Nursing Practice
Review
Public health
Keywords: Public health/Child health/
Accident prevention
Children under the age of five years are injured and killed by unintentional injuries
every year. Through education, many of these injuries and deaths could be prevented
Preventing unintentional
injuries in children
In this article...
ho is most at risk of experiencing an injury
W
What types of injury are most common
How to reduce unintentional injuries to children under five
Author Eustace de Sousa is national lead,
children, young people and families, Public
Health England.
Abstract de Sousa E (2014) Preventing
unintentional injuries in children. Nursing
Times; 110: 47, 12-14.
Parents and carers try to keep children
safe but accidents do occur, particularly in
children aged under five years, and many
take place in the home. Although it is rare,
some of these may even result in death. In
an effort to reduce the incidence of these
injuries and deaths, Public Health England
published a report earlier this year that
identifies who is at risk and how
professionals involved in children’s early
years care can help tackle the issue. This
article summarises the key findings of
that report.
K
eeping children safe in and
around the home is every parent’s and carer’s priority but we
know, from the moment a new
baby is home, an infinite number of hazards and risks can lead to unintentional
injuries. So what more can be done to keep
children safe, and what is the role of health
and early years staff ? This article draws on
a report by Public Health England, published in the summer, which looks specifically at children aged under five in the
home (Public Health England, 2014).
Why focus on unintentional
injuries and deaths?
As part of its priority work on child and
family health, PHE identified unintentional injuries as a major issue for the following reasons:
» The numbers of children affected each
year. Between 2008-09 and 2012-13, on
average, 450,000 attended accident and
emergency, 40,000 were admitted, and
60 under-fives died;
» The particular impact on poorer
households. Our analysis shows that
unintentional injury rates were 45%
higher for children from the most
deprived areas compared with children
from the least deprived;
» Many of these injuries are avoidable.
The work undertaken led to a collaboration with the Child Accident Prevention
Trust (CAPT), supported by the Royal
Society for the Prevention of Accidents
and the Association of Directors of Public
Health, to identify the scale of the issue
and what action could be taken. PHE published its findings earlier this year along
with data tools and more detailed analysis
for local authorities, health services and
injury prevention partnerships. The work
focused on children aged under five years
because this age group accounts for more
than one in three of all hospital admissions
for injuries in 0-25-year-olds (PHE, 2014).
Research involving child survivors and
their families has also shown that there
can be significant psychological trauma
(CAPT, 2014) to those involved in serious
injuries beyond the physical harm caused.
A serious burn or scald potentially has
consequences that last a lifetime, as do
injuries leading to a loss of function.
Key findings
Our analysis of injury and mortality data
of under-fives found that in England, for
each of the five years between 2008-09 and
2012-13, there were almost 40,000 emergency hospital admissions – this equates
to 110 admissions each day of the week.
Between 2008-09 and 2011-12 an analysis
12 Nursing Times 19.11.14 / Vol 110 No 47 / www.nursingtimes.net
5 key
points
1
More than a third
of admissions in
those aged 0-25
years are children
aged under five
There are more
unintentional
injuries and deaths
in areas of
deprivation than in
wealthier areas
Parents and
carers may not
realise which
household objects
are hazards
Most injuries
fall into one of
five categories
Multi-agency
working is
crucial to make
homes safer for
children
2
3
4
5
Nursing
Times.net
For articles on children’s nursing, go to
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Table 1. Accidental deaths of 0-5-year-olds in
and around the home, 2008-09–2012-13
of hospital episode statistics showed
there was a steady increase in admissions,
but by 2012-13 this fell back to a level that
was only just above the rates for 2008-09.
Deaths from an unintentional injury for
this age group in and around the home are
relatively rare. Between 2008-09 and 201213, an average of 60 children died each year
but there is no room for complacency, as
more can be done to prevent such events
from happening altogether. Table 1 shows
some of the main causes of death (for more
detailed analysis please refer to the PHE
(2014) report). Nationally, these deaths
account for around 8% of all deaths in this
age group.
Who gets injured and how?
Boys are more likely to be admitted to hospital for injuries than girls – 55% compared
with 45% respectively. This ratio barely
changed in the five years we studied. We
also found some key patterns that will be
helpful to public health workers, and
health and early years professionals to
target interventions and actions:
» Focusing on five main types of injuries
makes sense;
» Children from areas of deprivation are
more likely to experience unintentional
injuries.
Approximately nine out of 10 of these
hospital emergency admissions were
caused by five main types of injuries (Table
2). While these injuries could happen in a
range of circumstances (for example, falls
could occur down the stairs or from a table
while changing a nappy), seeing this pattern allows us to think in a more focused
way about what actions we can take to
reduce the most common types of injuries.
The second critical pattern from the
analysis confirmed findings from other
research – namely that, compared with
children from wealthier areas, those from
poorer areas are more likely to experience
unintentional injuries and be admitted to
hospital (Edwards et al, 2006). The difference in rates was 45%.
Deaths (n)
Accidental threats to breathing
138
Accidental drowning and submersion
62
Falls
24
Exposure to smoke, fire and flames
23
Exposure to inanimate mechanical forces
18
Source: PHE (2014)
Reducing injuries in the home
Health professionals, and those with
whom they work in early years settings,
have a central role to play in helping parents take action to reduce injuries in the
home. This applies across professions, and
includes health visitors and nurses, as well
as other health, play and education services – in effect, making every contact
count with parents of young children
(PHE, 2013).
