Archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Safe by Design Prevention is the Key Lessa Payne Infant Mortality Prevention Coordinator

archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org

Safe by DesignPrevention is the Key

Lessa PayneInfant Mortality Prevention

CoordinatorArkansas Children’s Hospital


Introduction to Injury Prevention

• Injuries are not accidents.• Injuries can be predicted and prevented.• Injuries are caused by multiple factors

including environmental factors.• Injury prevention doesn’t just happen. It

requires careful assessment of the target population and environment.


Injuries are NOT Accidents

• With the evidence-based knowledge, effective strategies, and training, injuries and injury-related deaths can be predicted and prevented.


Unintentional Injuries


Accident or Preventable Injury?

Paragould, July 2012: 6 month old killed; 2 year old injured• Trapped inside burning home

Jonesboro, March 2012: 1 and 2 year olds killed in one-vehicle crash• Both children were ejected.• Witness said there were no car seats in

vehicle.


Accident or Preventable Injury?Little Rock, December 2012: 3 year old admitted to ACH with alcohol in system• Toddler arrived with bloody nose and hardly

breathing• Suspect injury from falling out of bed while

being intoxicated• Mother stated she had left alcohol in a

container mixed with juice

Conway, April 4, 2012: 2 year old killed when dresser fell on her• Playing with 6 year old sister in a back room• Mother found her pinned underneath the

dresser


Accident or Preventable Injury?Fort Smith, October 2012: 15 month old drowned in bucket of water• Adults in the home were visiting with

guests• Found suspended over the edge of a five-

gallon bucket of soapy water• Two small toys were found inside the

bucket of water

Center Ridge, June 2011: 9 month old drowned in small pool • Adult in charge left outside with 4 year old

brother to make lunch inside• Water in pool was < 1 foot deep


Accident or Preventable Injury?Waldron Arkansas, January 2012: 14 month old killed by blunt force trauma that ruptured the sac around his heart.• Child also had broken right tibia, broken

humerus, and broken scapula that were all in different stages of healing

• Non-parent male was babysitting• Reported baby would not stop crying so he

pick child up and squeezed his chest until tears started coming out of the child’s eyes and he stopped crying


Conclusions

• Injuries are not accidents.• Injuries can be predicted and prevented.• Injuries are caused by multiple factors

including environmental factors.• Injury prevention doesn’t just happen. It

requires careful assessment of the target population and environment.


Poisoning

• The key is to supervise children at all times.• Store Poisons in their original containers.• Lock up Medicine• Every 8 minutes a child goes to the ER for

medication poisoning


Poisoning

• Button Batteries- choking and poison hazard• Put Poison hotline number in your cell phone1-800-222-1222.


Laundry Pods real risk to Poison kids


Prevent Poisoning

• Common products: medications, cleaning products and beauty products, often in kitchen and bathroom

• Give medicine according to directions• Keep poisons in original containers with labels• Store poisons where baby/child can’t reach


Prevent Burns• Prevent fires:

– Keep a smoke-free home– Don’t put anything on/near space heaters– Be careful when cooking

• Prevent harm from fires:– Install smoke alarms– Test and replace batteries

and alarms when needed– Create family escape plan

and practice it


Top Tips

• Working Smoke Alarms reduce the chances of dying in a fire by nearly 50%.

• Teach kids to never play with matches, lighters and fireworks.

• Create and practice a home fire escape plan with two ways out of your house

• Children should know how to respond to a smoke alarm.



Prevent Scalds• Keep baby away from hot foods and liquids• Do not microwave formula/breast milk• Test bath water with water thermometer• Set hot water heater temperature at 120

degrees or below


Prevent Drowning• Common places for drowning under the age of

2: bathtubs, toilets, buckets• Stay close enough to touch

the baby in the bathtub at all times• Keep babies away from

toilets and buckets• Empty containers after use


Drowning in the US

• ~ 3,500 people died due to unintentional drowning in 2005-2009– An estimated 10 people per day– Two of the drowning's will be 14 or younger

• Drowning is the 5th leading cause of death • Males, children ages 1-4, and minorities have

the highest drowning rates

Center for Disease Control and Prevention


Drowning in Arkansas

• Leading cause of death for 1-4 year olds 2007-2010– Falls into swimming pools and other water at

home• Third cause of death for 5-14 year olds

– Swimming in open water or boating• Third cause of death for 15-34 year olds

– Swimming in open water or boatingCenters for Disease Control and Prevention

Quan et al.,Injury Prevention 2011


Drowning Facts and Myths

• Fact– drowning is a result of lungs filling with water which

deprives the brain of oxygen

• Myth– drowning is noisy with thrashing and calling for help– it takes a long time to drown– only unsupervised children drown


