Transcript Straight Idea - Children`s & Women`s Health Centre

Company
name
Company
here
“Too
Hot For Tots
”©|
2010
Frances Slogan
MacDougall
and BC Children’s Hospital
Early Childhood Injury Prevention Program
WELCOME
to the
Educator’s Handbook
Developed by: Frances MacDougall RN
With support from
Safe Kids Canada and Senga Consulting
Funding provided by the
BC Professional Fire Fighters’ Burn Fund and
BC Children’s Hospital
Early Childhood Injury Prevention Program
TABLE OF
CONTENTS
1. Beginnings
Slide 3
2. Objectives
Slide 4
3. Best Practice Guidelines
Slide 7
4. Key Message
Slide 11
5. Characteristics leading to
Injury
Slide 15
6. Images
Slide 22
7. Prevention & First Aid
Slide 26
8. References
Slide 34
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Copyright 2010 © Frances MacDougall and BC Children’s Hospital (BCCH)
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Early Childhood Injury Prevention Program
BEGINNINGS
Frances MacDougall
This tool was developed by Frances MacDougall, a clinical nurse who worked for many years on
the Burn Unit at BC Children’s Hospital. After hearing many caregivers say they were not aware
of the burn hazards in the home or how seriously their child could be injured, Frances
developed an evidence-based educational resource for front line educators.
This resource was developed with the support of Dr. Cynthia Verchere, pediatric plastic surgeon
and Director for BC Children's Hospital Burn Unit, Safe Kids Canada, the BC Professional Fire
Fighters' Burn Fund and Safe Start, the injury prevention program of BC Children's Hospital.
Frances would like to extend her appreciation to the BC Injury Research and Prevention Unit,
the Division of Plastic Surgery at BC Children's Hospital and to the Vancouver Costal Health
Authority for supporting the Impact Evaluation of this program.
“It only takes a second to change a life forever.”
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Early Childhood Injury Prevention Program
OBJECTIVES
For this Resource
Resource Objectives
Increase caregiver awareness about the high risk of burn and scald injuries to children 5 years and under.
Structure
This resource is structured on the principles of Evidence-Based Learning and best practices. This learning model proves that strong
scientific and medical evidence can effectively promote behaviour change and stimulate parents and caregivers to perform the
necessary steps to prevent many of the common burn injuries seen in this young and vulnerable age group.
Key Concepts
• Burn injury rates are highest during a child’s first year of life.
• Scald injuries from hot liquids like tea, coffee and hot water are the most common sources of burns in this age group.
• Although less than 7% of scald burns are caused from hot water, these injuries tend to be more serious than scalds from other
sources and require more medical care.
• Providing constant, close supervision of a child when they are near a burn hazard is the most important strategy parents can
employ to keep their child safe.
Suggested Procedure



Review the information in this handbook to familiarize yourself with the latest data and statistics and recommendations.
Create opportunity for caregivers to view the video in a facilitated session followed by group discussion. The Impact Assessment
Study showed that knowledge transfer and behavior change was most successful when delivered in this format.
The Caregiver’s Discussion presentation was developed to support post-video discussion. The take-home, Too Hot for Tots!
Brochure high lights the video’s key messages and includes a temperature testing card and link to view the video online.
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Early Childhood Injury Prevention Program
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Early Childhood Injury Prevention Program
Introduction
The video Too Hot for Tots!© was developed as a tool to help community educators teach
parents about how to prevent burn injuries to young children in the home.
The recommendations provided in this program were developed from the guide,
Safer Homes for Children produced by Safe Kids Canada.
The video begins with Dr. Cynthia Verchere, Director for the BC Children’s Hospital Burn Unit
explaining how common these injuries are, where in the home they occur and why it’s critical to
provide immediate first aid when a burn happens to reduce the damage caused by the injury.
Caregivers will also learn The Three B’s of Burn Prevention:
1. Be Aware of the burn hazards in the home and the serious risk they pose to a child.
2. Be Close within arm’s reach when a child is near or around a burn hazard.
3. Burn Proof the family home.
Following these simple, yet effective strategies will help to reduce the risk of a burn injury which
happen all too frequently to young children in the home.
