Childhood injuries are the leading cause of avoidable death and disability. It is one of the most common reasons for admissions to hospital (Audit Commission 2007).

There is strong evidence to show that injuries to children and young people are more likely in more deprived communities. People from poorer communities are more likely to die as a result of unintentional injury. Nationally, although the number of accidental deaths has fallen in recent years, the rate of deaths among the poorest children has risen.

There are persistent and widening inequalities between socioeconomic groups for childhood deaths from accidents (Children’s Accident Prevention Trust, 2012).

Childhood injuries are accepted as an inevitable part of normal child development. Although protecting children and young people from every perceivable harm would be impossible, there is evidence to suggest that a large proportion of unintentional and intentional injuries are preventable.

The cost of childhood injuries to the NHS is estimated to be £2.2 billion. The wider costs to the NHS associated with domestic injury is estimated to be in the region of £25 billion (this includes indirect costs such as days lost to education, parents and carers taking leave from the workplace and the psychological effects caused by some injuries). (Audit Commission, 2007)

Preventing childhood injuries is an important public health priority and has been identified by the government within the Public Health Strategy ‘Healthy Lives Healthy People (DH 2010). Hospital admissions due to unintentional and deliberate injury have been included as an indicator within the Public Health Outcomes Framework (DH 2012).

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Last updated: 2013-01-04 08:36:52
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1. What are the key issues?

  • About 34% of under 18-year-olds in Middlesbrough are living in poverty.
  • In 2010/11, the rate of children (under-18 years old) admitted to hospital as a result of an injury in Middlesbrough (200.2 per 100,000) was higher than the England average (124.3 per 100,000).
  • In 2010/11, the rate of under 5-year-olds admitted to hospital as a result of fall injuries in Middlesbrough (256 per 100,000) is higher than the England average (143.2 per 100,000).

The five most common injuries that result in a hospital admission in Middlesbrough are:

  • Falls
  • Exposure to inanimate mechanical forces
  • Intentional self-harm
  • Transport accidents
  • Exposure to animate mechanical forces
Last updated: 04/01/13

2. What commissioning priorities are recommended?


Ensure unintentional injury is included in local plans and strategies.


Ensure adequate resources are available for local partnerships and prevention strategies.


Ensure that in local plans, the home safety assessments and education is aimed at vulnerable families with a child under-5 years old.


Local plans should consider outdoor play, leisure and road safety.


Consider housing associations and landlords as key partners.


Develop a standardised data collection method that enables sharing within and between organisations.


Improve identification of vulnerable families and strengthen planning and co-ordination of prevention activities.


Develop guidelines for management and pro-active follow-up of childhood injuries.

Last updated: 04/01/13

3. Who is at risk and why?


Of all the children admitted to hospital as a result of an injury, the under 5-year-olds and over 11-year-olds represent the highest proportion.


A higher proportion of males are admitted to hospital as a result of injury than females.


Children with a disability or impairment (particularly sensory impairments) are at a higher risk of injury (HDA 2005).

Socioeconomic status

There is a higher incidence of injury amongst under 18-year-olds from disadvantaged groups and areas. 

A higher proportion of children from deprived areas are admitted to hospital than more affluent areas.


Children living in accommodation which potentially puts them at risk (including multiple occupied housing and social and privately rented housing) are at a higher risk of being injured (NICE 2010).

Last updated: 04/01/13

4. What is the level of need in the population?

Attendance at accident and emergency departments

Attendance rates at accident and emergency (A&E) departments vary between the electoral wards. There are many factors that influence an individual’s decision whether to attend A&E or not. These include:

  • Proximity to the department;
  • Severity of injury; and
  • Availability of other healthcare facilities.

The below table shows the twenty electoral wards in Tees that have the highest rate of attendances of under 18-year-olds:

Top 20 wards with the highest rates of attendances to A&E, Tees, Mar 2007 - Apr 2010

These wards are also shown on a map of deprivation in Tees.

