Accident prevention and poverty

1. Unintentional Injury and Safeguarding Children Monday 29th October 2012 Accident prevention and poverty Mike Hayes Child Accident Prevention Trust

2. 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

3. 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

5. 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

6. Bradford data:source of information • Child and Maternal Health Observatory (ChiMat) accident prevention report – published last Friday • http://tinyurl.com/chimat-accidents

7. Hospital admissions for unintentional injuries: rate per 10,000 population (2010-11)

8. Hospital admissions for falls: rate per 100,000 population (2008/9-2010/11)

9. Hospital admissions for burns and scalds: rate per 100,000 population (2006/7-2010/11)

10. Hospital admissions for burns and scalds - under 5s: rate per 100,000 population (2006/7-2010/11)West Yorkshire councils

11. Deaths due to unintentional injuriesEngland and Wales, 1979 - 2010 No. of deaths

12. 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

13. Selected causes of death due to unintentional injuries by age, England and Wales, 2010

14. On average, one child in five is taken to hospital after an accident each year

15. 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

16. Death rates per year per 100 000 children aged 0-15 years by eight class NS-SEC, 2001-3, England and Wales

17. Injury mortality rates by social class Source: I Roberts and C Power (1996), BMJ Vol 31.3

18. 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

19. 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)

20. 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 Case-Control 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

21. 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.

22. 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

23. 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

24. Accident prevention and poverty • The challenges • Children! Our understanding of their development • Our knowledge of what works

25. 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

26. Fine motor skills • Holding and manipulating objects • Picking up objects • Opening containers – child-resistance • Using “tools” – cutlery, crayon, knife, scissors • Chewing, swallowing and breathing

27. 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

29. 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

30. 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

31. 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?

32. World report on child injury preventionWorld 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”

33. Key strategies to prevent burns among children 1 = effective 2 = promising 3 = insufficient evidence 4 = ineffective 5 = harmful

34. Key strategies to prevent falls among children 1 = effective 2 = promising 3 = insufficient evidence 4 = ineffective 5 = harmful

35. 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

36. 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

37. Home safety education and provision of safety equipment for injury prevention • Home safety education provided most commonly as one-to-one, 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.

38. Safe at HomeNational 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

39. 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

40. 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

41. You are not alone! www.capt.org.uk www.makingthelink.net