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Early Childhood
Childhood Injury
Injury Prevention
Prevention Program
Program
Early
Information to Support You
PROGRAM RESOURCES AND
BEST PRACTICE GUIDELINES
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Early Childhood Injury Prevention Program
World Health Organization:
Safe Communities Model 8
Too Hot for Tots!© incorporates these Best Practice recommendations from the WHO (World Health Organization):
Target groups at high risk – parents of children from birth to five years of age.
Target the caregiver, not the child.
Focus on a single cause of injury – Thermal injuries.
Develop intervention strategies targeting different causes of injury: The Three B’s which target the three most common
sources of thermal injury in children under 5; hot liquids, hot water, and hot surfaces.
Link Injury Prevention Programs to a healthcare setting – Community Health Units and B.C Children’s Hospital.
Aim of the program should be to increase caregivers’ beliefs that their own child is vulnerable to injuries and that those
injuries can be serious. Educator’s can stress the serious nature of burn injuries and how common these injuries are in this age
group, while parents share the story of how their child was injured and how quickly the injury happened.
Include short and long term goals with injury outcomes as a measure.
Short term goals: an Impact Evaluation has been conducted in Vancouver Costal Health units to establish whether there was
significant change in parental knowledge, attitudes and practices around the prevention of scald and burn injuries after being
exposed to the Too Hot for Tots! program.
Long term goals: to reduce the number of pediatric burn injuries in the province of British Columbia.
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Early Childhood Injury Prevention Program
To achieve long term change and success, injury prevention programs should
include a multi-dimensional approach known as The Three E’s. 9
Education
Changing parental knowledge,
attitudes and behaviors
Enforcement Environment
Minimizing or eliminating
Legislative changes
hazards in the home
9
Early Childhood Injury Prevention Program
The Three E’s
The Too Hot for Tots!© program is based on a behavior change Model
known as: The Ecological Theory of Risk Perception10
Education
This model provides insight into what motives parent to implement injury
prevention strategies based on the perceived risk of injury to their child.
Enforcement
Modifying the home environment to reduce hazards is an essential
component of successful injury prevention programs.
Refers to the enactment of legislation and product safety regulations which
help to make home products and environments safer.
Environment
For example, changing building code legislation so that water delivery
temperature to bathtubs is no greater than 49°C (120o F).
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Copyright 2010 © Frances MacDougall and BC Children’s Hospital (BCCH)
10
Early
Childhood
Injury
Prevention
Program
Early
Childhood
Injury
Prevention
Program
What We Want Everyone to Know
PROGRAM’S KEY MESSAGE
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Early Childhood Injury Prevention Program
Why Focus on Burns?
Research estimates that 90% of unintentional injuries
are preventable by implementing strategies
that are known to be effective. 1
 For injuries that occur in the home, burns are the second leading cause of emergency
room visits for children under 5 in British Columbia. 2
 Infants and 1 year olds suffer a disproportionately high percentage of these serious
burns. 3
 Approximately 130 children in this age group are treated for burn related injuries at B.C
Children’s Hospital every year. 4
 70% of Canadian parents do not know that the most common cause of burn injuries to
children is scalds from hot liquids, such as tea and hot tap water, rather than from fire. 5
 Medical care following a scald injury is approximately two times higher than the average
for all injuries in the CHIRPP Database. 6
 Tap water scalds alone cost $5 million annually in direct health care costs. 7 This does not
include additional costs such as skin grafting, physical therapy or pressure garments.
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Early Childhood Injury Prevention Program
Emergency Department Surveillance of Pediatric Burn Injuries
(CHIRPP) database 1990-2008
The average annual decline of burn injuries since 1993 was 0.07%.
