Search

Among 1-19-year olds, unintentional injuries accounted for 12% of 5.1 million global deaths from injuries in 2010. Despite this high burden, childhood injuries have not received much attention in global health. This paper describes the major causes of deaths from childhood unintentional injuries and provides a review of interventions for reducing this burden. About 627,741 deaths were due to unintentional injuries in 2010 among 1-19-year olds. The proportionate mortality increased with age-from 12.6% among 1-4-year olds to 28.8% among 15-19-year olds. Deaths from Western sub-Saharan Africa and South Asia accounted for more than 50% of all deaths. Rates in these regions are 68.0 and 36.4 per 100 000 population, respectively, compared to 6.4 in Western Europe. Road traffic injuries (RTI) are the commonest cause of death, followed by deaths from drowning, burns and falls. Male children are more predisposed to unintentional injuries except for burns which occur more frequently among females in low and middle income countries (LMICs). Effective solutions exist--including barriers for preventing drowning; safer stoves for burns; child restraint systems for RTI--but the effectiveness of these measures need to be rigorously tested in LMICs. The general lack of a coordinated global response to the burden of childhood unintentional injuries is of concern. The global community must create stronger coalitions and national or local plans for action. Death rates for this paper may have been underestimated, and there is need for longitudinal studies to accurately measure the impact of injuries in LMICs.

Since vision is the major sensory modality in humans, normal vision is important for the general development of a child.1 2 Visual impairment has significant implications for the affected child and family in terms of education, future employment, and personal and social welfare throughout life. Using the World Health Organisation (WHO) classification of levels of visual impairment3 (shown in table 1 and used throughout this paper), it is estimated that globally almost one in 1000 children are blind, which is less than a tenth of the prevalence in adults.4 5 However, the 1.5 million blind children in the world account for about 75 million person years of blindness,6 equivalent to the burden due to cataract related blindness, which accounts for 40% of adult blindness worldwide.7 As the combined categories of low vision in childhood (table 1) are three to 10 times more common than blindness,5 6 the total burden of childhood visual impairment is considerable. It has been estimated that globally, the financial costs of childhood blindness incurred by countries, in terms of care and productivity lost, are between 6 and 27 thousand million US dollars.8 Most of this is accounted for by children in high income countries where childhood blindness is less common but life expectancy and earning capacity are greater than in low income countries. Reduction of avoidable visual impairment remains an important international public health goal. View this table: Table 1 WHO classification of levels of visual impairment (adapted from International Classification of Diseases, 10th revision3) Knowledge of the magnitude and causes of childhood visual impairment is important to the planning, provision, and evaluation of educational and health services for affected children. This is also essential information for all strategies to reduce visual disability in the population. The purpose of this paper …

Imaging has many uses, but in cases of suspected child abuse, radiographs and CT scans are vital in identifying fractures and head injury that may not be clinically obvious. There are growing concerns about the small but potential adverse effects of radiation, including cancer, in the paediatric population as a result of imaging. The vast majority of general paediatricians undertaking child abuse assessments request skeletal surveys and CT scans, subjecting children to significant amounts of radiation. Informed consent must be taken from parents for these procedures and therefore this paper aims to look at evidence of the dangers of radiation in children and raise awareness among paediatricians.

Despite the fall in numbers of unexpected infant deaths that followed the ‘Back to Sleep’ campaigns in the early 1990s in the UK and many other countries, such deaths remain one of the largest single groups of deaths in the postneonatal period in many Western countries. Changes in the ways in which unexpected infant deaths are categorised by pathologists and coroners, and increasing reluctance to use the term ‘sudden infant death syndrome’, make assessment of nationally and internationally collected data on incidence potentially inaccurate and confusing. In this paper, we review current understanding of the epidemiology and aetiology of unexpected deaths in infancy, and current hypotheses on the pathophysiology of the processes that may lead to death. We also review interventions that have been adopted, with variable degrees of effectiveness in efforts to reduce the numbers of deaths, and new approaches that offer the possibility of prevention in the future.

While prevention of iatrogenic harm is a sufficient priority to determine service structures and practice, the concept of harm is largely restricted to the physical. Psychological harm has received scant attention despite its importance, particularly for children and adolescents. A professional climate increasingly reliant on measurement and evidence and coloured by fear of litigation contributes to perpetuating the anomaly. The aim of this paper is to consider how and why iatrogenic psychological harm may happen, why i-dt matters, how it may be manifest and how it may be prevented. Prevention of psychological harm should be as great a priority as that of physical harm.