Wards with highest rates of attendances at A&E v IMD 2007, Tees, Mar 2007 - Apr 2010

Hospital admissions

Tees under 18 hospital admissions due to injury 2007/8 to 2010/11

Middlesbrough has had the most hospital admissions due to injuries in Tees every year from 2007/08 to 2010/11. The rate in Middlesbrough is considerably higher than the North East and the national average for all the four years shown. The rate of admissions has been fairly static for four years.

Number of hospital admissions as a result of injury, under-18 years old, Tees, April 2007 - March 2010

The chart shows that more males than females are admitted to hospital as a result of an injury for all ages.  The age profile is similar for both sexes.

Admissions are higher in the pre-school (under 5s) and secondary school (11and over) age groups.

Last updated: 20/03/14

5. What services are currently provided?

Children’s centres

Middlesbrough children’s centres participate in the Royal Society for the Prevention of Accidents (ROSPA) scheme and employ outreach workers to undertake home visits. Staff from the centres are then able to follow up these families once the equipment is in place and provide one-to-one home safety advice and hazard identification.

Families at risk are identified through joint work with the local health visiting teams and general (albeit seasonally tailored) safety advice is routinely distributed along with marketing materials.

Schools and universal settings

School travel plans

Most schools have a travel plan (including a road safety element).  School Travel Plans can be used as a lever for addressing accident/safety issues and the yearly refresh process is an opportunity to raise any issues relating to injuries and introduce or enhance prevention strategies such as cycle training.

Pedestrian and cycling training

Pedestrian training is offered to all primary schools and all programmes are led by the local authority. Cycling training is offered to all primary and secondary schools. In 2011/12, 3675 children in Cleveland participated in pedestrian training and 2677 participated in cycling training.

Crucial Crew events

Year 6 pupils (10 and 11-year-olds) participate in a variety of scenarios which aim to give the children the chance to learn how to cope with a wide range of safety issues.

Integrated Youth Services

Injury prevention was not a core issue addressed by Integrated Youth Service teams though some ad hoc exposure to first aid courses does take place. 

Last updated: 04/01/13

6. What is the projected level of need?

Using a linear trend, the number of admissions to hospital due to unintentional injuries for under 18-year-olds is increasing over time. There was a large rise in attendances in 2011/12, this may need looking into as to why this occurred.

Last updated: 04/01/13

7. What needs might be unmet?

Pedestrian and cycling training

Not all schools take up the offer, if all schools did positively respond to the offer it would be unlikely that local authority would have the capacity to deliver in all schools.

Last updated: 04/01/13

8. What evidence is there for effective intervention?

There are many core resources that provide guidance on the effectiveness of methods for injury prevention, treatment and rehabilitation.

England injury information resources guide

The South West Public Health Observatory provides an up to date guide to national strategies and policies as well as a variety of injury statistics and costs.

Injury Observatory for Britain and Ireland (IOBI)

IOBI is an international collaborative venture representing public health observatories from Wales, Scotland, Ireland, and regions of England. It is managed by a steering group of public health professionals committed to injury prevention.

Collaboration for Accident Prevention and Control (CAPIC)

IOBI works closely with other injury prevention websites, most notably CAPIC, based in the Welsh School of Medicine.  CAPIC reviews the scientific literature to identify all the relevant studies across the world, appraise the quality of the studies and summarise the findings of those meeting a quality threshold. There are often several reviews on a particular topic. CAPIC aims to include all the reviews and not just the recent on the focus and inclusion and exclusion criteria can differ between reviews

National Institute for Health and Clinical Excellence (NICE)

NICE develops guidance to support health and social care professionals to make sure that care provided (including primary prevention) is of the best quality.  The guidance is intended for use by the NHS, local authorities, charities and anyone with commissioning healthcare, public health or social care services.

A list of NICE resources for injuries, accidents and wounds is available.

