Unintentional injuries are predictable and preventable. Yet every hour, a child in the United States dies from an unintentional injury. Globally, the number is even more staggering, with nearly 1 million children dying from unintentional injuries each year. Motor vehicle–related injuries, burns, drowning, falls, suffocation or choking, and poisoning are just a few of the unintentional injury risks threatening children. Patient safety requires a three-pronged strategy of behavior change, use of safety devices, and improvement of laws and regulations to ensure that all children lead healthy and productive lives.
Key Points
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Safe Kids Worldwide has created, implemented, and evaluated data-driven injury prevention programs to combat leading injury risks to children.
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In addition to the case studies highlighted previously, these multifaceted programs also address other motor vehicle safety issues (eg, hyperthermia prevention); pedestrian safety; fire and burn prevention; drowning prevention; and home safety (eg, poisoning, carbon monoxide, falls, and suffocation prevention).
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Continued attention to encourage behavior change, distribute safety devices, and improve laws and regulations impacting child safety requires a multifaceted, consistent, and direct contribution from all stakeholders.
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Based on the success of the last 25 years and building on the momentum already gained, it is essential that the focus continue to be on reducing childhood injury in the United States and around the world.
Introduction
Unintentional injury is the number one cause of death to children in the United States and the role of health care professionals in promoting patient safety has never been more urgent. The US Centers for Disease Control and Prevention (CDC) recently released its National Action Plan for Child Injury Prevention , which describes its vision for reducing childhood injuries and provides a guide for stakeholders in the field. On the global level, the World Health Organization and the United Nations Children’s Fund published an overview of childhood injury, including intervention strategies, in the 2008 World Report on Child Injury Prevention . Proved injury prevention efforts have focused primarily on three strategies: (1) behavior change, (2) correct and consistent use of safety devices, and (3) safety regulations and legislation. Bicycle helmets, smoke alarms, four-sided fencing around pools, and child safety seats are examples of well-established and successful means for reducing child injury.
One organization eager to help health professionals promote patient safety is Safe Kids Worldwide ( http://www.safekids.org/worldwide/ ), a global network of organizations dedicated to providing parents and caregivers with practical and proved resources to protect kids from unintentional injuries. Safe Kids Worldwide works with an extensive network of more than 600 coalitions in 23 countries to reduce traffic injuries, drowning, falls, burns, poisonings, and more. Since 1988, Safe Kids Worldwide has helped reduce the US childhood death rate from unintentional injury by 53%. Yet, there is still much more work to be done to keep kids safe, because approximately 135 million children are born in the world each year.
Aggregated injury statistics
Worldwide
Globally, 110 children die every hour from an unintentional injury, more than 2600 every day. It is estimated that more than 970,000 children ages 19 and younger died from injuries in 2008, more than 80% of which were unintentional. As children age, injuries make up an increasing proportion of deaths. Beginning at age 10, unintentional injuries are the leading cause of death for children. Road traffic accidents, drowning, fires, falls, and poisoning account for 62% of these deaths. Estimates indicate that more than 95% of injury-related deaths among children occur in low- and middle-income countries. One of the risk areas receiving the greatest attention is motor vehicle–related injury, with experts predicting that these injuries will become the fifth leading cause of death around the world by 2030. Among the emerging risks are increases in cars and lack of child restraint legislation.
Although there are no specific data on the overall global costs of childhood injury, the information that is available is staggering. Motor vehicle–related injuries in developing countries are thought to consume 1% to 2% of gross domestic product, or about $100 billion every year. Although these data speak volumes, they say nothing of the unquantifiable pain and suffering inflicted on individuals, families, and communities.
