Baby Walker Safety Awareness Training

1. Baby Walker Safety Awareness Training

2. Introduction Section 1 – the issues surrounding baby walkers. Section 2 – advising parents and carers. Section 3 – offering alternatives to baby walkers. Section 4 - what about a ban? Section 5 – will my advice make any difference? Training outline

3. Introduction • What are they? • When were they invented? • What age of children typically use them? • How many babies use walkers? • How many injuries are we talking about?

4. Activity A This quiz has been used with the kind permission of Dr. Kendrick. See handout for full reference to the 2005 trial.

5. What are they? • Used by pre-walking infants. • Age range 6-15 months. • Mobile – on wheels. • Narrower than a doorway. • Harness in which child sits.

6. When were they invented? Activity B

7. When were they invented? • This one dates to Tudor period! (1400-1650 AD) • Believed they existed in the medieval period (500-1500 AD) • Became most popular during post World War II baby boom. Source: http://www.smr.herefordshire.gov.uk/education/tudor/Tudor%20education%20and.htm

8. What age of children typically use them? • Pre-mobile children from 6 to 15 months. • Aimed at those who can sit unaided, and who weigh no more than 12kg (26.4lbs). • Average age for an injury (in reviews for this project) = 8.7 months.

9. How many babies use walkers? • It has been estimated that up to 50% of parents in the UK with children between 3 and 12 months old, use a baby walker. • That could equate to approximately 300,000 children. (National Statistics Online)

10. How many injuries are we talking about? 1999 3,300 babies were taken to hospital after being injured whilst in a walker. 1997 over 5000 baby walker related accidents in the UK. 2000 Chartered Society of Physiotherapists estimated that baby walkers accounted for 4000 injuries a year in the UK. 2002 2,350 babies were taken to hospital after being injured in a walker.

11. The bottom line It is estimated that baby walkers are responsible for injuring more children than any other nursery product.

12. Section 1The issues surrounding baby walkers • Mobility • Falls • Burns and scalds • Poisonings • Other injuries and death

13. Mobility • Mobility way beyond child’s normal range for that age. • Access to other rooms. • Wheel into fireplaces. • Wheel into work surfaces. • Pull at cables, saucepans etc. • No awareness of danger at 6-15 months.

14. Mobility Demonstration How far do you think a child could travel on a non-carpeted surface in a walker?

15. Falls • Falls are the main cause of serious injury. • Stairs involved in 71-96% of cases. • 1996 study 36 infants injured: 35 had fallen down stairs. 27 minor injuries to face or head. 3 needed dental treatment. 3 fractured collar bones.

16. Head injury • Skull fractures account for 1 in 10 of walker-related injuries. • 97% walker injuries involve the head and neck. • In one study, 9 out of 19 walker injuries resulted in a skull fracture.

17. Tip-over injury • Babies’ heads can weigh a third of their body weight. • Infants in walkers are therefore top-heavy and unstable. • One study found 21% walker injuries resulted from tip-overs.

18. Burns and scalds • Account for 2-5% of walker injuries. • Most commonly from electric/gas fires, heater bars, kettle chords and pulling down hot drinks. • A quarter of burn victims under the 12 months sustained their injury whilst in a walker. • Of the 8 infants, 3 needed surgery, 1 needed formal resuscitation. • Further study – walker burns victims resulted in a 20 day stay in hospital.

19. Poisonings, other injuries and death • One study found 20% of ingestion poisonings in 6-9 month old infants resulted from substances accessed whilst using a baby walker. • 1989-1993 USA 11fatalities from baby walker use. (4 drownings, 4 suffocations, 3 falls) • 1982-1987 Canada 4 fatalities from baby walker use.

20. Section 2Advising parents and carers • When is an appropriate time? • Why do parents/carers like to use walkers?

21. Antenatal period 97% of parents-to-be had alreadyheard about baby walkers pre-birth. ------------------------------------------------ 35% of parents had already got hold of a baby walker during this period. -------------------------------------------- Studies have shown that most midwives feel this is too early to discuss baby walkers.

22. Birth – 4th month period 66% of Health Visitors in the sample did not routinely discuss baby walker safety during the 3-4 month health check. ---------------------------------------------------------- 53% of parents made the decision to buy a baby walker when their child was a few months old.