Drowning is Preventable

• Wear a Life Jacket (PFD)– Sometimes drowning occurs due to the swimmer

getting to tired to make it back to safety • Swim with a Buddy

– Make sure you swim with a buddy or in areas with supervision i.e. lifeguards

• Check for Danger – Always make sure there are no unseen hazards

Weiss. American Academy of Pediatrics, 2010


Drowning is Preventable

• Swim Sober– Drugs and alcohol impair judgment and decreases

ability to perform even simple task • Learn to swim

– Swim lessons do not make you drown proof– Knowing how to swim can reduce your risk of

drowning

Weiss. American Academy of Pediatrics, 2010


Arkansas Boating Laws • Life jackets and boating

– Children 12 and younger must wear PFD at all times on any boat/PWC

– All boats/PWC must have one USCG approved PFD for every person on board

• Boating education course– Required by law for anyone born after 1/1/1986

Arkansas Game and Fish Commission, 2011


Prevent Falls• Keep your hands on your baby when diapering• Do not use a baby walker• Only leave baby alone in safe place (like a crib)• Do not place infant seats on raised surfaces• Follow directions on all baby products• Place safety gates at the top and bottom of stairs• Protect windows• Check the home for fall risks for adults


• Feed your baby in a semi-upright position.• Don’t give your young children foods that must be

chewed with a grinding motion.• Cut foods into small pieces.• Watch your baby or young child when they eat.• Do not allow your young children to play with

balloons.• Choose toys carefully.

Prevent Choking


Child Passenger Safety


Why is child passenger safety important?

• Motor vehicle crashes are the number one killer of children.

• Riding unrestrained is the greatest risk factor for death and injury among child occupants of motor vehicles.

• Most children are not transported correctly. In Arkansas, nine out of ten car seats are misused.

• The most common critical misuses are loose harness straps securing the child to the safety seat and loose seat belts securing the car seat to the vehicle.


Arkansas Child Passenger Protection Law

All children under age 15 must ride in a child passenger restraint system:

• Child safety seat until child is 6 years old or weighs 60 lbs (best practice is 8 years old, 80-100 pounds or 4’9” tall)

• Seat belt until age 15 regardless of seating position in vehicle (best practice is seat belt for life)

• Fine $25-$100 per child• No smoking in vehicle with children*

*Beginning July 1, 2011 the age goes up to 15.


Types Of Restraints For Children

• Rear-facing only restraints

• Convertible restraints• Forward-facing only

restraints• Vehicle safety belts• Special needs CRS

18


4 Steps to Car Safety

Step 1: Rear-Facing Seat until age 2 or upper height and weight limits

are met

Step 2: Forward-Facing Seat with

Harness until upper height and weight limits are met

Infant Carrier(Rear facing

only)

Convertible seat(Rear & forward

facing)

Convertible seat(Rear & forward

facing)

Combination seat(Forward facing

only)


4 Steps to Car Safety

Step 3: Belt-Positioning Booster Seat until the seat belt fits (usually

around 4’9” and age 8-12)

Step 4:Adult Seat Belt for Life!

High back booster Backless booster

http://www.amazon.com/exec/obidos/tg/detail/-/B00005QYYD/102-1867962-0420112?v=glance&s=baby&me=A1F83G8C2ARO7P&vi=pictures&img=14#more-pictures


• Only use items that come with the car seat. Stay away from after-market add-ons.

• Secure projectiles. Use soft toys for travel.

• Window shades, mirrors, toy bars are not recommended.

Additional Warnings

X X

X

X

X

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5 Step Test for Seat Belts

1. Can the child sit all the way back against the vehicle seat?

2. Do the child’s knees bend comfortably at the edge of the vehicle seat?

3. Is the shoulder belt centered on the child’s shoulder and chest?

4. Is the lap belt on the top part of the child’s thighs?

5. Can the child stay seated like this for the entire trip? (SafetyBeltSafe USA)

Answer must be “Yes” to all questionsbefore child is ready to sit in a seat belt.

Testing Readiness for Seat Belt


Second Hand Seats*(*regardless of what type of seat is used)

• Make sure Child safety seat:– Is no more than 6 years old.– Has all its parts.– Isn’t damaged.– Not recalled or repaired if recalled.– Hasn’t been in a serious crash.– Has an instruction booklet.

A CSS may need to be replaced after a crash. Call the manufacturer.


Conclusion

• Motor vehicle crashes are the leading cause of death for children.

• While some crashes are not survivable, the risks of death or injury is greatly reduced when properly restrained.

• Child restraint includes:- the correct seat- for the age and size of the child- that is installed correctly


Safe Sleep for Infants

http://cribsforkids.org/wp-content/uploads/2011/05/SleepSck_SSProducts.png


Infant Mortality in Arkansas


A, B, C’s of Safe Sleep• ALONE

• Keep your baby’s sleep area close but separate from where others sleep. Your baby should not sleep with others in a bed, on a couch, or in a chair

BACK IS BEST

• Your baby should be placed to sleep on his or her back in a safety-approved crib on a firm mattress every time during naps and at nighttime.

CRIB IS UNCLUTTERED

• Remove all loose bedding, comforters, quilts, sheepskins, stuffed animals, bumpers, wedges, and pillows from your baby’s crib.


