Injury and Violence Prevention Program CA4, American Academy of Pediatrics

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Injury and Violence Prevention Program CA4,
American Academy of Pediatrics

• Keep Kids Safe
• Prevent Injuries

Injuries are the leading cause of death and
disability for children 0- 44 yrs
Raise safe, strong, resilient kids
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Learning ObjectivesPresentation for San
Francisco Department of Public Health Conference
5/29/09

• Discuss child development and risk of injury
• Identify at least 2 risk factors for injury
  including health disparities
• Intentional must be discussed with unintentional-
  most risk factors shared
• List 3 of the most common injuries of children
  0-14 years and one prevention strategy for each
• Know at least two resources for injury prevention
  
• Create strategies for integrating injury
  prevention into the work that you do

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Leading Causes of Injury Deaths by Age, CA
2007 (CA4, AAP Injury Violence Prevention
Program (D. Winn RN, MPH) (State of CA EPIC web
site data)
lt1 (n129) 1-4 (n195) 5-9 (n99) 10-14 (n150) 15-19 (n1089)
Suffocation 46 Drowning 53 MVT Occupant 23 Homicide 28 Homicide 385
Homicide 35 Pedestrian 37 (21MVT, 16NT) MVT Unspec 16 MVT Unspec 22 MVT Unspec 188
Drowning 10 Homicide 29 Pedestrian 12 (11MVT, 1 NT) MVT Occupant 20 MVT Occupant 122
MVT Occupant 7 MVT Unspec 23 Homicide 11 Pedestrian 14 (13 1) Suicide 122
MVT Unspec 4 MVT Occupant 15 Burn 9 Suicide 12 Poisoning 71
Burn 3 Fall 8 Drowning 8 Bicyclist 11 Pedestrian 40 (36 4)
Fall 3 Suffocation 8 Bicyclist 6 Drowning 9 Motorcyclist, Drowning 18
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Unintentional, Neglect, Intentional Shared Risk
Factors

• Injury is a Health Disparities Issue
• Poverty
• Poor environment physical and social
• Substandard housing
• Lower educational level
• Lower literacy
• Lack of social capital/support systems
• Gender, age and race/ethnicity
• Children with challenging behaviors (Autism,
  ADHD)

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Vision Keep Kids SafeHow do we promote injury
prevention?

• Focus on most serious and preventable
• Professional education
• Parent education culturally and linguistically
  appropriate
• Readiness to learn
• Aware of risk factors for both intentional and
  unintentional
• Need comprehensive approach with families
• Advocate for public health policies

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The Es of Injury Prevention Strategies

• Education
• Parents, Care Providers, Educators
• Public Policy Makers
• Environment and Product Modification
• Car seats Lap/Shoulder belt in school bus
• Bike helmets
• Enactment of Legislation and Public Policies
• Enforcement of Legislation
• Mandatory car seat and seat belt laws
• Graduated licensing law for teens and new drivers
• Ban cell phone/electronics use

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The Spectrum of Prevention
CA4, AAP Injury and Violence Prevention Program
strives to work at multiple levels to create a
cultural norm Car Safety Seats A Success Story
Larry Cohen, 1991 Cohen and Swift, 1999
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(No Transcript)
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Evolution of a Child Kids Are Not Mini-Adults
Wiggling, kicking, rolling over
Crawling
Walking, curiosity
Climbing
Running
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Leading specific causes of serious injury by
3-month age intervals. CA 1996-98 (Agran, Winn,
Anderson, Trent,Walton-Hayes, Pediatrics.
2001108-45
Other fall from ht Battering Fall-
furniture Non-airway FB Hot liquid Poisoning -
med Pedestrian
Rate
Age in 3 month intervals
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Birth to 2 monthsBabies Cry

• Risk Factor for Abusive Head Trauma
• Crying is normal
• Colic is a normal part of
• infant development

• Sometimes feeding, holding, changing, rocking
  and soothing may help
• Sometimes nothing we do can stop the baby from
  crying
• Make sure your baby is OK by having your
  pediatrician check her

CA4, AAP
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Birth to 2 monthsWhat should you do when the
baby doesnt stop crying
and you feel like you need a break for a few
minutes?

