Childhood unintentional injuries are the leading cause of death among children ages 1 to 19 years, representing nearly 40 percent of all deaths in this age group. Each year, an estimated 8.7 million children and teens from birth to age 19 are treated in emergency departments (EDs) for unintentional injuries and more than 9,000 die as a result of their injuries—one every hour. Common causes of fatal and nonfatal unintentional childhood injuries include: drowning, falls, fires or burns, poisoning, suffocation, and transportation-related injuries. Injuries claim the lives of 25 children every day.
While tragic, many of these injuries are predictable and preventable. Diverse segments of society are involved in addressing preventable injuries to children; however, until now, no common set of national goals, strategies, or actions exist to help guide a coordinated national effort.
More than 60 partners joined the National Center for Injury Prevention and Control’s (NCIPC) Division of Unintentional Injury Prevention (DUIP) in developing the National Action Plan for Child Injury Prevention (NAP) to provide guidance to the nation. The overall goal of the NAP is to lay out a vision to guide actions that are pivotal in reducing the burden of childhood injuries in the United States and to provide a national platform for organizing and implementing child injury prevention activities in the future.
The NAP provides a roadmap for strengthening the collection and interpretation of data and surveillance, promoting research, enhancing communications, improving education and training, advancing health systems and health care, and for strengthening policy. Elements of the plan can inform actions by cause of injury and be used by government agencies, non-governmental organizations, the private sector, not-for-profit organizations, health care providers, and others to facilitate, support, and advance child injury prevention efforts.
Every year, nearly 9 million children ages 0–19 are treated for injuries in emergency departments and more than 225,000 require hospitalization at a cost of around $87 billion in medical and societal costs related to childhood injuries. Child and adolescent unintentional injury deaths have not declined to the same extent as other diseases have, and resources directed at reducing child injury are not commensurate with the burden it poses.
One framework for reducing childhood injuries is based on the public health model – a
model that is used for preventing many other diseases. The public health approach
includes identifying the magnitude of the problem through surveillance and data
collection, identifying risk and protective factors, and, on the basis of this information,
developing, implementing, and evaluating interventions, and promoting widespread
adoption of evidence-based practices and policies.
Interventions can be implemented during various time frames before, during, or after
an adverse event. Safety latches on medicine cabinets provide protection before an injury
event, child safety seats minimize injury during the injury-causing event, and effective
emergency response speeds treatment and improves outcomes after an injury event has
Like diseases, injuries do not strike randomly. Males are at higher risk than females. Infants are injured most often by suffocation. Toddlers most frequently drown. As children age, they become more vulnerable to traffic injuries. Motor vehicle injuries dominate among teens. Poverty, crowding, young maternal age, single parent households, and low maternal educational status all confer risk and make children more vulnerable to injury. Death rates are highest for American Indians and Alaska Natives and lowest for Asians or Pacific Islanders. States with the lowest injury rates are in the northeastern part of the United States.
The NAP lays out a vision to guide actions that are pivotal in reducing the burden of childhood injuries in the United States and will be relevant to all those with an interest in children’s health and safety, including:
- federal, state, and local agencies
- philanthropies, businesses and non-governmental organizations
- schools, educators, insurers, and health care providers
The plan is intended to help align priorities, to capitalize on existing strengths, to fill gaps, and to spark action across the nation that will result in measurable reductions in death and disability, and diminish the financial and emotional burden of childhood injuries in families and society. This outcome can only be realized if relevant stakeholders act on the plan.
While implementing the plan can potentially prevent many injuries to children and adolescents, the focus was on actions that would influence those injuries that are most burdensome to society, those for which there are feasible evidence-based interventions, those for which outcomes can be most easily measured, and those for which partners and stakeholders are likely available. Such injuries include:
- motor vehicle-related
- sports and recreation
The NAP is structured across six domains, which comprise a blueprint for action. Each domain, summarized below, consists of three to five goals. The actions recommended in each goal lay out broad areas for improvement. CDC and its partners will work together to identify implementation strategies for these actions by type of injury.
Data and Surveillance
Systematic surveillance is essential for accurate needs assessment. Only with good data can one estimate the relative magnitude of problems in order to set priorities. Current data collection systems are imperfect and incomplete. Better data can lead to better decisions, increased effectiveness (doing what works) and efficiency (avoiding waste). This plan calls for better data standardization (so that it is comparable across geography and time), better data quality (so that it is reliable and believable), and filling gaps (information about circumstances of injury events, outcomes, costs, and information that is local and community-specific). Information systems must allow for making existing data more available to those who can use and share it to design and implement interventions.
Some of the actions include developing an online access to key databases, collecting better data on the costs of injury, improving links between police, hospital, and emergency department data, and standardizing data collection and reporting.
