Unintentional Injury and Safeguarding
Children
Monday 29th October 2012
Accident prevention and poverty
Mike Hayes
Child Accident Prevention Trust
www.makingthelink.net
About CAPT

CAPT is a national charity committed to reducing the
number of children and young people who are killed,
disabled or seriously injured as a result of accidents.

CAPT provides training, publications, consultancy and
information services
 CAPT runs Child Safety Week –
community education campaign,
raising awareness of serious
childhood accidents & how to
prevent them
www.makingthelink.net
CAPT’s philosophy

We aim to create a safer environment in which children
and young people can live, learn and play

We understand that experimenting and risk-taking are
part of growing up

We do not want to secure low injury rates at the
expense of children’s health and quality of life
www.makingthelink.net
www.makingthelink.net
What are the consequences of injury?
Pain (from injury or subsequent treatment)
Fear / anxiety
Physical disability
Emotional effects
Education – loss of schooling
Disruption to usual routine (social)
Family stress and breakdown
Financial costs - to family, NHS and emergency services
www.makingthelink.net
Bradford data:
source of information

Child and Maternal Health Observatory (ChiMat)
accident prevention report – published last Friday

http://tinyurl.com/chimat-accidents
www.makingthelink.net
Hospital admissions for unintentional injuries:
rate per 10,000 population (2010-11)
180
160
140
120
100
Under 5s
80
5-17 years
60
40
20
0
Bradford
www.makingthelink.net
Yorkshire and The
Humber
England
Hospital admissions for falls:
rate per 100,000 population (2008/9-2010/11)
800
700
600
500
400
Under 5s
5-16 years
300
200
100
0
Bradford
www.makingthelink.net
Yorkshire and The
Humber
England
14
Hospital admissions for burns and scalds:
rate per 100,000 population (2006/7-2010/11)
12
10
8
Under 5s
6
5-16 years
4
2
0
Bradford
www.makingthelink.net
Yorkshire and The
Humber
England
14
Hospital admissions for burns and scalds - under 5s:
rate per 100,000 population (2006/7-2010/11)
West Yorkshire councils
12
10
8
6
4
2
0
Bradford Calderdale
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Kirklees
Leeds
Wakefield Yorkshire
and The
Humber
England
Deaths due to unintentional injuries
England and Wales, 1979 - 2010
1200
1000
No. of deaths
800
600
Under 15
400
Under 5
200
0
www.makingthelink.net
Downward trend
Why?

Safety education, awareness-raising

Increased child restraint and seat belt use and
improved vehicle design

Increased smoke alarm ownership

Safer (and new) consumer products

Improvements in medical care

Changes in child behaviour, reducing exposure
to hazards
www.makingthelink.net
Selected causes of death due to unintentional injuries by
age, England and Wales, 2010
All
accidents
M
<1
1–4
5–9
10–14
0-14
15
33
19
43
110
F
10
25
11
16
62
M
2
1
-
1
4
Falls
Inanimate
mechanical
forces
F
-
1
-
1
2
M
-
1
-
2
3
F
-
-
1
-
1
M
1
7
4
3
15
Drowning
Other
threats to
breathing
F
-
4
-
3
7
M
7
13
3
11
34
F
9
www.makingthelink.net
4
-
3
16
0-14
0-4
1-14
172
83
147
6
4
4
4
1
4
22
12
21
50
33
34
On average, one child in five is taken to hospital
after an accident each year
www.makingthelink.net
Rates of death and injury due to accidents

For every death there are
 about 550 hospital admissions
 10,500 A&E attendances.

