PATRICIA G. SCHNITZER, PH.D., College of Missouri-Columbia Sinclair School of Nursing, Columbia, Missouri

Am Fam Physician. 2006 Dec 1;74(11):1864-1869.

You are watching: Regardless of the cause of a child’s injury, your first priority is to:

An even more current write-up on avoidance of unintentional childhood injury is easily accessible.

Related Editorial

Patient information: See related handout on childhood injuries, written by the author of this short article.

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This write-up exemplifies the thedesigningfairy.com 2006 Annual Clinical Focus on caring for youngsters and also teens.


Injuries are the leading cause of death in kids 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 auto, bicycle, and pedestrian-related crashes. Most injuries are preventable by editing the child’s environment (e.g., usage of stair gates) and having actually parental fees connect in security practices (e.g., keeping matches or lighters out of reach of children). Effective injury prevention approaches incorporate the usage of childproof caps on drugs and also household poisons, age-appropriate restraints in motor vehicles (i.e., automobile seats, booster seats, seat belts), bicycle helmets, and also a four-sided fence with a locked gate approximately residential swimming pools.


Childhood injuries are responsible for around 16,000 deaths yearly in the United States, and also more than 70 percent of these deaths are the result of unintentional injuries.1 Nonfatal unintentional injuries also are a far-reaching reason of childhood morbidity. More than 20 million nonfatal injuries are estimated to happen in U.S. children each year, costing $347 billion and accountancy for more than 300,000 hospital adgoals.2,3


SORT: KEY RECOMMENDATIONS FOR PRACTICEClinical recommendationEvidence ratingReferences

To prevent sudden infant death syndrome, newborns should be inserted on their backs to sleep.

B

21

To prevent injury in motor vehicle crashes, all children must be placed in age-appropriate son restraint seats.

A

12

To prevent drownings, swimming pools need to be surrounded completely by fencing that is hard to climb and also that does not permit straight access from the house. Gates must have actually self-closing latches.

A

16


A = continuous, good-quality patient-oriented evidence; B = incontinuous or limited-high quality patient-oriented evidence; C = consensus, disease-oriented proof, usual practice, skilled opinion, or situation series. For indevelopment about the SORT evidence rating mechanism, see web page 1821 orhttps://www.thedesigningfairy.com/afpkind.xml.


SORT: KEY RECOMMENDATIONS FOR PRACTICEClinical recommendationEvidence ratingReferences

To proccasion sudden infant fatality syndrome, newborns need to be placed on their backs to sleep.

B

21

To proccasion injury in motor auto crashes, all kids need to be placed in age-correct child restraint seats.

A

12

To proccasion drownings, swimming pools should be surrounded completely by fencing that is challenging to climb and also that does not allow straight access from the house. Gates have to have self-closing latches.

A

16


A = continuous, good-high quality patient-oriented evidence; B = inconstant or limited-high quality patient-oriented evidence; C = consensus, disease-oriented proof, usual practice, expert opinion, or instance series. For information around the SORT evidence rating system, watch web page 1821 orhttps://www.thedesigningfairy.com/afptype.xml.


A transition in semantics from “accident prevention” to “injury avoidance and control” was initiated in the 1970s to focus attention on avoidable wellness outcomes.4 Injury avoidance tactics mainly are classified right into 3 types: education and learning, engineering and ecological change, and legislative interventions.5 Active interventions are those that need activity on the component of an individual perkid to confer security (e.g., buckling a seatbelt), whereas passive interventions provide automatic defense regardless of individual habits (e.g., auto airbags).

Parent-concentrated and also ecological strategies are reliable in avoiding injuries, specifically those developing in young kids at residence.6 However, the majority of paleas cannot identify certain avoidance methods and also think that simply “being careful” is adequate defense from injury.7 Although bit research has actually addressed the straight effect of counseling parental fees on the reduction of injury prices, tbelow is evidence that clinical counseling can affect automobile seat usage, at least in the short term,8,9 and can positively influence the prices of owning a functioning smoke alarm.9–11 The UNITED STATE Preventive Services Task Force uncovered fair proof to assistance counseling paleas of young children on measures to minimize injury danger.12 Anticipatory guidance topics should be considered an important component of medical treatment for kids and family members.


