Last partial update: July 2016 - Please read disclaimer before proceeding
Childhood accidents and injuries
Injury is a leading cause of child death and disability in Australia, being responsible for 12 per cent and 9 per cent of the total burden of disease in boys and girls respectively. Boys are considerably more likely to be injured than girls in all types of injuries, with bicycle and pedestrian injuries and drowning being particular problems. In boys, the highest rate of hospitalization was in the 10 to 14 and 1 to 4 year age groups. In girls, it occurred in the 1 to 4 age group. Over 50 per cent of injuries occur in the home, with another 25 per cent occurring at school or associated with sport.
Injury is more common in rural and especially remote areas. Compared to metropolitan areas, death from injury was 1.6 times more common in rural areas and 2.9 times more common in remote areas. Children on farms also suffer different types of injury, with drowning and injury involving farm equipment often being involved. Injury is more common in poorer communities, especially for motor vehicle accidents and drowning.
In decreasing order of importance, the incidence of childhood injuries in 1996 was:
- motor vehicle accidents. The provision of adequate child restraints and their use until the child is large enough to safely use adult seat belts is a major issue.
- falls, which are common in all age groups, especially after infants start walking.
- drowning, which mostly occurs in the 1 to 4 year age group. The incidence in boys is three times that of girls. Thirty-three per cent occur in swimming pools.
- burns/scalds, which occur mostly in children 4 years of age or under. All hot water systems should be fitted with tempering valves to help reduce scalding.
- bicycle and other transport related accidents, especially in boys aged 10 to 14. Pedestrian accidents are relatively more common in children with the maximum incidence occurring in the 1 to 4 year age group and then decreasing with age.
- suffocation / foreign bodies, which mainly affects the 0 to 4 year age group.
- intentional injury (assalt), which occurs mostly in children under one and in boys aged 10 to 14.
In addition to those mentioned above, there are other less-well recognized preventable causes of injury including poisonous plants, insect/animal bites and stings, dog bites, horse riding accidents and dangers associated with child furniture/equipment, such as bunk beds, cots, mattresses, chairs, strollers, ceiling fans, toys etc.
Excellent information concerning all the above topics and many more can be obtained from the web site of the New Children’s Hospital, Westmead, a major paediatric hospital in Sydney (www.chw.edu.au/parents). Of special importance is their home safety check list. This can be accessed on
www.chw.edu.au/parents/factsheets/safhomej.htm. The more important causes of accidents in children are discussed below.
*Mostly bicycle accidents |
1. Child protection in motor vehicles
The use of properly fitting approved child restraints is of paramount importance in protecting children in the car. These restraints must be fitted properly and children should not be moved out of their restraints until they are large enough to use the next sized restraint safely.
Infants should be kept in rear-facing restraints until they physically do not fit them and should be able to sit and hold their head upright before moving into a forward-facing child seat. The child should stay in this seat until he or she is too big for it as it provides better protection than booster seats. The common practice of moving an older child into a booster seat too early because the child seat is needed for a younger child should be avoided. Booster seats should be rigid with side-wings and a sash guide to keep the belt in place. Remember, it is the size of the child, not their age, which determines when they can safely move up to the next size of restraint.
It is never safe to hold children in the car when driving.
For further information about child restraints, including their fitting, contact the appropriate state roads and traffic authority (in NSW – the RTA on Ph 1800 042 865 or motorist organization. The NSW RTA also tests and rates child restraints and produces a buyers guide with its recommendations. It is obtainable from the Roads and Maritime web site: www.rta.nsw.gov.au (and look in: safety > road safety information > child restraints).
Children should never be left in a car alone. Parked cars can become hot very quickly, with the temperature inside reaching levels much greater than those outside. Most of this temperature rise occurs in the first five minutes and leaving the window open slightly makes little difference. Other risks include choking and even abduction of the child.
Driver safety and teenagers
See separate section
2. Fall prevention in children
Falls are the second most important cause of injury after motor vehicle accidents and occur in all age groups.
