Human bites can be either accidental or intentional. Make sure the person that your child bit is OK. The skin was broken and she bled from 4 out of the 8 teethmarks (it was a truly impressive bite). Print. The incident took place on May 24 about 3. g. After the biting victim has calmed down, the caregiver should deal with the biter. • Take detailed history to identify who needs further investigations outlined below. J. In these situations, postexposure prophylaxis is indicated (8,14). A child with hepatitis B who bites another child and breaks the skin may expose the bitten child to hepatitis B infection. Evaluate the severity of the wound and try to determine the best course of treatment. Show area effected. Apply an ice pack or cool cloth to help prevent swelling. Wash the wound with soap and water under pressure from a faucet for at least 5 minutes, but do not scrub, as this may bruise Jan 22, 2019 · Generally, it depends on a child’s maturity level as to whether they are likely to bite at school age. Separate the biter from the other children. Usually, the bite has to be really deep or severe. Cover the wound with a sterile bandage or dressing to protect it from further injury. Confidentiality of all children involved will be maintained. Powerless biting occurs when a child is in need of feeling strong and in control of a situation. Slow the bleeding with a clean cloth. Get it checked out. For context, my daughter is 20 months old. Always seek medical advice if you’ve been bitten by an animal or person and the bite has broken the skin. Jul 2, 2008 · Kewcumber · 02/07/2008 15:10. Rarely, some germs (bacteria) can get into the bloodstream through a wound and cause a serious infection in the body. 3XXA is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. I got but by a cat, the second worst bite you can get, and within 3 hours my finger was swollen and I had to go to the hospital. Usually prophalaxic antibiotics are given routinely for any type of human bite. If your dog was bitten by another dog, it’s important that you seek veterinary assistance immediately if possible. This is in Texas, a very reputed and expensive daycare facility. Low immunity. Feb 24, 2012 · The answer: Since the skin was broken, it is important to see a doctor. Of 133 children followed by Solomons and Elardo ( 2 ), 66 (50%) suffered 224 bites over 3. Bites from a wild infected animal cause most U. Cat scratch disease is an illness that can occur after being bitten or scratched by a cat. Evaluate the wound. ICD-10-CM Coding Rules. Serious animal and human bites can get infected if they’re not checked and treated quickly. Jan 23, 2008 · M. Give her other ways to handle frustration. For example, when a child bites another child. “Be sure to hang up your coat on the hook. 20pm, when three children under the age of two were placed down in separate cots for an afternoon nap. But biting after age 3 may be a sign that a child has problems with self-control or expressing feelings. Tdap or Td booster shot for adults every 10 years. Wash the wound. Apply an ice pack or give an older child a popsicle to help numb the area and reduce swelling. Jul 5, 2019 · Dog bites account for a whopping 90% of the 5 million animal bites that children and adults sustain in the U. Avoid cleaning with strong disinfectants or other chemicals, as they can sting and cause additional pain around the wound. For more information on testing and interpretation of test results, see the CKS topics on Hepatitis B, Hepatitis C, and HIV infection and AIDS. May 3, 2024 · In most cases, children are bitten by common pets like dogs or cats. Toddlers need a lot of space – even more than older children – for movement and physical play. Teachers can very quickly identify "problem parents", as well as "problem children". Public Health Service recommends that parents of Rabies is caused by the rabies virus. Look at the bite to evaluate how severe the victim's condition is. The Child Who Bites By Barton D. Explain in simple language that biting hurts and is not okay. If the bite is bleeding and the wound appears to be deep, call your child 1. If your child was bitten or scratched by an unfamiliar or wild animal, note the location of the animal. Treatment may include: If the bite is bleeding, apply pressure to it with a clean bandage or towel to stop the bleeding. We never found out who did it. No baseline HIV test. 13. Some animals may have to be captured, confined, and observed for rabies. In this article, we look into the world of toddler biting at daycare, offering insights, solutions, and strategies to help your child and others navigate this challenging behavior. If the skin is broken, bacteria introduced into the wound can cause a tissue infection that needs to be treated by a health professional. every year, and lead to about 1% of emergency room visits annually. A Perth childcare has been fined $10,000 after a 10-month child was bitten all over her body by another child while unsupervised at the centre last year. Biting is a Toddler habit