1. Unintentional injuries among children under five years

2. Hospital Episode Statistics (HES) and mortality statistics for the most recent five years Other datasets may be useful to allow in-depth study of the topic, for example −Trauma Audit and Research Network (TARN) −UK National Burn Injury Database −Information from child death overview panels (CDOPs) −Coroners’ data These other datasets may comprise small sample sizes, but contain very detailed information on the most serious injuries They may provide narrow topic coverage 2Unintentional injuries among children under five Datasets

3. England 2008/09–2012/13 (five years) Emergency hospital admissions only Data for the under 25s but main focus is on the under fives ICD-10 codes W00-X59 −Non-transport accidents −Unintentional injuries Not just home accidents 3Unintentional injuries among children under five Admissions to hospital

4. Location codes incomplete Not just home accidents May need more detail to allow most effective prevention programmes to be identified Millions of A&E attendances annually −not life-threatening but numerous and costly −potentially distressing and disruptive for the child and family 4Unintentional injuries among children under five Some data issues

5. Location Home32% Residential institution0% School8% Sports7% Street / highway3% Trade / service area (shops, etc)2% Industrial / construction1% Farm0% Other7% Unspecified40% Unintentional injuries among children under five Distribution of emergency hospital admissions for unintentional injuries (ICD-10 W codes only) among under 25s, by location, 2008/09–2012/13 Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. 5 Unintentional injuries among children under five

6. Numbers of home and leisure A&E attendances in the UK, by age (HASS and LASS national estimates), 2002 Unintentional injuries among children under five6

7. Numbers of emergency hospital admissions for unintentional injuries, by age group and year Unintentional injuries among children under five Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. 7 Unintentional injuries among children under five

8. Emergency hospital admission rates by deprivation quintile for unintentional injuries among under fives, with 95% confidence intervals, 2012/13 Unintentional injuries among children under five Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. 8 Unintentional injuries among children under five

9. Numbers of emergency hospital admissions for unintentional injuries, by age group, 2012/13 Unintentional injuries among children under five 0-45-910-1415-1920-240-24 Falls18,28611,9809,6916,0656,77652,798 Exposure to inanimate mechanical forces8,0284,0513,4404,2975,39325,209 Exposure to animate mechanical forces1,3261,5051,7721,9312,2008,734 Accidental drowning and submersion10533161310177 Other accidental threats to breathing41372596796707 Exposure to electric current, etc3314202660153 Exposure to smoke, fire and flames106796187111444 Contact with heat and hot substances2,2152911741272013,008 Contact with venomous animals & plants252112103199 Exposure to forces of nature317182725108 Accidental poisoning5,1055136231,8642,23310,338 Overexertion, travel and privation1431834495036161,894 Other and unspecified factors3,3071,0689781,1481,4987,999 Total39,12319,81717,31316,16519,250111,668 Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. 9 Unintentional injuries among children under five

10. Emergency hospital admission rates for unintentional injuries among under fives, by sex and year Unintentional injuries among children under five Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. 10 Unintentional injuries among children under five

11. 0-45-910-1415-1920-240-24 Falls18,28611,9809,6916,0656,77652,798 Exposure to inanimate mechanical forces8,0284,0513,4404,2975,39325,209 Exposure to animate mechanical forces1,3261,5051,7721,9312,2008,734 Accidental drowning and submersion10533161310177 Other accidental threats to breathing41372596796707 Exposure to electric current, etc3314202660153 Exposure to smoke, fire and flames106796187111444 Contact with heat and hot substances2,2152911741272013,008 Contact with venomous animals & plants252112103199 Exposure to forces of nature317182725108 Accidental poisoning5,1055136231,8642,23310,338 Overexertion, travel and privation1431834495036161,894 Other and unspecified factors3,3071,0689781,1481,4987,999 Total39,12319,81717,31316,16519,250111,668 Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. Unintentional injuries among children under five Numbers of emergency hospital admissions for unintentional injuries by age group, 2012/13 11 Unintentional injuries among children under five

12. Emergency hospital admission rates due to unintentional injuries among under fives, by year, with 95% confidence intervals Unintentional injuries among children under five Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. 12 Unintentional injuries among children under five

13. Major causes of emergency hospital admission for unintentional injuries among under fives, 2008/09–2012/13 Unintentional injuries among children under five Falls93,315 Impacts, entrapments, lacerations40,558 Accidental poisoning23,014 Thermal injuries11,115 Struck or bumped into by a person, and dog bites6,553 Suffocation and strangulation2,024 These six causes represent almost 90% of emergency admissions in this age group. Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. 13 Unintentional injuries among children under five