Share a Room- Not a Bed

• Bond Safely• Dangers of Bed Sharing:

• Breast feed safely

– Suffocation– Strangulation– Entrapment– Falls


Selecting a Safe Crib• New cribs meet current safety standards• If you use a secondhand crib, make sure it:

– has not been recalled – has rails that are no more than 2 3/8 inches apart

(soda can)– has all of its parts – has a firm mattress, with no space between

mattress and crib bars


NOT SAFE!


NOT SAFE!


Put Babies on Their Backs to Sleep

• Babies are less likely to choke on their backs Facing down – Choking Risk Facing up – the Safer Way


Back to Sleep…Tummy to Play

• Babies will learn to be comfortable if they start out on their backs and stay on their backs

• Educate other caregivers – babies should sleep on their backs every time – at night and at naps

• Make safety the first priority every time a baby sleeps


Keep Babies at the Right Temperature

• Overheating is a risk factor for SIDS• Set the room temperature the

same as you would for an adult• Dress the baby in as little or as

much clothing as you would wear to be comfortable

http://cribsforkids.org/wp-content/uploads/2011/05/SleepSck_SSProducts.png


Other Tips to Prevent Sleep-Related Infant Death

• Keep Babies in smoke-free environments• Offer a pacifier at nap and night• Take your baby for immunizations• Breastfeed your baby


What sleep risks do you see in the following pictures?



http://www.wikihow.com/images/e/eb/Crib_popcan_thru_slats_39.jpg



Conclusion

• Recommendations for safe sleep changed in 2011 to include position and environment.

• Some babies are more vulnerable than others for SIDs.

• Other causes of sleep-related deaths in infants are: – Suffocation– Strangulation– Entrapment– Falls


Infant Crying and Shaken Baby Syndrome


Background• Frustration with a crying infant is the number one trigger for the

shaking and abusing of infants.• Shaken baby syndrome is abusive head trauma.• In more severe cases, the child usually becomes immediately

unconscious and suffers rapidly escalating, life-threatening central nervous system dysfunction.

• In less severe cases, the consequences may not be brought to the attention of medical professionals and may not be diagnosed.

• The same injuries can be seen in children as old as 4 or 5 years.• About 1 in 5 cases are fatal in the first few days after injury. The

majority of survivors are left with handicaps ranging from mild to severe.

• Head trauma can result from as little as 5 to 10 seconds of shaking.National Center on Shaken Baby Syndrome


Common Symptoms• Decreased muscle tone• Extreme irritability• Decreased appetite, poor feeding, or vomiting for no apparent

reasons• No smiling or vocalization• Difficulty breathing• Seizures• Inability to lift head• Inability of eyes to focus or track movement or unequal size of pupils• Rigidity or posturing• Head or forehead appears larger than usual or soft-spot on head

appears to be bulgingNational Center on Shaken Baby Syndrome


Risk Factors• Parents who have been previously identified• Parents with a child in DCFS custody• Teen parents (especially if no extended family support system)• Drug/Alcohol abuse• Maternal depression• Parent(s) with history of ADHD• Unwanted pregnancy/child• Non-biological father figure in home• Premature infant• Special needs infant• Twins

Vermont AHD Prevention Project


“Period of Purple Crying”©

• Evidence-based and proven educational program for parents of newborns

• Two formats – booklet or DVD• 3rd grade reading level, multi-cultural, and

multi-language available• When ordered in bulk, as low as $2.00 per

copy


Period of Purple Crying


Demonstration


Important Action StepsWhen the crying is Frustrating

• Carry, Comfort, Walk and Talk with your baby

• If it is too frustrating it is ok to Walk Away

• NEVER shake or hurt a baby


Advice to Parents

• Never shake a baby in play or anger• Do not hold a baby during an argument• When you find yourself becoming annoyed,

put the baby in the crib, leave the room and call someone for support

• Contact a local crisis hotline for help and guidance

• Do not ignore signs if you suspect


Conclusion

• Periods of excessive crying is normal for infants.

• Shaken baby syndrome is abusive head trauma.

• Educating parents of newborns about crying and coping mechanisms are important prevention strategies.


Wrap up and Questions


Resources• http://www.carseatsar.org• http://www.archildresn.org/IPC• http://www.aap.org• http://www.chop.edu/service/car-seat-safety• http://www.nhtsa.dot.gov• http://www.safekids.org• http://www.injuryfree.org• http://www.dontshake.org• http://www.purplecrying.info• http://www.cdc.gov• http://www.cpsc.gov

http://www.carseatsar.org/

http://www.archildresn.org/IPC

http://www.aap.org/

http://www.chop.edu/service/car-seat-safety

http://www.nhtsa.dot.gov/

http://www.safekids.org/

http://www.injuryfree.org/

http://www.dontshake.org/

http://www.purplecrying.info/

http://www.purplecrying.info/

http://www.cdc.gov/

http://www.cpsc.gov/

Documents

Archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Safe by Design Prevention is the Key Lessa Payne Infant Mortality Prevention Coordinator