Preventing childhood injury in the home

When you are in the business of advising on best health outcomes for children, injury prevention, including firearms and ATVs, is one of the top priorities. At the session, "Injury Prevention 101: Staying Safe at Home," Maneesha Agarwal, MD, FAAP; and Sofia Chaudhary, MD, FAAP, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, offered key tips to maintaining child safety in a number of areas. Preventable injuries are the number #1 killer of children, a sobering statistic, with more than 50% of injury deaths unintentional. Here is what they shared.

Sleep
With some 3500 sleep-related infant deaths annually, Agarwal and Chaudhary offered this advice to share with caregivers:
-put the child on their back for every sleep session
-use a firm, flat, noninclined sleep surface
-always move the child for sleep (when possible) from a seated device to a flat surface
-avoid soft objects and loose bedding

Other suggestions included using a pacifier at naptime and bedtime; avoid overheating and head covering; not using weighted swaddles or adding weighted objects; and avoid such products as infant loungers, crib bumpers, and weighted sleep sacks when putting the infant to sleep.

Firearms
Firearms are the leading cause of death for children aged 1 to 19 years, and with a declared gun violence epidemic in the United States, firearm safety has never been more crucial. Risk factors for firearm mortality include being a male teenager, living in a low-income area, and living in a city. Agarwal and Chaudhary also noted that 4.6 million children live in a home with a loaded or unlocked gun. In light of this, the presenters recommend that firearms be locked and unloaded, with ammunition locked and stored separately. To further prevent gun violence, pediatric health care providers are urged to ask about guns in the home during a patient visit, including asking about availability, counseling for safe storage device. “Keep the conversation neutral, respect gun ownership, make it routine, and just focus on child safety,” said Agarwal.

ATVs
All-terrain vehicles (ATVs) are currently used by 20% to 95% of youths. There are now more ATV deaths than bicycle crashes, with those at high risk including being younger males driving adult-sized ATVs on public roadways; night-time use of vehicle; and the use of alcohol or a substance before driving. Lack of helmet-wearing, supervision, and training add to these risks.

Recommendations here include that only children aged 17 years or older drive an ATV; mandatory use of helmets; and use of youth-sized ATVs. Formal training is also recommended (ATVsafety.org), along with helmets and protective gear (eg, gloves, pants). Additionally, educate the child on ATV safety even if there is no ATV in the home (the child can use a friend’s ATV or use one on vacation, etc).

Sports
With children now back to full-time recreational and competitive sports and activities, emergency departments (EDs) are filled again annually with accidents from bicycling (26,000), skateboarding (6000), snow sports (4300), horseback riding (3600), ice skating (1600) and roller skating (1100). The key to prevention here, no surprise is also helmet efficacy. Encouraging both children and parents to use helmets for these types of activities is key to injury prevention. Strategies to improve helmet use include community education, helmet giveaways and increasing availability at point of sales and rentals.

Reference
Agarwal M, Chaudhary S. Injury prevention 101: staying safe at home. 2022 AAP National Convention & Exhibition. October 11, 2022. Anaheim, California