10 admissions per 1,000 children

184 A&E attendances per 1,000 children

1 child in every 5.4 attends A&E annually

About 5% of A&E attendances result in admission
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Death rates per year per 100 000 children aged 0-15 years
by eight class NS-SEC, 2001-3, England and Wales
Higher managerial/professional occupations
1.9
Lower managerial/professional occupations
1.6
Intermediate occupations
2.9
Small employers/own account workers
2.9
Lower supervisory/technical occupations
2.7
Semi-routine occupations
4.0
Routine occupations
5.0
Never worked/long term unemployed
25.4
0
5
10
15
20
Source: Edwards P, Green J, Roberts I, Lutchmun S, BMJ, 2006;333;119-123
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25
30
Injury mortality rates by social class
Professional
17
Managerial
16
Non-manual skilled
19
Manual skilled
34
Partly skilled
38
Unskilled
83
0
10
20
30
40
50
60
70
80
European age standardised mortality rate per 100,000 population
Source: I Roberts and C Power (1996), BMJ Vol 31.3
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90
Hospital admissions and inequalities
Hippisley-Cox J, Groom L, Kendrick D, Coupland C,
Webber E, et al. (2002) Cross sectional survey of
socioeconomic variations in severity and mechanism of
childhood injuries in Trent 1992–7. British Medical
Journal 324: 1132–1134.
http://www.bmj.com/content/324/7346/1132
www.makingthelink.net
Hospital admissions and inequalities

The total number of admissions for injury and
admissions for injuries of higher severity increased with
increasing socioeconomic deprivation

These gradients were more marked for 04 year old
children than 514 year olds

The steepest socioeconomic gradients were for



pedestrian injuries (adjusted rate ratio 3.65)
burns and scalds (adjusted rate ratio 3.49)
poisoning (adjusted rate ratio 2.98)
www.makingthelink.net
Risk factors using GP records

Orton E, Kendrick D, West J, Tata LJ (2012)
Independent Risk Factors for Injury in Pre-School
Children: Three Population-Based Nested CaseControl Studies Using Routine Primary Care Data.
PLoS ONE 7(4): e35193.

http://tinyurl.com/orton-paper

> 180,000 records from GP database

Thermal injuries, fractures and poisoning
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Thermal injuries risk factors

Male gender

Increasing birth order

n-shaped relationship with child age, with the highest
odds of injury occurring at age 1-2 years

Decreased with increasing maternal age

Children living in 2-adult households had a lower odds
of injury compared with those in single adult
households.
www.makingthelink.net
Thermal injuries risk factors

Increased if the mother had a diagnosis of
depression in the perinatal period

Adult hazardous or harmful alcohol consumption

Increasing socioeconomic deprivation
www.makingthelink.net
Poisoning risk factors

Increasing birth order

Younger maternal age

An even steeper n-shaped relationship with child age,
with the highest odds of injury occurring at age 2–3
years

Diagnosis of perinatal depression

Adult hazardous or harmful alcohol consumption

Increasing socioeconomic deprivation
www.makingthelink.net
Accident prevention and poverty
 The challenges


Children! Our understanding of their development
Our knowledge of what works
www.makingthelink.net
Accidents and child development the changing child

Anatomical and physical
characteristics

Physical abilities - gross and fine
motor skills

Exploring behaviours

Cognitive abilities

Speech and language development

Social and emotional development

Risk behaviours
www.makingthelink.net
Fine motor skills

Holding and manipulating
objects

Picking up objects

Opening containers – childresistance

Using “tools” – cutlery, crayon,
knife, scissors

Chewing, swallowing and
breathing
www.makingthelink.net
Exploring behaviours

Mouthing behaviour – risk of
choking, suffocation, poisoning

Colour, sound, shape, lights,
texture, movement, characters and
faces, shape, size, smell,
resemblance to food


child-appealing products
natural hazards (fire, water, plants,
etc)
 burns, drowning, poisoning, choking,
electrocution
www.makingthelink.net
www.makingthelink.net
Exploring behaviours

Mouthing behaviour – risk of
choking, suffocation, poisoning

Colour, sound, shape, lights,
texture, movement, characters and
faces, shape, size, smell,
resemblance to food


child-appealing products
natural hazards (fire, water, plants,
etc)
 burns, drowning, poisoning, choking,
electrocution
www.makingthelink.net
What works?

What do we mean by “works”? How should we measure
effectiveness?