that causes distress to both the child who has bitten (the ‘biter’) and their family and the child who has been bitten (the ‘bitee’) and their family. Apply gentle pressure to the area with a clean, damp cloth for up to 10 minutes. Biting in young children usually does not lead to behavior problems at a later age. May 29, 2024 · Human bites — Children are the most common victims of human bites, usually as a result of aggressive play with another child. Suggest the bitten child be seen by a health care provider if the skin is broken or there are any signs of infection (redness or swelling). ” “You can each have a bucket to use in the sandbox. Blood-borne diseases could be a concern if the biter breaks the skin and blood is drawn into the biter’s mouth or if the biter has bleeding gums or Apr 23, 2018 · Bite (community, intentional) Yes: Skin broken: 1: Yes: Yes: No: Medium: Child tested HIV positive 4 years after being bitten by father. Human bites can be as dangerous as or even more dangerous than animal bites because of the types of bacteria and viruses in the human mouth. Even little teeth can break the skin. 1. The daycare facility takes the position that all health information is "personal" and I do not have a right to know if my child has been exposed to any potential diseases. Often, children bite to express negative feelings such as anger. Sometimes actual pain medications, often with a sedative component, can help with comfort and reduce your dog’s anxiety during recovery, because unfortunately this kind of tissue crushing injury can be painful and take time to improve. Unless you are trained, vaccinated and wearing protective clothing, you should avoid handling bats or flying foxes in Australia. The childminder doesn't even tell us it's happened, and we are left to discover it when my daughter is in the bath. 3XXA - other international versions of ICD-10 W50. Its a phase lots of childrne go through it and are none the worse for being a biter or a bitee. If the wound is deep, it may require Jan 29, 2023 · There are a few important steps you should take when your dog is bitten by another dog and has swelling from the bite. Sep 7, 2023 · A human bite is when a person, typically a child, bites another person. Animal and human bites. Biting usually ofers some form of initial gratification either from teething, frustration or anger. Then, take action with the following steps. I asked him how this happened and he said conor (another little boy in his class) had bitten him at dinner time. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024. OK I have just put my son to bed and noticed a nasty mark on his shoulder when i asked him he said a boy in his class bit him. It is important to keep an eye on your child’s wound. Indent but no broken skin- same as above Broken skin - wound cared for, parents contacted, images provided Deeply broken skin (never experienced this) parents contacted, medical care encouraged. The Asian Parent. Quickly defuse the situation that’s prompting the biting — being jostled in a loud, crowded room, for example. 2. A human bite could be accidental or on purpose, with most bites due to another person. 3XXA is an initial encounter code, includes a 7th character and Clean the wound and place ice or a cold cloth on it. You can also follow Typically if I have a child bit at daycare my response varies by wound. Call parents as soon as possible, don’t wait until the end of the day. Your child has signs of infection, such as: Increased pain, swelling, warmth, or redness near the wound. Human bites are extremely dangerous because the human mouth contains a lot of bacteria. The incidence rate varied with the age of children but not with sex, and toddlers (age 16 to 30 months in the Garrard et al study, age 13 to 24 months in the Solomons and Apr 11, 2024 · The first thing to do after a dog bite is to ensure the safety of the child. Sometimes, the youngest child in the family uses biting for attention seeking or act in self-defense. Determine the severity of the bite. xmaslolly76 Posts: 3,974 Forumite. Wash the wound gently under running water — avoid scrubbing. By this age, a lot of children have already developed excellent communication skills and would not feel the need to resort to biting. Approach stray cats with caution and be mindful of their body language. [5] Remember that all human bites are serious. Dec 13, 2022 · How to Stop Them From Biting. Red streaks leading from the wound. Some people also develop a distinctive "bullseye Human bites may occur directly when one person bites another person (e. Bear in mind that every child is different, but this is a general trend I have seen. Console and soothe the child who was bitten. Like a dog bite might cause more damage but the amount of bacteria in a humans mouth makes it much more dangerous. placed a bandage on the bite. Clean the area and cover it with a sterile bandage. Apply ice. Twice the skin has been broken. rabies cases. Dec 16, 2009 · Son bitten by another child in school. Our 2. People