The accident gap

Childhood is full of near misses. No sooner are babies crawling than they are exposed to risks ranging from minor bumps and bruises to, in the worst cases, serious injury and even death. Child accident victims who escape with their lives may face years of treatment, disfigurement or disability. Parents and carers need to be constantly vigilant to keep kamikaze tots and adventurous young children out of the accident and emergency waiting room.

The good news is that vigilance combined with greater public awareness is paying off and childhood accidents have fallen steadily in recent years. In 1997 more than 2.5 million children were taken to hospital after an accident – by 2002 this had fallen to 2.01 million. However, the statistics are only half the story. Deaths from accidental injury have a steeper social class gradient than any disease says Katrina Phillips, chief executive the Child Accident Prevention Trust (Capt). Put simply, children from the poorest families are five times more likely than their better off counterparts to die from road accidents, be admitted to hospital and suffer the most severe injuries. When it comes to house fires poorer children are 15 times more likely die.

There is growing recognition of the link between poverty and accidents. A 2002 report by the cross-government accidental injury task force, highlighted the need to cut children’s accidents and their disproportionate affect on poorer social groups.

When it comes to prevention, finding out what works is vital. Last October the Health Development Agency published an evidence briefing on children and accident prevention. Among the gaps identified was the need for more work on how accident rates are affected by deprivation.

Sure Start projects are putting some of the theories around prevention into practice. Sure Start’s national targets include a 10 per cent reduction in pre-school children admitted to hospital with serious injuries by March 2006.

Scalding risk
According to the Sure Start Unit, local programmes and children’s centres are involved in a wide range of prevention and education activities. For example, Sure Start Whitton and Central Ipswich has set up a safety equipment scheme that distributes fireguards, gates, socket covers, and safety film for glass to the area’s families. At the moment there is no charge for the items but the parents’ forum is debating whether or not there should be a small charge or voluntary contribution.

The programme considered operating a safety equipment loan scheme but the administrative costs were prohibitive, says programme manager Jacqui Leith. “And the items would have to be checked by someone qualified to decide they were fit to be given out again,” she explains.

Burns and scalds are a major cause of injury among the under fives, accounting for 33,000 injuries in 1999. While the injuries themselves can happen in seconds, the treatment can take years of repeated skin graft operations as the child grows. One boy, now aged seven, fell into a bath of hot water aged 18 months, spent nine months in hospital and has undergone 37 operations on the 60 per cent burns he sustained.

Alarmingly, the number of scalding injuries has failed to drop, unlike most other home accidents which have fallen steadily, according to research by the Department of Trade and Industry. Now there is hope that a proposed change in the law will have a significant effect. In January the government ordered a review of building regulations that could result in a requirement that all newly built or converted private properties are fitted with a safety device to control the temperature of bath, shower and basin water.

The news was greeted unenthusiastically by some newspapers who called it further evidence of the nanny state. Joy Huston, of the Children’s Fire and Burns Trust, says the coverage missed the point. If introduced the move would not result in lukewarm baths, “baths would still feel hot but they wouldn’t scald”.

But most importantly, “even a little burn with very hot water is very rarely minor for older people and children. As well as ongoing treatment and the trauma, children miss so much school because they are in and out of hospital. One child was having reconstructive surgery into her teens. The human cost is enormous and so too is the cost to the NHS.”

Data loss
Although campaigners welcome the moves to reduce scalding there are concerns that other government policies will hinder accident prevention. Katrina Phillips of the Child Accident Prevention Trust is concerned about the DTI’s decision to stop collecting the crucial data – the home and leisure accident surveillance statistics – as a cost-cutting measure. These figures have informed researchers and helped policy-makers decide where to focus their efforts, says Phillips.

“We will still know how many children die because of the mortality statistics but we won’t know how many children are injured and what caused it,” she says. Professionals are also concerned that accident prevention expertise might not survive the latest health service restructuring intact. They also want to ensure that accident prevention is on primary care trust’s and children’s trusts agendas. For now, accident prevention professionals remain hopeful that the momentum gained through recent road safety and anti-scalding initiatives will not be lost and that injury figures will continue to fall.

Preventing accidents   

Accident prevention starts early at Marks Gate Sure Start in the London Borough of Barking and Dagenham. Parents who join the programme are welcomed with a pack containing a smoke alarm and the message is underlined at each developmental check where health visitors offer safety advice and provide other equipment such as thermometers, choke testers, cupboard locks and plug socket covers.  

“At events our health visitor puts up cartoon pictures with the safety message and give out information packs,” says development worker Jeannie Terry. “And we try to introduce the play safely theme at all our events.” Now the programme is preparing to evaluate its accident prevention work.  

“My gut feeling is that not all the parents are using the stuff we’re giving them,” says Terry. “I’ve been to houses where the smoke alarms have not been put up and although the video covers get used I think items like the door stops are less popular.” 

Marks Gate is considering moving to a more targeted approach. “Those families who need to install safety equipment don’t appear to be doing it without our support so we are considering assessing families’ needs, providing those who need it with the necessary safety equipment and ensuring it’s properly installed. If we prevent even one accident then it’s absolutely worth it.”

Alarming facts   

  • Accidental injury is the leading cause of death among children and young people – in 2002 some 320 children under 15 died in the UK as a result of injury or poisoning. 
  • Accidents put more children in hospital than any other cause – each year two million are taken to A&E departments. Around half of these accidents happen at home. 
  • House fires are the biggest single cause of accidental death to children in the home. 
  • In a single year in the UK, 50,000 children under the age of 14 are burned or scalded. 
  • Falls account for the largest number of non-fatal injuries in the home, followed by burns, scalds and poisoning.

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