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Company name | Company Slogan here
Early Childhood Injury Prevention Program
Treatment Required Following Burn Injuries
CHIRPP Database, B.C Children’s Hospital, 2004 - 2007
14
Early
Childhood
Injury
Prevention
Program
Early
Childhood
Injury
Prevention
Program
Social and Cultural Context
CHARACTERISTICS THAT LEAD TO
TRAGIC INJURIES
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Early Childhood Injury Prevention Program
The Ecological Theory of Risk Perception
Social and Cultural factors that impact parenting behaviour by raising risk perception
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Caregiver
Characteristics
•
•
•
•
•
Parenting experience
Beliefs
Parenting style
Knowledge
Perception
Child
Characteristics
•
•
•
•
•
Developmental Age
Activity Level
Cognitive Ability
Risk Taking
Temperament
Environmental
Characteristics
•
•
•
•
Risks/Hazards present
Hot water
Hot surfaces
Hot liquids
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Early Childhood Injury Prevention Program
Actions Taken based on Risk Perception
Passive Strategies
One-time actions
Active Strategies
On-going actions
•Use a mug with a lid*
• Lower the temperature of the
hot tap water
•Provide constant close
supervision when around
burn hazards
• Secure a barrier around
the fireplace
• Keep appliances and
cords out of reach
•Childproof bathroom and
laundry room doors
Risk of injury decreases as use of strategies increases
*The Impact Study showed that although this behaviour change (using a mug with a lid) resulted in the best improvement to
decreasing burn injuries, surprisingly few caregivers actually made this change. See Discussion Questions in the Caregiver’s
Discussion presentation to help caregivers strategize and plan for this behaviour change.
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Early Childhood Injury Prevention Program
Caregiver Characteristics
Parenting Style
• Injuries are more likely to occur when there is no supervision or intermittent parental supervision.
• The lowest rate of injury occurred when there was constant supervision. 11
Parenting Experience
• Parents often underestimate or overestimate their child’s abilities and do not adjust those expectations based on
the child’s development.12
Parenting Beliefs
• Parents may believe that children learn from being injured and that injuries are a natural consequence of play. 13
• Parents may also believe that teaching their child about burn hazards will keep them safe, but young children do
not always remember or follow safety rules. 14
Perceptions
Knowledge
Mother’s were more likely to follow safety
precautions and practices when they
perceived the risk of injury to be
serious.16
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As parent’s education level increased, so
did their belief that injuries could be
prevented.15
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Early Childhood Injury Prevention Program
Child Characteristics
Developmental Age
• The type of burn injury a child sustains is closely linked to their developmental age.
• Contact burns from gas fireplaces are more common in children under one year of age.17
Activity Level
• Around 6 months of age children usually start to crawl. They are then able to reach for, and grab objects of
interest such as appliance cords or mugs containing hot liquids.21
Cognitive Ability
• Burn injuries peak between the first and second year of life19 because children's physical and motor development
are growing faster, than their cognitive ability to understand the hazards.20
Temperament
Risk Taking
Some children are naturally more inquisitive
and active which puts them at greater
risk for injury.18
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Boys are more likely to be injured
than girls.19
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Copyright 2010 © Frances MacDougall and BC Children’s Hospital (BCCH)
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Early Childhood Injury Prevention Program
Emergency Department Surveillance of Pediatric Burn Injuries
(CHIRPP) database 1990-2008
Public Health Agency of Canada
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Early Childhood Injury Prevention Program
Environmental Characteristics
Hot Liquids
• More than half of the children treated for scald injuries in the CHIRPP Database were burnt from hot beverages
such as tea, coffee and soup. 22
Hot Water
• Children who are hospitalized due to hot tap water scalds spend twice as long in hospital as result of their injury,
compared to children who are scalded from other sources.23
• Tap water set at 60°C (140°F) cause a serious burn in less than 1 second, where as hot water that is lowered to
the recommended 49°C (120°F) would take 10 minutes to cause the same damage.24
Hot Surfaces
• The glass of a gas fireplace heats up to 200°C (400°F) in just 6 minutes and takes 45 minutes to cool down to a
safe temperature.
• This is hot enough to cause a third degree burn on contact.25
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Early Childhood Injury Prevention Program
Hot Liquid Scald
Hot Water Scald
Contact burn
from fireplace
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Early Childhood Injury Prevention Program
Time & Temperature Interaction Associated with
Scald Burns 26
Temperature:
(°F)
Burn Risk
Possible Exposure in
Exposure Time
Environment
(seconds)
130°
30
Adults can consider this a reasonable temperature for
hot drinks.
