Minimizing Risk of Unintentional Injury For Children with Disabilities- Part One

July 11, 2013

A couple of summers ago, I awoke to the sound of the doorbell ringing at 7AM. Puzzled, I looked through the window and saw a young girl with Down syndrome standing on our front step. She said that she was lost and didn’t know where her mom was. We quickly called the police, and thankfully, her mother found us within a short period of time, explaining that her daughter had run out of the house while they were preparing for a move.

Thankfully, no one was hurt during that experience, but it was a dangerous situation. With the recent buzz of excitement in my clinical practice about summer’s increased outdoor time, and inspired by the recent Twitter Chat hosted by @TeenHealthGov (#TeenSummer) on adolescent summer safety, I thought it would be helpful to discuss why children with developmental disabilities are at higher risk of unintentional injury, especially when the weather’s warm. And in a future post, I'll share prevention tools that are available.

In general, unintentional injuries occur more frequently among children with disabilities than in those without disabilities. (In one study, the prevalence was 67 percent versus 51 percent per year). Behavioral, physical, and cognitive characteristics of children with disabilities may not be well-adapted to their environments, particularly those that are new, such as camp. This mismatch can contribute to the increased risk of unintentional injury.

It is helpful for parents, caregivers, and health-care providers to understand the factors that increase the risk of injury and the potential strategies to minimize the risk. Primary care providers play an important role in improving the safety of children with disabilities through anticipatory guidance, counseling, treatment, and referral.

Predisposing factors for injury include:

Behavioral factors

  •     Hyper-activity, impulsivity, inattention (e.g. seen in children with ADHD, autism spectrum disorders, or oppositional defiant disorder). 
  •     Self-injurious behaviors (head banging, biting), such as those seen in children with autism or intellectual disabilities (ID).

Intellectual factors

  •    Cognitive skills needed to prevent injury, such as the ability to learn and obey safety rules, accurately assess physical abilities, and attend to the risks of a given situation, may be impaired.
  •    In studies, the prevalence of injury in children and teens with ID is 1.5 to 2 times that of children without ID.

Biologic factors

  •    Children with cerebral palsy have decreased bone density which increases the risk of fractures with minor trauma.
  •    Children with certain neurologic conditions such as myelomeningocele where sensory pathways are disrupted are at increased risk for burns and an increased risk of complications when burns occur.

Environmental factors

  •   In a national study of almost 300 children with disabilities, the risk of vehicle-pedestrian or vehicle-bicyclist collisions was almost five times greater for children with disabilities than for those without disabilities, after adjusting for age, sex, and family income. Children with visual and hearing impairment are at particular risk of pedestrian injury.
  •   Individuals with a physical or cognitive disability have a two to six times higher risk of dying in a house fire as compared to the general population. It may be harder for individuals to be aware of danger and execute an escape plan without help.
  •   Impaired physical and cognitive abilities also may increase the risk of drowning.
  •   Elopement, such as running out of the house, can occur in up to 5% of children with disabilities. Elopement can lead to life-threatening situations, such as running into busy street).

The good news is that there are resources to prevent unintentional injury among children with disabilities. Stay tuned for my next post.

 

References:

Petridou E, Kedikoglou S, Andrie E, et al. Injuries among disabled children: a study from Greece. Inj Prev 2003; 9:226.

Slayter EM, Garnick DW, Kubisiak JM, et al. Injury prevalence among children and adolescents with mental retardation. Ment Retard 2006; 44:212.

Sherrard J, Tonge BJ, Ozanne-Smith J. Injury risk in young people with intellectual disability. J Intellect Disabil Res 2002; 46:6.

Sherrard J, Tonge BJ, Ozanne-Smith J. Injury in young people with intellectual disability: descriptive epidemiology. Inj Prev 2001; 7:56.

Gaebler-Spira D, Thornton LS. Injury prevention for children with disabilities. Phys Med Rehabil Clin N Am 2002; 13:891.

Ramirez RJ, Behrends LG, Blakeney P, Herndon DN. Children with sensorimotor deficits: a special risk group. J Burn Care Rehabil 1998; 19:124.

Xiang H, Zhu M, Sinclair SA, et al. Risk of vehicle-pedestrian and vehicle-bicyclist collisions among children with disabilities. Accid Anal Prev 2006; 38:1064.

Roberts I, Norton R. Sensory deficit and the risk of pedestrian injury. Inj Prev 1995; 1:12.

Marshall SW, Runyan CW, Bangdiwala SI, et al. Fatal residential fires: who dies and who survives? JAMA 1998; 279:1633.

Jacobson JW. Problem behavior and psychiatric impairment within a developmentally disabled population I: behavior frequency. Appl Res Ment Retard 1982; 3:121.