The leading reasons of fatal unintentional injuries in kids and also adolescents younger than 18 years are motor automobile crashes, drowning, fires and burns, and also suffocation.1 The leading causes of nonfatal injuries resulting in hospitalization are drops, poisoning, scald burns, and also motor vehicle, bicycle, and also pedestrian-associated crashes.13,14 Evidence-based references for the avoidance of fatal and nonfatal injuries are summarized in Table 1.10–12,15–21

INFANTS

Suffocation

Most injury-associated deaths in babies (66 percent) are the outcome of suffocation.1 Today, many suffocation deaths take place because babies are put in resting environments that carry out not fulfill guidelines for infant safety. A 17-year testimonial of infant suffocation deaths discovered that the leading causes of suffocation are wedging (in between the mattress and also wall or bed frame), oronasal obstruction by bedding or a soft sleeping surchallenge, overlaying by an additional person, head entrapment in an area via which the body had passed, and also hanging (e.g., by recorded clothing).22 A descriptive research of babies that died suddenly and all of a sudden found that most infants were uncovered in unsafe sleeping positions (e.g., vulnerable position, head or confront spanned by soft bedding) or in atmospheres not especially designed for infants (e.g., adult beds, couches, cushioned chairs, co-sleeping through one or even more persons).23 Both studies concluded that safe sleeping methods may proccasion many type of infant deaths (Table 110–12,15–21).22,23 The American Academy of Pediatrics (AAP) freshly stressed the prominence of safe sleeping methods in its updated plan on reducing the hazard of sudden infant death syndrome (SIDS).21


TABLE 1Evidence-Based Prevention Strategies for Childhood InjuriesCause of injuryHigh-hazard groupsPrevention strategiesEvidence ratingReferences

Bicycle crashes

School-age children

Apconfirmed bicycle helmet to reduce the hazard of head injury after crashing

B

12

Educational programs to increase helmet use

B

15

Drowning

Toddlers and also school-age children

Fencing that totally surrounds pool and does not enable direct accessibility from residence. Fence have to be made of product that is difficult to climb and also have actually self-latching gateways.

A

16

Personal flotation gadgets roughly water

C

17

Vigilant adult supervision

B

17

Cardiopulmonary resuscitation training

B

12

Falls

Infants and toddlers

Avoiding the usage of infant walkers

B

18

Gates for stairways

C

19

Releasable window guards or home window stops over initially floor

A

12

Clinical counseling for parents to proccasion falls

B

11

Fires and also burns

Toddlers and school-age children

Properly mounted and preserved smoke detectors

A

12

Clinical counseling to rise smoke detector use

B

10

Water heater temperature preset to much less than 130° F (54.4° C)

A

12

Motor car crashes

All children

Correct usage of age-correct kid restraints

A

12

Clinical counseling to encourage correct use of boy restraints

C

12,20

Poisoning

Toddlers

Child-resistant packaging

A

12

Suffocation

Infants

Smoking cessation in the time of pregnancy

B

21

Recommending safe sleeping practices

Place babies on their backs to sleep

B

21

Use a firm mattress that meets currently mandated safety standards

B

21

Rerelocate quilts, loose bedding, stuffed playthings, and also other soft objects from crib

B

21

Keep infant’s head uncovered

B

21

Do not allow infant to share a bed through adults or other children

B

21

Do not allow infant to sleep via adults on a sofa or recliner

B

21

Consider offering a pacifier during sleep

C

21

Avoid overheating

C

21

Avoid commercial tools marketed to reduce the incidence of sudden infant death syndrome (e.g., monitors, wedges to maintain sleeping position)

C

21


A = constant, good-high quality patient-oriented evidence; B = incontinuous or limited-top quality patient-oriented evidence; C = agreement, disease-oriented evidence, usual practice, experienced opinion, or case series. For indevelopment around the SORT proof rating mechanism, watch web page 1821 orhttps://www.thedesigningfairy.com/afptype.xml.