145°
2.5
Too hot to drink for most people.
150°
1.8
Dishwasher water temperature before cycle begins.
170°
0.03
When the "rolling" metallic sound is heard in a metal
teapot on stove.
175°
0.01
The temperature of water or hot drinks from some
home/office counter-top brewing units.
180°
instant
Coffee/hot chocolate temperatures found in some
family restaurants.
185°
instant
Coffee/hot chocolate temperatures found in some
family restaurants.
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Copyright 2010 © Frances MacDougall and BC Children’s Hospital (BCCH)
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Early Childhood Injury Prevention Program
Emergency Department Surveillance of Pediatric Burn Injuries
(CHIRPP) database 1990-2008
Public Health Agency of Canada
* Please note the statistics are not nationally representative of the entire Canadian population 0-14 yrs old, but
rather only of the people 0-14 yrs old captured in CHIRPP hospitals across Canada.
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Early Childhood Injury Prevention Program
Emergency Department Surveillance of Pediatric Burn Injuries
(CHIRPP) database 1990-2008
Percentage of Hot Water and Beverage Scalds by Circumstance
Public Health Agency of Canada
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Early
Childhood
Injury
Prevention
Program
Early
Childhood
Injury
Prevention
Program
PREVENTION AND
FIRST AID STRATEGIES
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Early Childhood Injury Prevention Program
Best Practices and Balanced Approach
Best approach to injury prevention
Passive Methods
Active Methods
• Lower the
temperature of the
hot tap water.
• Provide constant close
supervision when
around burn hazards.
• Secure a barrier
around the fireplace.
• Use a mug with a lid.
• Childproof bathroom
and laundry room
doors.
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Risk
Perception
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• Keep appliances and
cords out of reach.
Copyright 2010 © Frances MacDougall and BC Children’s Hospital (BCCH)
27
Early Childhood Injury Prevention Program
Be
Aware
Of the burn hazards in
the home and the serious
danger they present to a child
Burn Prevention
BE
CLOSE
The 3B’s
within arm’s reach
when a child is near
or around a burn
hazard
BURN
PROOF
the home
environment
.
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Early Childhood Injury Prevention Program
What Every Parent Should Know
First Aid Treatment for a Burn Injury
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Early Childhood Injury Prevention Program
Stop the Burning!

Remove any hot wet clothing unless it is stuck to the
skin.

At the same time find some cold water or cold liquid
to cool the skin. Seconds count!

Cool the skin and any clothing that is stuck to the skin
for 10-15 minutes or until the skin feels cool to touch.

Continue cooling the skin, even if the skin peels or
blisters. Cooling the skin helps reduce the pain and
damage caused by the burn.

Then cover with a clean cloth
Butter, oil, creams or ice should
never be used on a burn.
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Early Childhood Injury Prevention Program
When to get help:
• If the burn is on the face, hands, feet or
groin
• If blisters develop
• If the burn is larger than the size of a
loonie
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•
Parents should have someone else
drive them to the hospital.
•
Otherwise, call an ambulance!
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Early Childhood Injury Prevention Program
Knowledge and Behaviour
Behaviour is influenced by more than
“what we know” or “what we believe”
27
Studies have shown that even with this information, there are still a number of barriers that can
prevent caregivers from implementing the behaviour changes required to reduce burn injury in the
home.
Parents are more likely to change their behaviour if they possess the following – be sure to ask:
 Do they have the necessary skills and resources to modify the child’s environment, i.e. hire a
plumber to reduce water temperatures? Explore strategies they can use – how they can “be
aware” and “be close” to keep their child safe when in these types of environments.
 Are there barriers to changing the home environment, such as cultural and family, i.e.
grandparents and spouses that are resistant to this learning?
 Do they believe there is value and benefit in doing so? Many parents believe that it will “never
happen to them”. Give a vivid example how quickly and easily this tragedy can happen. The
Caregivers Discussion presentation has case studies and questions you can use.
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Early Childhood Injury Prevention Program
Through education and advocating for legislative
change, we can make a difference and reduce
the number of these preventable injuries.