23. 5 month period Most (64%) Health Visitors estimated that parents will obtain their baby walkers during this period. --------------------------------------------------- However, by this stage 64% of them would not have even discussed baby walkers with parents.

24. 6 – 9 month period Health Visitors most often discussed baby walkers for the first time here. (Kendrick et al, 2003)

25. CONCLUSION Simple, REPEATED baby walker safety training intervention is needed. Antenatal period 9 months of age

26. Tackling why parents use walkers Don’t they offer safe supervision? In short, no. 78-89% of infants were being supervised at the time of the accident.

27. The bottom line No matter how well a child is supervised, walkers allow a child to move into danger much faster than any parent can react to prevent the injury occurring.

28. Aren’t they a walking aid? 30-59% of parents believe that walkers aid child development. There is no evidence to show that walkers aid walking development. In fact, they show the opposite…

29. At least 6 studies carried out between 1977-1999 show that walkers hamper a child’s development. Two reasons: 1. The infant may attempt walking-like movements which, in a walker, create some forward movement. However, if the infant was trying to walk without the walker, these movements would be incorrect (for example, pushing from the tip-toes) but within the walker these movements create forward motion and are therefore reinforced.

30. 2. If correct walking-like movements are used, the child’s view of their feet is often obscured by the frame of the walkers. This means that the correct movement is not registered in their visual field, and therefore cannot be reinforced.

31. A large study in 2000, nearly 200 infants were analysed. Walker and non-walker groups were compared. Those who used walkers achieved crawling, standing alone and walker later than those who did not use a walker. Walker use was not found to help sitting, standing with support or walking with support.

32. The bottom line ‘There is absolutely no evidence that (baby walkers) encourage children to walk any earlier – in fact, there is medical research that shows they may actually damage hip joints by putting too much weight on them too early.’ Pinckney, 2004

33. Aren’t they fun for the child? Yes, they might appear to be fun. However, with no developmental benefits and an increased safety risk, why put a child in one? The Child Accident Prevention Trust states how important for children to experience floor play, as it helps develop correct motor skills.

34. Isn’t labelling enough? Labelling walkers with warning labels has not proven to be effective. In the United States labelling has taken place since 1997, but there continued to be a steady increase in baby walker injury.

35. Isn’t it OK if a new, wider design walker is used? Wider-design walkers can prevent some stair falls (by preventing an infant leaving a room). However, tip-over injuries, contact burns and scalds, and poisonings are all still possible. One Australian study found that even by taking out the fall injuries, 50% of walker injuries would still occur.

36. Section 3Offering alternatives to baby walkers If supervision is the issue – encourage parents to use a crib or play pen. If entertainment is the issue – recommend a stationary activity centre:

37. Finally, emphasise the benefits of: • floor-work • crawling • cruising (walking whilst holding on to furniture) • which all include development of motor skills in preparation for walking.

38. Section 4What about a ban?

39. ‘Our advice – don’t use one.’ ‘Elimination of baby walkers is being promoted as the safety strategy at present.’ ‘Baby walkers should be prohibited.’ ‘The sale and use [of baby walkers] should be actively discouraged.’ ‘Baby walkers are dangerous..Don’t tick this box until you have thrown yours out.’

40. Section 5Will my advice make any difference at all? • Yes! • Even one consultation with a parent can make a difference. • Your advice can changebehaviour. • If you are trained, you are more likely to discuss walkers with parents, especially during the antenatal period.

41. Parents who are educated about walkers are significantly lesslikely to: ~ own or use a walker ~ recommend a walker to a friend ~ agree with the claim that walkers are safe. • Educating parents is particularlyeffective in those who are undecided about whether to use a walker.

42. The bottom line • The most effective way of reducing or eliminating walker injuries is: • Training health practitioners. • Providing educational interventions to parents. • Campaigning for legislation to ban the sale/re-sale of walkers, and recall and destroy those already in circulation.

43. This training pack, and the information you take out to colleagues and parents forms a vital part of the first 2 stages of this process. Thank you for your valuable work!

44. How much have you learn? Try quiz again!