Childhood injuries

Last updated: 2019-11-27 14:30:35
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1. Introduction

Exploring environments, taking risks and engaging in play are all part of positive child development, and injuries are accepted as an inevitable part of this development. However, a balance needs to be struck between giving children opportunities for positive development, and supporting families to avoid those serious injuries which are predicable, and preventable. 

Unintentional injury is a leading cause of death for children and young people under 15, and one of the most common reasons for admission to hospital (NICE 2010). In addition, children under 5 account for a disproportionate number of deaths and a large number of hospital admissions for unintentional injuries.  The majority of injuries in for children under 5 years take place in and around the home, with injuries taking place outside of the home setting become more common as children get older (PHE 2015).

Analysis of national data highlights that the leading causes of death and injury for under 5’s are:

  • Choking, suffocation and strangulation
  • Falls
  • Poisoning
  • Burns and scalds
  • Drowning

There is a social gradient & inequalities associated with childhood injuries, with children from more deprived communities more likely to experience injuries, children of unemployed parents (both long term and never employed) are estimated to be thirteen times more likely to die from an unintentional injury than children whose parents are employed. (PHE 2014).  Risk factors that increase inequalities in childhood injuries include:

  • overcrowded homes, or homelessness
  • lack of safety equipment in the home
  • lack of accessible information and poor literacy
  • parental understanding of child development

As young people move through transitions from childhood to young adulthood, behavioural risks become one of the leading causes of death and disability in the 15-24year age group (IHME2018). Mental health, self-harm and substance abuse are among the leading causes of death and disability for adolescents while alcohol and drugs remain the leading risk factors that contribute to disability adjusted life years for this age group (Kassebaum et al., 2017). 

Injuries to children have broad and long-term impacts including lower educational attainment and employment prospects for the individual, and impact on parents & carers associated with taking time off work to care for the child, and in dealing with longer term impact of the injury (PHE 2015). Childhood injuries are associated with significant costs to NHS, social care services, and the wider economy, with costs increasing with the severity of the injury. For example, the average short term healthcare cost of an unintentional injury is estimated at £2,494, however if an injury leads to permanent disability (e.g. traumatic brain injury) the lifetime cost for a child under 3 is estimated at £4.89million (including education, social care costs, loss of earnings, disability benefit costs).

There is a strong evidence base about the economic impact of preventable injuries, a costing report for NICE guideline on unintentional injuries highlighted that nationally an 11% reduction in unintentional injuries for children and young people (under 15) could save £26.4 million in admission and hospital costs, which could offset the cost of implementing coordination of injury prevention activities and the delivery of home safety assessments as outlined in prevention guidance (NICE 2010).

Other JSNA topics this topic closely linked to:

Transport

Housing

Poverty

Environment

Aclohol misuse

Physical inactivity

 

Last updated: 27/11/19

2. Data and Intelligence

A large proportion of wards within Stockton-on-Tees (12 out of 26) are ranked among the most deprived wards nationally. In addition, Stockton-on-Tees has a higher proportion of under 16’s living in income deprived households (20.6%) compared to the national average (16.8%). While the proportion of under 16’s living in income deprived households has been reducing over the last 7 years and remains lower than the North East average, it is still significantly higher than the national average.

The rate for hospital admissions caused by unintentional and deliberate injuries in under 5’s has fluctuated over recent years, however there remains a clear gap between the Stockton-on-Tees average rate and the national rate, with Stockton-on-Tees having a significantly higher rate than the national average.

The rate of emergency hospital admissions due to poisoning from medicines in the under 5’s for Stockton-on-Tees is significantly worse that the national average, and the gap between the 2 has not decreased in recent years.

The rate for hospital admissions caused by unintentional and deliberate injuries for the 0-14 year, and 15-24 year groups have been reducing over recent years, but remain significantly higher than the national average.

In 2017/18, there were 457 admissions to hospital due to unintentional injuries for children and young people aged under 19 years, this is similar to numbers for 2016/17 (460).

In 2017/18, falls remained the main reason that under 19’s resident in Stockton-on-Tees were admitted to hospital for unintentional injuries, followed by inanimate forces, poisoning and animate forces, which reflects a similar trend for previous years.

In 2017/18, the highest proportion of hospital admissions as a result of unintentional injuries was in the 0-5 age range, with the proportion of admissions reducing with age. This reflects a similar trend noted in hospital admission data for previous years.

There is a correlation between deprivation and admission to hospital due to unintentional injury within Stockton-on-Tees, the chart below highlights that as deprivation increases, so does the number of hospital admissions due to unintentional injuries for that area.

