Unintentional injuries among children less than 14 years of age are very common. One in eight children admitted to hospital has been injured. One in three deaths among children is due to injury. Almost half of all deaths among children aged one to four years are due to injury.
Although motor vehicle crashes and other traffic-related injuries are the most common cause of death and long-term disability among Canadian children, unintentional injuries also occur in the home.
The commonest causes of injury in the home to children less than five years of age are falls from heights, burns and scalds, and poisoning.
A prospective, multi-centre, Canadian study recently published in the journal of the Canadian Medical Association compares the hazards in the homes of young children with unintentional injuries to those without injury. Five Canadian children's hospitals across Canada participated in this two-year study.
How did they study unintentional injury?
Children aged less than eight years of age who came to the emergency department (ED) because of a fall, scald, burn, poisoning, ingestion, or choking episode at home were identified by daily screening of the ED logs. These children constituted the cases of the case-control pair design of the study. Another child who presented to the same ED with a non-injury related diagnosis was selected as a control on the basis of age and gender. Three hundred and forty six case-control pairs participated in the study.
Each child's home was visited, usually within one month of the initial visit to the ED. The home visitor, who did not know to which group the child belonged, collected demographic data and inspected the home for specific hazards known to be associated with injuries to children.
The injury hazard for each child's home was calculated by dividing the actual number of hazards in the home by the total number of potential hazards. The difference in proportions of hazards in the home between the cases and the matched controls were assessed.
The relationship between specific hazards and the odds of being a case or a control was also analyzed.
What hazards were found in the home?
Hazards found in the homes of young children included:
- baby walkers in 21% of homes with infants aged less than one year
- no functioning smoke alarm in 17% of homes
- no fire extinguisher in 51% of homes
In an initial analysis, there was no difference in the number of hazards in the homes of young children with unintentional injury when compared to the homes of young children without injury.
However, after adjusting for the number of children in the family, the mother's education, and mother's employment status the homes of young children with unintentional injury differed from the homes of young children without injury on five hazards:
- the presence of a baby walker (risk of injury increased 9-fold)
- the presence of choking hazards within a child's reach (risk of injury increased 2-fold)
- no child-resistant lids in the bathroom (risk of injury increased 1.6-fold)
- no smoke alarm (risk of injury increased 3.2-fold)
- no functioning smoke alarm (risk of injury increased 1.7-fold)
What should be done to protect young children from unintentional injury within the home?
Although there is a widely held view that about 90% of childhood injuries are preventable, it is not easy to design, test, and implement injury prevention interventions.
Parents of young children can make changes in the family home to reduce the risk of unintentional injury from falls from heights, burns and scalds, and poisoning.
Reduce the risk of unintentional injury caused by falls from heights by not using a baby walker and also making sure that:
- there are safety straps on the diaper change table
- there are gates at the top of all stairs in the home
- there is a mechanism to prevent a young child opening the basement door
- there is a mechanism to prevent all bedroom and living room windows opening more than 15 cm
Reduce the risk of unintentional injury caused by burns and scalds by making sure that:
- the hot water tap temperature is less than 54 o C
- cords do not dangle from the kettle or other appliances in the kitchen
- there is a stove guard to prevent a young child from grabbing pots
- matchers and lighters are placed out of a young child's reach.
- there is a functioning smoke detector in the home
- there is a fire extinguisher in the home
Reduce the risk of unintentional injury caused by poisonings and ingestions by making sure that:
- all choking hazards in the kitchen, living room, bedroom, or garage cannot be reached by a young child
- all bathroom beauty supplies and medications cannot be reached by a young child
- there are child-resistant lids on all bathroom bottles
- there are child-resistant lids on all medications in the home including the medications of visitors, especially grandparents
- all household cleaning supplies cannot be reached by the young child
- there are child-resistant lids on all household cleaning supplies
- there is a functioning carbon monoxide alarm in the home