TABLE 1Evidence-Based Prevention Strategies for Childhood InjuriesCausage of injuryHigh-danger groupsPrevention strategiesEvidence ratingReferences

Bicycle crashes

School-age children

Approved bicycle helmet to alleviate the risk of head injury after crashing

B

12

Educational programs to rise helmet use

B

15

Drowning

Toddlers and school-age children

Fencing that entirely surrounds pool and also does not permit direct access from house. Fence have to be made of product that is difficult to climb and have self-latching entrances.

A

16

Personal flotation devices about water

C

17

Vigilant adult supervision

B

17

Cardiopulmonary resuscitation training

B

12

Falls

Infants and toddlers

Avoiding the use of infant walkers

B

18

Gates for stairways

C

19

Releasable home window guards or home window stops over first floor

A

12

Clinical counseling for parents to proccasion falls

B

11

Fires and also burns

Toddlers and also school-age children

Properly installed and preserved smoke detectors

A

12

Clinical counseling to increase smoke detector use

B

10

Water heater temperature preset to much less than 130° F (54.4° C)

A

12

Motor car crashes

All children

Correct use of age-correct child restraints

A

12

Clinical counseling to encourage correct usage of boy restraints

C

12,20

Poisoning

Toddlers

Child-resistant packaging

A

12

Suffocation

Infants

Smoking cessation in the time of pregnancy

B

21

Recommending safe resting practices

Place infants on their backs to sleep

B

21

Use a firm mattress that meets presently mandated security standards

B

21

Rerelocate quilts, loose bedding, stuffed toys, and also various other soft objects from crib

B

21

Keep infant’s head uncovered

B

21

Do not enable infant to share a bed through adults or various other children

B

21

Do not permit infant to sleep with adults on a sofa or recliner

B

21

Consider offering a pacifier in the time of sleep

C

21

Avoid overheating

C

21

Avoid commercial devices marketed to minimize the incidence of sudden infant death syndrome (e.g., monitors, wedges to maintain sleeping position)

C

21


A = continuous, good-top quality patient-oriented evidence; B = incontinuous or limited-high quality patient-oriented evidence; C = agreement, disease-oriented proof, usual practice, professional opinion, or instance series. For information around the SORT evidence rating device, check out page 1821 orhttps://www.thedesigningfairy.com/afpsort.xml.


Falls

Falls are a leading reason of nonfatal injuries in youngsters of all eras. Parental counseling has actually been effective in staying clear of infant drops, and home window guards are extremely reliable in preventing serious injuries regarded falls from home windows.24 Anvarious other considerable cause of falls in infants—specifically falls down stairs—is the usage of infant walkers. The AAP recommends banning the manufacture and also sale of these gadgets because no benefit has actually been prcooktop from their use, and also they pose an extensive hazard of injury or death.18

TODDLERS

Almany one 3rd of injury-associated deaths in toddlers result from motor auto crashes, and even more than one fourth are the outcome of drowning.1 Fires and also burns additionally contribute considerably to injury-associated mortality rates. Falls and poisonings are the leading reasons of nonfatal injuries requiring hospitalization in this age team, complied with by scald burns and also motor vehicle–connected injuries.

Motor Vehicle Crashes

The correct usage of age-correct child restraints and seat belts is an efficient means to proccasion or alleviate injuries in the event of a motor car crash. Laws requiring the usage of seat belts and son restraints have enhanced their usage.25 However, incorrect usage of kid restraints stays a significant trouble.26

