Article published in:
American Family Physician – A peer reviewed journal of the American Academy of Family Physicians
2006 Dec 1;74(11):1864-9.
http://www.aafp.org/afp/20061201/1864.html
Schnitzer PG.
University of Missouri-Columbia Sinclair School of Nursing, Columbia, Missouri 65211, USA.
ABSTRACT
Injuries are the leading cause of death in children and teenagers in the United States. The leading causes of unintentional injury vary by age and include drowning, poisoning, suffocation, fires, burns, falls, and motor vehicle, bicycle, and pedestrian-related crashes. Most injuries are preventable by modifying the child’s environment (e.g., use of stair gates) and having parents engage in safety practices (e.g., keeping matches or lighters out of reach of children). Effective injury prevention methods include the use of childproof caps on medications and household poisons, age-appropriate restraints in motor vehicles (i.e., car seats, booster seats, seat belts), bicycle helmets, and a four-sided fence with a locked gate around residential swimming pools.
EXCERPTS
Childhood injuries are responsible for approximately 16,000 deaths each year in the United States, and more than 70 percent of these deaths are the result of unintentional injuries. Nonfatal unintentional injuries also are a significant cause of childhood morbidity. More than 20 million nonfatal injuries are estimated to occur in U.S. children each year, costing $347 billion and accounting for more than 300,000 hospital admissions.
A shift in semantics from “accident prevention” to “injury prevention and control” was initiated in the 1970s to focus attention on preventable health outcomes. Injury prevention strategies generally are classified into three types: education, engineering and environmental modification, and legislative interventions. Active interventions are those that require action on the part of an individual person to confer protection (e.g., buckling a seatbelt), whereas passive interventions provide automatic protection regardless of individual behavior (e.g., automobile airbags).
Parent-focused and environmental strategies are effective in preventing injuries, particularly those occurring in young children at home. However, most parents cannot identify specific prevention strategies and believe that simply “being careful” is adequate protection from injury. Although little research has addressed the direct effect of counseling parents on the reduction of injury rates, there is evidence that clinical counseling can influence car seat use, at least in the short term, and can positively influence the rates of owning a functioning smoke alarm. The U.S. Preventive Services Task Force found fair evidence to support counseling parents of young children on measures to reduce injury risk. Anticipatory guidance topics should be considered an important component of medical care for children and families.
TODDLERS
Almost one third of injury-related deaths in toddlers result from motor vehicle crashes, and more than one fourth are the result of drowning. Fires and burns also contribute significantly to injury-related mortality rates. Falls and poisonings are the leading causes of nonfatal injuries requiring hospitalization in this age group, followed by scald burns and motor vehicle-related injuries.
POISONING
Poisoning continues to be a leading cause of injury-related hospitalization among toddlers, even after implementation of the Poison Prevention Packaging Act of 1970. The American Association of Pediatrics (AAP) recommends against using syrup of ipecac, which is not effective in completely removing poison from the stomach. Syrup of ipecac often is administered when it is contraindicated or not necessary, and it may result in intractable vomiting that prohibits the use of other orally administered poison treatments, such as activated charcoal and acetylcysteine.
Another ineffective poison prevention strategy for toddlers is the use of “Mr. Yuk” poison warning stickers. These stickers display a green scowling face with a protruding tongue and were designed to be placed on hazardous substances to discourage children from handling the containers or ingesting the poison. However, studies have shown that supplying the stickers to families with young children does not reduce the risk of poisoning. Furthermore, labeling containers with the stickers does not deter young children from touching, holding, or attempting to open the labeled containers.
COUNSELING RECOMMENDATIONS
Priority topics for office-based injury prevention counseling include the use of motor vehicle restraints, smoke detectors, and pool fencing; reducing residential hot water temperature; the hazards of infant walkers; the safe storage of poisons and medications; and parental supervision. The AAP has created the Injury Prevention Program for parents of children 12 years and younger. It can be accessed at http://www.aap.org/family/tippmain.htm. The program includes injury prevention counseling guidelines and schedules for providers, safety surveys designed to assess parents’ specific educational needs, and age-specific parent education handouts for use in providing anticipatory guidance in primary care offices. This program has been shown to be cost-effective.