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Early Childhood Injury Prevention Program
References
The Canadian Hospital Injury Reporting and Prevention Program (CHIRPP) collates data obtained
from emergency admissions at ten pediatric hospitals and four general hospitals across Canada.
The BC Children’s Hospital CHIRPP data contains information obtained from emergency admissions
through BC Children’s Hospital.
1 Safe KIDS Canada. Safer Homes for children – A guide for Communities 2006:3. www.safekidscanada.ca
2 Safe KIDS Canada. “Injuries Occurring In and Around Private Homes.” (CHIRPP) database, ages birth to four years, 1997- 2003; Table 3:8.
3 Public Health Agency of Canada. “Emergency Department Surveillance of Pediatric Burn Injuries” (CHIRPP) database 1990-2008. www.hc-sc.gc.ca/pphbdgspsp/publicat/chirpp-schirpt/21se02/index.html
4 BC Children’s Hospital. “Burns in Children-Excluding Sunburns and Electrical burns.” BC Children’s Hospital (CHIRPP) database, ages birth to six years of age,
2004-2007.
5 Safe KIDS Canada. “ Majority of Canadian Parents Don’t Know Biggest Burn Hazards.” Safe Kids Week media release 2001.
www.safekidscanada,ca/ENGLISH/Media/mediarelease_skweek2001.html
6 Public Health Agency of Canada. “Burns and Scalds in 1999 CHIRPP Database.” (CHIRPP) database 2002:09 (21)
www.hc-sc.gc.ca/pphb-dgspsp/publicat/chirpp-schirpt/21se02/index.html
7 Safe KIDS Canada. “ National Code for Changes to Prevent Hot Tap Water Injury." Brief to Ministers January 2003.
8 Coggan C, Patterson P, Brewin M, Rhonda H, Robinson E. “Evaluation of the Waitakere Community Prevention Project.” Injury Prevention June 2000; 130-
134.
9 Speller V, Mulligan J, Law C, Foot B. “Preventing Injury in Children and Young People: A Review of the Literature and Current Practice.” Database of Abstracts
of Reviews of Effectiveness , Centre for Reviews and Dissemination 1995:61.(Cited November, 2005) http://144.32.150.197/script/WEBC.EXE/nhscrd/newsearch
10 Saluja G, Brenner R, Morrongiello B. “The Role of Supervision in Child Injury Risk: Definition, Conceptual and Measurement Issues.” Injury Control and
Safety Promotion 2004; 11(1):17–22.
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Early Childhood Injury Prevention Program
References (continued)
11
Morrongiello B, Ondejko L, Littlejohn A. “Understanding Toddlers’ In-Home Injuries: Examining Parental Strategies and Their Efficacy for Managing Child Injury Risk.”
Journal of Pediatric Psychology 2004; 29(6): 433- 446.
12
Morrongiello B, Ondejko L, Littlejohn A. “Understanding Toddlers’ In-Home Injuries: Examining Parental Strategies and Their Efficacy for Managing Child Injury Risk.”
Journal of Pediatric Psychology 2004;29(6): 433–446.
13 Morrongiello B, Dayler L. “A Community-Based Study of Parents’ Knowledge, Attitudes and Beliefs related to Childhood injuries”. Canadian Journal of Public Health
November-December1996;383-388.
14
Morrongiello B, Ondejko L, Littlejohn A. “Understanding Toddlers’ In-Home Injuries: Examining Parental Strategies and Their Efficacy for Managing Child Injury
Risk.” Journal of Pediatric Psychology 2004;29(6): 433–446.
15
Hu S, Wesson D. “Pediatric Injuries: Parental Knowledge, Attitudes and Needs.” Canadian Journal of Public Health March–April 1996; 101–104.
16
Morrongiello B, Kiriakou S. “Mothers’ Home-Safety Practices for Preventing Six Types of Childhood Injuries: What Do They Do and Why?” Journal of Pediatric
Psychology 2004; 29(4):285–297.
17
Health Canada. “For the Safety of Canadian Children and Youth.” 1997; 8:139-141.
