1. Injury prevention in the home environment for children and young people Effective interventions Presented by Louise Woodfine, National Public Health Service for Wales Erlas Centre, Wrexham 26.06.2009

2. Preventing childhood injuries A combination of factors are required to prevent children sustaining injuries in the home. Environment Improvement in planning and design results in safer homes and leisure areas. Adaptations such as fireguards and stair-gates help to make the home a safer environment. Education This involves increasing the awareness of the risk of accidents in a variety of settings and providing information on ways of minimising these risks. Empowerment Local consultation and community involvement can generate a strong sense of commitment and ownership. Accident prevention initiatives, which have been influenced by the community, are more likely to reflect local need and therefore encourage greater commitment. Enforcement There is legislation which relates to child safety. These regulations ensure that the products we buy meet a reasonable level of safety performance and that new dwellings meet an acceptable level of safety.

3. Interventions in the Home Environment General Product DesignInjury ReductionSome Evidence Safety DevicesInjury ReductionSome Evidence Burns and Scalds Smoke detector promotion programmesBehaviour Change/Injury ReductionGood Evidence Tap Water Temperature ReductionBehaviour Change/Injury ReductionSome Evidence Parent and Child EducationBehaviour ChangeSome Evidence Poisoning Child Resistant PackagingInjury ReductionGood Evidence Parent EducationBehaviour ChangeSome Evidence Falls Prevention Window Bars (Education and environmental modification and Legislation) Behaviour Change/Injury ReductionReasonable Evidence Parent EducationBehaviour ChangeReasonable Evidence General Campaigns Parent Education on Hazard ReductionBehaviour ChangeReasonable Evidence

4. Evidence suggests that the implementation of the following programmes would help to prevent injury and deaths of children and young people in Wales. Following identification of families in need, through contact with services such as: Health Visitor Midwife Communities First Team Pre School provision Flying Start Community Nurses Social work teams Vulnerable families should receive the following safety equipment: Smoke alarms (where it does not currently happen) Thermostatic mixing value to prevent bath scalds Fireguards Appropriate safety gates Window restrictors 4 point safety harness for highchairs Cupboard/drawer restrictors

5. Royal Society for the Prevention of Accidents The Royal Society for the Prevention of Accidents (RoSPA) website provides a summary of guidance and advice for preventing childhood injuries in the home. www.rospa.co.uk/homesafety/advice/child/accidents.htm#injuries

6. Safety and Child Development

7. Safety and child development Children differ in their rate of development but the information below is a guide to development stages. AgeDevelopmentAdvice 0-6 monthsWriggle and Kick, grasp, suck, roll overDo not leave on a raised surface 6-12 monthsStand, Sit, Crawl, put things in mouth.Keep small objects and dangerous substances out of reach 1-2 yearsMove about, reach things high up, find hidden objects, walk and climb. Never leave alone, place hot drinks out of reach, use a fireguard and stair- gates. 2-3 yearsBe adventurous, climb higher, pull and twist things, watch and copy. Place matches and lighters out of reach. Be a good role model. Be watchful. 3-4 yearsUse grown-up things, be helpful, understand instructions, be adventurous, explore, walk downstairs alone Continue to be a good role model, keep being watchful but start safety training. 4-5 yearsPlay exciting games, can be independent, ride a bike, enjoy stories They can actually plan to do things and carry it out. Rules are very important to them, as long as everybody keeps the same ones. They enjoy learning. Continue safety training. Source: RoSPA

8. Causes of injuries Falls Falls are the most common causes of accidents in the home; they account for 44% of all children’s accidents. Most falls involve tripping over on the same level. However, the most serious consequences result from falls between two levels. Prevention Fit a safety gate at the top and bottom of stairs Never leave tripping hazards on the stairs. Stairs should be carefully maintained – damaged or worn carpet should be repaired or removed. Make sure balustrades are strong and do not have any footholds for climbing. Stairs should always be well lit. Fit child resistant window locks but make sure you can get out easily in an emergency. Do not put anything under the window that can be climbed on. Furniture and tall kitchen appliances, at risk from being pulled over, should be secured to the wall.

9. Fires Domestic fires pose one of the greatest risks to children. Children playing with matches and lighters frequently start house fires – 46% of all fatal accidents to children are in house fires. Prevention Keep matches and lighters out of sight and reach of children. Always use a fireguard and secure it to the wall. Extinguish and dispose of cigarettes properly. Have an escape route planned, and practise it, in case of fire. Fit a smoke alarm and check it regularly. The incidence of burns and scalds in young children is much higher than that of older children and adults.

