Injury Prevention Across Childhood

McKenzie Pediatrics 2011

The following is a collection of injury statistics and injury prevention suggestions based on the most common injuries in different settings, ages, and seasons. We hope that you�ll take a few minutes to look them over.

Holiday-Related Injuries

Holidays create an atmosphere of excitement, jubilation, and often recklessness and poor parental supervision. The varied activities in which people participate during holiday seasons create environments in which injuries can easily occur. Visits to new locations, the introduction of new activities, decorations, etc., coupled with the possible reduction of supervision of children leads to an increase in injury rates as compared to non-holidays.

Most injuries that are sustained on holidays that require medical treatment are not holiday-specific, but are associated with more general activities. Overall, the majority of injuries occurring on holidays are related to sports and recreational activities, or related to home structure (stairs, ramps, floors) or home furnishings (coffee table, bed, tables, chairs).

From 1997 to 2006, an estimated 5.7 million holiday-related injuries (in other words, more than 500,000 each year!) sustained by children <19 years of age required treatment in an emergency department. The greatest number of injuries occurred on Labor Day followed by Memorial Day, Fourth of July, and Halloween. Injuries that were associated with fireworks were more likely to occur on the Fourth of July than any other holiday, yet fireworks accounted for only a small proportion of Fourth of July injuries.

Overall, children younger than age 5 sustained a greater proportion of injuries on holidays than other age groups.

Help to reduce your child�s risk of injury around the holidays � every holiday � by:

Increasing your awareness of your tendency to decrease your supervision of children as you celebrate a holiday with family and friends. Adults should consider �taking shifts� watching the kids.
Be more proactive about creating safe activities for children during family gatherings. A new toy or game that might prove a safety hazard should be set aside until an adult can devote their undivided attention to its setup and usage.

Trampolines

Trampolines are often described as fun for kids and a way to get exercise. However, an estimated 100,000 people are injured on trampolines each year (70:10000 kids 0-4, 160:10000 kids 5-14). Most of these injuries happen on home trampolines, and to children.

Common injuries include ankle sprains (60%), broken bones (usually upper extremities, sometimes requiring surgery), concussions and other head injuries, sprains and strains, bruises, scrapes, and cuts. Neck and spinal cord injuries resulting in paralysis or even death can and do occur (0.5% of all trampoline injuries seen in ED).

Children can be hurt on trampolines in many ways. Most injuries results from landing wrong while jumping, attempting stunts, colliding with another person (the smaller child is 14X more likely to be injured) on the trampoline, falling or jumping off the trampoline, or landing on the springs or frame of the trampoline.

Reduce your child�s risk of trampoline injury by purchasing only a trampoline with safety netting, and by placing the trampoline away from trees or building structures. Restrict use to ages 6 and older. Ban somersaults and flips. Ban water on the trampoline, such as placing a sprinkler underneath. Most importantly, enforce the rule that only one child may be on a trampoline at one time.

Choking Injuries

Choking is a leading cause of injury and death among children, especially those aged 5 years and younger. Food, coins, and toys are the primary cause of choking-related injury and death. Please review the following list of suggestions so to hopefully avoid your child becoming a choking victim:

Do not offer teething biscuits, teething cookies, or teething toast to infants under 1 year of age
Hold off on offering small round chokable foods such as raisins, nuts, and popcorn to children until at least age 2 years
Do not allow small children to walk around as they are eating
Hard candies should not be given to children under age 5 years
Be certain to chop up grapes and hot dogs into quarters before serving them to children. Better yet, avoid hot dogs in young children under age 3 years.
Read toy warning labels carefully to be certain chokable toys are not being given to children at unsafe ages
For households with an infant, use the cardboard center of a toilet paper roll to visually explain to older siblings that no toy small enough to fit inside the roll can be allowed around the baby. Tape the roll in a prominent place, such as on the refrigerator.
Be certain no coins are ever left within reach of an infant or small child.
There were 66000 battery ingestions presenting to US EDs between 1990 and 2009�84% were button batteries. Be sure to keep all batteries up and out of reach, in the same manner you should store poisons and medications!
In a home with an infant and/or small children, parents should vacuum frequently, and regularly inspect under furniture for small items easily seen and retrieved by little ones.

Scalds and Burns

Each year, nearly 4000 deaths (1 in 8 are children) occur from fire and burns. In addition, 500,000 burn injuries (1 in 4 are children) are treated in hospital emergency rooms, and 25,000 are hospitalized in burn centers. Burns are painful, and can be cosmetically disfiguring and permanently disabling.

Reduce your child�s risk of household scald and fire burns by following these tips:

Be certain there is a functional smoke alarm on each floor of your home. Regularly test the alarm (such as every 6 months with the change of clocks) and change batteries.
Smoke detectors with a recordable human voice are far more likely to wake a sleeping child than are traditional tone (loud noise) alarms.
Hard-wire your alarms if possible
Never place cigarette lighters or matches within the reach of children of any age
Set your home�s hot water heater to 120 degrees, never higher
Never allow small children to use a microwave oven, or to move a piece of furniture so to be able to reach the microwave oven
When using the stovetop, only use the back burners (and turn the handles inward) if small children are in the home
Create a �kid-free� zone in the kitchen to prevent small children from accessing the kitchen while a meal is being prepared.
Never set a pot from just off the stove top onto the counter top within reach of a small child
Never carry a child while also carrying a cup of hot coffee or tea
Never leave appliance cords hanging off the kitchen counter

Falls

Falls are the leading cause of non-fatal unintentional injury resulting in an emergency department visit in infants under 1 year of age. An estimated 1.3 million U.S. infants were seen in an ED for an injury during the four-year period from 2001-2004, and just over 50 percent of these were due to a fall.

Most falls involve beds. Too often has it happened that parents have allowed their young infant to nap on the parent�s bed, only to discover by the suddenly crying infant who has fallen onto the floor that the infant has learned to roll.

Stairs and infant walkers are also common causes of falls in infants. Parents are encouraged to place a gate at the bottom and top of the stairs in the home where there is an infant 6 months of age or older. Parents are also greatly discouraged from purchasing an infant walker. Infant walkers are not only a leading cause of injury to infants, they delay the natural ability to walk!

Household Cleaners and Medications

Cases of unintentional household cleaning product-related and prescription medication-related injury have declined by 50 percent over the past two decades, nevertheless still over 12,000 children receive medical treatment in emergency departments each year for such injuries. Children 1 to 3 years of age account for 3/4ths of all cases.

The most common injuries attributable to household cleaning products is bleach. The most common source or container related to injury was spray bottles.

Examples of common household cleaning products that MUST be kept out of the reach of small children include: drain cleaners, ammonia, metal polishes, tarnish removers, turpentine, dishwasher detergents, swimming pool chemicals, oven cleaners, pine oil cleaners/disinfectants, laundry soaps/detergents, toilet bowl products, abrasive cleaners, general-purpose household cleaners, noncosmetic bleaches, windshield wiper fluids, lye, wallpaper cleaners, room deodorizers, acetone, and spot removers.

Obviously, such household products, as well as all medications (prescription OR over-the-counter) should be kept high and out of the reach of small children. And remember, small children are often little monkeys, easily climbing onto countertops or employing chairs and stepstools to reach higher cabinets. Therefore, any cabinet no matter how high that contains chemicals or prescription medications should be locked!!!