and animals have a lot of bacteria in their mouths, which can cause an infection if a bite breaks the skin. If the mouth injury is from a fall or an accident, it’s best to call your dentist. Apr 24, 2024 · Overview. • Bacterial infection is a risk if there is a break in the skin. The parent of the child who has been bitten is usually very upset and worried about the risk of infection. Mar 12, 2011 · Posted 12-03-11. put an antiseptic ointment on the bite. She was bruised and swollen for about a week/10 days but there is no scarring. However, human bite wounds are often caused indirectly during fistfights when a person's closed fist strikes the tooth of their opponent during a punch, breaking the skin on the hand. If your child was bitten, take them to the pediatrician so a professional can examine the wound. Aug 28, 2013 · As soon as possible, preferably within 8 hours, do the following to an animal or human bite: Gently wipe away any dirt. 3XXA may differ. W50. May 19, 2016 · The physical and functional impairment of a child can be significant after a bite wound from a dog. But if bleeding occurs continuously for more than 10 minutes, Smile’s advice is to seek medical care. It has been estimated Sep 17, 2018 · Two year old has habit of biting when excited but has never broken the skin. Feb 3, 2023 · Authoring team. Occlusion bites occur most often among young children. Try to stay calm. We comforted your child and washed the bite. The skin was not broken. Give lots of affection. In these situations, postexposure prophylaxis is indicated ,. Adjudication on whether it is a child or adult bite mark must not be But if the skin is broken, the risk of infection is higher. I know this isnt really related to our birth group but i am absolutely fuming!!! my 4 year old son came back from nursery yesterday. Intentional bite injury: This generally happens during fights and can result in a wide range of injuries from minor bruising to partial loss of body parts (for example, ears or nose). Bullous impetigo causes larger fluid-containing blisters that Children's Hospital of Philadelphia. If he's bitten another child, check how severe the bite is. Tdap booster at age 11 or 12. First Aid for the Biting Child. For example, offer gentle reminders, phrased in a way that tells them what behaviors are expected. Flush the wound with at least 16 ounces of the saline using the syringe. If you have been, or think you may have been, bitten or scratched by a bat — seek immediate medical attention. 5 years. Sep 22, 2008 · Elk · 22/09/2008 13:54. Offer the bitten child comfort and first aid. As soon as you experience a human bite wound, inspect the site of the bite mark. Bites are under the heading of a puncture wound, and by nature, puncture wounds tend to be a little bit more dangerous because they close off and can trap bacteria. Gently clean the wound with hand soap. Her daycare class ranges from 18mo to 3 years. As well, a susceptible child who bites a child with HBV infection may be exposed if blood comes into contact with the oral mucosa of the biting child. Apply over-the counter antibiotic cream if you have it. It begins as tiny blisters that eventually burst and leave small wet patches of red skin that may weep fluid. Anything For Family | Parenting Articles, Tips and Advice Move him away from the person he's bitten, and give him a quiet moment to calm down. For last 8 weeks she has been bitten 6 times by the same child at the childminder. 16 December 2009 at 8:04PM. The 2024 edition of ICD-10-CM W50. If your child has a weakened immune system, a dog bite can be Mar 15, 2018 · March 15, 2018. 3XXA. Transmission occurs directly through close contact with an infected individual or indirectly via contaminated objects such as toys, clothing, or towels. Lots of bleeding. Most incidents were observed in September, and in the middle of the morning. Mar 10, 2023 · They occur when someone else’s teeth sink into your skin with enough force to break through the surface. a 2 year old is not a “problem child” for showing developmentally appropriate behavior. See a doctor if the skin surrounding a wound becomes more tender, painful, swollen, or red over the few days following the bite. Keep the wound bandaged and see your doctor. Use as much force with the syringe as the child will Jun 16, 2024 · Download Article. The Dangerous Dog Act, 1991 is made up of two parts: Part 1. [6] Human bites can range from everything from deep flesh bites from a fight or other situation, to something Only a bite that breaks the skin can pass hepatitis B, and even then, spread is rare. 6. There it multiplies and causes inflammation and damage. injury to the clenched fist from a punch to the mouth) or 'love bites', or in care settings for children or people with learning disabilities (1) the majority human bites are on the fingers or hands but other common sites include the neck, breasts and genitalia. Sharing is Caring. A child who bites a child who has hepatitis B may be exposed to the virus if blood from the bitten child