In the under five year age group, most falls occur from furniture, nursery equipment, stairs, and bicycles. Prevention includes the use of door gates and stair barriers, and always using harnesses in prams, strollers and high chairs. Avoid using baby walkers and never leave children alone on change tables or in supermarket trolleys.
Important issues with older children include ensuring play areas have soft fall surfaces (such as sand) that are at least 300mm in depth under play equipment, ensuring helmets are always worn when riding horses, bikes or skateboards or skiing, and ensuring elbow and knee pads are worn when using skateboards, scooters, roller blades or roller skates.
For all children, ensure bunk beds have guard rails and fixed ladders and don’t allow wheeled riding toys on uneven surfaces. Try to have non-slip surfaces around the house where possible.
3. Drowning
Drowning is a major preventable health issue for Australian children and accounts for about 21 per cent of childhood deaths due to injury. About 750 children died from drowning in the period from 1991 to 2000. It is three times more common in boys and most prevalent in the one to four year age group.
Australian parents should ensure that all members of their family can swim well and are adequately educated with regards to swimming safely in the surf. AUSTSWIM is Australia’s national organization for the teaching of swimming and possession of an AUSTSWIM certificate is the industry standard for swimming teachers. Parents can contact their local council or ‘community pool’ regarding gaining a list of accredited teachers or visit the AUSTSWIM web site at www.austswim.com.au.
Over 11,800 people were rescued from Australian beaches by lifesavers in 2001 and learning how to swim safely in the surf is should be a priority for all Australians. To get more information regarding ‘surf education’, visit your local surf life saving club on any Sunday and enquire about available educational programs provided. (Programs are also run through some schools.) Parents can also access the Surf Life Saving Australia web site on www.slsa.asn.au.
And remember, swim between the flags! Other important issues in preventing childhood drowning include:
a. Adequate supervision
Adequate supervision of children when they are near water is by far the most important drowning prevention strategy. This means being with them and actually watching them all the time. Drowning occurs in seconds, not minutes. Watching children from a distance or from a window inside the house is not adequate supervision and it is important that the supervising adult is not trying to do another activity, such as doing a small job around the pool / home / garden or preparing food at a picnic, that may distract them from their supervising task. It is also important that the supervisor is a competent adult. Older children should not be left to supervise younger children around water.
It is also imperative the supervising adult does not consume any alcohol. When away from home, there is usually a delegated driver who can fill this role.
b. Creating a safe water environment in the home
Homes should be ‘water safe’. Remember that a child can drown in as little as 5cm of water and that young children who fall into shallow water are not sufficiently developed to act to save themselves. This means that they will just lie in the water and drown unless an adult is there to pull them out.
About a third of all childhood drownings occur in swimming pools, mostly in the one to four year age group. Adequate pool safety requires pool fencing with gates and locks that are well maintained, competent supervision of children at all times and the display of a CPR (cardiopulmonary resuscitation) chart (available from local councils and pool shops). There should be no objects close to gates that might be used by children to climb on so that they can open the gate lock. Do not consider floatation devices as life saving devices. They are no substitute for supervision. Spas should be emptied when not in use. Remember that young children can drown even in small plastic pools.
In rural areas, dams, lakes, rivers etc. need to be checked for hidden dangers and access may need to be restricted to these swimming spots. This may require home fencing. As stated above, supervision of all water activities is essential.
Outside, open drains or garden ponds should be covered with a grill.
Inside, children should never be left unsupervised in the bath. To avoid the likelihood of needing to leave the bathroom when bathing a child, take the phone off the hook and do not have food cooking that may require attention. Always having a towel at the ready so that the bathing child can be quickly taken out of the bath and wrapped up enables parents to take the child with them should an emergency arise eslewhere; as it often can with other older children in the house. When very young children are about, all buckets filled with water, such as nappy buckets, should be covered and the lid should be kept on the toilet.
