Transcript PowerPoint Presentation - Injury and Violence Prevention

Injury and Violence Prevention Program
CA4, American Academy of Pediatrics
Keep Kids Safe
Prevent Injuries
Injuries are the leading cause of death and disability for children 0- 44 yrs
Raise safe, strong, resilient kids
Learning Objectives
Presentation for San Francisco Department of
Public Health Conference 5/29/09
• Discuss child development and risk of injury
• Identify at least 2 risk factors for injury including
health disparities
– Intentional must be discussed with unintentionalmost risk factors shared
• List 3 of the most common injuries of children 014 years and one prevention strategy for each
• Know at least two resources for injury
prevention
• Create strategies for integrating injury
prevention into the work that you do
Leading Causes of Injury Deaths by Age, CA 2007
(CA4, AAP Injury & Violence Prevention Program (D. Winn
RN, MPH) (State of CA EPIC web site data)
<1
1-4
5-9
10-14
15-19
(n=129)
(n=195)
(n=99)
(n=150)
(n=1089)
Suffocation
46
Drowning 53
MVT Occupant
23
Homicide 28
Homicide 385
Homicide 35
Pedestrian 37
(21MVT, 16NT)
MVT Unspec 16
MVT Unspec
22
MVT Unspec
188
Drowning 10
Homicide 29
Pedestrian 12
(11MVT, 1 NT)
MVT
Occupant 20
MVT Occupant
122
MVT
Occupant 7
MVT Unspec 23
Homicide 11
Pedestrian 14
(13+ 1)
Suicide 122
MVT Unspec
4
MVT Occupant
15
Burn 9
Suicide 12
Poisoning 71
Burn 3
Fall 8
Drowning 8
Bicyclist 11
Pedestrian 40
(36 + 4)
Fall 3
Suffocation 8
Bicyclist 6
Drowning 9
Motorcyclist,
Drowning 18
Unintentional, Neglect, Intentional
Shared Risk Factors
Injury is a Health Disparities Issue
– Poverty
– Poor environment: physical and
social
– Substandard housing
– Lower educational level
– Lower literacy
– Lack of social capital/support
systems
– Gender, age and race/ethnicity
– Children with challenging behaviors
(Autism, ADHD)
Vision: Keep Kids Safe
How do we promote injury prevention?
• Focus on most serious and preventable
• Professional education
• Parent education culturally and
linguistically appropriate
• Readiness to learn
• Aware of risk factors for both intentional
and unintentional
• Need comprehensive approach with
families
• Advocate for public health policies
The E’s of Injury Prevention Strategies
• Education
– Parents, Care Providers, Educators
– Public Policy Makers
• Environment and Product Modification
– Car seats; Lap/Shoulder belt in school bus
– Bike helmets
• Enactment of Legislation and Public Policies
• Enforcement of Legislation
– Mandatory car seat and seat belt laws
– Graduated licensing law for teens and new drivers
– Ban cell phone/electronics use
The Spectrum of Prevention
CA4, AAP Injury and Violence Prevention Program strives
to work at multiple levels to create a cultural norm
Car Safety Seats – A Success Story
Influencing policy and legislation
Changing organizational practices
Fostering coalitions and networks
Educating providers
Promoting community education
Strengthening individual knowledge and skills
Larry Cohen, 1991; Cohen and Swift, 1999
Evolution of a Child
Kids Are Not Mini-Adults
Wiggling, kicking,
rolling over
Crawling
Walking, curiosity
UNAWARE
OF
DANGER
Climbing
Running
CA 4 AAP Injury and Violence Prevention
Program
Leading specific causes of serious injury by 3-month
age intervals. CA 1996-98 (Agran, Winn, Anderson, Trent,WaltonHayes, Pediatrics. 2001:108-45
Other fall from ht
Battering
Fall- furniture
R
a
t
e
Non-airway FB
Hot liquid
Poisoning - med
Pedestrian
Age in 3 month intervals
Birth to 2 months
Babies Cry
•Risk Factor for Abusive Head Trauma
•Crying is normal
•Colic is a normal part of
infant development
• Sometimes feeding, holding, changing, rocking and
soothing may help
• Sometimes nothing we do can stop the baby from
crying
• Make sure your baby is OK by having your pediatrician
check her
CA4, AAP
Birth to 2 months
What should you do when the
baby doesn’t stop crying
…and you feel like you need a break for a few minutes?
It is OK to let your baby cry
• Place your baby on his back
in the crib
• Do something to calm
yourself
• Call a friend or relative
• Call your
• Period of Purple Crying
•(R. Barr, MD, PhD- National Center On
Shaken Baby Syndrome)
CA4, AAP
Period of Purple Crying
Ronald Barr MD
http:www.dontshake.org
P for Peak of Crying—Crying peaks
during the second month, decreasing after
that;
U for Unexpected—Crying comes and
goes unexpectedly, for no apparent reason;
R for Resists Soothing—Crying
continues despite all soothing efforts by
caregivers;
P for Pain-like Face—Infants look like
they are in pain, even when they are not;
L for Long Lasting—Crying can go on
for 30-40 minutes, and as much as 5 hours,
and longer;
E for Evening Crying—Crying occurs
more in the late afternoon and evening.
