Creating a safer Europe for children

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Creating a safer Europe for children

• AJ Nicholson Bristol Conference
• Sept 2007

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Challenging old attitudes

• Injuries are an inevitable part of growing up
• Parental supervision plays a key role
• Preventive measures are unproven
• Changing behaviour is impossible
• You cannot legislate for what happens at home
• No solution to road deaths epidemic

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The IMPACT of child injury beyond deaths
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Injuries the disease model

• Explore epidemiology
• Identify risk factors
• Establish countermeasures
• Assess effectiveness of countermeasures

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Studies in Ireland

• Home injury patterns (Archiv Dis Child 2006 91
  A88)
• Lay safety workers in areas of high deprivation
  (IMJ 2006 in print)
• Use of carseats on discharge from a maternity
  hospital (Archiv Dis Child 200489A 40)
• Road-related injuries in Ireland (Archiv Dis
  Child 2003 88A24, IMJ 2006 99119-21)

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Data Collection
Pedestrian Injury
Fatalities
Police Assistance
Injury Severity
Serious
Minor
CT68 form
Light Conditions
Road Conditions
NRA
STATA JMP
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Childhood Road Injuries Ireland (96-00)n 6,045
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Pedestrian injuries

• Typically, accidents in 1-2 year olds are back
  overs and 3-9 year olds are dart outs.
• High traffic volume, lower income and younger age
  are all associated with pedestrian injuries.
• www.cdc.gov/ncipc/pedestrian.

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Overview re Pedestrian Injuries

• Childhood pedestrian injuries occur largely in
  urban areas during the evening time.
• Boys are more commonly involved than girls.
• Children in the most deprived wards have a
  fivefold increase in pedestrian injury.

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Bicycle Injuries

• Helmets lead to reductions in head and brain
  injuries of 63 - 88
• Motorcycle helmets can reduce head injuries in
  motorcyclists by 72
• Mandatory helmet wearing legislation has lead to
  a 25 reduction in head injuries in cyclists

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Protecting car passengers

• Age -appropriate car restraints are effective
• Vehicle design so that compartment maintains its
  integrity in a crash
• Carseat fitting stations
• EU standards re carseats

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Carseats at different ages
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Do not forget

• 6 12 year olds
• Booster cushion
• Frequently non-compliant

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Seatbelt Wearing by Agen 3,719
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Carseat study (97-05)

• In initial cohort, car seat use was associated
  with higher social class(plt0.01) and breast
  feeding (plt0.05)
• Subsequent cohorts car seat usage in all social
  classes
• Persistent non-compliant group asylum
  seekers/unemployed/leaving in a taxi

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Car seat usage over study period
plt0.001
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Compliance with road safety rules

• Enforcement levels need to be high and maintained
  
• Apprehension with swift administration of
  penalties
• Speed cameras -gt automated fines
• Enforce BAC limits -gt random (1 in 10 drivers/yr)
• Public education without enforcement has
  negligible effect

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Enforcement is the key !
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Preventing home injuries

• Burns/scalds smoke detectors , tap water temp.
  regulation , spill-resistant mugs
• Poisoning safe packaging of drugs and household
  poisons
• Falls window guards
• House fires steep social gradient

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Background

• Targetting high risk households and combining
  home visits with free safety devices greater
  impact
• Educational programmes alone are ineffective
• (Lyons RA et al Cochrane Library 2007 .
  Kendrick D et al Cochrane Library 2007)

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Home injury patterns in lt 5yos
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Lay safety worker study

• Appoint and train safety workers
• visit members every 2-3 months (12 visits)
• structure visit to focus on 3 areas
• Child development
• A safety topic
• First aid
• Support the programme with low cost safety
  equipment

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AE ATTENDANCES
p lt 0.001 p lt 0.005 p lt 0.01 p
lt 0.05 p 0.05
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Future Best Practice

• Data is required A/E based and electronic
• Confidential inquiry into all childhood injury
  deaths
• Set targets specific counter-measures
• Work together
• Learn from countries such as Australia and Sweden
• Start with road-related injuries

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The end result will be a safer Europe not only
for children, but families, communities and
society.