A leading paediatrician is calling for an injury database in a bid to keep our children safer, writes Elaine Edwards
A national database to record injuries suffered by children presenting at A&E departments would enable professionals to target appropriate action to prevent such accidents, a leading paediatric emergency consultant has said.
Dr Mary McKay, consultant at Children's University Hospital at Temple Street in Dublin, called for all new IT systems being installed in hospitals to be adapted to help build an "injury surveillance" system to track the number, type and nature of child injuries and deaths.
"Accidental injury would be the most common cause of death and disability in childhood - much more common than any other childhood disease," she says.
"Overall, about 70-75 children die every year because of accidents. Fifteen thousand are admitted to hospital because of accidents and about 150,000 attend emergency departments because of accidents. It's a huge thing."
Temple Street alone sees 50,000 children a year, of which about half have had accidents.
"One of the difficulties is that we don't have a good system for surveillance of injuries - if you are trying to prevent children's injuries, you need to be able to collect information about every child who comes into an emergency department. You need to know where the injury happened, what they were doing, what age they are, what type of injury it was.
"By gathering data like that, you see patterns and you can pinpoint the areas where you can intervene to make changes - we can target that group and try to reduce that injury," Dr McKay says.
"Ireland falls about the middle of the league in Europe for childhood deaths and injuries. Sweden is the top and it has a very well developed system of injury surveillance. They know a lot about how their children are injured, and they are able to target intervention to try to reduce that injury," she says.
"I think it's something that needs to be decided at a Government or a Department of Health level. We can collect information on all sorts of other things and it wouldn't be a huge step beyond that to incorporate it into how we do our job," Dr McKay says.
The ways in which children can hurt or seriously injure themselves in the home, the garden or at school are multiple. But most accidents can be prevented with common sense, says Dr McKay. "Maybe 40 per cent of the accidents are road traffic related, but that still means that most of the accidents occur in the home or the school environment.
"The sort of things you are talking about are accidental poisoning, falls, burns and scalds and occasionally things like drowning, or odd sorts of accidents like children getting caught up in curtains.
"It affects all ages, but children who aren't mobile yet don't have many accidents. But once they start becoming mobile you get a big rise in the accident rate, with a peak at between about 15 and 17 months for a toddler at home. That's because they're able to get around or they are starting to climb and they have no sense of danger.
"People such as public health nurses going into homes play a huge role in advising parents about things like preventing falls and installing things like stair gates. Baby walkers are quite dangerous, before anyone thinks of buying one.
"It's well documented in Australia, where they also have good injury surveillance. That's where this idea of knowing about where all our injuries are coming from would help us to reduce them."
She also says legislation introduced in New York forcing landlords to fit window guards and locks coupled with an information campaign helped reduce child deaths from falling out windows by half.
"Every few months we get a child, a toddler usually, who has fallen out a window - sometimes an upstairs window."
Accidental poisoning accounts for a great number of visits to A&E, but most turn out to be non-toxic. The National Poisons Information Centre said recently it received more than 13,000 calls from hospital staff last year in relation to potential poisonings. Just less than half the contacts related to children under 10.
Dr McKay says the use of childproof caps on medicine bottles and cleaning products should be made mandatory.
Other devices and safety equipment available for the home include padded or rounded corner covers for tables, flexible kettle cables and locks for toilets and fridges.
New categories of injury being witnessed by A&E departments in the past year or two include trampoline injuries and serious injuries to young children using 'quad' bikes and mini, motorised motorbikes, says Dr McKay. She says the bikes are "totally unsuitable" for children.
Car accidents account for about 40 per cent of injuries, including car crashes and incidents where the child is a pedestrian or a cyclist. The worst injuries are seen in unrestrained children, yet it's still common to see children "bouncing around" in the back of often very expensive "safe" cars, according to Dr McKay. The fact that proper child restraints and seats are the law is welcome, she says. "But you have to enforce it."
The National Safety Council has just begun a campaign on baby car seats.
Tony Kealy, who runs two shops in Dublin supplying baby equipment and safety products, says research shows that 65 per cent of all car seats are either incorrectly fitted or incompatible with the car.
"Once you put a child in a car seat, it's a life and death scenario, whereas prams are invariably a convenience or possibly even fashion related," he says.
Dr McKay says there is also a great "social class gradient" in terms of injuries presenting. "If you come from social class five, you are much more likely to be injured or have a serious injury than if you come from social class one. So it's possibly an issue for families too about being able to afford things like stair gates and things like that, or proper car restraints and baby seats, fire guards, the guard for around the cooker - and that needs to be looked at."
Concerted efforts by farming organisations have gone a long way towards cutting the number of injuries to children on farms, according to Dr McKay.