Injury prevention in the home environment for children and

young peopleEffective interventions

Presented by Louise Woodfine, National Public Health Service for WalesErlas Centre, Wrexham

26.06.2009

Preventing childhood injuries

A combination of factors are required to prevent children sustaining injuries in the home.

Environment

Improvement in planning and design results in safer homes and leisure areas. Adaptations

such as fireguards and stair-gates help to make the home a safer environment.

Education

This involves increasing the awareness of the risk of accidents in a variety of settings and

providing information on ways of minimising these risks.

Empowerment

Local consultation and community involvement can generate a strong sense of

commitment and ownership. Accident prevention initiatives, which have been influenced

by the community, are more likely to reflect local need and therefore encourage greater

commitment.

Enforcement

There is legislation which relates to child safety. These regulations ensure that the

products we buy meet a reasonable level of safety performance and that new dwellings

meet an acceptable level of safety.

Interventions in the Home Environment

General

Product Design Injury Reduction Some Evidence

Safety Devices Injury Reduction Some Evidence

Burns and Scalds

Smoke detector promotion programmes Behaviour Change/Injury Reduction Good Evidence

Tap Water Temperature Reduction Behaviour Change/Injury Reduction Some Evidence

Parent and Child Education Behaviour Change Some Evidence

Poisoning

Child Resistant Packaging Injury Reduction Good Evidence

Parent Education Behaviour Change Some Evidence

Falls Prevention

Window Bars (Education and environmental modification and Legislation)

Behaviour Change/Injury Reduction Reasonable Evidence

Parent Education Behaviour Change Reasonable Evidence

General Campaigns

Parent Education on Hazard Reduction Behaviour Change Reasonable Evidence

Evidence suggests that the implementation of the following programmes would help to prevent injury and deaths of children and young people in Wales.

Following identification of families in need, through contact with services such as:• Health Visitor• Midwife• Communities First Team• Pre School provision• Flying Start• Community Nurses• Social work teams

Vulnerable families should receive the following safety equipment:• Smoke alarms (where it does not currently happen)• Thermostatic mixing value to prevent bath scalds• Fireguards• Appropriate safety gates• Window restrictors• 4 point safety harness for highchairs• Cupboard/drawer restrictors

Royal Society for the Prevention of Accidents

The Royal Society for the Prevention of Accidents (RoSPA) website provides a summary of guidance and advice for preventing childhood injuries in the home.

www.rospa.co.uk/homesafety/advice/child/accidents.htm#injuries

Safety and Child Development

Safety and child developmentChildren differ in their rate of development but the information below is a guide to development stages.

Age Development Advice0-6 months Wriggle and Kick, grasp, suck, roll over Do not leave on a raised surface

6-12 months Stand, Sit, Crawl, put things in mouth. Keep small objects and dangerous substances out of reach

1-2 years Move about, reach things high up, find hidden objects, walk and climb.

Never leave alone, place hot drinks out of reach, use a fireguard and stair-gates.

2-3 years Be adventurous, climb higher, pull and twist things, watch and copy.

Place matches and lighters out of reach. Be a good role model. Be watchful.

3-4 years Use grown-up things, be helpful, understand instructions, be adventurous, explore, walk downstairs alone

Continue to be a good role model, keep being watchful but start safety training.

4-5 years Play exciting games, can be independent, ride a bike, enjoy stories

They can actually plan to do things and carry it out. Rules are very important to them, as long as everybody keeps the same ones. They enjoy learning. Continue safety training.

Source: RoSPA

Causes of injuries Falls

• Falls are the most common causes of accidents in the home; they account for 44% of all children’s accidents.

• Most falls involve tripping over on the same level. However, the most serious consequences result from falls between two levels.

Prevention•Fit a safety gate at the top and bottom of stairs •Never leave tripping hazards on the stairs.•Stairs should be carefully maintained – damaged or worn carpet should be repaired or removed.•Make sure balustrades are strong and do not have any footholds for climbing.•Stairs should always be well lit.•Fit child resistant window locks but make sure you can get out easily in an emergency.•Do not put anything under the window that can be climbed on.•Furniture and tall kitchen appliances, at risk from being pulled over, should be secured to the

wall.

Fires• Domestic fires pose one of the greatest risks to children. Children playing with matches

and lighters frequently start house fires – 46% of all fatal accidents to children are in house fires.

Prevention•Keep matches and lighters out of sight and reach of children.•Always use a fireguard and secure it to the wall.•Extinguish and dispose of cigarettes properly.•Have an escape route planned, and practise it, in case of fire.•Fit a smoke alarm and check it regularly.•The incidence of burns and scalds in young children is much higher than that of older

children and adults.

Scalds & burnsMany of the children who attend A&E with a burn or scald are referred on for further hospital treatment.

Hot drinks cause most scalds to children under the age of 5. A child’s skin is much more sensitivethan an an adult’s and a hot drink can still scald a child 15 minutes after being made. Young children are also vulnerable to sunburn.