18
American Academy of Pediatric. “The Injury Prevention Program” A Guide to Safety Counseling in Office practice: Age-Related Safety Sheets 2003. (Cited June 2005)
19
Health Surveillance and Epidemiology Division (Public Health Agency of Canada). “Injuries Occurring In and Around the Home.” (CHIRPP) database 1997-2003
(unpublished report) 2005.
20 Health Surveillance and Epidemiology Division (Public
Health Agency of Canada). “Injuries Occurring In and Around the Home.” (CHIRPP) database 1997-2003
(unpublished report) 2005.
21
Wilson M, Baker S, Teret S, Shock S, Garbarino J. Saving Children: A Guide to Injury Prevention. New York, NY: Oxford University Press, 1991; 86–87.
Public Health Agency of Canada. “Scalds associated with Hot Beverages” (CHIRPP) database, all age, 1996.
23 Safe KIDS Canada. “Tap Water Scalds - Position Paper.” Position Paper 2000.
24 Safe KIDS Canada. “Bathing your child.”
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Early Childhood Injury Prevention Program
Reference (continued)
22- 25 BC Children’s Hospital, Safety Station. “Tips for a Child-Friendly Home, Your Fireplace.” September 2007.
www.bcchildrens.ca/safetystation
26 The American Journal of Pathology, 1947
27 National Social Marketing Center. “Big pocket Guide- Social Marketing, second edition. The community against Preventable Injuries 2007:63.
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Early Childhood Injury Prevention Program
FEEDBACK
Going Forward
FRANCES MACDOUGALL
RN, BC Children’s Hospital
Developing this program has been a true labour of love. With the help of many individuals, organizations and our
friends at Senga Consulting who helped put together the presentations and handbooks – it wouldn’t have gotten
off the ground and into your hands.
However, now that it has been distributed we need to work on the next phase which is fine-tuning and
improvement.
Now it is time to work with you, our front line educators. We would very much like to obtain your feedback on the
resource and program. We will do this through an on-line survey. We appreciate and welcome all constructive
suggestions and comments.
Together I know that we can make a huge difference in the lives of small children – I look forward to hearing from
you.
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Early Childhood Injury Prevention Program
SUPPORTERS
FOR THIS PROGRAM
AND THEIR
MISSION STATEMENTS
BC Professional Fire Fighters’ Burn Fund
BC Children’s Hospital
Dedicated to burn prevention as well as survivor support and
recovery programs in the province of British Columbia. The
organization is committed to providing financial assistance
for the purchase of equipment, training of medical staff and
the operation of a children's burn survivor camp.
1.
2.
3.
4.
5.
6.
7.
Safe Kids Canada
Safe Kids Worldwide is a global network of organizations with a
mission of preventing unintentional childhood injury, a leading
cause of death and disability for children ages 14 and under.
Senga Consulting Inc.
We are a communication and learning services company that
works closely with our clients to create clear and vibrant
messages. Our mission is to help people unleash the power of
effective communication that educates, engages and influences
others to achieve their aspirations.
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Improve quality. Be safe.
Educate, learn and discover
Deliver innovative sub-specialized care
Work together as a caring team
Partner with families
Plan provincially
Collaborate to create novel, community-based
approaches
BC Injury Prevention and Evaluation Unit
To reduce the societal and economic burden of injury
among all age groups in British Columbia through
surveillance, research and knowledge development,
knowledge synthesis, translation and education, and public
information for the support of evidence-based, effective
prevention measures.
Copyright 2010 © Frances MacDougall and BC Children’s Hospital (BCCH)
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Early Childhood Injury Prevention Program
CONTACT
INFO
ONGOING SUPPORT
Ongoing support will be provided by:
 The Burn Fund (www.burnfund.org) as well as
 BC Children’s Hospital Safe Start (www.bcchildrens.ca/safestart)
If you require additional copies of these materials, please contact:
www.bcchildren’s.ca/safestart
www.burnfund.org
|
www.bcchildrens.ca/safestart
|
Copyright 2010 © Frances MacDougall and BC Children’s Hospital (BCCH)
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Company name | Company Slogan here
Early Childhood Injury Prevention Program
THANK YOU FOR
CARING.
For more information, visit us at
www.bcchildrens.ca/safestart
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