not delay CPR to get it. Shockable rhythms are a minority, especially in children.
- TransportAll people who needed any resuscitation after drowning, including only rescue breaths, should go to the emergency department.
Key points from the American Heart Association and American Academy of Pediatrics 2024 focused update: [5]
- In-water rescue breathing by trained rescuers, when safe, may prevent progression to cardiac arrest. [5]
- Cardiac arrest after drowning is generally the result of severe hypoxaemia, so oxygen administration is recommended when available. [5]
- Trained rescuers should provide rescue breaths as part of CPR and may initiate with breaths or compressions. [5]
- There is no preferred mode of delivering ventilation in the pre-hospital setting. [5]
- Public-access defibrillation programmes may help in aquatic environments. [5]
Prevention is more effective than rescue. The WHO recommends: [2]
- Control access to water: cover wells, use doorway barriers and playpens, fence swimming pools on four sides with self-closing, self-latching gates, and drain or fence water containers.
- Supervise young children closely and non-stop ("touch supervision" for children under 5 in the water).
- Teach school-age children basic swimming, water safety and safe rescue skills.
- Provide community-based supervised day care for pre-school children; WHO modelling suggests that scaling day care and swim-skill programmes between now and 2050 would prevent 774 000 child drownings and 178 000 severe non-fatal injuries. [2]
- Ensure children and non-swimmers wear approved life jackets for boating and open water.
- Swim where there are lifeguards, and never swim alone.
- Build resilience to floods and support safe water transport (regulated, non-overcrowded vessels, life jackets).
United Kingdom (NICE)
NICE guideline PH29 on unintentional injuries in children under 15 (2010) advises providing age-appropriate water-safety information to children, parents and carers, encouraging swimming competence and rescue skills, and noting that boys, children with certain medical conditions, and older children are at greater risk. [6]
- Keep water storage covered and fenced, and supervise children around any collection point, irrigation channel or flood water.
- A non-swimmer who gets into trouble is best helped from land with a pole, rope or flotation aid; untrained rescues often create a second victim.
- After a drowning with no breathing, mouth-to-mouth or bag-mask ventilation started early, by the first available means, saves more lives than waiting for equipment. [5]
A burn is an injury to the skin or other tissue caused by heat, or by electricity, chemicals, friction, radiation or radioactivity. [3] Thermal burns come from hot liquids (scalds), hot objects, flames and other heat sources; chemical burns from caustic agents; electrical burns from current; and inhalation injury from hot air or smoke. [3][8]
About 163 000 people died from fire, heat and hot substances worldwide in 2023, two thirds of them in the African and South-East Asia Regions. [3] About 35 600 of those deaths were children under 15 years, which is 22% of the global total. [3] Females account for about 70% of deaths in South-East Asia, linked to cooking with open fires and hazardous fuels. [3]
Non-fatal burns cause pain, prolonged treatment, scarring, disability, psychological distress and social and economic harm. [3] Younger children most often sustain scalds from hot liquids or steam; older children more often flame burns from direct contact with fire. [9] In the United States, about 435 children aged 0 to 19 years are treated in an emergency department for burns each day and about two die from burns daily. [9]
The main risks are poverty and overcrowded housing, open cooking fires and unstable stoves, hazardous fuels, unsafe electrical installations, lack of smoke alarms, and limited access to emergency care and care. [3]
Emergency care for a thermal burn in a child
- Make the scene safeRemove the child from the source. Extinguish flames by drop-and-roll or by smothering with a blanket or coat. Do not put yourself at risk.
- Stop the burning processRemove non-adherent clothing and tight jewellery early. Do not pull off clothing or material stuck to the wound; cut around it.
- Cool the burnIrrigate with cool or tepid running water. Common advice is about 20 minutes for smaller burns; irrigate within 20 minutes of injury where possible; run for 15 to 30 minutes when feasible.
- Keep the child warmCover the rest of the body with coats, sheets or blankets to avoid hypothermia, especially when cooling a large area in infants or older children.
- Cover the woundAfter cooling, lay cling film loosely over the burn (layers laid on, not wrapped around), or use a clean cotton sheet. A clean plastic bag is useful for a hand.
- Relieve painOffer paracetamol or ibuprofen for mild to moderate pain; escalate analgesia if pain is severe.
- Do NOT applyNo ice, very cold water, butter, grease, oils, toothpaste, traditional pastes, sprays, ointments, creams or adhesive dressings at this stage. Ice delays healing and may deepen the wound.
- Question: Does the burn need urgent hospital care?