Hot bath water is responsible for the highest number of fatal and severe scalding injuries among children.

Children can also suffer burns after contact with open fires, a cooker, irons, curling tongs and hair straighteners, cigarettes, matches, cigarette lighters and many other hot surfaces.

Prevention

•Never hold a hot drink and a child at the same time.•Never leave young children alone in the bathroom.•Put hot drinks out of reach and away from the edges of tables and worktops.•Encourage the use of a coiled flex or a cordless kettle.•Keep small children out of the kitchen whenever possible.•Run the domestic hot water system at 46C or fit a thermostatic mixing valve to taps.•When running a bath turn the cold water on first and always test the water temperature with your

elbow before letting a child get into the bath or shower.•Always use rear hotplates and turn the panhandles away from the front of the cooker.•Keep hot irons, curling tongs and hair straighteners out of reach even when cooling down.

Glass related accidents

The increase use of glass in the home has led to more glass related accidents. Every year

children die following an accident with architectural glass. Many children are also injured

when glass tumblers and bottles break.

Poisoning

Most poisoning accidents involve medicine, household products and cosmetics.

Prevention•Use safety glass in all replacement windows and doors.•Make existing glass safer by applying shatter resistant film.•Always clear up broken glass quickly and dispose of it safely.•Buy a greenhouse or cold frame with special safety glazing features or isolate with fencing.

Prevention•Keep medicines and chemicals out of sight and reach of children, preferably in a locked cupboard.•Buy products in child resistant containers when possible.•Always store chemicals in their original containers.•Dispose of unwanted medicines and chemicals safely.•Avoid buying plants with poisonous leave or berries or those that irritate the skin.

Suffocating and choking

Children can swallow, inhale or choke on items such as small toys, peanuts and marbles.

Drowning

Children can drown in less than 3cm of water.

Prevention•Choose toys appropriate to the age of the child.•Ensure that small objects such as marbles and peanuts and small toys are kept out of reach of children

under 3 years.•Encourage older children to keep their toys away from their younger playmates.•Pull chords on curtains and blinds should be kept short and kept out of reach.•Keep animals, especially cats, out of the bedroom and use a net on the pram.

Prevention•Never leave children or babies in the bath unsupervised, even for a moment.•Never leave uncovered bowls or buckets of water around the home.•Paddling pools should be emptied and stored away when not in use.•Garden ponds should be filled in while children are small or securely fenced off.

Good Practice for general child home safety

Good Practice for fall prevention in children

Home safety counselling (addressing issues such as using window bars, stair gates, other home safety equipment and not using baby walkers, bath seats and other injury hazard producing equipment)

Education

Home based social support, such as home visiting programmes for new mothers Education

Individual-led education/counselling on unintentional childhood injury prevention in the clinical setting

Education

Window safety mechanisms to prevent children from opening windows, such as bars and position locking devices

Engineering

Stair gates at the top of stairs in households with small children Enforcement

Surfacing materials such as sand or wood chips to a depth of 23-31cm under playground equipment. Optimal equipment height to reduce risk of head injury is 1.5m

Enforcement

Legislation banning baby walkers OR requiring modification to remove the mobility issue

Enforcement

Enforcement of standards requiring safe depth of specified types of surfacing materials under playground equipment and regular maintenance of those materials

Enforcement

Education programmes encouraging use of fall prevention safety devices such as window safety mechanisms to prevent children from opening windows down stairs

Education

Good Practice for burn and scald prevention in children

Product modification, specifically child resistant cigarette lighters and self-extinguishing cigarettes

Engineering

Legislation requiring a safe pre-set temperature for all water heaters Enforcement

Legislation requiring installation of smoke detectors in all new and existing housing, combined with multi-factorial community campaigns and reduced price coupons

Enforcement

Legislation regulating flammability of sleepwear Enforcement

Smoke detector give away programmes targeting high risk neighbourhoods and multi faceted community campaigns with specific objective of installation of working smoke detectors

Education

Education/Advocacy campaigns around fireworks are useful as supplemental efforts and can be used to build support for legislation

Education

Fire safety skills training to increase knowledge and behaviour of both children and parents

Education

Good practice for poisoning prevention in children

Good practice for choking/strangulation prevention in children

Secure storage for poisons. Engineering

Legislation for child resistant packaging Enforcement

Poison control centres with education of public regarding the use of centre Education

Product modification of existing entrapment hazards such as crib/cot design and enforcement through legislation

Enforcement

Product banning of unsafe products through legislation Enforcement

Legislation requiring product warning labels to include an explanation of the specific hazard

Enforcement

Acknowledgements

• Claire Jones, Health Information Analysis Team, NPHS

• Nathan Lester, Health Information Analysis Team, NPHS

For further information contact: louise.woodfine@nphs.wales.nhs.uk

END