Drownings

Pool fencing is efficient in preventing drownings in residential swimming pools as soon as the fence entirely surrounds the pool, does not allow direct accessibility from the house, has self-closing, self-latching entrances, and is made of material that is hard to climb.16 However before, young kids proceed to be at risk of drowning in natural bodies of water (e.g., ponds, lakes, streams), bathtubs, buckets, and inadequately fenced or unfenced swimming pools. Drowning rates are greatest in youngsters one to 3 years of age. Drownings in this age team frequently happen during a brief lapse in supervision. The AAP recommends that kids four years and younger never be left alone or in the treatment of one more son while in bathtubs, pools, or spas, or once they are close to open water. The AAP additionally recommends that adults supervise youngsters from within an arm’s size and also refrain from distracting tasks whenever youngsters are in or about water.17

Fires and Burns

Scalding is a leading reason of hospitalization for burns in toddlers. An reliable strategy for staying clear of injuries from scald burns is reducing the temperature of hot water heaters to much less than 130° F (54.4° C).27

Children playing via matches and also lighters are a significant reason of residence fires28; parents have to be counsebrought about store these items out of children’s reach. Injuries and deaths from residence fires can be prevented by correctly installing and keeping residential smoke detectors.29 Paleas must note that young children often carry out not know what to carry out as soon as the smoke detector sounds and also might be frightened by the noise; as an outcome, these youngsters proceed to be at high threat of injury and fatality in residence fires. The AAP recommends counseling paleas around fire prevention (e.g., adequate supervision of children, usage of smoke alarms, teaching young youngsters what to do when the smoke alarm sounds).30

Poisoning

Poisoning continues to be a leading cause of injury-associated hospitalization among toddlers, even after implementation of the Poikid Prevention Packaging Act of 1970. The AAP recommends versus making use of syrup of ipecac, which is not efficient in completely rerelocating poichild from the stomach.31 Syrup of ipecac frequently is administered as soon as it is contrasuggested or not necessary, and it may bring about intractable vomiting that prohibits the usage of other orally administered poiboy therapies, such as triggered charcoal and also acetylcysteine.31

Anvarious other ineffective poikid avoidance strategy for toddlers is the use of “Mr. Yuk” poiboy warning stickers. These stickers screen a green scowling confront through a protruding tongue and also were designed to be placed on hazardous substances to discourage kids from handling the containers or ingesting the poison. However, studies have presented that providing the sticker labels to family members through young kids does not mitigate the threat of poisoning.32 Furthermore, labeling containers through the stickers does not deter young children from emotional, holding, or attempting to open up the labeled containers.33

SCHOOL-AGE CHILDREN

Many fatal injuries in school-age youngsters are the result of motor car crashes (58 percent), drownings (10 percent), and fires and burns (8 percent).1 Nonfatal injuries causing hospitalization a lot of frequently are resulted in by drops and also by bicycle and pedestrian-related crashes.

In addition to appropriate restraints in passenger vehicles, the AAP recommends that youngsters need to not take a trip in the cargo locations of pickup trucks. Children younger than 16 years must not use off-road vehicles or ride on lawn mowers.

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Bicycle helmets are effective in reducing the danger of head injury in the event of a crash.34 Interventions such as legislation, educational programs, and also subsidies might be reliable for enhancing the usage of bicycle helmets, specifically among younger youngsters.15,35 In addition, several researches have uncovered that interventions that effectively increase bicycle helmet usage additionally alleviate prices of bicycle crash–related head injuries.36 Parental involvement and riding partners (consisting of paleas or various other adults) that likewise wear helmets boost the effectiveness of educational programs.36 Protective equipment for inline skating, skateboarding, and scooter riding likewise is recommended.

ADOLESCENTS

Motor vehicle crashes are the leading cause of injuries and all-cause mortality in teens.1,13 Teenage motorists have actually high crash prices, generally bereason of inendure and riskies driving habits (e.g., speeding, tail-gating). Nighttime driving is risky for teens, as is driving via teenage passengers.37

Wearing a seat belt effectively reduces or avoids injury in the event of a crash.38 Parental administration of teenage driving is a promising component of an reliable injury avoidance strategy.39 Driver’s education and learning courses are not efficient in preventing crashes, and some proof says that these courses actually may increase teenagers’ crash hazard if participation results in previously licencertain.40