Risk factor for abusive head trauma, family dysfunction
and possibly depression
CA4, AAP
Birth to 2 months
How do we keep kids safe?
• Suffocation is a leading cause of death for
infants
•
•
•
•
•
Back to Sleep
Use a firm mattress
no soft things in bed
No co-sleeping
No smoking
CA4, AAP
6 to 12 Months
6 to 8 Months
• Rolls over
• Sits up
• Grabs things
• Puts things in
mouth
8 to 10 Months
• Crawls
• Picks up very
small objects
(pincer grasp) and
puts in mouth
10 to 12 Months
• Stands
• Walks
• Finds hidden objects
CA4, AAP
6-12 Months
How do we keep kids safe?
• Safe Home
• Barriers and Locks
• Get on floor- check for
small objects
• Medicines and cleaning
agents high, locked, and
out of reach
CA4, AAP
1 to 3 Years
18 to 24 Months
12 to 18 Months
• Runs and climbs
• Walks and climbs
• Finds hidden objects
• Pulls and carries things
• Turns knobs and
• Still puts things into mouth
containers
and can choke
• Opens doors and
• Imitates
drawers
2 to 3 Years
• Jumps and climbs
• Opens containers
• Unscrews lids and
caps
• Makes things work
CA4, AAP
Cause of Burn Injuries
Children 0-4 yr, 2004-2006 (complied for CA, AAP by
D. Winn from EPIC data base)
Toddlers at
highest risk
Temperature and Duration
• 70o C (160oF)
• 65o C (149oF)
thickness
• 60o C (140o F)
• 55o C (131o F)
• 50o C (122o F)
instant full-thickness
instant partial2.0 seconds
7.5 seconds
1.5 minutes
• (M. Cinat, MD, Director Burn Unit (UCIMC)
Toddlers
Furniture
• Able to open drawers, climb
• Curious about environment
• Poor coordination & balance
• Poor danger recognition
Keep Kids Safe: How we started
1998: CA Tobacco tax initiative – School Readiness
First 5 and County Commissions. The Children and
Families Commission of Orange County
If we want children ready for school and not in
need of special education because they were injured
We must address injury – the leading cause of death
and disability for children.
Funded the CA4, AAP Injury and Violence Prevention
Program
Raise safe, strong, resilient kids
Injury Prevention Program
• Capacity Building
• Integrate injury prevention into health,
education and social services for kids
• Link the health of the families to the
public health of the community
• Bridge program silos
• Create innovative strategies
OC
Nurse-Family
Partnership
Medical/
Dental Care
School
Readiness
Nurses
Public Health
Nursing
School
Districts
Injury and Violence
Prevention Program
CHOC & UCI
Pediatric
Residents
Early
Childhood
Education
Centers
California Chapter 4, American Academy of Pediatrics
Libraries
Police
Departments
Family
Resource
Centers
IVPP Resources www.ockeepkidssafe.org
Newer Tools
Connected Kids
Parent Education
Curriculum
New Tool:
Parent Education Curriculum
Keep Kids Safe
An educational program for parents about how the growth and development
of children affects their risk for injury
Facilitator’s Guide
2009
Phyllis Agran, MD, MPH, FAAP – Medical Director
Jamie McDonald, MPH, CHES – Program Manager
Cheryl Fennik, MPH, CHES – Provider Education Manager
www.ockeepkidssafe.org
Connected Kids:
AAP Violence Prevention Program
Infancy & Early
Childhood
2 days – 4 years
Middle Childhood
Adolescence
5 – 10 years
11 – 21 years
Community Connections (from
Connected Kids- American Academy of
Pediatrics)
Social capital
 Connections with people
 Connections with community
Connect families to community
resources
*Identify local community
connections
ChildCentered
ParentCentered
Community
Connections
Physical
Safety
California Chapter 4, American Academy of
Pediatrics
Bullying: It’s Not OK
You are on a home visit with a
family with a newborn.
The mother lets you know that
her older child will not go to
school.
He cries each morning and
claims he has a stomachache.
What are you gong to do?
California Chapter 4, American Academy of
Pediatrics
Summary
• 1. Injury: leading cause of death and disability
• 2. Work with pediatricians, public health
professionals, social workers, early child
educators, child care providers
• 3. Address intentional with unintentional
• 4. Most preventable
• 5. Consistent messages
• 6. Relate to development
• 7. Give tools
• 8. Multiple doses
How do we work with families to
prevent injury
Teachable moments
Simple messages
Readiness to learn
Can the family do what is needed?
Is it individual family issue? Do they have
resources?
Is it code or regulatory issue?
Resources
• http://www.ockeepkidssafe.org
• http://www.cippp.org/
• www.sfdph.org/dph/comupg/oprograms/CHP
P/Injury/
• http://.www.aap.org
• http://www.cdc.gov/ncipc
• http://www.dontshake.com National Center on
Shaken Baby Syndrome
• http:www.nhtsa.gov