14. Numbers of emergency hospital admissions for fall injuries among under fives, 2008/09–2012/13 Unintentional injuries among children under five W10Fall on and from stairs and steps12,140 W01Fall on same level from slipping, tripping and stumbling11,904 W06Fall involving bed9,468 W09Fall involving playground equipment9,121 W07Fall involving chair8,298 W04Fall while being carried or supported by other persons7,445 W18Other fall on same level7,157 W08Fall involving other furniture6,647 W17Other fall from one level to another6,312 W13Fall from, out of or through building or structure1,901 W03 Other fall on same level due to collision with, or pushing by, another person 1,141 W19Unspecified fall10,469 Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. 14 Unintentional injuries among children under five

15. Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. Emergency hospital admission rates for fall injuries among under fives, by year, with 95% confidence intervals 15 Unintentional injuries among children under five

16. Emergency hospital admission rates for certain falls, by age, with 95% confidence intervals, 2008/09–2012/13 16 Unintentional injuries among children under five

17. Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. Emergency hospital admission rates for furniture falls by age, with 95% confidence intervals, 2008/09–2012/13 17 Unintentional injuries among children under five

18. Numbers of emergency hospital admissions for impacts, entrapments and lacerations among under fives, 2008/09–2012/13 Unintentional injuries among children under five W22Striking against or struck by other objects11,400 W23 Caught, crushed, jammed or pinched in or between objects 10,930 W44 Foreign body entering into or through eye or natural orifice 10,429 W20Struck by thrown, projected or falling object2,463 W25Contact with sharp glass1,687 W45Foreign body or object entering through skin1,443 Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. 18 Unintentional injuries among children under five

19. Numbers of emergency hospital admissions for accidental poisoning among under fives, 2008/09–2012/13 Unintentional injuries among children under five X40 Accidental poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics 7,090 X44 Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances 6,391 X49 Accidental poisoning by and exposure to other and unspecified chemicals and noxious substances 3,979 X41 Accidental poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified 2,114 X46 Accidental poisoning by and exposure to organic solvents and halogenated hydrocarbons and their vapours 1,185 Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. 19 Unintentional injuries among children under five

20. Emergency hospital admissions for accidental poisonings among under fives, 2008/09–2012/13 Unintentional injuries among children under five Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. 20 Unintentional injuries among children under five

21. Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. Emergency hospital admission rates for poisonings among under fives, by type of poison and year, with 95% confidence intervals 21 Unintentional injuries among children under five

22. Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. Emergency hospital admission rates for accidental poisonings by age, with 95% confidence intervals, 2008/09–2012/13 22 Unintentional injuries among children under five

23. Numbers of emergency hospital admissions for unintentional thermal injuries among under fives, 2008/09– 2012/13 Unintentional injuries among children under five X10Contact with hot drinks, food, fats and cooking oils4,174 X15Contact with hot household appliances2,122 X12 Contact with other hot fluids (incl. water heated on stove) 2,104 X11Contact with hot tap-water1,110 X16 Contact with hot heating appliances, radiators and pipes 984 Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. 23 Unintentional injuries among children under five

24. Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. Emergency hospital admission rates for unintentional thermal injuries among under fives, by year, with 95% confidence intervals 24 Unintentional injuries among children under five

25. Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. Emergency hospital admission rates for unintentional scalds among under fives, by year, with 95% confidence intervals 25 Unintentional injuries among children under five

26. Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. Emergency hospital admission rates for unintentional contact burns among under fives, by year, with 95% confidence intervals 26 Unintentional injuries among children under five

27. Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. Emergency hospital admission rates for unintentional scalds by age, with 95% confidence intervals, 2008/09– 2012/13 27 Unintentional injuries among children under five

28. Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. Emergency hospital admission rates for unintentional appliance burns by age, with 95% confidence intervals, 2008/09–2012/13 28 Unintentional injuries among children under five

29. Numbers of emergency hospital admissions from exposure to animate mechanical forces among under fives, 2008/09– 2012/13 Unintentional injuries among children under five W54Bitten or struck by dog2,427 W50 Hit, struck, kicked, twisted, bitten or scratched by another person 1,408 W51Striking against or bumped into by another person1,392 Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. 29 Unintentional injuries among children under five

30. Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. Emergency hospital admission rates for dog bites among under fives, by year, with 95% confidence intervals 30 Unintentional injuries among children under five

31. Numbers of emergency hospital admissions for other accidental threats to breathing among under fives, 2008/09–2012/13 Unintentional injuries among children under five W79 Inhalation and ingestion of food causing obstruction of respiratory tract 972 W80 Inhalation and ingestion of other objects causing obstruction of respiratory tract 439 W78Inhalation of gastric contents407 Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. 31 Unintentional injuries among children under five

32. Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. Emergency hospital admission rates for inhalations and ingestions by age, with 95% confidence intervals, 2008/09– 2012/13 32 Unintentional injuries among children under five

33. Proportions of emergency hospital stays for specific causes that were over three days among under fives, 2008/09– 2012/13 Unintentional injuries among children under five Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. Other accidental threats to breathing14.2% Exposure to smoke, fire and flames12.0% Contact with heat and hot substances11.8% Accidental drowning and submersion9.0% Falls3.8% Accidental poisoning2.1% Impacts, entrapments, lacerations1.7% All causes4.5% 33 Unintentional injuries among children under five

34. Source: Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. Variations in lengths of emergency hospital stay among under fives, 2008/09–2012/13 Under 2 daysOver 3 days 2008/0987.5%4.9% 2009/1087.1%4.8% 2010/1188.0%4.3% 2011/1288.2%4.2% 2012/1388.3%4.4% 34 Unintentional injuries among children under five

35. 35Unintentional injuries among children under five Social inequalities gradient for the under fives Drop in overall emergency admission rates in 2012/13 Falls (93,000) −falls on stairs and steps (one year olds) −drops (under ones) −furniture falls (decrease with age) −drop in falls admissions in 2012/13 but reason not clear Bumps, crushing and entrapments (40,500), small objects Overview of emergency hospital admissions for the under fives

36. 36Unintentional injuries among children under five Poisonings: medicines (16,000). Increasing annual trend. Short lengths of stay. Thermal injuries (11,000): scalds and appliance burns (one year olds). No clear annual trend. Long lengths of stay. Dog bites (2,400): after age of one. The annual trend is flat. Suffocations (2,000): vomit (under ones) and food (both under ones and older). Long lengths of stay. Overview of emergency hospital admissions for the under fives

37. 37Unintentional injuries among children under five Mortality statistics from the Office for National Statistics England 2008-2012 inclusive – five years ICD-10 codes W00-X59 - Non-transport accidents - Unintentional injuries Not just home accidents Deaths

38. Deaths by age group, 2008–2012 Unintentional injuries among children under five 0-45-910-1415-1920-24Total Falls242145381174 Exposure to inanimate mechanical forces1856133678 Exposure to animate mechanical forces3023715 Accidental drowning and submersion65201765 232 Other accidental threats to breathing138185768123404 Exposure to electric current, radiation, etc202122238 Exposure to smoke, fire and flames2320572681 Contact with heat and hot substances310004 Exposure to forces of nature0016613 Accidental poisoning by and exposure to noxious substances10415156461646 Accidental exposure to other and unspecified factors2582 49109 311781214088761,794 Source: Office for National Statistics. Crown copyright reserved. 38 Unintentional injuries among children under five

39. Deaths among under fives, 2008–2012 Unintentional injuries among children under five Other accidental threats to breathing138 Accidental drowning and submersion65 Falls24 Exposure to smoke, fire and flames23 Exposure to inanimate mechanical forces18 Accidental poisoning by and exposure to noxious substances10 Exposure to animate mechanical forces3 Contact with heat and hot substances3 Exposure to electric current, etc2 Contact with venomous animals and plants0 Exposure to forces of nature0 Overexertion, travel and privation0 Accidental exposure to other and unspecified factors25 Source: Office for National Statistics. Crown copyright reserved. 39 Unintentional injuries among children under five

40. Distribution of deaths among under fives by sex, 2008–2012 Unintentional injuries among children under five Source: Office for National Statistics. Crown copyright reserved. 40 Unintentional injuries among children under five

41. Numbers of deaths due to other accidental threats to breathing among under fives, 2008–2012 Unintentional injuries among children under five W75Accidental suffocation and strangulation in bed37 W76Other accidental hanging and strangulation28 W79 Inhalation and ingestion of food causing obstruction of respiratory tract 19 W78Inhalation of gastric contents16 W80 Inhalation and ingestion of other objects causing obstruction of respiratory tract 7 W83Other specified threats to breathing6 W84Unspecified threat to breathing25 Total138 Source: Office for National Statistics. Crown copyright reserved. 41 Unintentional injuries among children under five

42. Numbers of deaths due to accidental drowning and submersion among under fives, 2008–2012 Unintentional injuries among children under five W65Drowning and submersion while in bath-tub18 W67Drowning and submersion while in swimming-pool6 W69Drowning and submersion while in natural water2 W70Drowning and submersion following fall into natural water2 W68Drowning and submersion following fall into swimming-pool1 W66Drowning and submersion following fall into bath-tub0 W74Unspecified drowning and submersion22 W73Other specified drowning and submersion14 Total65 Source: Office for National Statistics. Crown copyright reserved. 42 Unintentional injuries among children under five

