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OBJECTIVE. Because an increasing proportion of US children spends time in day care center environments, a national estimate of injury risks in day care centers is needed. METHODS. We interviewed directors of 1797 day care centers from every state and the District of Columbia from October to December 1990 and analyzed medically attended injuries and center characteristics reported by the directors. RESULTS. The centers were attended by 138,404 children. In the 2 months before the center directors were interviewed, 556 children sustained injuries requiring medical attention while attending the centers. The injury rate was 1.5 injuries per 100,000 child hours in day care. The most common injuries were cuts or lacerations (31%), bumps or bruises (15%), fractures (10%), and dental injuries (8%). Most injuries (51%) occurred on the playground. Many injuries (18%), and more than half of fractures and concussions (53%) were due to falls from climbing equipment. CONCLUSIONS. Day care center injury rates estimated by this study were relatively low. Many injuries that occur in this setting are probably minor. However, lowering the height of playground equipment and providing more resilient playground surfaces could further reduce injury risks in day care centers. [ABSTRACT FROM AUTHOR]

Background: Because injuries are the leading cause of death in children, injury prevention counseling is recommended as part of routine pediatric care. Increasing such counseling is a national health objective. Estimating the proportion of US children who receive such counseling and assessing their compliance with safety recommendations may help improve counseling efforts., Methods: Respondents to a 1994 random digit-dial telephone survey of the US population were asked about receipt of age-appropriate injury prevention counseling at a medical visit and related safety practices for a randomly selected child 0 to 14 years of age in the household (N = 1596)., Results: Receiving any injury prevention counseling was reported for 39.3% of children 0 to 14 years old who had a medical visit in the past year and was more common among children who were younger, lived in urban areas, and lived in poverty. In general, receiving counseling was associated with safer behaviors. Counseling about ipecac was reported for 17.2% of children 0 to 6 years old; having ipecac in the home was more likely for those counseled (73.4% vs 32.0%). Counseling about posting the poison control number was reported for 24.9% of children 0 to 6 years old; posting this number was more common among those counseled (79.3% vs 52.6%). Counseling about bicycle helmets was reported for 18.6% of children 5 to 14 years old; a report of always wearing a helmet was more common among those counseled (43.9% vs 19.1%). Counseling about car seats and safety belts was reported for 25.4% of children 0 to 14 years old; a report of always using occupant restraints was more common among those counseled (89.0% vs 78.2%)., Conclusions: Injury prevention counseling is associated with reported preventive safety practices among US children, but a relatively small proportion of households with young children report receiving such counseling. Health care providers should increase efforts to provide injury prevention counseling. counseling, wounds and injuries, child, accident prevention.

Objectives: To determine the prevalence of proper fencing around outdoor swimming pools among US households and to describe this fencing in relation to demographic and other household factors. To estimate the number of drownings among children <5 years of age that might be prevented by having proper fencing around all residential pools in the United States., Methods: A 1994, randomly dialed national telephone survey contacted 5238 adults who reported demographic information and household characteristics including whether the household had an outdoor swimming pool and the fencing around the pool. Data were weighted to obtain national estimates and percentages. The number of preventable drownings was estimated with a population-attributable risk equation., Results: Approximately 18.5 million American households owned or had access to an outdoor swimming pool in 1994, and 76% (13.9 million) of them appeared to have had adequate fencing. Adequate fencing was associated with household income and type of home. We estimate that 19% of pool-related drownings among children <5 years of age in 1994 (88 drownings) might have been prevented if all residential pools in the United States were properly fenced., Conclusions: Adequate pool fencing prevents a child from having access to a swimming pool if a responsible adult is not present and has been promoted as a method to prevent drowning. Our research suggests that even if all residential pools in the United States were properly fenced, most drownings among children <5 years of age would not be prevented. Thus, additional strategies to prevent drowning will be needed.

Objective: To estimate the potential benefit of increasing bicycle helmet use among children and adolescents in the United States., Design: All bicycle-related deaths (Multiple Cause-of-Death Public Use Data Tapes, 1989 through 1992) and bicycle-related injuries treated in sampled emergency departments (National Electronic Injury Surveillance System, 1989 through 1993) were used to calculate traumatic brain injury-associated death and head injury rates per 1,000,000 US residents. Preventable injuries and deaths were estimated by calculating the population-attributable risk of head injury due to nonuse of bicycle helmets., Patients: US residents aged 0 through 19 years who were injured or who died as a result of a bicycle crash., Results: An average of 247 traumatic brain injury deaths and 140,000 head injuries among children and adolescents younger than 20 years were related to bicycle crashes each year in the United States. As many as 184 deaths and 116,000 head injuries might have been prevented annually if these riders had worn helmets. An additional 19,000 mouth and chin injuries were treated each year. The youngest age groups had the highest proportions of both head and mouth injuries., Conclusion: There continues to be a need to advocate for greater use of bicycle helmets, particularly among young children. Helmet design changes should be considered to prevent mouth injuries.