United States
The United States has made significant progress in reducing unintentional childhood injuries; however, the battle is far from over. Today alone, approximately 25 children will die from a preventable injury. For every child that dies, 25 more are hospitalized. More than 25,000 children are treated in emergency departments each day. The rate of death per 100,000 in the United States is 8.7, compared with Sweden at 2, the United Kingdom at 2.9, Canada at 4.6, and Poland at 6 ; the lower rates in these countries may be the result of stronger safety-related laws and regulations. The type of injury that children are at greatest risk for evolves as they age. Among infants, the biggest threat is suffocation. By the time a child is between the ages of 1 and 4, drowning becomes the leading injury-related killer. Beginning at age 5 and throughout the remainder of childhood, motor vehicle–related injury is the leading cause of death. As shown in Fig. 1 , by the time children are between the ages of 15 and 19, unintentional injury comprises the largest portion of all causes of death.
The cost of childhood injury in the United States is high in terms of years of potential life lost and financial costs. It is estimated that in the last decade unintentional injuries accounted for more than 40% of the years of potential life lost among children. This rate is substantially higher than that of other causes of death. When compared with the years of potential life lost for cancer-related deaths, heart disease, and influenza and pneumonia, the rate for injury is 5, 13, and 31 times higher. Exacerbating the toll that injury takes on families and communities, unintentional childhood injury results in approximately $87 billion in medical and societal costs. Taking into account the reduced quality of life among injured children and their families impacted by injury, the costs are estimated to be more than $200 billion each year for the United States alone.
Introduction
Unintentional injury is the number one cause of death to children in the United States and the role of health care professionals in promoting patient safety has never been more urgent. The US Centers for Disease Control and Prevention (CDC) recently released its National Action Plan for Child Injury Prevention , which describes its vision for reducing childhood injuries and provides a guide for stakeholders in the field. On the global level, the World Health Organization and the United Nations Children’s Fund published an overview of childhood injury, including intervention strategies, in the 2008 World Report on Child Injury Prevention . Proved injury prevention efforts have focused primarily on three strategies: (1) behavior change, (2) correct and consistent use of safety devices, and (3) safety regulations and legislation. Bicycle helmets, smoke alarms, four-sided fencing around pools, and child safety seats are examples of well-established and successful means for reducing child injury.
One organization eager to help health professionals promote patient safety is Safe Kids Worldwide ( http://www.safekids.org/worldwide/ ), a global network of organizations dedicated to providing parents and caregivers with practical and proved resources to protect kids from unintentional injuries. Safe Kids Worldwide works with an extensive network of more than 600 coalitions in 23 countries to reduce traffic injuries, drowning, falls, burns, poisonings, and more. Since 1988, Safe Kids Worldwide has helped reduce the US childhood death rate from unintentional injury by 53%. Yet, there is still much more work to be done to keep kids safe, because approximately 135 million children are born in the world each year.
Aggregated injury statistics
Worldwide
Globally, 110 children die every hour from an unintentional injury, more than 2600 every day. It is estimated that more than 970,000 children ages 19 and younger died from injuries in 2008, more than 80% of which were unintentional. As children age, injuries make up an increasing proportion of deaths. Beginning at age 10, unintentional injuries are the leading cause of death for children. Road traffic accidents, drowning, fires, falls, and poisoning account for 62% of these deaths. Estimates indicate that more than 95% of injury-related deaths among children occur in low- and middle-income countries. One of the risk areas receiving the greatest attention is motor vehicle–related injury, with experts predicting that these injuries will become the fifth leading cause of death around the world by 2030. Among the emerging risks are increases in cars and lack of child restraint legislation.
Although there are no specific data on the overall global costs of childhood injury, the information that is available is staggering. Motor vehicle–related injuries in developing countries are thought to consume 1% to 2% of gross domestic product, or about $100 billion every year. Although these data speak volumes, they say nothing of the unquantifiable pain and suffering inflicted on individuals, families, and communities.
