A Brief Synopsis of AFP's "Prevention of Unintentional Childhood Injury"

A brief synopsis of:

Prevention of Unintentional Childhood Injury

WESLEY M. THEURER, MAJ, MC, USA, Madigan Army Medical Center, Tacoma, Washington

AMIT K. BHAVSAR, LTC, MC, USA, Tripler Army Medical Center, Honolulu, Hawaii

Am Fam Physician. 2013 Apr 1;87(7):502-509.

http://www.aafp.org/afp/2013/0401/p502.pdf

     The most common causes of unintentional death in children are motor vehicle accidents, drowning, poisoning, fire, and suffocation. In motor vehicle accidents, proper use of restraints is the best way to reduce this risk. There is an algorithm explaining how to transition a child from a safety seat to an adult car seat. Patients younger than 2 to 4 years old should be placed in rear facing safety seats, in the back seat. Once the child has outgrown the height and weight requirements, a front facing child seat may be more appropriate, again in the back seat. A booster seat may be used in the back seat once the patient outgrows the previous seat (between 4-8 years old). The seat belt should fit appropriately across the thighs and mid-sternum to graduate to a booster seat. Once the child outgrows the booster seat, he or she should still not sit in the front seat until 13 years or older.

    Suffocation has increased in the last 20 years, even though the amount of SIDS cases has gone down. The most common cause is infants wedging their heads in the corner playpens and cribs. It can also happen with infants getting a blanket wrapped around their neck, lying face-down on soft bedding, or if the playpen itself collapses. The best way to prevent this is to use the original mattress that the crib comes with, to ensure a proper fit. Tight fitting sheets can also reduce the risk. Cords and strings should be out of reach.

     Drowning is another unfortunate cause of unintentional death. Adult supervision of swimming children is not sufficient. Adults need to be in the water within arms reach of the child, especially those children younger than 4 years old. Often times, the child may be quietly drowning without the parent being aware. Fencing around the pool itself has been shown to be more effective than fencing around the entire yard. Supervising adults should be trained in CPR and have proper life preservers, rather than floating toys. Telephone access should be poolside as well. Children should be aware to avoid safety drains that may cause entrapment.

     As far as poisoning is concerned, education is paramount. Adults should know how to property store medications in locked cabinets with poison control stickers. If a child has ingested medication inappropriately, poison control should be contacted immediately, rather than trying to get the child to vomit.

     Having properly installed and functioning smoke detectors is the best way to prevent unintentional deaths from fires. Detectors should be check regularly, and a "home escape plan" should be developed and discussed with the children. 

     The use of bicycle helmets had greatly reduced the risk of head and brain injuries. Many states require and strictly enforce their use. Parents should set good examples and use them as well. Physicians should encourage their use, as well as reflective and bright colored clothing during bicycling.

     Physicians should make it a point to counsel patients routinely during office visits on safe practices to avoid unintentional accidents. Screening questionnaires may help to identify which practices can help each patient on an individual level.