Safety /Prevention of injury in preschool children

Aim of assessment

The purpose of this report is for students to acquire knowledge about contemporary issues that are relevant to the health and wellbeing of young Australians and identify the risks and safety factors required in their application to nursing practice.

Details

Students will undertake a report into a key health issue that has been identified by unit staff from the document ARACY report card: The wellbeing of young Australians, 2013.

Topic of report: The safety / prevention of injury in Australian children / adolescent.

Choose a specific age group (infant, or toddler or preschooler or school age or adolescent).

Write the report for the nursing profession that highlights the issue, its contributing factors the impact on the family and recommendations for nursing practice.

Students are expected to make recommendations for nursing practice based on their research that are aligned to health promotion and prevention of health issues.

Use the structure provided on vUWS to construct the report.

Consult your campus coordinator or workshop lecturer if you are unclear about what you have to do.

Report writing is an essential skill for professionals. A report aims to inform, as clearly and succinctly as possible. A report is similar to an essay in that both need: formal style ,introduction, body and conclusion ,analytical thinking, careful proof-reading and neat presentation . A report differs from an essay in that a report: presents information, not an argument ;is meant to be scanned quickly by the reader ;uses numbered headings and sub-headings ;is often followed by recommendations and/or appendices . (University of Canberra, 2012 ) Retrieved from www.canberra.edu.au/studyskills/writing/reports

Safety /Prevention of injury in preschool children

Purpose

The purpose of this report is to examine the safety issues, their contributing factors and how they can be prevented and the role of the nurse in preventing injuries.

Introduction

The ARACY report card on the wellbeing of Australian children 2013 has cited injury as a leading cause of death among Australian children and youth (0-14years). In comparison to other OECD countries, Australia is doing poorly in preventing injuries (ARACY, 2013).While most of these injuries are preventable, most parents and caregivers only think of the risk after the event. Injury is also the second most common reason for hospital admission for children. Of particular concern are preschool children who are independent and very adventures, falling risk to such injuries as falls, drowning, cuts, piercings, burns, scalds, poisoning and animal related injuries such as dog bites (Centre for Community Child Health, (nd)). Other than death, serious injuries can result in long term effects such as disfigurement and disability which is a major problem for the family due to financial constraints and care and attention needed. It is therefore necessary to reduce the number and the severity of childhood injuries.

Definitions

Safety- the state of being at little or no risk of injury (NPHP, 2005)  

Injury- the physical harm that occurs on a person’s body (NPHP, 2005)

 Preschool children- children between 31/2 -5 years (Kidsafe 2010)

Background

Most injuries can be prevented by identifying and removing their causes or reducing children’s exposure to them. Injuries are a major public health concern in Australia; with the Australian government identifying injuries in children aged 0-14 as a priority issue in 2004 Australian Institute for Health and Welfare (AIHW 2006). More children die from injuries than from cancer and diseases of the nervous system. Moreover, around 300 children die and about 60,000 are hospitalized annually from accidental injuries with children under five being most affected (Kidsafe, 2010).

Preschoolers are at a learning stage and tend to be independent and adventures. They want to play and explore their environments and products around them. Since it is from these environments and products that they get these injuries, it is important that parents and caregivers such as health workers and preschool teachers ensure that the environments are safe and provide supervision. Products to which children are exposed and those designed for use in child care should also be made safe (NPHP, 2005).

Discussion

The AIHW identified several factors that contribute to injuries in children. These factors are:

  • Boys are at a greater risk of injury resulting in hospitalization than girls, about 60%. This is due in part to the fact that boys tend to be more adventurers and the nature of the games they get involved in. while girls play more safe games, boys are into more risky games.
  • Social disadvantage. Children from poor social backgrounds are at higher risks of injuries.
  • Risk of injury depends on the age. Hospital admissions resulting from burns, near drowning and poisoning are more common in infants and children (0-4 years)

Factors associated with specific injuries in preschoolers include:

Falls, drowning, and transport accidents were the major reason for deaths resulting from accidental injuries (AIHW, 2007). The major causes of hospitalization was injuries from falls, being hit or struck by a person or object, cuts and piercings, animal related injuries, transport, burns, scalds, and poisoning.

Falls- falls are from scooters, bicycles, beds, chairs and preschool furniture and playground equipment (Kidsafe, 2010). The outcome of a fall depends on the height involved. In 2001, there were 135 cases of injuries from low falls and 6 cases from high falls in preschool children (ABS, 2003).

Cuts and piercings result from knives, and sharp objects and striking against edges of furniture. Jammed doors and heavy falling objects could result in crushing injuries.

Choking or suffocation resulted in 55 deaths in 2002 (ABS, 2007). This resulted from inhalation of food and other small objects. On the other hand, strangulation in bed resulted in 11 deaths. Entrapment in cabinets can also result in suffocation.

Dog bites are the most common cause of animal related injuries resulting in hospitalization. Preschoolers are often bitten on their heads and face due to their height. These incidents often occur at the children’s own home or where the child has gone to visit.

Most transport related deaths resulted from injuries from car crashes and drive way run-overs. Due to their size, preschoolers are often run over in the drive way as drivers reverse. This is also referred to as low speed vehicle run over and it may occur in the drive way, parking lot or off- road (Anthikat,  & Barker, 2013). Death also results if children are not properly restrained in the vehicle in the event of a crash.