enters the biter’s mouth. ” “Put a small dot of toothpaste on your brush. I think the real issue lies within you. Seek an Emergency Vet. Your child has trouble moving a limb near the bite. Care for them first, offering first aid, a band-aid, or whatever the person needs. Bitten by another child. Infection is the most common complication of bite injuries. The virus enters the body through broken skin or the eyes, nose, or mouth, and travels through nerves to the brain. Unfortunately, this can also be an injury seen in child abuse, sexual abuse, and self-mutilation. Common scenarios that lead to a bite wound include children's play-fighting or a hand striking a tooth when punching. A human bite could arise when you cut your knuckles on another person's teeth, as might happen in a fight. Do not scrub, as this may bruise the tissue. Human bite marks in children are relatively common but are either not recognized as such or, when suspected, not subjected to rigorous forensic assessment. The skin was broken and there was saliva/blood exposure to my child. Change the bandage several times a day once your doctor has examined the wound. Observe standard precau-tions if there is bleeding. If necessary, give the child basic first-aid – run the bitten area under warm tap water and put on a plaster. If you are on the scene when your child bites, your reaction needs to be quick and levelheaded. Wrap the wound in a sterile bandage. To help prevent this type of biting: Make sure your child feels protected and is not always being "picked on" by others. 5 year old has been bitten by another child (same kid) 5 times now. If the bite has broken the skin at all, you will need to take your child to a doctor or hospital to seek medical attention to prevent infection. If that happens, a child who is not vaccinated against hepatitis B Have another adult step in to care for any other children in the area if you can. 1-800-TRY-CHOP. Human bites are typically located on the face, upper extremities, or trunk (chest or abdomen). Apr 27, 2023 · Symptoms are similar with dog bites or scratches that happen from a dog’s teeth, even though the bacterium is different. Impetigo can develop as a primary infection A child with hepatitis B who bites another and breaks the skin may expose the child who was bitten to hepatitis B infection. See a dentist if needed. They seem to reassure everytime that they pay Clean the wound immediately and seek medical attention if needed when bitten by a stray cat. Provide ample space for movement. Jul 10, 2024 · Care for the bitten child should include soothing the child, cleaning the wound, and seeking medical treatment if the bite has broken the skin. If your child has bitten another child or adult, it is important to address the behavior and provide first aid if necessary. Schmitt, MD The Problem Biting another child is one of the more unacceptable aggressive behaviors children may engage in. Tetanus booster during the third trimester of pregnancy, regardless of vaccination status. Infected animals have the virus in their saliva. Cats, and especially kittens, become infected with the cat scratch bacteria from fleas. Note that if the bite has not broken the skin there is no risk of blood-borne virus transmission. If the bitten child is a guest, tell the parents what happened. They may see a sibling, peer or older child bite and copy them. 3XXA is a billable diagnosis code used to specify a medical diagnosis of accidental bite by another person, initial encounter. 3. UHL Children’s ED and Children’s Hospital when treating people with human or animal bites, their families and carers. Nurse will enter biting incident into SNAP program for both the biter and victim. S. Redness, swelling or pus. , a child biting another child). If the skin IS broken: 1. Go to a drug store and buy a large bottle of sterile saline and a large syringe. I was changing him out of his uniform and noticed a bad bite mark on his chest. He has just bitten my five year old through his school shirt abd the woun Mar 31, 2023 · Biting is very common among young children but usually does not lead to serious infectious disease issues. If your little one did the biting, suggest to the other parent or babysitter that they get checked by the doctor. No other HIV risk factors reported: CDC 22: 1996: USA: Bite (community, intentional) Yes: Multiple bites: 1 b: Yes: Unknown: No: Confirmed: HIV negative at time of bite and confirmed Impetigo. Your child is going to get hurt. 3XXA became effective on October 1, 2023. May 3, 2023 · Published: May 3, 2023. Specific treatment for a human bite will be discussed with you by your child's healthcare provider. Imitation – children of pre-school age love to copy others and find this is also a great way to learn. Human bites can cause a semicircular or oval area of skin redness or bruising, and the skin may be punctured. Make sure to separate them and the dog, and check the child for injuries. Preventing biting Reinforce desired behavior. Suggest the bitten child be seen by a health