Yes
- Call emergency servicesBurn above the neck; on the hands, feet, groin, face or a joint; a baby or very small child; burns that look white or chalky; electrical or chemical burns; any inhalation injury (soot, stridor, hoarse voice); a burn larger than about a 2-euro coin; signs of shock; or uncertainty about cause (possible safeguarding issue).
No (minor, superficial)
- Observe and follow upArrange follow-up as clinically indicated; watch for infection or increasing pain and redness.
First-aid consensus statements to remember: [3][7][8]
- Cooling ideally happens within about 20 minutes of injury; if water is not available, use wet towels or compresses. [3][7]
- Do not use ice or very cold water, which may cause vasoconstriction and deepen the wound. [3][7][8]
- Hypothermia is more likely when a large area is cooled, especially in infants and older people; the aim is to cool the burn, not the whole child. [3]
- Chemical burns need removal of contaminated clothing, brushing off dry chemical, and irrigation with copious water for about an hour; do not try to neutralise the chemical, because heat is produced. [3][7]
- Electrical burns need power to be switched off or the person removed with a non-conductive object before contact; arrange immediate hospital assessment. [7]
- Chemicals in the eye need prolonged irrigation; call the local poisons line (for example, 1-800-222-1222 in the USA) for product-specific advice. [8]
From the Health Service Executive (Ireland) and the American Academy of Pediatrics: [7][8]
- Burn or scald above the neck, or on the hands, elbows, knees, ankles, feet or groin.
- Baby or very small child burnt or scalded.
- Burn area larger than a 2-euro coin (or not a trivial burn in any child).
- Burns that appear white or chalky, or full-thickness/charred.
- Electrical, chemical or inhalation burns.
- Signs of shock: cold, clammy skin, sweating, fast shallow breathing, weakness or dizziness.
- Non-accidental injury suspected, regardless of burn size.
- Burns involving the face, mouth or genitals, a joint, or circling a limb.
From the CDC and HealthyChildren (American Academy of Pediatrics): [8][9]
- Set the water heater to no more than 120°F (48.9°C) at the faucet; risk falls sharply below this. [9]
- Never carry a baby and a hot drink, tea, coffee or soup at the same time; keep hot drinks out of reach and never pass them over a child's head. Hot drinks stay hot enough to scald for some time after being poured. [9]
- Stir or stand microwaved food for two minutes so heat distributes evenly. [9]
- Never leave food cooking on the stove unattended; turn pan handles to the back; use back rings; keep toddlers out of the kitchen while cooking. [9]
- Keep children away from oven doors, irons, hair straighteners, radiators, grills and glass-fronted gas fires; screen fireplaces and heaters. [8][9]
- Cover electrical outlets, keep chemicals out of reach and locked, and keep household products in original child-proof containers. [8]
- Install smoke alarms on every floor, outside bedrooms, the kitchen and near the furnace; test monthly; practise a family fire escape plan with at least two routes per room. [8][9]
- Avoid consumer fireworks; a sparkler tip can reach about 1 800°F. [9]
- Limit sun exposure between 10:00 and 16:00, use protective clothing and sunscreen, and check hot playground surfaces. [9]
- Store flammable liquids outside the home and out of reach. [9]
Scalds and burns with an unclear or inconsistent history, or on soft-tissue areas unlikely to touch a hot object in an accidental mechanism, should prompt a safeguarding assessment and consultation with local child-protection services, regardless of burn size. [6]
Road traffic injuries are the leading cause of death in children and young adults aged 5 to 29 years. [4] Even within high-income countries, children from lower-income families face higher risk. [4]
- Preschool: children are unpredictable near traffic and cannot judge speed or distance.
- School age: cyclists and pedestrians; many are injured on the journey to and from school.
- Adolescents: passengers and novice drivers; risk rises with alcohol, mobile phone use and not wearing seat belts.
The WHO and NICE describe a "safe system": design for human error, through safe speeds, safe roads and roadsides, safe vehicles and safe users. [4][6]
Evidence-based measures: [4][6]
- Speed: 20 mph (32 km/h) limits and zones where children walk and play; engineering measures such as humps and chicanes; enforcement where compliance is poor. [6]
- Vehicles and restraints: use appropriate child restraints (infant seats rear-facing as long as possible, then forward-facing seats, then boosters until the adult belt fits), which reduce infant deaths by about 71%; seat belts reduce deaths by up to 50%; no riding in the bed of a pickup truck. [4]
- Helmets: correctly fitted helmets reduce death in a crash by more than six times and brain injury by up to 74%; wear them on every bike, scooter and skate ride, and ATVs should not be used by children under 16. [4]
- Pedestrians: younger children should cross roads with an adult; teach looking and listening; walk on pavements and cross at controlled corners.