Objectives: To update data on fatal dog bites and see if past trends have continued., Design: To merge data from vital records, the Humane Society of the United States, and searches of electronic news files., Setting: United States., Subjects: U.S. residents dying in the U.S. from 1989 through 1994 from dog bites., Results: We identified 109 dog bite-related fatalities, of which 57% were less than 10 years of age. The death rate for neonates was two orders of magnitude higher than for adults and the rate for children one order of magnitude higher. Of classifiable deaths, 22% involved an unrestrained dog off the owner's property, 18% involved a restrained dog on the owner's property, and 59% involved an unrestrained dog on the owner's property. Eleven attacks involved a sleeping infant; 19 dogs involved in fatal attacks had a prior history of aggression; and 19 of 20 classifiable deaths involved an unneutered dog. Pit bulls, the most commonly reported breed, were involved in 24 deaths; the next most commonly reported breeds were rottweilers (16) and German shepherds (10)., Conclusions: The dog bite problem should be reconceptualized as a largely preventable epidemic. Breed-specific approaches to the control of dog bites do not address the issue that many breeds are involved in the problem and that most of the factors contributing to dog bites are related to the level of responsibility exercised by dog owners. To prevent dog bite-related deaths and injuries, we recommend public education about responsible dog ownership and dog bite prevention, stronger animal control laws, better resources for enforcement of these laws, and better reporting of bites. Anticipatory guidance by pediatric health care providers should address dog bite prevention.

Objective: Dog bites cause an estimated 585,000 injuries resulting in the need for medical attention yearly and children are the most frequent victims. This study sought to determine dog-specific factors independently associated with a dog biting a nonhousehold member., Methods: A matched case-control design comprising 178 pairs of dogs was used. Cases were selected from dogs reported to Denver Animal Control in 1991 for a first-bite episode of a nonhousehold member in which the victim received medical treatment. Controls were neighborhood-matched dogs with no history of biting a nonhousehold member, selected by modified random-digit dialing based on the first five digits of the case dog owner's phone number. Case and control dog owners were interviewed by telephone., Results: Children aged 12 years and younger were the victims in 51% of cases. Compared with controls, biting dogs were more likely to be German Shepherd (adjusted odds ratio (ORa) = 16.4, 95% confidence interval (CI) 3.8 to 71.4) or Chow Chow (ORa = 4.0, 95% CI 1.2 to 13.7) predominant breeds, male (ORa = 6.2, 95% CI 2.5 to 15.1), unneutered (ORa = 2.6, 95% CI 1.1 to 6.3), residing in a house with > or = 1 children (ORa = 3.5, 95% CI 1.6 to 7.5), and chained while in the yard (ORa = 2.8, 95% CI 1.0 to 8.1)., Conclusions: Pediatricians should advise parents that failure to neuter a dog and selection of male dogs and certain breeds such as German Shepherd and Chow Chow may increase the risk of their dog biting a nonhousehold member, who often may be a child. The potential preventability of this frequent public health problem deserves further attention.

The results of recent surveys in the United States have suggested a rising tide of fatalities due to child abuse or neglect (CAN). Because these surveys lack consistency in case definition and are incomplete in coverage, the use of death certificate data to estimate the number of CAN deaths was explored. To estimate these deaths among children 0 through 17 years old for 1979 through 1988, three models were formulated, each comprising six coding categories: (1) deaths coded explicitly as due to CAN, (2) homicides, (3) injury deaths of undetermined intentionality, (4) accidental injury deaths, (5) sudden infant death syndrome fatalities, and (6) natural-cause deaths. Research studies and crime data were relied on to estimate the proportions of deaths in categories 2 through 6 that were actually due to CAN, and other assumptions were varied to create a range of estimates. For the 10-year period, the estimated mean annual CAN fatalities ranged from 861 to 1814 for ages 0 through 4, and from 949 to 2022 for ages 0 through 17. Child abuse and neglect death rates did not increase over the period; in fact, they were relatively stable for ages 0 through 17 and showed a modest decline for 0 through 4. Ninety percent of fatal CAN occurs among children younger than 5 years old, and 41% occurs among infants. About 85% of CAN deaths are recorded as due to other causes.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors analyzed data from a national survey of 2003 directors of licensed child day-care centers to determine employee smoking policies, measure compliance with state and local employee smoking regulations for child day-care centers and state clean indoor air laws, and to estimate the extent of exposure to environmental tobacco smoke in these settings. Forty states regulated employee smoking in child day-care centers, but only three states required day-care centers to be smoke-free indoors. More than 99% of licensed child day-care centers had employee smoking policies that complied with the appropriate state or local smoking regulations. Nearly 55% of centers were smoke-free indoors and outdoors, and 26% were smoke-free indoors only. The best predictors of more stringent employee smoking policies were location in the West or South, smaller size, independent ownership, or having written smoking policies. Despite the presence of strong smoking policies at the majority of licensed child day-care centers, more than 752,000 children in the United States are at risk for environmental tobacco smoke exposure in these settings. Health care professionals and parents should insist that child day-care centers be smoke-free indoors and, preferably, smoke-free indoors and outdoors.

Although bicycle helmets are effective in preventing head injuries, use of helmets among children remains infrequent. In response to the bicycling deaths of two children, Howard County, Maryland, became the first US jurisdiction to mandate use of bicycle helmets for children. Schoolchildren were lectured by police about the law before its enactment. Prelaw and postlaw helmet use was observed in Howard County and two control counties: Montgomery (which sponsored a community education program) and Baltimore County (no helmet activities). Prelaw crude helmet use rates for children were 4% (95% confidence interval [CI] 0% to 10%) for Howard, 8% (95% CI 3% to 13%) for Montgomery, and 19% (95% CI 5% to 33%) for Baltimore. Postlaw rates were 47% (95% CI 32% to 62%), 19% (95% CI 11% to 27%), and 4% (95% CI 0 to 11%), respectively. The rate of bicycle helmet use by Howard County children is now the highest documented for US children. A similar increase in helmet use among children younger than 16 years nationwide could prevent about 100 deaths and 56,000 emergency-department-treated head injuries annually. Physicians and other health professionals should consider proposing and supporting the Howard County approach in their communities.