Drowning or near drowning occurs in backyard or private swimming pools. In 2002, almost half all deaths by drowning in children 0-4 years occurred in swimming pools (Medscape, (nd)) while falling into water bodies such as dams and objects containing water resulted in almost a quarter of drowning deaths.

Poisoning from medicines is most common from in three year old children. The most common cause of poisoning death in preschoolers is from cardiovascular medications often found at home. Paracetamol and analgesic drugs constitute the leading cause of poisoning that leads to hospitalization. However, death and long term injuries from these drugs are rare. The low severity levels could be as a result of legislation on availability of poisons in Australia (Connor, 2001).

Burns and scalds result from hot beverages, hot tap water, oil and food and hot household appliances. In 2001, hot beverages, food, cooking oil and fats were the major cause of burns and scalds in preschoolers.

Preventing injuries

To ensure safety, engineering, education and enforcement are three aspects that must be considered. Engineering refers to designing and modifying the environments in order to eliminate hazard. Enforcement on the other hand refers to regulations and standards that require compliance. Education refers to the attitude and behavior change that is required to eliminate injuries (Pearson, et al. 2010). Engineering, education and enforcement could work hand in hand. Engineering and enforcement measures include:

Bicycle helmets- ensure that it fits and has the Australian/ New Zealand Standards label

Keep medicines and poisons out of reach of children- they should be tightly closed and stored in closed cabinets. Where possible, buy medication with child resistant lids.

Keep children out of the kitchen.

Supervise children while they eat to prevent choking.

Supervise children at swimming pools and get them professional training. Cover fish ponds and do not let them walk alone around any water bodies.

Matches and cigarette lighters should be kept out of reach.

Children should be well restrained in vehicles and should not be left alone.

Ensure safe water temperatures- temperatures should be less than 500 Celsius. Keep hot liquids and food at the center of the table or where the children cannot reach them.

The swimming pool area should be properly fenced

Install smoke alarms.

Bumps should be installed and speed limits introduced in neighborhoods

Replace broken window panes

Parents and care givers should learn first aid

Education interventions can take place at school, at home, in the community, in clinical settings and in the mass media.

At school, there should be active supervision for the preschoolers, play equipment and other structures should be properly maintained and a regular hazard and safety checks should be conducted. The school should involve the children’s parents in injury prevention.

At home, nurses and other professions should make home visits and conduct training especially for disadvantaged groups.

In clinical settings, safety education should combine counseling on behavior and attitude change and demonstrations.

The mass media is critical in informing and educating the public on safety and prevention of injuries. They do this by carrying out exhibitions and campaigns.

In the community, social and environmental interventions are employed. The community and professionals create tailor made solutions to the safety problems.

Overall, the education approaches that will have an impact in reducing injuries to preschoolers include: educating the parents in order to change behavior and attitudes, close and continuous supervision, creating a social environment that promotes safety, and creating a physical environment that is safe through design, policy and legislation.

The impact of injuries on the family:

Child injuries result in economic costs for the family due to the medical bills incurred. Most injuries from falls, and transport involve the head and neck which would take long periods of time to heal or in other cases, results in disability. There is significant psychological stress involved in caring for disabled children. The costs could strain families especially the socially disadvantaged who may not have enough to meets all their basic needs. This results in the family not meeting its nutritional, communication and rest needs. They also result to psychological, social and emotional problems for parents, siblings and care givers. In some cases, marriages and sibling relationships have been strained and in few cases detrimental (Shudy, et.al, 2006).

Recommendations

The role of the nurse among other health workers in preventing injuries cannot be ignored. They are involved in conducting home visits to care for patients and while at it, they also conduct training for parents and care givers and provide advice. Nurses are also involved in counseling parents and children who have been involved in injuries in order to help them in the recovery process. They also provide materials such as checklists, and information leaflets.

The nursing practice, in recognizance with the alarming statistics, should become more involved in preventing injuries through safety training, education and counseling. They should work hand in hand with other professionals involved in providing safety environments and appliances. This will provide a holistic means of ensuring safety of preschoolers and all children and youth. As health care moves towards patient- centered care and research provides guidance for widespread fall prevention, fall and fall-related injuries have the chance to be addressed across the healthcare system. Nurses should ensure that no fatal injuries result while patients are in hospital (Currie, 2008).

Conclusion

While injuries are the major cause of death and the second most common reason for hospitalization in children, they are preventable. Parents, care givers, health workers and other professionals should play an active role in preventing preschool injuries. Education, engineering and enforcement should be considered in ensuring safety and injury prevention. There are risk factors associated with various injuries such as age and sex. Boys are at a higher risk of dying and getting serious injuries than girls. There are different risks at different ages and social disadvantage is also a factor. Injuries have a major impact on the family’s economic, social and psychological status. Injuries are also a public health issue because of the burden placed on the health care system through disability and premature death (DHHS, (nd)).

References

Anthikat, P., Page, A., & Barker, R. (2013) Risk factors associated with injury and mortality

ARACY (2013) Report card: The well being of young Australians.pdf.

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