Specific public health guidance has recently been published for three topics:

1. Strategies to prevent unintentional injuries among the under-15s (PH29)

2. Preventing unintentional injuries among under-15s in the home (PH30)

3. Preventing unintentional road injuries among under15s: road design (PH31)


The European Association for Injury Prevention and Safety Promotion runs the Effective Measures in Injury Prevention (EMIP) Programme. EMIP produces short evidence statements on effective injury prevention interventions for practitioners.

Royal Society for the Prevention of Accidents (ROSPA)

ROSPA is a registered charity at the heart of accident prevention in the UK for almost 100 years. It promotes safety and the prevention of accidents at work, at leisure, on the road, in the home and through safety education.

Childhood Accident Prevention Trust (CAPT)

CAPT is the leading charity in the UK working to reduce the number of children and young people who are killed, disabled or seriously injured in accidents.

There are several of guidance documents which highlight the following approaches:

  • Legislation;
  • Environment changes;
  • Use of safety equipment;
  • Education;
  • Skill building; and
  • Multi-faceted approaches.

Wood, S., Bellis, M.A., Towner, E. and Higgins, A. (2010) ‘Childhood Injuries: A review of evidence for prevention’

NICE Public Health Guidance, 29, 30 and 31

Last updated: 04/01/13

9. What do people say?

Middlesbrough’s Crucial Crew 2010

Children were asked to think of a time when they had been involved in an accident, and to consider whether they thought that that accident could have been prevented.

Over half of the children (60%) felt that their accident/s could have been prevented.

When asked what prevention methods could have been used, the children gave the following answers:

  • Better maintenance of areas, i.e. clearing away broken glass and rubbish, trimming shrubbery to remove obstructions to paths, gritting school areas to prevent ice. It was pointed out that a high proportion of the children had been injured by broken glass;
  • Road safety, i.e. drivers taking more care, reduce speeding and pedestrians being more aware;
  • Children taking more responsibility for their own actions, i.e. being careful in playgrounds; and
  • Controlling unruly teenagers.

When asked where they thought most accidents occurred, the majority of children said “on the road”, which corresponds with their suggestion for better road safety.

 Linx - Hemlington detached youth work project

Three focus groups took place with 12 to 17-year-olds to gather opinions and perceptions of accidents. A brief overview of the focus group outcomes are described below:

What do you think an accident is?

All young people answered similarly. The general consensus was that an accident was something that happens that isn’t supposed to.

Is an accident different to an unintentional injury?

Opinions differed in this section, the girls thought it was the same but the boys thought it was different. The males in both groups claim that an accident is different because if you break a glass it is classed as an accident even if no-one gets hurt, whereas an unintentional injury means you definitely get hurt by mistake.

Is there a difference between an avoidable and unavoidable accident?

Some young people claimed yes, stating reasons such as you need to check equipment before using it and wear safety equipment to avoid accidents. Other young people stated no, as you could trip over a loose paving slab and injure yourself.

How can preventing accidents be promoted?

All of the groups of young people asked came up with similar answers including: social media, leaflets, posters, television/radio advertising, bus-stops and billboards.

Who should be involved in accident prevention?

The standard answer for this question was ‘whoever’s fault the accident was’.

What messages should young people get about accidents?

All groups stated to be extra careful if under the influence of drugs and/or alcohol and many young people said to take more notice of safety warnings.

Last updated: 04/01/13

10. What additional needs assessment is required?

Further and more detailed analysis of the reasons for admissions is required, particularly for those in the young age range and those admissions that last less than 24 hours.

Last updated: 04/01/13

Key contact: Emma Thomas

Job title: Children’s Business Manager


Phone number: 01642 745198


Local strategies and plans, with dates

Healthy Lives Healthy People DH 2010

PH Outcomes Framework

CYPP M’bro H’pool Stockton, R&C

Wood, S., Bellis, M.A., Towner, E. and Higgins, A. (2010) ‘Childhood Injuries: A review of evidence for prevention’

NICE Public Health Guidance, 29, 30 and 31

Brown G and Thomas E.  Unintentional and deliberate injuries to children (in Teesside). NHS Tees, October 2010.