• It is OK to let your baby cry
• Place your baby on his back in the crib
• Do something to calm yourself
• Call a friend or relative
• Call your
• Period of Purple Crying
• (R. Barr, MD, PhD- National Center On Shaken Baby
  Syndrome)

CA4, AAP
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Period of Purple CryingRonald Barr
MDhttpwww.dontshake.org
P for Peak of CryingCrying peaks during the
second month, decreasing after that U
for UnexpectedCrying comes and goes
unexpectedly, for no apparent reason R
for Resists SoothingCrying continues despite all
soothing efforts by caregivers P for
Pain-like FaceInfants look like they are in
pain, even when they are not L for Long
LastingCrying can go on for 30-40 minutes, and
as much as 5 hours, and longer E for Evening
CryingCrying occurs more in the late afternoon
and evening.
Risk factor for abusive head trauma, family
dysfunction and possibly depression
CA4, AAP
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Birth to 2 months How do we keep kids safe?

• Suffocation is a leading cause of death for
  infants
• Back to Sleep
• Use a firm mattress
• no soft things in bed
• No co-sleeping
• No smoking

CA4, AAP
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6 to 12 Months

• 8 to 10 Months
• Crawls
• Picks up very
• small objects
• (pincer grasp) and puts in mouth

• 6 to 8 Months
• Rolls over
• Sits up
• Grabs things
• Puts things in
• mouth

• 10 to 12 Months
• Stands
• Walks
• Finds hidden objects

CA4, AAP
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6-12 Months How do we keep kids safe?

• Safe Home
• Barriers and Locks
• Get on floor- check for small objects
• Medicines and cleaning agents high, locked, and
  out of reach

CA4, AAP
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1 to 3 Years

• 12 to 18 Months
• Walks and climbs
• Pulls and carries things
• Still puts things into mouth and can choke
• Imitates

• 18 to 24 Months
• Runs and climbs
• Finds hidden objects
• Turns knobs and containers
• Opens doors and drawers

• 2 to 3 Years
• Jumps and climbs
• Opens containers
• Unscrews lids and caps
• Makes things work

CA4, AAP
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Cause of Burn InjuriesChildren 0-4 yr, 2004-2006
(complied for CA, AAP by D. Winn from EPIC data
base)
Toddlers at highest risk
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Temperature and Duration

• 70o C (160oF) instant full-thickness
• 65o C (149oF) instant partial-thickness
• 60o C (140o F) 2.0 seconds
• 55o C (131o F) 7.5 seconds
• 50o C (122o F) 1.5 minutes
• (M. Cinat, MD, Director Burn Unit (UCIMC)

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(No Transcript)
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Furniture
Toddlers

• Able to open drawers, climb
• Curious about environment
• Poor coordination balance
• Poor danger recognition

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Keep Kids Safe How we started

• 1998 CA Tobacco tax initiative School
  Readiness
• First 5 and County Commissions. The Children and
  Families Commission of Orange County
• If we want children ready for school and not in
  need of special education because they were
  injured
• We must address injury the leading cause of
  death and disability for children.
• Funded the CA4, AAP Injury and Violence
  Prevention Program

Raise safe, strong, resilient kids
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Injury Prevention Program

• Capacity Building
• Integrate injury prevention into health,
  education and social services for kids
• Link the health of the families to the public
  health of the community
• Bridge program silos
• Create innovative strategies

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California Chapter 4, American Academy of
Pediatrics
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IVPP Resources www.ockeepkidssafe.org
Newer Tools Connected Kids Parent Education
Curriculum
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New Tool Parent Education Curriculum
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Connected KidsAAP Violence Prevention Program
Infancy Early Childhood 2 days 4 years
Middle Childhood 5 10 years
Adolescence 11 21 years
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Community Connections (from Connected Kids-
American Academy of Pediatrics)

• Social capital
• Connections with people
• Connections with community
• Connect families to community resources
• Identify local community connections

Child-Centered
Parent- Centered
Physical Safety
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Bullying Its Not OK
You are on a home visit with a family with a
newborn. The mother lets you know that her older
child will not go to school. He cries each
morning and claims he has a stomachache. What are
you gong to do?
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Summary

• 1. Injury leading cause of death and disability
• 2. Work with pediatricians, public health
  professionals, social workers, early child
  educators, child care providers
• 3. Address intentional with unintentional
• 4. Most preventable
• 5. Consistent messages
• 6. Relate to development
• 7. Give tools
• 8. Multiple doses

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How do we work with families to prevent injury

• Teachable moments
• Simple messages
• Readiness to learn
• Can the family do what is needed?
• Is it individual family issue? Do they have
  resources?
• Is it code or regulatory issue?

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Resources

• http//www.ockeepkidssafe.org
• http//www.cippp.org/
• www.sfdph.org/dph/comupg/oprograms/CHPP/Injury/
• http//.www.aap.org
• http//www.cdc.gov/ncipc
• http//www.dontshake.com National Center on
  Shaken Baby Syndrome
• httpwww.nhtsa.gov