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Accidents and Injuries in

Childhood
Maha Mohamed El Gaafary
Ass. Prof. of Public Health
The events that lead to unintentional injuries
often are referred to as "accidents“,
although scientific evidence indicates that
many of these events can be predicted and
prevented.
An injury is a physical damage to the body
resulting from acute exposure to thermal,
mechanical, electrical or chemical energy or
from the absence of essentials as heat and
oxygen.
 Injuries are grouped into 3 major categories:

• Unintentional injuries (sometimes referred to as

"accidents") are those caused by motor vehicles
and other forms of transportation, drowning,
poisoning, burns and falls.
• Intentional injuries (also called "violence") are
homicides, suicides interpersonal assaults. Rape
and domestic violence are considered intentional
injuries.
• Occupational injuries are those unintentional and
intentional injuries that occur at work or while
traveling to or from a work setting.
 Types of injuries
Unintentional Injuries (Accidents)
• Motor vehicle crashes - Sports and recreation
• Drownings - Poisonings
• Falls - Burns
• Asphyxiation, chocking, suffocation
• Fire-arm related injuries
• Animal bites
Intentional Injuries (Violence)
• Homicides
• Suicides
• sexual violence, rape,
• child maltreatment
• self-inflicted injuries.
 Mortality from Injuries
• Injuries were the 5th leading cause of death
in both males and females
• The leading causes of injuries were
fatalities associated with:
– Motor vehicle traffic
– Poisonings
– Fatal falls
 Types of Accidents by Age
• Infants: foreign body ingestion or
inhalation, falls, wounds, exposure to
cooking fire in rural areas leading to severe
burns.
• Young school children: drowning.
• Adolescents: road traffic accidents and
suicides.
• Elder……..
 School Environment

• Physical Environment
• Psychosocial Environment
 Physical Environment

• Site of the school

• School buildings
• Furniture
• Health reform
 Psychosocial Environment

• Safety
• Respect
• Love
• Appreciation
• Freedom
• Success (Scholar achievement)
School-Related Injuries
The most frequent causes of school-associated
injuries resulting in hospitalization are falls and
sports activities
The majority of injuries at school are unintentional,
not violent. Injuries at school are most likely to
occur on playgrounds (particularly on climbing
equipment), on athletic fields, and in gymnasiums
The majority of school injuries are minor; serious
injuries are more likely to occur at home or in the
community.
Fewer than 1% of homicides and suicides among
children and adolescents are school-related
 Playground Injuries- 1
• Playground-related injuries range from mild contusions and
haematomatas to severe—fractures, internal injuries,
concussions, dislocations, and amputations.
• While all children who use playgrounds are at risk for
injury, boys experience injuries slightly more often than
girls.
• Children ages 5 to 9 have higher rates of emergency
department visits for playground injuries than any other age
group. Most of these injuries occur at school.
• Low-socioeconomic areas had more maintenance-related
hazards than playgrounds in high-socioeconomic areas
(more trash, rusty play equipment, and damaged fall
surfaces).
 Sports-Related- 2
Injuries
Males are twice as likely as females to get sports-
related injury, probably because males are more
likely than females to participate in organized and
unorganized sports that pose the highest risk for
injury (e.g., football, basketball, gym games, and
wrestling)
Children and adolescents also are involved in
recreational activities that pose a substantial injury
risks.
 Sports-Related- 2
Injuries
Many sports injuries are a result of re-injury. One
such injury, called second impact syndrome, is a
result of repeated mild brain concussions over a
short time.
Severity of concussions increases with recurrent
injuries. Second impact syndrome might lead to
severe traumatic brain injuries and death.
Other re-injuries (e.g., those occurring to the knee or
ankle) can lead to lasting disability.
 Poisonings- 3
• Children, especially those under age 6, are more likely to
have unintentional poisonings than older children and adults.
• The most common poison exposures for children were
ingestion of household products such as cleaners, cosmetics
and personal care products, cleaning substances, pain
relievers, foreign bodies, and plants
• Family neglect and child maltreatment are the main cause
of poisoning
• Adolescents are also at risk for poisonings, both intentional
and unintentional. Among teenagers suicide attempt is
considered.
• For adults, the most common poison exposures were pain
relievers, sedatives, cleaning substances, antidepressants,
and bites/stings
4- Fire and burn Injuries
• Fire and burns are the leading cause of home, school
and leisure injury mortality in Egypt. Majority occur
at home mostly during Summer and Spring.
• Most victims of fires die from smoke or toxic gases
and not from burns
• Among young children in Egypt, scalds from hot
liquid were the most common cause of burns
• Children 4 and under
• Persons living in rural areas
• Low socioeconomic status families: Lack of proper
hygiene, use of kerosene stoves that lack any safety
measures
Motor vehicle injuries- 5
• The greatest public health problem facing
children today. In fact, they are the leading
cause of death among them (CDC 2004).
• Unstrained (no seat belt) below 14 years old
children are prone to non fatal and fatal car
injuries
Violence- 6
Violence is "the threatened or actual use of
physical force or power against another
person, against oneself, or against a group
or community that either results in or has a
high likelihood of resulting in injury, death,
or deprivation"
 Violence
• Community and family instability, housing and
population density, extreme poverty and high
residential mobility are associated with community
violence
• Exposure to media violence is associated with
aggressive behavior in children. The relation between
media violence and aggressive behavior could be
mediated by cultural and group norms
• For example, children who live in communities where
aggressiveness is unacceptable are less likely to react
aggressively to media violence.
 Violence
• Physical injuries are not the only consequences of
violence; violence affects the emotional, psychological,
and social well-being of young persons
• Violence can adversely affect the ability of students to
learn
• Childhood maltreatment also increases the likelihood
that young persons will engage in health risk behaviors
including suicidal behavior and aggressive behaviors
in adolescence
• Childhood maltreatment has been linked to several
adverse health outcomes in adulthood, including
mood and anxiety disorders and diseases, including
ischemic heart disease, cancer, and chronic lung disease
7- Work-Related Injuries
• Approximately 5 million adolescents and
children are legally employed;
• 1--2 million more could be employed
illegally, working with dangerous and
prohibited equipment
RISK BEHAVIORS ASSOCIATED WITH
INJURY