care provider if the skin is broken or Aug 31, 2015 · If the bitten child is a guest, tell the parents what happened. Oct 13, 2021 · Without knowing the child/situation, it could be that everyone around the child knows that the place in a mainstream school is wholly unsuitable, but unfortunately there isn’t a place Available in a More appropriate setting, they don’t have funding for a 1-2-1 and so everyone struggles, But most of all the child whose needs are not being Jul 5, 2024 · In the weeks following a tick bite, you may start to feel flu-like symptoms such as a fever, headache, chills, fatigue, and muscle and joint pain. This is because Jul 1, 2008 · A child with HBV infection who bites another child and breaks the skin can expose the bitten child to the virus. This is the American ICD-10-CM version of W50. A punch to the mouth can result in an indirect bite The recommended tetanus vaccine schedule is: DTaP (diphtheria, tetanus and pertussis) vaccine at 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years. Attention – some children bite for attention, even negative attention is better than NO attention. Nov 29, 2022 · The first thing to do for any biting injury is to wash the area with soap and water. Oct 16, 2023 · Stop the bleeding. Your child loses feeling in the area near the bite, or it feels numb or tingly. Mar 7, 2021 · If the cat bite has broken the skin, immediate action should be taken. Sadly, sometimes it’s going to be another toddler biting, hitting, etc. These are signs of infection and may require antibiotics. One study found that facial bites predominated (70 percent) in children up to 7 years old, and bites to extremities occurred in 72 percent of children older than 7 years. Dec 2, 2012 · The most common complication following a bite is infection of the wound. Biting is very common among young children. Jun 18, 2024 · If your child is involved, understanding the reasons behind biting and how to manage it is crucial to understanding why a child may be biting other children. Notice and acknowledge when you like what your child is doing, especially for showing A bite or scratch on a child's face, hand, or foot is particularly at risk for infection and should be checked by your doctor as soon as possible. Nov 1, 2018 · My daughter is 20 moths old. Sep 14, 2023 · If the skin has been broken, apply an antiseptic cream or ointment to prevent infection. Maybe a nanny or a smaller daycare would be best for you and your child. Fill out the Parkway Incident Report(Form #214) 8. Once the victim is calm, deal with the biter. The more severe the bruising or bleeding looks, the worse the bite is. It’s also important in a broken-skin situation to review the immunization status of both children involved, to make sure tetanus and hepatitis B vaccines are up-to-date. Gradually, a yellowish-brown or tan crust covers the area, making it look like it has been coated with honey or brown sugar. Non-bullous or crusted impetigo is most common. I asked if he told the teacher he said yes but she didn't do anything i said did you show her your shoulder and he . If a dog bites all the time, this becomes a safety issue. Adjudication on whether it is a child or adult bite mark must not be Oct 1, 2023 · W50. If biting occurs in a child-care setting, the parents of the other children may want The skin near the bite turns cold or pale or it changes colour. Infective Most infants and young children bite once in a while. The skin near the bite turns cold or pale or it changes color. 2 In a study that looked at motivations for biting, children less than 6 Bite form will be filled out and signed by school nurse and copy given to parent). Wash the wound with soap and water under pressure from a faucet for at least 5 minutes. There are about 250,000 human bites treated in the United States each year. Bites by children on other children are actually quite common, and this happens at an early age. My dd2 had her face bitten by another child at a soft play area. Dog bites can easily and quickly become infected. ‘Dangerously out of control’ means if the dog causes injury to a person or an animal or a person to reasonably be scared that they will be attacked by the dog. Bites are most dangerous when they come from an animal that may have rabies. For some parents it is just an easier life to tell some parents everything, as it defuses any problems that might come later, particularly as small children are not reliable sources all the time. Check for signs such as bruising, punctured skin, bleeding, and objects stuck in the wound. For deeper bites or puncture wounds from any animal, or for any bite from an unknown animal: If the bite or scratch is bleeding, apply pressure to it with a clean bandage or towel to stop the bleeding. Please bear in mind that if an adult bites the child back, this is sending Biting Policy. 