- Driver behaviour: never use a mobile phone while driving (four times the crash risk), never drink and drive, and set a good example by wearing a belt. [4]
- Community: maintain road-safety partnerships, repeat child road-safety reviews at least every 3 years, and run media campaigns for 20 mph zones. [6]
Falls are a leading cause of injury across childhood: from changing tables and bannisters in toddlers, from play equipment and bicycles in school-age children, and from heights in adolescents. Prevention includes stair gates, window restrictors, securing furniture to walls, soft landing surfaces under play equipment and sports protective gear.
Children explore with their mouths, so medicines and household products must be kept locked and out of sight, in original containers. Do not call medicine "candy." Program the poison helpline (1-800-222-1222 in the USA) into every phone, and tell caregivers the number. If a poisoning is suspected, call the line immediately even if you are unsure; about 100 young children are taken to USA emergency rooms each day after getting into medicines left in reach. [9] If a child is unconscious, seizing or struggling to breathe, call emergency services first. [8]
Never leave infants or children in a parked car, even with the windows cracked: cabin temperature can rise about 20°F within 10 minutes, and heat stroke and death can follow. [9]
Counsel at every well-child visit, documented in the record, tailored to season, activities and family circumstances. Injury-prevention counselling works best when it includes the parent or carer, starts early, and uses teach-back. [8]
| Age | Key counselling topics |
|---|---|
| Birth to 12 months | Safe sleep; car seat (rear-facing, back seat); never leave on a high surface; water temperature below 120°F (48.9°C); keep hot drinks away from baby; medicines and chemicals locked; never leave in car; smoke alarms and escape plan |
| 1 to 4 years | Touch supervision near water; pool fencing; stair gates; locked medicines and chemicals; cooking precautions (handles turned, stay out of kitchen); car seat progression; hand holding on roads; helmets on trikes |
| 5 to 12 years | Booster seat until adult belt fits; helmet on every ride; pedestrian skills; swimming lessons and water safety; sports protective equipment; life jackets in boats; fire drills |
| 13 to 18 years | Seat belts for everyone; no drink-driving or drug-driving; no phone use while driving; no passengers in truck beds; ATV avoidance under 16; swimming with others; drowning recognition; mental health and impulsive risk |
Clinical pearlTeach one change at a time
Evidence supports office injury-prevention counselling, but attention is limited. Pick the one change most relevant to this child's age and setting, agree it with the family, and document it. Recall studies show families remember and act on advice most reliably when it is specific (for example, "fit a 4-sided pool fence with a self-latching gate") rather than general ("be careful"). [6][8]
- Very young and preterm infants need particular care with burns (their skin is thinner, so a brief scald goes deeper) and with temperature control during cooling. [7]
- Children with disabilities may have higher home-injury risk and need assessments of mobility, seizures and medication storage, plus adaptations. [6]
- Refugee and migrant families may face unfamiliar cooking and water hazards (open wells, unsafe vessels). Water safety and home-safety advice should be adapted to housing. [2]
- Adolescents need the message delivered to them, not only to parents, in the context of substance use and road safety. [4]
- Families in poverty carry higher road and burn risk; home-safety assessments, smoke alarms and child restraints should be provided, not just recommended. [6]
- Prioritise the cheapest effective measures: covered water storage, pool and well fencing, supervised play areas, thermostatic mixing valves (or test bath temperature with an elbow), smoke alarms where affordable, window restrictors.
- Burns emergency care with limited water: if no running water, use wet towels or compresses, and prioritise cooling the burn while keeping the child warm. [3]
- Safe rescue equipment (a pole, robust rope, a flotation aid) costs little and prevents rescuer drowning.
- Community-based day care and swim-skill programmes have strong evidence and WHO costing support. [2]
- Where advanced burn care is unavailable, early cooling, clean covering, pain relief, hydration and prompt referral save lives; secondary transfer to a burn unit when possible improves outcomes, but never delay starting emergency care.
- Injury, not disease, is the leading threat to children after the first birthday; most injuries are predictable and preventable. [1]
- Drowning kills about 300 000 people a year, including many children under five; more than 90% is preventable with barriers, supervision and swim skills. [2]
- Burns and scalds kill about 163 000 people a year from fire, heat and hot substances, including about 35 600 children under 15; cool with running water, do not apply ice or fats, and cover loosely. [3][7]
- Road traffic injuries are the leading cause of death in children and young adults aged 5 to 29 years; use restraints, helmets and 20 mph zones. [4][6]
- Emergency care at the scene saves lives: rescue breathing and CPR with ventilation for drowning; cooling and covering for burns.