Managing a drowning victim
Cardiopulmonary resuscitation (CRP) can help save lives in many situations, including drowning, and all Australians should have a good working knowledge of how to do CPR. Courses are available from St John’s Ambulance http://stjohn.org.auThe Royal Life Saving Society of Australia http://www.royallifesaving.com.au or the Red Cross of Australia www.redcross.org.au. Recently the basic CRP recommendations changed and if adults have not studied CPR since mid-2006, it would be worth updating their knowledge.
When resuscitating a drowning victim, it is important to continue CPR for at least 30 minutes. Often drowning victims suffer from hypothermia (low body temperature) and this can help protect their brains from damage due to lack of oxygen. This means that CPR will be more likely to give a favourable outcome without significant brain damage, especially in children.
Many drowning survivors aspirate water into their lungs, adversely affecting their ability to provide oxygen to the blood. For this reason, all drowning victims should be treated with oxygen initially if available and assessed by a medically qualified person regarding the likelihood of aspiration. This usually means that an ambulance needs to be rung quickly. If there is evidence of aspiration, the person needs to be transferred to hospital by ambulance with oxygen.
4. Burn and scald prevention
Burns and scalds can occur from numerous sources, including scalding from hot water, contact burns, and flame burns. They are responsible for about seven per cent of illness due to accidental injury and mostly occur around the home and in children under the age of five years.
Contact burns most commonly occur from touching heaters, BBQs, ovens, irons and cigarettes. Preventative measures include the following.
- The placement of suitably-sized guards made of a heat-resistant or low heat-conducting metal around fires. These should be able to be secured to the floor or walls.
- The use of doorway barriers to keep children out of the kitchen when cooking and oven guards to prevent children touching hot oven doors and stove elements. These also protect children from pulling pots and saucepans containing hot fluids over themselves.
- Keep children away from smoking adults and keep cigarettes, ashtrays and matches out of reach.
- Keep children away from BBQs, camp fires, hot motor bike exhausts, and hot tools such as soldering irons. (Camp fires should be put out with water, not sand or dirt.) Even lamps and the inside of a hot car can cause burns.
As well as being kept away from radiators and fires, children should wear ‘low fire danger’ night clothing. Well fitting clothes, such as track suits, are a good choice. All child night clothes sold in Australia must have a label stating the fire danger of the garment. Category one garments are the safest, being made from materials that are slow to burn. Category two garments are styled to reduce fire danger (like track suits) but are made of more flammable materials and category three garments have a high fire danger.
Hot water is a very common source of burns. These mostly occur in the bathroom due to tap water that is too hot. Water at a temperature of 60oC can cause severe burns in one second, whereas water at 50oC takes five minutes. It is important to reduce the maximum temperature of bath tap water and this is best achieved by installing temperature controlling devices or by reducing the temperature setting of the hot water system. Such devices are mandatory for newly installed hot water systems. Other preventative measures include child-proof taps or taps that have a hot water limiter. It is also important to practice safe bathroom habits, such as keeping the bathroom door closed when not in use and not leaving the bath unattended once it has started being filled. (Taking the phone off the hook with help avoid interruptions.) Never run a hot tap by itself, test the water before putting the child in, and turn off taps tightly.
House fires are sometimes started by children with matches. Lighters and matches should be kept away from children and child-resistant cigarette lighters should be used. It is now compulsory to have smoke detectors in every Australian home. There should be at least one for every floor in the home and preferably one in each bedroom. Once installed it is important to maintain the detectors and make sure batteries are replaced regularly. Checking cords to electric blankets each year, keep heaters away from curtains and having two planned escape routes in case of fire that the whole family knows well are also important considerations. With security an every increasing issue, many families now lock themselves in at night. This can make escape from the home in an emergency difficult. One way of preventing this is to have keys inserted into inside of the door lock.
What to do if a child’s clothes have caught alight:
If a child’s clothing has caught alight, stop them from running, drop them to the floor, and roll them until the flames are extinguished. A blanket is helpful for this purpose. Remove clothing unless it is stuck to the skin and apply cold water to the burnt area for 30 minutes. Do not use ice and do not put anything else on the burn, such as creams. The child should be kept warm and medical help should be sought.