We identified five factors that influence
the occurrence of accidents. Professionals
should be aware of each of these following
points when working with parents and visiting homes:
» The child’s development – we can easily
underestimate how quick and curious
new crawlers and walkers can be and, as
children become more mobile, their
exposure to new risks changes,
requiring health and early years
professionals to adapt their advice
to families;
» The physical environment in the home
– including any overcrowding;
» The knowledge and behaviour of
parents and other carers – do they
understand the vulnerability of young
children as they become more mobile?
Are they aware, for example, that
behaviour such as leaving children
unattended (even for a moment) when
they are being changed from a height
could be a hazard? Do they realise that
nappy sacks, if not disposed of safely,
could be a suffocation hazard?;
» Safety equipment – are these available
and are they being used correctly?;
» Consumer products in the home
– products such as hair straighteners
and irons, as well as newer products
such as e-cigarettes and liquid refills,
can pose a risk if left unattended
(Chatham-Stephens et al, 2014).
Among all this safety awareness, the
last thing we want is for families to become
so anxious that they unnecessarily restrict
their child’s movements and opportunities
for exploration. These are important elements of every child’s development, and
are crucial for learning, socialising and
building a child’s confidence and independence. There is a balance to be struck,
which many professionals and parents do
successfully every day – for example
encouraging “rough and tumble” play in
the home on rainy days, but keeping this
as safe as possible through supervision.
Our report (PHE, 2014) highlighted
three key points that can help reduce the
number of unintentional injuries in children aged under five and the corresponding actions that local leaders can
take. These are:
» Providing leadership and mobilising
Table 2. Main types of admissions for
0-5-year-olds, by injury in and around the
home, 2008-09–2012-13
Injury type
Admissions (n)
Falls
93,315
Impacts, entrapments, lacerations
40,558
Accidental poisoning
23,014
Thermal injuries
11,115
Stuck, bumped into by a person, dog bites
6,553
Suffocation and strangulation
2,024
Source: PHE (2014)
www.nursingtimes.net / Vol 110 No 47 / Nursing Times 19.11.14 13
Alamy
Parents may not realise household hazards
Cause of death
Nursing Practice
Review
injuries to under-fives. Our analysis shows
that for this age group, each year approximately 450,000 attended A&E, 40,000
were admitted, and 60 died, just from
home-based injuries. There is a significant
social inequality, with children from
poorer areas having an injury rate 45%
greater than children from the least
deprived areas. We know that with the
right support, such as education, information and safety equipment, we can keep
children safer.
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QUICK
FACT
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There are compelling reasons why we need
to do more to reduce unintentional
● For more information about Public
Health England’s (2014) report:
www.chimat.org.uk/earlyyears/injuries
● For tools and other resources:
Child Accident Prevention Trust –
www.capt.org.uk
Royal Society for the Prevention of
Accidents – www.rospa.com
● For epidemiology and information for
parents and professionals:
Injury Epidemiology and Prevention
Research, University of Nottingham –
tinyurl.com/injuryresearch
How to childproof your home,
NHS Choices – tinyurl.com/childproofhome
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Conclusion
Box 1. more resources
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existing services prevents injuries.
Working with families is a multiagency responsibility, so working
collaboratively is essential to make
homes safer;
» The early years workforce needs
support and training to enable it to
strengthen its central role in helping to
reduce unintentional injuries. Make
sure that all key staff are familiar with
the main injury prevention messages
and that services are helping to provide
equipment and support for the most
vulnerable families;
» Focusing on five kinds of injuries for
the under-fives makes sense. Our
analysis, and that of others, has shown
that there is a case for focusing on
choking/suffocation/strangulation,
falls, poisonings, burns/scalds and
drowning. We chose not to focus on
impacts, entrapments and lacerations
even though they are responsible for a
large number of injuries. The general
view among accident prevention
specialists is that these injuries are
more part and parcel of growing up and
harder to prevent.
Local areas can do this most efficiently
and effectively by working through injury
prevention partnerships where they exist,
alongside local emergency health services,
commissioners, and community groups
to identify any local issues. Plans to
improve safety levels would include targeting education programmes to areas
that would benefit most, working closely
with early years settings, as well as,
where possible, home safety checks, which
might include safety equipment, such as
stair gates.
110
Number of admissions
each day of the week for
unintentional injuries to
under-fives
This article has focused on what we
know about under-fives and the relatively
simple steps we can take to have a beneficial impact on the incidence rates of unintentional injuries and accidental death in
this group.
Being focused on our interventions, in
terms of the types of injuries and vulnerabilities of the family, is likely to be an effective use of limited resources. Our report
gives more details about the crucial role of
the early years workforce in supporting
parents to keep children safer. A key part
of this work is in relation to education. For
example, giving information and guidance
to parents of very young children in a positive way that recognises the daily pressures families are under. In many areas
this will be supplemented by practical
aides, such as safety gates, smoke alarms
and door catches.
Combined with an approach that sees
injury prevention as the responsibility of
all local agencies working in partnership
with families, we can collectively help to
keep children safer to give them the best
start in life. NT
References
Child Accident Prevention Trust (2014) The Costs
of Child Accidents. www.makingthelink.net/tools/
costs-child-accidents
Chatham-Stephens K et al (2014) Note from the
field: calls to poison centers for exposures to
electronic cigarettes — United States, September
2010–February 2014. Morbidity and Mortality
Weekly Report; 63: 13, 292-293.
Edwards P et al (2006) Deaths from injury in
children and employment status in family: analysis
of trends in class specific death rates. The BMJ;
2006: 333, 119.
Public Health England (2014) Reducing
Unintentional Injuries in and Around the Home
Among Children Under 5 Years. tinyurl.com/
PHEReducingInjury
Public Health England (2013) Nursing and
Midwifery Contribution to Public Health:
Improving Health and Wellbeing. tinyurl.com/
PHEPHContrib
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