United States
The United States has made significant progress in reducing unintentional childhood injuries; however, the battle is far from over. Today alone, approximately 25 children will die from a preventable injury. For every child that dies, 25 more are hospitalized. More than 25,000 children are treated in emergency departments each day. The rate of death per 100,000 in the United States is 8.7, compared with Sweden at 2, the United Kingdom at 2.9, Canada at 4.6, and Poland at 6 ; the lower rates in these countries may be the result of stronger safety-related laws and regulations. The type of injury that children are at greatest risk for evolves as they age. Among infants, the biggest threat is suffocation. By the time a child is between the ages of 1 and 4, drowning becomes the leading injury-related killer. Beginning at age 5 and throughout the remainder of childhood, motor vehicle–related injury is the leading cause of death. As shown in Fig. 1 , by the time children are between the ages of 15 and 19, unintentional injury comprises the largest portion of all causes of death.
The cost of childhood injury in the United States is high in terms of years of potential life lost and financial costs. It is estimated that in the last decade unintentional injuries accounted for more than 40% of the years of potential life lost among children. This rate is substantially higher than that of other causes of death. When compared with the years of potential life lost for cancer-related deaths, heart disease, and influenza and pneumonia, the rate for injury is 5, 13, and 31 times higher. Exacerbating the toll that injury takes on families and communities, unintentional childhood injury results in approximately $87 billion in medical and societal costs. Taking into account the reduced quality of life among injured children and their families impacted by injury, the costs are estimated to be more than $200 billion each year for the United States alone.
Case studies in unintentional injury
Medication Safety
Safe Kids Worldwide recently undertook an in-depth study of medication safety among children in the United States. The death rate among children ages 14 and younger from poisoning has been cut in half since the late 1970s. Yet, during the same time period, medication deaths as a percentage of all child poisoning deaths have nearly doubled, as shown in Fig. 2 . Each day, approximately 165 kids are rushed to emergency rooms for medication-related poisoning treatment. Unsupervised ingestion of medication led to 95% of medication-related poisoning visits to emergency departments, whereas dosing errors made by caregivers were responsible for approximately 5%.
Investigation into the forces behind the medication-related poisoning trends brought to light several factors. A primary factor is the increase in medications in the home, especially prescription pain medications. The aging US population has led to more adults taking prescription medications and often multiple medications. Simultaneously, there has been a rise in multigenerational households in which children may now have greater access to grandparents’ medications ; one study found that up to 20% of pediatric poisonings involve a grandparent’s medication. Complicating medication safety, today’s working and single parents may rely on multiple caregivers, making coordination and timing of children’s dosages a challenge. Lastly, formulation of medications that taste good and often look like candy may entice toddlers to take them unsupervised.
Through a 3-year partnership with McNeil Consumer Healthcare, Safe Kids Worldwide is taking a multifaceted approach to reducing medication-related poisoning among children, as articulated in a recent report. In partnership with the CDC-led Up and Away and Out of Sight Campaign , Safe Kids Worldwide is educating caregivers on the importance of safe storage and safe dosing of medication, and keeping the national poison control center number (1-800-222–1222) easily accessible. A new video illustrates how quickly children can gain access to medication ( http://www.safekids.org/safety-basics/safety-guide/medication-safety-guide/ ). Further, Safe Kids Worldwide is urging the US Food and Drug Administration to allow the pharmaceutical industry to provide dosing instructions on labels for nonprescription acetaminophen for children between the ages of 6 and 23 months to help reduce caregiver confusion. To promote patient safety, health care professionals must educate caregivers about proper storage and dosing of medications and send home safety instructions to reinforce key messages. Easy-to-read medication safety information is available for download at www.safekids.org .
Button Battery Ingestion Prevention
Although several injury-related threats have been endangering children for centuries, others are only just emerging. One such risk is that of button batteries. Button batteries are the coin-sized lithium batteries that come in everyday items, such as small remote controls, bathroom scales, reading lights, and greeting cards. These batteries are increasingly common in the home and children are getting a hold of them. Although in many cases the body passes these batteries without issue, the trouble arises when they get lodged, often in the esophagus, and a chemical reaction leads to burns. From 1990 to 2009, the number of children seen in emergency departments for battery-related injury significantly increased, with the greatest increase in exposure during the last 8 years. Approximately 66,000 children ages 17 and younger visited emergency departments for battery ingestion, mouth exposure, or insertion into the ear canal or nasal cavity. This is a troubling trend, especially among children ages 5 and younger, who comprise three-quarters of cases. Increased awareness of the dangers of button batteries, additional laws and regulations to reduce the risk they pose, and continued research into risks are important next steps in this field.
