Childhood injury prevention advice: a survey of health professionals responses to common scenarios

Perception of Choking Injury Risk Among Healthcare Students

Choking injuries in children represent a severe public health burden. Although most choking injuries are due to food, parents have often been found to be unaware of the choking hazards presented by food. In this context, healthcare professionals may play an important role in choking prevention by educating families. We investigate the perception of choking injury risk among healthcare profession students by comparing their awareness and knowledge of choking hazards with those of people without a specific health education. A survey was conducted among a sample of final year healthcare profession students from two universities in northern Italy and a sample of adults from the general population without any health education. Respondents were asked to look at ten pictures and identify the items that pose the greatest choking hazard to children of different age groups. Seventy-one students and 742 adults without any health education responded to the survey. A higher percentage of the adults without a health education identified a food item as posing the greatest choking hazard in comparison to the percentage of healthcare profession students. The results of this study suggest that there is a need to include specific educational modules on choking prevention in healthcare-related degree programs.

Palestinian Nurses' and Doctors' Perceptions and Practices Regarding the Prevention of Injuries to Children in the Home: An Explorative Qualitative Study

Unintentional injuries are a growing global public health problem that causes mortality, morbidity, and disability among children. These injuries are common among under-fives and form a significant burden on healthcare systems, particularly in low- and middle-income countries. Nurses and doctors have a major role to play in the prevention of home injuries, as expressed in many international reports. In Palestine, there is a paucity of research in this area. Therefore, this study aims to explore nurses' and doctors' perceptions and practices regarding the prevention of home injuries among children aged under-five years. A qualitative approach was followed, whereby semi-structured interviews were undertaken with 24 nurses and doctors who worked with children in a primary health care setting. The derived data were analyzed using thematic analysis. This study found that most of the nurses and doctors who were interviewed reported positive attitudes toward working on this topic; the majority of them attempted to work on injury prevention. Nevertheless, they needed further support to fulfil this potential role, as they faced many barriers in their daily practice in this area. Policy makers could potentially take advantage of this attitude and support them by providing training, resources, and time for them to implement this role.

Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives

Background

Unintentional injuries among 0- to 4-year-olds are a major public health problem incurring substantial NHS, individual and societal costs. However, evidence on the effectiveness and cost-effectiveness of preventative interventions is lacking.

Aim

To increase the evidence base for thermal injury, falls and poisoning prevention for the under-fives.

Methods

Six work streams comprising five multicentre case–control studies assessing risk and protective factors, a study measuring quality of life and injury costs, national surveys of children’s centres, interviews with children’s centre staff and parents, a systematic review of barriers to, and facilitators of, prevention and systematic overviews, meta-analyses and decision analyses of home safety interventions. Evidence from these studies informed the design of an injury prevention briefing (IPB) for children’s centres for preventing fire-related injuries and implementation support (training and facilitation). This was evaluated by a three-arm cluster randomised controlled trial comparing IPB and support (IPB+), IPB only (no support) and usual care. The primary outcome was parent-reported possession of a fire escape plan. Evidence from all work streams subsequently informed the design of an IPB for preventing thermal injuries, falls and poisoning.

Results

Modifiable risk factors for falls, poisoning and scalds were found. Most injured children and their families incurred small to moderate health-care and non-health-care costs, with a few incurring more substantial costs. Meta-analyses and decision analyses found that home safety interventions increased the use of smoke alarms and stair gates, promoted safe hot tap water temperatures, fire escape planning and storage of medicines and household products, and reduced baby walker use. Generally, more intensive interventions were the most effective, but these were not always the most cost-effective interventions. Children’s centre and parental barriers to, and facilitators of, injury prevention were identified. Children’s centres were interested in preventing injuries, and believed that they could prevent them, but few had an evidence-based strategic approach and they needed support to develop this. The IPB was implemented by children’s centres in both intervention arms, with greater implementation in the IPB+ arm. Compared with usual care, more IPB+ arm families received advice on key safety messages, and more families in each intervention arm attended fire safety sessions. The intervention did not increase the prevalence of fire escape plans [adjusted odds ratio (AOR) IPB only vs. usual care 0.93, 95% confidence interval (CI) 0.58 to 1.49; AOR IPB+ vs. usual care 1.41, 95% CI 0.91 to 2.20] but did increase the proportion of families reporting more fire escape behaviours (AOR IPB only vs. usual care 2.56, 95% CI 1.38 to 4.76; AOR IPB+ vs. usual care 1.78, 95% CI 1.01 to 3.15). IPB-only families were less likely to report match play by children (AOR 0.27, 95% CI 0.08 to 0.94) and reported more bedtime fire safety routines (AOR for a 1-unit increase in the number of routines 1.59, 95% CI 1.09 to 2.31) than usual-care families. The IPB-only intervention was less costly and marginally more effective than usual care. The IPB+ intervention was more costly and marginally more effective than usual care.