5. Avoiding choking on food
Young children can not grind and chew properly and are therefore more likely to inhale larger pieces of food. For this reason, they should not be given small hard foods, such as nuts, popcorn, hard lollies or corn chips, or foods that can break off into hard pieces, such as raw carrots and pieces of apple. Hard foods need to be grated, cooked or mashed and meat and sausages should be cut into small pieces and have any hard skin removed.
Inhalation of food is more likely if children are moving about while eating, so ensure that they sit quietly and that an adult is present while they eat. Forcing children to eat can increase the risk of choking.
6. Poisoning prevention
Most poisonings occur in the home and involve children under six years of age. The one to three year age group has the highest incidence. Child poisoning most commonly involves pain killers, cough medicines, cleaning substances, personal care products and plants. Factors that commonly contribute to poisonings include:
- inappropriate storage of drugs and chemicals in the home.
- product mislabelling, label misreading and putting chemicals or drugs into unlabelled containers. Used food and drink containers should NEVER be used to store poisonous substances.
- excessive dosage of pharmaceutical drugs due to dosing errors and inappropriate prescribing.
In the home parents should have a childproof cabinet(s) where medications, alcohol, and other drugs and dangerous household products, such as caustic detergents, automotive products, cleaning products etc., can be kept. They should be at least 1.5m out of the reach of children. Products should be returned to their safe storage place immediately after use. Children should not self-administer any medication, including paracetamol.
Out-of-date or unwanted medicines or chemicals should be disposed of promptly. A check should be made every three months. Purchase household products in child resistant containers. Check that the garden does not have poisonous plants.
All chemicals and medications should be kept in their original, properly labelled containers, and never put chemicals into a container that may be or was used for drink or food.
If a case of poisoning occurs, ring a GP or the poisons information centre in your state immediately.
Further information on preventing childhood injury
The New Children’s Hospital, Westmead.
www.chw.edu.au/parents
Recognising child abuse
Child abuse and maltreatment is one of the most significant public health problems in Australia and one that is under-recognised. Its early detection and prevention through family intervention can mean the difference between a ‘normal life’ and one scared by chronic mental health problems, especially depression, anxiety and substance abuse. (Such problems are four times as common in adults who were abused as children.)
As well as physical, emotional (or psychological) and sexual abuse, this problem includes neglect of the child’s need for attachment, nurturing and stimulation.
Intervention is especially crucial if the affected child is very young as the most influential period of psychological development is the first three years of life and neglect during this time can have long-lasting consequences. Abuse by the main care givers (this is usually the parents) is the most damaging.
In 1999 about 100,000 reports of child abuse were made in Australia, with about 33 per cent being substantiated. Girls are more at risk of sexual, educational and nutritional neglect while boys and young children generally are at greater risk of physical abuse.
Risk factors for child abuse can be divided into parent / carer factors and child factors. The more factors that are present, the greater the risk.
Parental factors
- History of child abuse (About 33 per cent of adults abused as children will abuse their children.)
- Mental health problems, including depression, low self-esteem, personality / relationship disorders, self-harm / suicide, eating disorders, sexual difficulties
- Social isolation, especially if there is a lack of child care options / family support
- Socioeconomic hardship, especially in single parent families
- Unstable relationships, especially where separation / divorce has occurred
- Aggression, poor impulse control
- Substance abuse
- Unrealistic expectations of the child
- Lack of knowledge regarding child development
Child factors
- Prematurity
- Disability or chronic illness
- Unwanted pregnancy
- Hyperactivity / other behavioural problems
Symptoms and signs of child abuse in the child
- Physical: Unusual / unexplained bruises, cuts, burns, fractures, brain injury and bleeding into the eyes from shaking, abdominal injuries from punches / kicks, genital injury
- Complaints: Anal or vaginal pain, urinary symptoms, abdominal pains, eating problems including anorexia, nightmares, insomnia, changes in mood (withdrawal / aggression / tantrums)
Prevention of child abuse
Identifying at risk parents during pregnancy and after birth is important as they can be helped by parenting programs and by home visitation programs e.g. by early childhood nurses
Reporting suspected cases is a role all adults can adopt (not just health professionals and teachers) and all adults need to help support relatives and friends with young children.