10. Scalds & burns Many of the children who attend A&E with a burn or scald are referred on for further hospital treatment. Hot drinks cause most scalds to children under the age of 5. A child’s skin is much more sensitive than an an adult’s and a hot drink can still scald a child 15 minutes after being made. Young children are also vulnerable to sunburn. Hot bath water is responsible for the highest number of fatal and severe scalding injuries among children. Children can also suffer burns after contact with open fires, a cooker, irons, curling tongs and hair straighteners, cigarettes, matches, cigarette lighters and many other hot surfaces. Prevention Never hold a hot drink and a child at the same time. Never leave young children alone in the bathroom. Put hot drinks out of reach and away from the edges of tables and worktops. Encourage the use of a coiled flex or a cordless kettle. Keep small children out of the kitchen whenever possible. Run the domestic hot water system at 46C or fit a thermostatic mixing valve to taps. When running a bath turn the cold water on first and always test the water temperature with your elbow before letting a child get into the bath or shower. Always use rear hotplates and turn the panhandles away from the front of the cooker. Keep hot irons, curling tongs and hair straighteners out of reach even when cooling down.

11. Glass related accidents The increase use of glass in the home has led to more glass related accidents. Every year children die following an accident with architectural glass. Many children are also injured when glass tumblers and bottles break. Poisoning Most poisoning accidents involve medicine, household products and cosmetics. Prevention Use safety glass in all replacement windows and doors. Make existing glass safer by applying shatter resistant film. Always clear up broken glass quickly and dispose of it safely. Buy a greenhouse or cold frame with special safety glazing features or isolate with fencing. Prevention Keep medicines and chemicals out of sight and reach of children, preferably in a locked cupboard. Buy products in child resistant containers when possible. Always store chemicals in their original containers. Dispose of unwanted medicines and chemicals safely. Avoid buying plants with poisonous leave or berries or those that irritate the skin.

12. Suffocating and choking Children can swallow, inhale or choke on items such as small toys, peanuts and marbles. Drowning Children can drown in less than 3cm of water. Prevention Choose toys appropriate to the age of the child. Ensure that small objects such as marbles and peanuts and small toys are kept out of reach of children under 3 years. Encourage older children to keep their toys away from their younger playmates. Pull chords on curtains and blinds should be kept short and kept out of reach. Keep animals, especially cats, out of the bedroom and use a net on the pram. Prevention Never leave children or babies in the bath unsupervised, even for a moment. Never leave uncovered bowls or buckets of water around the home. Paddling pools should be emptied and stored away when not in use. Garden ponds should be filled in while children are small or securely fenced off.

13. Good Practice for general child home safety Good Practice for fall prevention in children Home safety counselling (addressing issues such as using window bars, stair gates, other home safety equipment and not using baby walkers, bath seats and other injury hazard producing equipment) Education Home based social support, such as home visiting programmes for new mothersEducation Individual-led education/counselling on unintentional childhood injury prevention in the clinical setting Education Window safety mechanisms to prevent children from opening windows, such as bars and position locking devices Engineering Stair gates at the top of stairs in households with small childrenEnforcement Surfacing materials such as sand or wood chips to a depth of 23-31cm under playground equipment. Optimal equipment height to reduce risk of head injury is 1.5m Enforcement Legislation banning baby walkers OR requiring modification to remove the mobility issue Enforcement Enforcement of standards requiring safe depth of specified types of surfacing materials under playground equipment and regular maintenance of those materials Enforcement Education programmes encouraging use of fall prevention safety devices such as window safety mechanisms to prevent children from opening windows down stairs Education

14. Good Practice for burn and scald prevention in children Product modification, specifically child resistant cigarette lighters and self- extinguishing cigarettes Engineering Legislation requiring a safe pre-set temperature for all water heatersEnforcement Legislation requiring installation of smoke detectors in all new and existing housing, combined with multi-factorial community campaigns and reduced price coupons Enforcement Legislation regulating flammability of sleepwearEnforcement Smoke detector give away programmes targeting high risk neighbourhoods and multi faceted community campaigns with specific objective of installation of working smoke detectors Education Education/Advocacy campaigns around fireworks are useful as supplemental efforts and can be used to build support for legislation Education Fire safety skills training to increase knowledge and behaviour of both children and parents Education

15. Good practice for poisoning prevention in children Good practice for choking/strangulation prevention in children Secure storage for poisons.Engineering Legislation for child resistant packagingEnforcement Poison control centres with education of public regarding the use of centreEducation Product modification of existing entrapment hazards such as crib/cot design and enforcement through legislation Enforcement Product banning of unsafe products through legislationEnforcement Legislation requiring product warning labels to include an explanation of the specific hazard Enforcement

16. Acknowledgements Claire Jones, Health Information Analysis Team, NPHS Nathan Lester, Health Information Analysis Team, NPHS For further information contact: louise.woodfine@nphs.wales.nhs.uk

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