7. broken. Irrigate the wound. In such cases, it is important to clean the wound thoroughly with soap and water, and apply an antiseptic cream to prevent infection. ↓ See below for any exclusions, inclusions or special notations. Another high risk situation occurs when an unvaccinated child bites an infected one, and the blood from the infected child enters the biter’s mouth. If fever, redness or swelling occur, seek medical attention right away. Feb 1, 2011 · Separate the biter from the bitten child. Quote. Give the child plenty of comfort and sympathy. They have moved our kids class but couple of months later the other child moved back to his class. Help the biter understand what emotions prompted the bite and how to handle them. Don’t scrub as this may bruise the tissue. Wash broken skin with warm water and soap. Sep 14, 2023 · If a child bites another child or adult, it is important to seek medical attention if the injury is severe. Impetigo is a contagious, superficial bacterial infection of the skin that affects all age groups, but it is more common in young children. When a human bite mark on a child is identified, the explanation generally given is that it was either self-inflicted or the result of being bitten by another child. I know kids do dumb stuff sometimes and they occasionally bite and hit and push and etc, but this seems pretty serious and I feel like needs to be addressed instead of just being chucked up to “kids being kids”. Show the child you are interested in them. In some cases, the bite can break the skin and cause bleeding. Notify the parents of both the child who was bitten and the child who did the biting that a bite occurred with the skin being broken. Oct 21, 2021 · 2. human 'bites' may occur as the result of violent injury (e. Offer to test for Hepatitis B, Hepatitis C, and HIV (see table 1). Do not panic and assess the situation after being bitten. Infections can occur if your skin is broken by an animal bite. Mar 3, 2021 · Use positive guidance strategies to help your child develop self-control. If your child’s skin was broken, see a doctor right away. Report dog bites to law enforcement, even if it is your own dog. Sep 25, 2014 · Human bite marks in children are relatively common but are either not recognized as such or, when suspected, not subjected to rigorous forensic assessment. Apr 14, 2021 · If the bite has broken the skin, the same care is recommended. If the skin is broken, go to a doctor and make sure there is no chance of infection. Only 5% of people get infected with dog bites. Apr 6, 2023 · Anti-inflammatory medications can reduce the swelling that causes pain. Basically if the skin is broken, we'd like you to wash the Customer: My 18 month old child was just bitten for the second time at daycare by another child. If you can’t get in touch with your child’s pediatrician immediately, take him to the emergency room or to an urgent care clinic for treatment. 3XXA is a valid billable ICD-10 diagnosis code for Accidental bite by another person, initial encounter . doubt nursery would give you the phone number or tell you who the parents are - wehn your littel darling starts biting the otehrs (as will possibly happen) you'll understand why. A dog bite on a child’s face is especially Nov 9, 2023 · Broken skin. The human mouth is full of bacteria, so there is an increased risk of the wound becoming infected. Give the child a great deal of individual attention and time. Seek help ASAP if you can’t stop the blood after 15 minutes of pressure. Parents should keep an eye on the bite wound, looking for signs of infection. A dog bite may lead to serious infection, even if there’s lack of bleeding around Your child's healthcare provider will talk with you about specific treatment for a human bite. Most children stop biting on their own. Stay calm. 1-800-879-2467. The first part of the act makes it a criminal offence to have your dog ‘dangerously out of control’ in a public space. Explain to the parents that if the skin is broken, the U. Treatment for human bites is usually Augmentin antibiotics for 10 days. We have complained and spoken to the director of the facility. It is found in the 2024 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered transactions from Oct 01, 2023 - Sep 30, 2024 . Now. The adult should say something like “No biting! Jun 4, 2013 · It also depends on the parent as well. It is caused when the Bartonella henselae bacteria carried by cats gets under the skin in a human. Usually a bite is harmless and may not even leave a mark. Punctured skin and injured bones, joints or tendons all need immediate care. Both groups must be must be supported. Clenched or closed fist bites A child with HBV infection who bites another child and breaks the skin can expose the bitten child to the virus. No indent, skin red - notify parents at pick up. Be present for the child. Rabies is a potential risk and it is crucial to observe the cat’s behavior for 10 days. Your child _____ was bitten on the _____ today in the _____ class. KEY POINTS: • Dog bites are the most common mammalian bite. Removing the biter from the source of frustration is calming and also helps the victim feel safe. kq lr cm jg dc lh yv lm pc xy