Limitations

Our case–control studies demonstrate associations between modifiable risk factors and injuries but not causality. Some injury cost estimates are imprecise because of small numbers. Systematic reviews and meta-analyses were limited by the quality of the included studies, the small numbers of studies reporting outcomes and significant heterogeneity, partly explained by differences in interventions. Network meta-analysis (NMA) categorised interventions more finely, but some variation remained. Decision analyses are likely to underestimate cost-effectiveness for a number of reasons. IPB implementation varied between children’s centres. Greater implementation may have resulted in changes in more fire safety behaviours.

Conclusions

Our studies provide new evidence about the effectiveness of, as well as economic evaluation of, home safety interventions. Evidence-based resources for preventing thermal injuries, falls and scalds were developed. Providing such resources to children’s centres increases their injury prevention activity and some parental safety behaviours.

Future work

Further randomised controlled trials, meta-analyses and NMAs are needed to evaluate the effectiveness and cost-effectiveness of home safety interventions. Further work is required to measure NHS, family and societal costs and utility decrements for childhood home injuries and to evaluate complex multicomponent interventions such as home safety schemes using a single analytical model.

Trial registration

Current Controlled Trials ISRCTN65067450 and ClinicalTrials.gov NCT01452191.

Funding

The National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 14. See the NIHR Journals Library website for further project information.

Healthcare providers' knowledge, attitudes and counselling on injury prevention for preschool children in Croatia

Injuries are the leading cause of death for children and young adults in Croatia. Research has indicated that health care providers can be effective in reducing the risk for traumatic injury through anticipatory guidance, but successful guidance requires that providers have injury knowledge and informed safety attitudes. This is the first study in Croatia to identify health care provider's knowledge, attitudes, and practices regarding anticipatory guidance on injury prevention for children. A stratified, random sample of licensed Croatian healthcare providers was mailed a survey, with a response of rate of 39.5 %. Participants included pediatricians, family physicians, gynecologists, each with a focus on primary care, and community nurses. Participants filled out a 15-minute paper-and-pencil survey that tested their knowledge of injury risks and prevention strategies, assessed their safety-prone attitudes, and measured the extent to which they counselled their patients on injury prevention. Pediatricians had the highest knowledge of injury risks and intervention approaches, with an average correct score of six out of ten (significantly higher than all other provider types). Knowledge was highest regarding infant fall risk and lowest for safe sleep positions. Pediatricians and community nurses had the highest safety-prone attitudes. Safety prone attitudes were strongest for transportation safety and weakest for safe sleeping position for all providers. Community nurses reported the highest level of patient counselling, followed by pediatricians. Both factual education and support in translating knowledge into everyday practice are necessary for health care providers. Implementing anticipatory guidance for child safety is a promising approach in Croatia.

"You have to listen to me because I'm in charge": explicit instruction improves the supervision practices of older siblings

OBJECTIVES

Sibling supervision increases young children's risk of unintentional injury. Both noncompliance by the supervisee and insufficient supervision contribute to this risk. The current study examined whether explicitly instructing older siblings to supervise their younger siblings and prevent specific risky behaviors improves their supervision practices.

METHODS

Supervisees and older siblings were placed together in a playroom. One group of older siblings were given explicit instructions not to allow the supervisee to engage in specific risk behaviors, whereas a second group was not.

RESULTS

Informing older siblings that they were "in charge" resulted in a higher frequency of proactive supervision strategies, more forceful reactions to stop supervisee risk taking, and a trend toward improved watchfulness. Supervisees in the no instruction condition also engaged in more hazard interactions compared with those in the instruction condition.

CONCLUSIONS

Explicitly informing older children to supervise younger siblings may reduce younger children's risk of injury when siblings are supervising.

Older siblings as supervisors: does this influence young children's risk of unintentional injury?

Unintentional injury is a leading cause of death and hospitalization of young children. Many of these injuries occur in the home when children presumably are being supervised. This study focused on the under-explored issue of sibling supervision in the home, drawing on data collected from a sample of Canadian mothers. Mothers in this sample completed a structured telephone interview and mailed back questionnaires to provide information about the nature and extent of sibling supervision that occurs in the home, as well as the younger child's injury history. Results indicated that older siblings supervise younger ones about 11% of their mutual wake time, with children typically playing and parents usually doing other chores during this time. Time spent with siblings as supervisors was positively related to the supervisee's history of injuries suggesting that sibling supervision may elevate younger children's risk of injury. However, the behavior of the supervisee contributed to risk more so than that of the supervisor. Specifically, sibling supervisors were reported to utilize the same types of strategies as their mother and father in their efforts to supervise and persuade younger children to stop things that could lead to injury. However, poor compliance by the younger child when the older sibling was supervising predicted injury. Implications for childhood injury and directions for future research are discussed.