Standardised developmental tests are now widely used in neurodevelopmental assessments of infants and children. In 2006, the revised and updated version of the Bayley Scales of Infant and Toddler Development (version III) replaced the previous version and is now widely used in neonatal developmental follow-up clinics. Several papers from Australia have highlighted underestimation of developmental impairment up to age 2 using this revised version. We aimed to ascertain how a cohort of healthy 3-year-old children performed compared to the standardised norms of the Bayley Scales of Infant and Toddler Development (version-III).Term healthy newborn control infants from the prospective Development after Infant Surgery (DAISy) study were included. At 3 years of age, the mean scores on each of the five subscales for 156 children were compared with the standardised norms.At 3 years of age, the mean scores were higher than the standardised norms on four of the subscales, cognition (0.05), receptive and expressive language and fine motor (p0.001). There was no significant difference in the gross motor scale (p=0.435).Healthy term Australian children have a statistically significantly higher mean score on the Bayley Scales of Infant and Toddler Development (version-III) compared with the standardised means in four of the subtests, with the greatest difference in receptive language. This has implications for the assessment of children as the test may miss those with a minor delay and not reflect the severity of delay of infants that it does identify. We recommend that consideration ought to be given to re-standardising this assessment on Australian children.

Non-accidental injury (NAI) in children under the age of 17 years has an estimated incidence in the USA of 2.5%, and is considered to be on the increase.1 The range of skeletal, intracranial, and orbital manifestations in NAI have been well described.2-8 In comparison, visceral manifestations (excluding the superficial and cutaneous injuries) are much less common and less well recognised; they are considered to contribute less than 2% of injuries in NAI.9 Abdominal injuries in NAI arise mainly from blunt trauma, and include contusion, laceration, and rupture of solid or hollow viscera, for example of the liver, spleen, pancreas, kidneys, and bowel. Duodenal haematomas and mesenteric tears may also occur. Vascular injuries are less common and include avulsion of the superior mesenteric artery and pseudoaneurysms of the abdominal aorta.10 Chylous ascites after abdominal trauma has been described.11 Blunt thoracic injuries commonly result in rib fractures in the infant, but intrathoracic visceral injuries are much less common than abdominal visceral injuries.12 The former include lung contusions, chylothoraces, and cardiac lacerations and rupture.11 13 Superficial and cutaneous injuries, for example, bruises, cuts, burns, injuries to the pinna, frenulum of the mouth, and genitalia can impart information on the mechanisms of injury. They are well described and are not discussed in detail in this paper. Patients with visceral manifestations of NAI have been selected from a group of 300 patients referred or admitted for alleged physical abuse. The cases include pharyngeal, abdominal, and pelvic trauma. The radiological findings are illustrated and correlated in all cases bar one, with surgical or postmortem findings. ### PATIENT 1: PHARYNGEAL TRAUMA AND PHARYNGEAL FOREIGN BODY A 7 week old infant was brought by her father to a casualty department with respiratory distress. Stridor, drooling, and mild desaturation were noted. She had blood in the oropharynx, and a soft tissue …

Child pedestrian accidents are the most common road traffic accident resulting in injury. Much of the existing work on road traffic accidents is based on analysing clusters of accidents despite evidence that child pedestrian accidents tend to be more dispersed than this. This paper analyses pedestrian accidents in 573 children aged 0-11 years by a locally derived deprivation score for the years 1988-90. The analysis shows a significantly higher accident rate in deprived areas and a dose response relationship between degree of deprivation and accident rates. At the level of individual deprivation zones a strong correlation between accident rates and the degree of deprivation has been demonstrated. It is suggested that area wide engineering and educational schemes should be targeted at areas with high accident rates. Environmental improvements based on analysis of clusters of accidents may not be the most suitable method for reducing child pedestrian accidents.

This paper considers the response that is required by paediatricians to the increasingly recognised problem of Domestic Abuse. The evidence for the damage that living with abuse does to children is reviewed. In many areas midwives and health professionals in Accident and Emergency are beginning routine enquiry for domestic abuse. Police called to incidents where there are children in the family are informing health visitors. Paediatricians cannot ignore this problem and need to address it in the care of their patients. A Paediatrician's responsibility within the multi-agency context is set out. This is not only to act but also to ensure they can do so competently.

Injuries are the leading cause of death among children and young people in the industrialised world and are a major contributor to disability.1 2 In the early 1990s, both the UK Department of Health3 and the Scottish Office4identified accidents as a priority area for action in their respective policy statements. However, efforts to formulate and implement local, national, and international preventive policies have been hindered, at least in part, by the paucity of reliable data on injury frequency, cause, and outcome. Many countries compile routine data on injuries derived from mortality statistics, occupational records, or through incident reporting—for example, to police and fire departments.2 5-7 These data are of variable relevance and quality, however, and are often inaccessible. The establishment of specially designed injury surveillance systems is widely advocated as a prerequisite for the development and evaluation of injury prevention strategies, particularly at a local level.4 7 8 This paper reviews the published literature on injury surveillance based at accident and emergency departments and attempts to identify the characteristics of a successful injury surveillance system (ISS). Surveillance has been defined as the “continuous analysis, interpretation and feedback of systematically collected data”.9 It implies a proactive mechanism for identifying problems and implementing appropriate preventive strategies on a routine basis. Injury surveillance may be regarded as a specific form of public health audit. It can be designed to generate information on both the numbers and characteristics of injuries, such as the injury location, circumstances, cause, and mechanism. This information is crucial for detecting trends in injury incidence, identifying risk factors, developing injury control measures, and assessing their impact. This process is thus an epidemiological means to a public health end, namely prevention. As it is likely that most moderate and serious injuries present to hospital …