Safe Kids Worldwide has partnered with battery manufacturer Energizer (St. Louis, MO) on a campaign called The Battery Controlled to raise awareness and change behavior among adult caregivers about this little-known and emerging risk to small children. Educational materials have been distributed through coalitions and chapters nationwide and a compelling new video illustrates how quickly these ingestions can occur ( http://thebatterycontrolled.com/ ). Health care professionals are encouraged to counsel adult caregivers about keeping common items containing button batteries out of reach of young children and to distribute or refer families to downloadable materials available at www.safekids.org .
Sports Injury Prevention
Each year, approximately 38 million children play organized sports in the United States. Sports injuries are commonplace, resulting in 3.5 million medical visits among children ages 14 and younger annually. Most of these injuries, such as overuse, dehydration, and concussions, are preventable through teamwork among parents, coaches, athletes, schools, safety advocates, athletic trainers, and medical and health professionals. To investigate sports injuries further, Safe Kids Worldwide commissioned a survey of more than 500 children ages 8 to 18 years, 750 parents, and 750 coaches. The resulting report confirmed that children frequently get injured and suggested that behavior change could prevent many of these mishaps. More than one in three children who play team sports reported being injured seriously enough to miss practices or games. Most kids (three in four) said they rely primarily on coaches to keep them safe during practices and games. Unfortunately, young athletes often place themselves in harm’s way. For example, approximately 3 out of 10 children believed that even when they are hurt, good players should keep playing their sport unless a coach or adult makes them stop.
Information from the coaches revealed that injuries on their teams are frequent and they want and need more sports safety training. Nine in 10 coaches reported that a child on their team has suffered an injury, emphasizing the importance of safety training. Looking at specific injury risks, such as concussions, the study found that coaches need more education. Half of coaches surveyed believed there is an acceptable amount of head contact (ie, “getting their bell rung,” “seeing stars”) young athletes can receive without potentially causing a serious brain injury. Making injury prevention even more of a challenge for coaches, nearly half of them reported receiving pressure from parents or the kids themselves to play an injured child during a game.
Parents are taking many steps to reduce injury risk, yet misperceptions and uninformed behaviors about sports are all too common. Important steps, such as taking children for preparticipation physical examinations and making emergency contact information easily accessible, are being taken by parents. However, a better understanding of sports injury is necessary. For example, the survey revealed that 9 in 10 parents underestimated the length of time kids should take off from playing any one sport during the year and 4 in 10 underestimated the amount of fluids a typical young athlete needs per hour of play.
Based on the findings, Safe Kids Worldwide, in partnership with founding sponsor Johnson & Johnson (New Brunswick, NJ), launched a sports safety campaign aimed at keeping young athletes safe. Key messages focus on the importance of preparticipation physical examinations and consistent use of safety gear; preventing dehydration, overuse injuries, and concussion; and having an emergency plan in place if a child sustains an injury. Safe Kids Worldwide developed a tip sheet using the letters in “coaches” as a mnemonic device, as shown in Fig. 3 . Health care professionals should discuss these messages with young athletes and their caregivers during routine office visits. In addition, any athletes with suspected concussions should be examined and monitored closely before they are allowed to return to play, following the guidelines listed in Box 1 . Further, US residents should be encouraged to learn more by participating in one of the hundreds of Safe Kids Worldwide coalition-led sports safety clinics for coaches, parents, and young athletes being held across the country; a complete list of these events is available at www.safekids.org/sports .