43. Numbers of deaths due to falls among under fives, 2008–2012 Unintentional injuries among children under five W04Fall while being carried or supported by other persons5 W13Fall from out of or through building or structure5 W07Fall involving chair3 W06Fall involving bed2 W08Fall involving other furniture2 W10Fall on and from stairs and steps2 W18Other fall on same level1 W09Fall involving playground equipment0 W19Unspecified fall4 Total24 Source: Office for National Statistics. Crown copyright reserved. 43 Unintentional injuries among children under five

44. Numbers of deaths due to exposure to smoke, fire and flames among under fives, 2008–2012 Unintentional injuries among children under five X00Exposure to uncontrolled fire in building or structure18 X06Exposure to ignition or melting of other clothing and apparel3 X08Exposure to other specified smoke1 X09Exposure to unspecified smoke1 Total23 Source: Office for National Statistics. Crown copyright reserved. 44 Unintentional injuries among children under five

45. Numbers of deaths due to exposure to inanimate mechanical forces among under fives, 2008–2012 Unintentional injuries among children under five W20Struck by thrown projected or falling object10 W22Striking against or struck by other objects3 W23Caught crushed jammed or pinched in or between objects1 W24 Contact with lifting and transmission devices, not elsewhere classified 1 W29Contact with other powered hand tools and household machinery1 W31Contact with other and unspecified machinery1 W44Foreign body entering into or through eye or natural orifice1 Total18 Source: Office for National Statistics. Crown copyright reserved. 45 Unintentional injuries among children under five

46. Numbers of deaths due to accidental poisoning, among under fives, 2008–2012 Unintentional injuries among children under five X49 Accidental poisoning by and exposure to other and unspecified chemicals and noxious substances 4 X44 Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances 3 X42 Accidental poisoning by and exposure to narcotics and psychodysleptics, not elsewhere classified 2 X40 Accidental poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics 0 X41 Accidental poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified 1 X45Accidental poisoning by and exposure to alcohol0 X47Accidental poisoning by and exposure to other gases and vapours0 X48Accidental poisoning by and exposure to pesticides0 Total10 Source: Office for National Statistics. Crown copyright reserved. 46 Unintentional injuries among children under five

47. 47Unintentional injuries among children under five Suffocation and strangulation in bed (37), other hanging and strangulation (28) Inhalation and ingestion of food and inhalation of vomit (42) Drowning: bath (18); lack of specified causes (22) Falls (24): no single high cause – drops, window and furniture falls. Stair falls infrequent House fires (18) Mechanical forces (18): possibly cave-ins and collapse of structures Poisonings (10): medicines and household chemicals Source: Office for National Statistics. Crown copyright reserved. Overview of deaths among the under fives, 2008–2012

48. Overview of deaths (2008–2012) and emergency hospital admissions (2008/09-2012/13) among under fives, ordered by deaths Unintentional injuries among children under five DeathsAdmissions Admissions/ deaths Other accidental threats to breathing1382,024 15 Accidental drowning and submersion65498 8 Falls2493,315 3,888 Exposure to smoke, fire and flames23724 31 Exposure to inanimate mechanical forces1840,575 2,254 Accidental poisoning by and exposure to noxious substances 1023,014 2,301 Exposure to animate mechanical forces36,553 2,184 Contact with heat and hot substances311,115 3,705 Exposure to electric current, etc2188 94 Sources: Office for National Statistics. Crown copyright reserved. Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. 48 Unintentional injuries among children under five

49. Overview of deaths (2008–2012) and emergency hospital admissions (2008/09–2012/13) among under fives, ordered by admissions Unintentional injuries among children under five DeathsAdmissions Admissions/ deaths Falls2493,315 3,888 Exposure to inanimate mechanical forces1840,575 2,254 Accidental poisoning by and exposure to noxious substances 1023,014 2,301 Contact with heat and hot substances311,115 3,705 Exposure to animate mechanical forces36,553 2,184 Other accidental threats to breathing1382,024 15 Exposure to smoke, fire and flames23724 31 Accidental drowning and submersion65498 8 Exposure to electric current, etc2188 94 Sources: Office for National Statistics. Crown copyright reserved. Hospital Episode Statistics (HES). Copyright © 2014 Re ‐ used with the permission of The Health and Social Care Information Centre. All rights reserved. 49 Unintentional injuries among children under five