We were interested in the paper by Srinivasan et al 1 as it brings into focus the differences in the epidemiology of firearm injuries in children and young people between the USA and the UK and the importance that gun control has had in child and adolescent safety here. Through the Child Death Review in Wales, we have previously reviewed deaths from firearm injuries in the UK. This followed the death in Wales of a young person by his own hand using a shotgun. This prompted us …

See related article on page 10 The term failure to thrive (FTT) can imply very different conditions, depending on the context. To a general paediatrician, it might conjure up a respectably clad child, sitting on an anxious mother's lap as you study growth charts and test results in the hope of inspiration. To a social worker it might imply a wasted, miserable child found in a cold, dirty house. These differing images reflect not just the wide range of children who might receive the label “failure to thrive”, but also a diversity of ideas about what FTT is and how it should be managed. The term was first coined to describe a syndrome of delayed growth and development also called the “maternal deprivation syndrome”.1 Although it is now accepted that FTT has a predominantly nutritional cause,2the implication of an association with emotional and physical deprivation persists. However, all the early studies were of highly selected children, referred to hospital, and it is only in the past 15 years that population based studies have been conducted. What light have these studies shed on the subject and what implications do they have for practice? FTT has been defined as “a failure of expected growth (usually weight) and well being”.3 Therefore, does this make it a problem of growth alone, or something more? A previous consensus concluded pragmatically that definitions should be growth based, because growth can be measured objectively, whereas well being cannot.4 However, even growth based definitions present problems. Many reference texts and research papers provide no objective definition, and the remainder offer a wide range of differing criteria.5 The most common definitions require cases to drop below a low centile, a method that identifies many children with poor weight gain. However, such approaches will …

BACKGROUND The design of childhood injury prevention programmes is hindered by a dearth of valid and reliable information on injury frequency, cause, and outcome. A number of local injury surveillance systems have been developed to address this issue. One example is CHIRPP (Canadian Hospitals Injury Reporting and Prevention Program), which has been imported into the accident and emergency department at the Royal Hospital for Sick Children, Glasgow. This paper examines a year of CHIRPP data. METHODS A CHIRPP questionnaire was completed for 7940 children presenting in 1996 to the accident and emergency department with an injury or poisoning. The first part of the questionnaire was completed by the parent or accompanying adult, the second part by the clinician. These data were computerised and analysed using SPSSPC for Windows. RESULTS Injuries commonly occurred in the child’s own home, particularly in children aged 0–4 years. These children commonly presented with bruising, ingestions, and foreign bodies. With increasing age, higher proportions of children presented with injuries occurring outside the home. These were most commonly fractures, sprains, strains, and inflammation/oedema. Seasonal variations were evident, with presentations peaking in the summer. CONCLUSIONS There are several limitations to the current CHIRPP system in Glasgow: it is not population based, only injuries presented to the accident and emergency department are included, and injury severity is not recorded. Nevertheless, CHIRPP is a valuable source of information on patterns of childhood injury. It offers local professionals a comprehensive dataset that may be used to develop, implement, and evaluate child injury prevention activities.

Authors Lee and Mann argue for law compelling use of cycle helmets by children to prevent road deaths and serious injuries.1 This observer is surprised that the peer reviewers allowed publication of material lacking evidence either that the actual risks faced by child cyclists justify compulsion, or that the real world results of helmet compulsion in other countries justify compulsion in this country. These shortcomings are typical of papers in the medical literature that attempt to address the issue of cyclist safety. I believe that these chronic shortcomings are primarily the consequence of the failure of the peer review process. In the first place, it is irrational that consideration of helmet laws for children is restricted only to cycling, or even begins with cycling. Although, tragically, around 30 child cyclists have been killed on public roads annually in recent years, typically 110 child pedestrians are killed annually.2 Estimates of death risk per kilometre travelled derived from standard data sources3 do not suggest that child cyclists face greater risks than child pedestrians in most age groups. It is in any case evident that the average child is almost four times …

Editor,—In the paper by Barker et al on injuries and disabilities in teenagers and young adults the information obtained from the patients would appear to have been largely, if not wholly, derived from questionnaires,1which is likely to have been subjective and therefore biased. Specifically, ‘disability’ …