Childhood injury in the UK - an overview


 

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Unintentional injuries – a major killer of children

In the UK in 2011, 165 children aged under 15 died as the result of unintentional injury or poisoning (ICD-10 codes V01-X59). (England and Wales – 143; Scotland – 14; Northern Ireland – 8).

Accidental injury is a major killer cause of death in UK children over the age of one. More children die each year as the result of accidents than from illnesses such as leukaemia or meningitis.

Until recently, accidents were the leading cause of death for children over the age of one. However, as a result of the fall in accidental deaths, they have been overtaken by deaths due to cancers. In England and Wales in 2011 among the 1-14 age group, 218 children died due to cancers (ICD-10 codes C00-D48) compared with 125 who died in accidents (ICD-10 codes V01-X59). Corresponding figures for Scotland are cancers - 16, accidents - 11; and for Northern Ireland are cancers - 11, accidents - 6.

Every year, over 2 million children are taken to a hospital after accidents. Around half of these accidents happen at home. Put another way, one child in five attends an accident and emergency department every year – out of a class of 30 children, on average six will have to go to hospital annually.

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The trend is downwards

The good news is that the number of accidental deaths has been declining steadily. In England and Wales in 1979, almost 1,100 children were killed in accidents, compared with 139 in 2012.

Figures from the now-defunct Home and Leisure Accident Surveillance System show that the numbers of children being taken to hospital are also falling: in the UK in 1997 it was estimated that over 2.5 million children were taken to hospital after an accident. The 2002 figure was just over 2 million.

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The inequalities gap

Not all children are at the same risk of death and injury. Research published in 1996 showed that when those from the poorest families are compared with the most affluent, they are

  • 5 times more likely to die as a pedestrian

  • 15 times more likely to die in a house fire

  • overall, they are five times more likely to be killed

(Roberts I, Power C. Does the decline in child injury mortality vary by social class? A comparison of class-specific mortality 1981 - 1991. BMJ 1996; 313: 784-6)

Similar research published in 2006 showed that the gap between children from the the most affluent families (NS-SEC 1) and those from families in which there was long term unemployment or no-one had ever worked (NS-SEC 8) had widened.  The difference in injury-related deaths rates overall was a factor of 13.

(Edwards, P.; Roberts, I.; Green, J.; Lutchmun, S.; Deaths from injury in children and employment status in family: analysis of trends in class specific death rates. BMJ, 2006; 333(7559):119 )

In non-fatal events, research shows that the poorest children are more likely to suffer injuries that require hospital admission and that when they are admitted their injuries are likely to be more serious than those experienced by children from affluent families.

(Hippisley-Cox, J., Groom L., Kendrick, D., Coupland, C., Webber, E. and Savelyich, BSP., 2002. Cross sectional survey of socioeconomic variations in severity and mechanism of childhood injuries in Trent 1992-7. BMJ : British Medical Journal, 324(7346), 1132-1134.)

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Why do children have accidents?

Accidents to children are common as they develop and explore. The type of accidents children have relate very closely to their age and stage of physical development. Children are not small adults. They learn and develop rapidly and surprise us by how quickly they change. One day they may only be able to lie on their back. The next they will be able to roll over. Understanding the links between the development abilities of a child and the risks that these changes bring is essential to preventing accidents.

Accidents to children also happen because of they are naturally inquisitive and learn by exploring. Like most beginners they can be clumsy when first learning to do things. Young children do not have the experience or understanding to keep themselves safe from the hazards around them. Children should not be prevented from learning and developing naturally but they need to grow up in a safe environment protected from unnecessary harm. This requires a combined approach through education and training for adults who are involved in caring for children, safe product design and modifications to the environment.

It is also important for children, as they get older to learn how to deal with everyday risk like climbing the stairs, crossing the road, using knives or scissors or boiling a kettle. Learning to deal with risk is a skill that will help keep children safe as they grow up. Bumps and bruises are part of growing up and learning, but no one has to have an accident that results in serious injury.

