1. Baby Buggy or Baby Catapult? BACCH Annual Scientific Meeting Cardiff. 16 th and 17 th September 2014. Dr. Vanessa Impey Specialist Registrar in Community Paediatrics vanessa.impey@nhs.net Guy’s and St. Thomas’ NHS Foundation Trust Dr. Daniel James GP Registrar – danieljames@nhs.net Guy’s and St. Thomas’ NHS Foundation Trust #babycatapult @danielsjames

3. Case History typical of anecdotal evidence 10 days old baby Travelling in buggy on London Underground Fell from buggy on stairs Mechanism of fall Injury: skull fracture with underlying haematoma and infarction Dr. Vanessa Impey, Dr. Daniel James. BACCH Annual Scientific Meeting September 2014. Baby Buggy or Baby Catapult? Introduction

4. What is the extent of the problem? Literature Search 14 Papers in the English Literature concerning injuries related to buggies/prams/pushchairs. 5 of these concerning accidental deaths from asphyxia (in 1990s) 1 Non-Accidental Injury Case Study where a baby was shaken in a buggy 7 Case studies/prevalence studies about injuries related to falls from buggies 1 prevalence study of injuries on escalators Recurring Themes Injuries sustained on falling from buggies Head Injuries Improper use of straps Stairs/Escalators Dr. Vanessa Impey, Dr. Daniel James. BACCH Annual Scientific Meeting September 2014. Baby Buggy or Baby Catapult? Aims

5. How to find out more? Contacted Transport for London Freedom of Information Act incident reporting systems Were TFL aware of a problem? Yes and No How did TFL respond? Posters on buses Request for further recommendations Dr. Vanessa Impey, Dr. Daniel James. BACCH Annual Scientific Meeting September 2014. Baby Buggy or Baby Catapult? Methods

6. London Buses 677 buggy-related injuries on buses over a 2 year period. London Underground 1164 under 16yrs injured 2008-2012 110 of these injuries were buggy-related (10%) 72 babies ejected from buggies (inadequately secured) – 54 taken to hospital by ambulance (75%) – 52 head injuries (72%) – 17 <6months (23%) At least 6 descriptions of head injuries indicating CT Recurring Themes Injuries sustained on falling from buggies Head Injuries Improper use of straps Stairs/Escalators Dr. Vanessa Impey, Dr. Daniel James. BACCH Annual Scientific Meeting September 2014. Baby Buggy or Baby Catapult? Results

7. Moving Forward Is this a snapshot of a national problem? TFL has responded to the authors' suggestions Health Visitor advice locally to include use of buggy straps and safety on public transport and stairs Dr. Vanessa Impey, Dr. Daniel James. BACCH Annual Scientific Meeting September 2014. Baby Buggy or Baby Catapult? Discussion

8. Wider Issues No buggy manufacturer advocates carrying children in a buggy – strapped in or not Maclaren Never leave child in the buggy when ascending or descending stairs or escalators or when travelling on other forms of transport Stokke Never use the stroller on escalators iCandy Never lift your pushchair or use on escalators or stairs when your child is in the pushchair Mothercare Remove your child and fold the pushchair when ascending or descending stairs or escalators Quinny Never use stairs or escalators with your child in the pushchair BabyJogger Taking children up or down steps, stairs or escalators in a stroller could be dangerous and should not be attempted Dr. Vanessa Impey, Dr. Daniel James. BACCH Annual Scientific Meeting September 2014. Baby Buggy or Baby Catapult? Discussion

9. Wider Issues Discrepancy between safety and practicality TFL – Plan a route using escalators … lifts and ramps Buses: Hold on to your buggy Dr. Vanessa Impey, Dr. Daniel James. BACCH Annual Scientific Meeting September 2014. Baby Buggy or Baby Catapult? Discussion

10. What lessons are there? What recommendations can you suggest? Vanessa Impey: vanessa.impey@nhs.net Daniel James: danieljames@nhs.net #babycatapult @danielsjames