If we don’t know that a programme is effective, it doesn’t
mean that it isn’t
www.makingthelink.net
Approaches to prevention

Education and awareness-raising – who?

Engineering and environmental change – modifying
products, settings, etc

Legislation and enforcement – nationally, locally

Empowering people – giving people the ability to act.
What people?
www.makingthelink.net
World report on child injury prevention
World Health Organization and UNICEF
“There is no single blueprint for success but six basic principles
underlie most of the successful child injury prevention around
the world. These are:






Legislation and regulations, and their enforcement
Product modification
Environmental modification
Supportive home visits
The promotion of safety devices
Education and the teaching of skills”
www.makingthelink.net
Key strategies to prevent burns among children
Strategy
1
Setting (and enforcing ) laws on smoke alarms

Developing a standard for child-resistant lighters

Setting (and enforcing) laws on hot water tap temperature and
educating the public

Using thermostatic mixing valves to control hot water temperature

2
Banning the manufacture and sale of fireworks

Providing first aid for scalds – “cool the burn”

Conducting home visits for at-risk families

3
Distributing smoke alarms on their own (without accompanying
laws)

Conducting community-based campaigns and interventions

Using traditional remedies on burns
1 = effective 2 = promising 3 = insufficient evidence 4 = ineffective 5 = harmful
www.makingthelink.net
4
5

Key strategies to prevent falls among children
Strategy
1
Implementing multifaceted community programmes such as
“Children can’t fly”

Redesigning nursery furniture and other products

Establishing playground standards for impact absorbing surfacing,
height of equipment and maintenance

Legislating for window guards

2
Using safety gates and guard rails

Conducting supportive home visits and education for at-risk families

3
Raising awareness through educational campaigns

Implementing housing and building codes

4
1 = effective 2 = promising 3 = insufficient evidence 4 = ineffective 5 = harmful
www.makingthelink.net
5
Home safety education and provision of safety
equipment for injury prevention
Kendrick D et al. Home safety education and provision of
safety equipment for injury prevention. Cochrane
Database of Systematic Reviews 2012.
http://tinyurl.com/kendrick-cochrane
www.makingthelink.net
Home safety education and provision of
safety equipment for injury prevention
Overall families who received home safety education were
more likely to:
 have a safe hot tap water temperature
 have a working smoke alarm and a fire escape plan
 have fitted stair gates
 have socket covers on unused sockets
 store medicines and cleaning products out of reach of
children
www.makingthelink.net
Home safety education and provision of safety
equipment for injury prevention
 Home safety education provided most commonly as one-toone, face-to-face education, in a clinical setting or at home,
especially with the provision of safety equipment, is effective
in increasing a range of safety practices.
 Home safety interventions provided in the home may reduce
injury rates, but more research is needed to confirm this
finding.
 Home safety education was equally effective in the families
whose children were at greater risk of injury.
www.makingthelink.net
Safe at Home
National Home Safety Equipment Scheme
http://www.safeathome.rospa.com/evaluation.htm
Evaluation report:

If continued in the long term, the national programme
showed potential to reduce injuries, through the
combination of effective safety equipment, free installation
and targeted education

Has the potential to improve safety behaviours in vulnerable
families and to reduce unintentional injuries
www.makingthelink.net
Community-based injury prevention programmes
Towner et al. What works in preventing unintentional injuries in children
and young adolescents? An updated systematic review.
http://tinyurl.com/towner-review

Key elements:
Long-term strategy
 Effective focused leadership
 Multi-agency collaboration
 Involvement of the local community
 Appropriate targeting
 Time to develop
Use of local surveillance systems to motivate participants and
to evaluate interventions


www.makingthelink.net
Partnerships

Statutory sector

Local government, including public health and
children’s services
 Health sector
 Emergency services, especially fire and rescue
services
Voluntary and community sector


Support for the families in greatest need
www.makingthelink.net
You are not alone!
www.capt.org.uk
www.makingthelink.net
www.makingthelink.net