 

Last updated: 27/11/19

3. Which population groups are at risk and why?

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4. Consultation and engagement

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5. Strategic issues

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6. Evidence base

Issue number

1 = highest priority

 

1

Source

PHE

Title incl. web link

Reducing unintentional injuries in and around the home for children under 5 years

Link

Summary

The document explains the scale and nature of the unintentional injuries in and around the home for children under 5 years, including the frequencies and rates of deaths and injuries, and the significance of deprivation. It also covers the costs to families and health and social care services and presents the priorities for action, highlighting the main risks to children and the ways that local authorities and their partners can achieve change, building on what they do currently.

Source

NICE

Title incl. web link

Preventing unintentional injury in under 15s 

Link

Summary

The quality standard covers preventing unintentional injury in children and young people (under 15). It includes local coordination of prevention strategies, and advice and assessment to help prevent accidents in the home. It describes high-quality care in priority areas for improvement.

Source

NICE

Title incl. web link

Unintentional injuries: prevention strategies for under 15s

Link

Summary

This guideline covers strategies, regulation, enforcement, surveillance and workforce development in relation to preventing unintentional injuries in the home, on the road and during outdoor play and leisure.

2

Source

PHE

Title incl. web link

Reducing unintentional injuries on the roads among children and young people under 25 years

Link

Summary

The document also sets out the evidence for preventative action.

Source

NICE

Title incl. web link

Behaviour change: individual approaches

Link

Summary

This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.

 

Last updated: 27/11/19

7. What needs to be done and why?

Family Hubs

A home safety scheme is coordinated through family hubs, providing workforce training about childhood injury prevention, parent home safety awareness sessions, home safety equipment and home safety visits to families. A dedicated home safety coordinator works on an outreach basis with families identified as in need of targeted support.

0-19 service

Health visitors deliver the evidence based healthy child programme, a universal offer to all families within the borough. As part of this programme health visitor’s work in the home on a 1-1 basis with families, offering support to parents about attachment and relationship building, delivering home safety messages and signposting into home safety awareness sessions. In March 2019 the service implements a Stockton together to enhance positive strengths pathway (STEPS), families on the pathway will all receive a home safety visit. Healthy systems provide notifications to 0-19 services of A&E attendance and hospital admissions.

Children’s Services

The SLSCB (Stockton-on-Tees local safeguarding children’s board) works across statutory and voluntary sector provision to embed policy and practice that identifies and protects children and young people at risk of harm.

Public Health and Education Improvement

Public health and the local authority education improvement service work in partnership to develop resources and training to support secondary schools to deliver educational messages to young people about drugs, alcohol, sexual health, relationships, risk and choice as part of a comprehensive Personal, Social, Health and Economic education (PSHEe) programme.

Stockton-on-Tees active travel team and road safety team

The council road safety team offer level 1 and 2 bikeability training to children in years 5 and 6. Roadside pedestrian training is offered to year 3 children. A number of roadshows and information sessions are delivered across the year including:

  • KS1 Roadshow supporting children to explore how to be safe when they are outside
  • Crucial Crew: a multiagency interactive event teaching year 6 children about personal safety
  • Road safety quiz: an inter school event for year 6 pupils carried out in November each year.

A junior road safety officer scheme is currently being piloted, where children are given the role within their school of raising awareness about road safety. The scheme with be rolled out in March 2019.

In addition, the active travel team offer advice and information on walking and cycling routes within the Borough.

Youth Direction

Youth direction services offer group work and 1-1 case work to young people taking part in health risk behaviours with the aim of increasing their strengths and improving their wellbeing.

Schools

PSHE is a non-statutory element of the school curriculum which teaches children and young people about how to be healthy and safe. PSHE provision varies across schools within the borough, currently the Government are consulting on proposals to make health education (both physical and mental) statutory across all schools from September 2020.

Voluntary Sector

Youth United Stockton, a network of voluntary sector partners, deliver open access youth provision across the borough and offer workforce development to the wider voluntary sector about children and young people’s health and wellbeing.

 

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8. What needs are unmet?

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9. What needs to be done and why?

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10. What additional needs assessment is required?

No additional needs assessment required at present.

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11. Key contact

Name: Gemma Mann

Job title: Health Improvement Specialist

Organisation: Public Health

Phone number: 01642 524293

Last updated: 27/11/19

12. References

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Last updated: 27/11/19

Email: gemma.mann@stockton.gov.uk