Trends in Child Injury: An Article Review

September 24, 2013

I recently came across a new review article on child injury prevention by Drs. Brian Johnston and Beth Ebel at University of Washington. In it, they describe that although overall unintentional injury death among US children aged 0-19 years in 2000-2009 fell by 30%, there is still much work to be done. For instance, there remains significant disparity in child injury death rates, and poverty persists as a powerful risk factor for injury.  Injury deaths among infants has also increased since 2005, and injury deaths among teens has not fallen proportionately. The US unintentional injury death rate in the United States is three times that of other developed nations.

Their article then goes on to highlight some recent advances and remaining challenges in injury prevention for certain injury mechanisms. A few of the critical points:

Road  traffic injuries prevention:

  • The fall in teen driving deaths may be in part attributed to reduced exposure as teens delay driving and with GDL laws, although interventions to promote parental monitoring remains a priority in research.
  • Randomized trials of in-vehicle technology, such as in-vehicle camera/recording with parental and teen driver feedback, are needed.
  • Pedestrian and bicycle deaths, on a per mile basis, remains much riskier than automobile travel. In light of the epidemic of obesity in this country, there is a need to support healthy communities and habits, and ensure that these activities are made safer, rather than reducing the frequency of using these modes of transportation. This is especially important internationally, and the authors note that with the Decade of Action for Road Safety initiatives, “one priority area…includes efforts to preserve some of the beneficial transport practices prevalent in less resourced settings. The use of public transport is widespread, and many daily trips are made on foot. These practices should be supported and made safer, rather than cast aside in a model of development that prioritizes the use of private automobiles.“

Drowning           

  • Four-sided fencing reduces risk of drowning by 73%, but more information is needed on the benefits of automated pool monitors that scan the water environment and alert a lifeguard when a “human-shaped object exhibits behavior suggestive of drowning”;
  • A challenge in public health messaging persists in the area of determining how much and what kind of supervision is associated with significantly reducing the risk of drowning;
  • Studies suggest that formal swimming lessons are associated with an 88% reduction in the risk of drowning in children aged 1-4 years, although identifying the optimal age for starting lessons requires further research.

Violence

  • School based anti-bullying programs can result in a 20% reduction of bullying, though it is not clear whether the programs reduce the bullying itself or increases the community protection for potential victims;
  • Challenges include promoting known effective and evidence-based interventions, such as expanding nurse home visits for at-risk new parents to reduce the risk of child abuse, or safe firearm storage and child-access protection laws to protect children from firearm deaths.

Sports-related concussions

  • The impact of the Lystedt Law, which requires an athlete who is concussed to be pulled from play and evaluated/cleared by a medical professional, requires further exploration;
  • More research is needed to improve management of concussion, understand the long-term effects of mild traumatic brain injury, and promoting evidenced-based care among all those who may be involved, including parents, coaches/trainers, and clinicians. 

Broader questions and challenges

  • How do we strike a balance between preventing the most serious injuries without reducing a child’s free exploration of their environment?
  • When determining the best allocation of research resources, should a priority be placed on surveillance (which helps to boost an argument for interventions but can be costly and sometimes inaccurate) or on prevention itself?
  • Should interventions target selected high risk populations or universal community-wide populations? The first approach arguably reaches those who need it most but may also lead to stigmatization, particularly when risk factors are not very predictive at individual levels. The second, universal interventions, may reduce average risk but may also lead to inequities within the population.

I’m proud to note that CIRP@CHOP research and activity addresses several of these challenges. For instance, the theme of this year's National Teen Driver Safety Week (NTDSW) is promoting the parental role in their teen’s learning to drive phase and provides a universal message while we are also actively researching the impact of individualized parental and teen feedback/monitoring in our driving simulator research. Finally, we’ve recently posted new concussion resources at CHOP to universally promote better support for children recovering from a concussion injury while also training primary care providers and school based personnel in the Philadelphia area to work together to identify and manage a youth’s concussion.