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Which children are most at risk of accidents?

Children have different accidents at different stages of their development. Babies and toddlers have most accidents in the home, as this is where they spend most of their time. Typically the accidents they have are as a result of inexperience or poor coordination. By school age, children are experiencing fewer accidents in the home and more on the roads, at school and at play. Often these accidents are as a result of increased risk taking as children begin to test their limits.

The sex of a child also seems to be a factor in childhood accidents. Boys are approximately twice as likely as girls to have accidents. This may be a result of boys being more exposed to risk – more active, out and about more, more boisterous or aggressive or more subject to peer pressure.

The physical environment where a child lives or plays may have an influence on accidents. For example, high-rise flats with balconies or communal stairs where stair gates are not allowed, unsecured windows, cars parked in side streets or lack of public playgrounds can all increase the likelihood of accidents happening.

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The types of accidents that children suffer

Very young babies are completely passive so are at risk as a result of the actions or inactions of adults or their older siblings. They may be dropped, have hot drinks poured over them, be caught in a house fire, or be injured when carried unrestrained in a car.

As they start to roll and wriggle, they may be scalded if they grab at cups when sitting on someone’s lap. Falls if left unattended on raised surfaces when having a nappy changed can lead to head injuries and broken bones. Choking becomes a risk if fed food that they cannot cope with. If left on their own in the bath, even for a minute when their carer fetches a towel or answers the phone, they can drown. Just as in the youngest age group, house fires and car crashes can lead to serious and fatal injuries.

With greater mobility comes additional risks. Crawling and walking allows toddlers to find objects that were out of reach and can lead to choking or poisoning – babies and toddlers learn about taste and texture by putting things in their mouths. The first tentative attempts to climb stairs can result in falls. The kitchen is a hazardous place – hot pans, kettles and oven doors produce real risks of severe injuries that can require prolonged treatment.

As their dexterity increases toddlers may play with bath taps and severely burn themselves, or they may climb into a dangerously hot bath to recover a dropped toy – they still have little sense of danger.

As age increases so does the range of where they play. The garden often allows access to garden chemicals, the road if the gate is not secure, or an unguarded pond – sometimes next door.

When children start school, they face risks as pedestrians and eventually cyclists. They need safe access to stimulating and safe play areas, not necessarily formal playgrounds. School children have to be given independence as it is a part of growing up but without guidance, good design of their environment and enforcement of traffic laws they are at risk.

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How can accidents be prevented?

Education, engineering and legislation can all be used to reduce the numbers and severities of accidents. However these approaches are most effective when used together rather than individually. For example, the seat belt law was only introduced after a major public education campaign. This meant that by the time people had to ‘belt up’ they were already aware of the safety reasons for doing so.

Well-founded research tells us that there are many interventions that can reduce death and injury, or lead to improve behaviour to make accidents less likely. Programmes known to be effective are:

-   In the home

  • Smoke alarm programmes

  • Use of devices to control bath water temperature

  • Education campaigns on burn and scald prevention

  • Legislation/regulations to reduce bath water burns

  • Product design to reduce burn and scald injuries

  • Educational interventions aimed at children and parents to prevent poisoning

  • Use of child-resistant packaging for pharmaceutical products

  • General hazard reduction campaigns

  • Provision of safety equipment

  • Installation of window guards to prevent falls

-   On the road

  • Skills training for child pedestrians

  • Education through age-paced materials to promote parental teaching

  • School-crossing patrols

  • Traffic engineering measures

  • Skills training for cyclists

  • Cycle helmet promotion

  • Cycle helmet legislation

  • Child restraint loan schemes

  • Educational campaigns to increase restraint use

  • Child restraint legislation

The absence of specific programmes from this list is often an indication that they have not been rigorously evaluated. It does not necessarily mean that they do not work.

Revision date: 9 Nov 2013

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