For more than four decades, the scientific study of childhood injuries has paid rich dividends. Effective interventions such as bike helmets, four-sided pool fencing, booster seats, smoke alarms, concussion guidelines, and teen driving policies have already saved many lives. Additional research to improve our prevention efforts will be required to further drive down child injury rates and is needed at three different levels: 1) foundational research (how injuries occur), 2) evaluative research (what works and what doesn’t work to prevent injuries), and 3) translational research (how to put proven injury prevention strategies into action throughout the nation). Because research is a shared public, academic, and private endeavor, better coordination of research efforts will minimize waste and maximize return. Research can also help reduce health disparities through better understanding of the relationship between injuries and factors such as socioeconomic status, demographics, race and ethnicity.
Some of the actions include creating a national child injury research agenda, developing a national clearinghouse of child injury research, identifying key indicators related to child injury disparity, and increasing the number of child injury researchers through injury research training grants.
Raising awareness about childhood injuries is important at multiple levels. It can often trigger action, or support policies intended to reduce injuries. Better communication will better inform the actions by policy makers (enacting legislation to protect children), organizations (approaching injury prevention in a coordinated way), and by families (implementing evidence-based injury prevention strategies at home, on the road, on the playground, and in the community).
A balanced, coordinated communication strategy must be audience-specific and culturally appropriate, and use both traditional and innovative channels ranging from public relations campaigns to social media. Today more than ever, messages must be concise and relevant, and the messengers must be knowledgeable, credible, and easy to relate to. Various strategies can be used to deliver health messages to specific audiences, utilizing the talents of various injury partners.
Some of the actions include creating and implementing local and national campaigns on child safety, establishing web-based communications tool kits, finding local young people to be spokespersons for prevention, and using local businesses to support communication efforts to employees and their families.
Education and Training
Education and training is a cross-cutting strategy that can impact other facets of injury prevention. While some overlap between communications and education exists, education is considered here in a more formal context, with the intention to motivate change. Training specifically refers to the acquisition and use of skills. Education and training in injury prevention can benefit children and families, health care providers, public safety officials, and other professionals such as engineers, architects, journalists, teachers, and scientists. Education and training are intertwined because educators need to not only be deeply familiar with the topic they are teaching (subject matter expertise), but they need to know how best to transfer that information to the client (skill training). Identifying educational gaps and developing training capacity are current challenges.
Priorities include integrating injury prevention education into broader educational programs, developing effective educational materials, cataloging and sharing what works (best practices), and paying attention to educational needs and gaps at all levels from primary education to professional continuing education. The use of community based organizations to deliver education and training and the exploration of innovative media and new educational technologies are important to make educational opportunities more accessible to public health practitioners Education for professional credentialing of practitioners—such as doctors, nurses, teachers, and others who interact with children—should include appropriate competencies in preventing childhood injuries (knowledge and skills).
Some of the actions include integrating injury prevention into health promotion programs, developing metrics, like “report cards” to measure school progress in educating about child injury prevention, establishing an injury prevention clearinghouse, and including prevention education into minimum standards for health and safety professionals.
Health Systems and Health Care
Health care providers treat injuries, but they are also partners in prevention through health care systems. While responding to and treating trauma, health care providers are critical for accurately documenting external causes of injuries and circumstances. Beyond the clinical setting, health care providers are credible advocates for child safety and can facilitate change in communities and families. Health care systems can address child injury by providing anticipatory guidance to health care providers and collecting clinical data.
Trends and changes to health care delivery models, including adoption of electronic medical records, the medical home model, and quality improvement efforts should all be utilized to augment injury reduction goals and objectives by improving data collection while also ensuring quality and continuity of medical care for children. Best practices for delivery of preventive services should be identified and disseminated. Furthermore, opportunities exist for new technologies and information systems to improve injury outcomes. Information systems can equip providers with evidence-based data and protocols to strengthen the quality of clinical decision-making and improve trauma care.
Some of the actions suggested include incorporating child injury risk assessment into home visitation programs, creating injury prevention quality measures that apply to the medical home, and using linked data systems to improve treatment decisions.
The policy domain is important because it is system-based, affecting populations by
changing the context in which individuals take actions and make decisions. Historically,
policies regarding safe environments and products (swimming pool fences and safe cribs),
and safe behaviors (sober driving and bike helmets), have changed norms in communities
and nationally. Policy includes aspects of law, regulation, or administrative action and can
be an effective tool for governments and nongovernmental organizations to change
systems with the goal of improving child safety.
The NAP informs policymakers about the value of adopting and implementing evidence-based policies. It calls for better compliance and enforcement of existing policies to protect children, such as infant car seats or four-sided pool fencing where these policies exist. The NAP underscores the importance of documenting and disseminating the effective and cost-saving policies at the broadest level.
Some of the actions include developing national leadership training in policy analysis for child injury prevention, documenting successful policies that save lives and prevent injuries to children, and supporting state capacity building for implementing policy-oriented solutions that reduce childhood injuries.
The successful implementation of the NAP will require bold actions, effective leadership, and strong partnerships. We cannot afford to wait any longer. Child injuries are preventable, and improvements in the safety of children and adolescents can be achieved if there is an effort by various stakeholders to adopt and promote known, effective interventions—strategies that can save lives and money.
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