Other resources
National Association for the prevention of Child Abuse and Neglect
www.napcan.org.au
US Child Trauma Academy
www.childtrauma.org
See separate sections for the following topics
Infectious disease prevention
Developmental milestones in children
Dental health
Preventing and addressing anxiety disorders in children - An important parenting issue
Sleep in children
Driver safety and teenagers
Further information on parenting
The Children’s Hospital at Westmead.
This hospital is one of the two main paediatric teaching hospitals in Sydney. Its web site (www.chw.edu.au/parents) is a great source of information on children’s health topics. It provides fact sheets about many child health issues that are free and downloadable and lists books on most child health topics that have been assessed by members of the medical staff at the hospital. These books are available for purchase from the Kids Health Bookshop at The Children’s Hospital at Westmead (Phone 02 – 9845 3585) or they can be purchased via the ‘e-shop’ on the web site. Any profits go into supporting the work of the hospital.
Some suggested books on parenting children
Every parent. A positive approach to children’s behaviour by Matthew R Sanders, PhD.
More Secrets Of Happy Children by Steve Biddulph
Raising Kids- A parent’s survival guide by Charles Watson, Dr Susan Clarke and Linda Walton.
Bully Busting by Evelyn M. Field
Raising Boys by Steve Biddulph
Your Child's Self Esteem by Dorothy Corkhille Briggs
(All these books and many more appear in the ‘self esteem, behaviour and family life’ section of the books section in parents section of the Children’s Hospital at Westmead web site. (https://kidshealth.schn.health.nsw.gov.au/bookshop-and-products) There is information about each book on the web site; just click over the title.) Better still, for parents able to visit the hospital, most of the books are available to view and there will be someone there to help with book selection.)
Some suggested books on parenting adolescents
What to do when your children turn into teenagers by Dr D. Bennett and Dr Leanne Rowe (This is a wonderful book that is unfortunately now out of print. Second hand copies may still be available.)
You can't make me by Dr D. Bennett and Dr Leanne Rowe
I just want you to be happy. Preventing and tackling teenage depression. by Professors Leanne Rowe, David Bennett and Bruce Tonge. Published by Allen and Uwin, 2009.
Puberty boy by Geoff Price
Puberty girl by Shushann Movsessian
The puberty book by Wendy Darvill and Kelsey Powell
Teen esteem by Dr P. Palmer and M. Froehner
Most children suffer anxieties at some time and another book (not on the above list) that is very useful for parents is - Helping your anxious child. A step by step guide for parents. by Rapee, R., Spence, S., Cobham, V. and Wignall, A.New Harbinger, 2000.
The Resilience Doughnut parenting program to help build child resilience
The Resilience Doughnut Program is outlined in a book published by Lyn Worsley, which can be purchased through her website: www.lynworsley.com.au (The cost is about $30)
Triple P Positive Parenting Program
www.triplep.net.
Child and Youth Health
Parenting and child and youth health; links to research updates; telephone helps lines for parents and youth.
www.cyh.com
Further information on sexual health
Sexual health information
www.shinesa.org.au
Family Planning NSW
https://www.fpnsw.org.au
The Resource Center for Adolescent Pregnancy Prevention web site
(A good USA site that provides information and skills for both adolescents and for educators about preventing unwanted teenage pregnancies.)
www.etr.org/recapp
Further reading regarding teenager sexual health
Sexwise by Dr Janet Hall. Published by Random House Australia.
(What every young person and parent should know about sex. Dr Hall empowers her readers by telling them the facts - and giving it to them straight.)
Unzipped by Bronwyn Donaghy. Published by Harper Collins
(A book that deals frankly and sympathetically with the crucial role that love and emotions play in every aspect of adolescent sexuality.)
Further titles regarding puberty and adolescent sexuality are available on the Children’s Hospital at Westmead web site. www.chw.edu.au/parents/books. (Both the above books are mentioned on this web site and are recommended by staff at this hospital.)