- Prevention counselling should be age-specific, specific and documented at every well-child visit.
- Low-resource settings can prevent most injuries with fencing, covered water, smoke alarms, water-heater limits and close supervision.
- Follow WHO 2026 (drowning, burns, road traffic), WHO 2008 (World Report), AHA/AAP 2024 drowning, NICE PH29 (2010) and HSE (2026) guidance named here.
Answer each one in your head first, then open the answer.
A 2-year-old has tipped a kettle of hot tea over their lap and thigh. What is the correct emergency care, and when is hospital needed?
Show answerHide answer
Cool under running water for around 20 minutes, keeping the child warm with blankets over the rest of the body; remove soaked clothing unless stuck; cover loosely with cling film (laid on, not wrapped). Seek hospital care because of age (a toddler), likely area bigger than a small coin, proximity to groin, or uncertainty about depth. Do not apply ice, butter, creams or sprays. Reassess if healing is slow or the burn looks worse, because burns can deepen over time. [7][3]
You see a child floating face-down in a pool. Outline your actions in order.
Show answerHide answer
Call for help and tell someone to bring an AED; recognise that a drowning person cannot call or wave. Throw flotation and reach from land if possible; only trained rescuers enter the water. Remove the child as soon as safe, keeping the head above the body if they may be in arrest. If not breathing normally, start CPR promptly with ventilation (breaths matter as much as compressions), give oxygen if available, apply the AED only after CPR has started, and send for observation after any resuscitation. [5]
Which five evidence-based measures are cited to prevent paediatric drowning?
Show answerHide answer
Four-sided isolation fencing with self-closing, self-latching gates; wearing approved life jackets; swimming lessons for children and non-swimmers; swimming where there are lifeguards; and close, active supervision of weak or non-swimmers in and around water. [5]
A family with a new baby asks how to prevent burns. Give five concrete points.
At what age should a child use a booster seat, and when can they move to an adult belt?
Show answerHide answer
Use a booster seat until the adult belt fits properly (shoulder belt across the chest, lap belt low over the upper thighs), and follow the seat manufacturer's instructions and local law for weight and height. [6]
Why is drowning cardiac arrest different from a primary cardiac arrest, and how does that change resuscitation?
Show answerHide answer
Drowning arrests are usually due to severe hypoxaemia progressing from respiratory arrest, so restoration of breathing is as important as circulation: give ventilations, use oxygen if available, and start CPR with breaths; AED use is secondary because shockable rhythms are a minority. [5]
Child physical abuse and safeguarding; burns and scalds (surgical and rehabilitation); fluid resuscitation and shock in children; anaphylaxis; paediatric resuscitation and the sick child; poisoning and ingestions in children; acute gastroenteritis in children; drowning epidemiology and flood safety.
- Peden M, Oyegbite K, Ozanne-Smith J, Hyder AA, Branche C, Rahman AKMF, Rivara F, Bartolomeos K (eds). World Health Organization and UNICEF. World report on child injury prevention. Geneva: WHO; 2008. 232 pp. ISBN 978 92 4 156357 4. Accessed .
- World Health Organization. Drowning (fact sheet). WHO newsroom fact sheet, 1 May 2026. Accessed .
- World Health Organization. Burns (fact sheet). WHO newsroom fact sheet, 21 October 2026. Accessed .
- World Health Organization. Road traffic injuries (fact sheet). WHO newsroom fact sheet, 20 July 2026. Accessed .
- Dezfulian C, McCallin TE, Bierens J, et al. 2024 American Heart Association and American Academy of Pediatrics focused update on special circumstances: resuscitation following drowning. Circulation 2024;150:e501-e516. doi:10.1161/CIR.0000000000001274. Accessed .
- National Institute for Health and Care Excellence. Unintentional injuries: prevention strategies for under 15s. NICE public health guideline PH29, published 24 November 2010. Accessed .
- Health Service Executive (Ireland). Emergency care for burns and scalds. HSE patient information, page last reviewed 19 July 2026. Accessed .
- American Academy of Pediatrics. (HealthyChildren.org). Burn Treatment and Prevention Tips for Families. HealthyChildren.org, last updated 26 July 2023. Accessed .
- Centers for Disease Control and Prevention. Preventing burn injuries (burn prevention tips handout). CDC injury-prevention handout. Accessed .
Educational content for medical students and doctors. It is not a substitute for clinical judgement or local guidelines.