• Children and adolescents can engage in

many behaviors that increase their risk for
injury.
• These behaviors often co-occur.
• Among high school and college students,
associations have been reported among
suicide ideation, not using seat belts,
driving after drinking alcohol, carrying
weapons, and engaging in physical fights.
RISK BEHAVIORS ASSOCIATED WITH
INJURY

• Link with gender (boys)

• Activity level
• Anti-social behavior
• Discipline problems at home
• Aggression
 Why injury programs should be
? established
• Injuries have a significant impact on morbidity
and mortality. They account for more deaths in
persons between ages 1 and 44 than all infectious
diseases combined.
• Injuries have a significant impact on health care
and societal costs
• Though more researches into risk factors are
needed, injuries are preventable now.
• Morbidity caused by injuries is common during
childhood and adolescence.
 Injury Surveillance Systems

Surveillance systems represent the systematic

collection of data on a disease.
They identify the existing level of disease. Over
time they identify trends to show if diseases
are increasing or decreasing in incidence, and
which are changing in their distribution.
This information is needed to identify emerging
problems and also to assess the effectiveness
of measures to control old problems.
 INJURY-PREVENTION
STRATEGIES
• Injury-prevention interventions can target three different
periods:
1. Before an injury-causing event (e.g., avoiding a motor-
vehicle crash by not drinking and driving),
2. During an injury-causing event (e.g., wearing a seat
belt), or
3. After an injury-causing event to lessen the severity of an
injury (e.g., rapid emergency medical services)
• Regardless of the period, effective injury-prevention efforts
address several factors: the environment, individual
behavior, products, social norms, legislation, and policy.
 SCHOOL HEALTH
RECOMMENDATIONS TO
PREVENT UNINTENTIONAL
INJURIES, VIOLENCE, AND
SUICIDE
 Recommendations to prevent unintentional
injuries, violence and suicide
1. a social environment that promotes safety;
2. a safe physical environment;
3. health education curricula and instruction;
4. safe physical education, sports, and recreational
activities;
5. health, counseling, psychological, and social services for
students;
6. appropriate crisis and emergency response;
7. involvement of families and communities; and
8. staff development to promote safety and prevent
unintentional injuries, violence, and suicide.
Recommendation 1:
Social environment

• Schools can implement strategies to improve

the social environment schoolwide (e.g.,
those designed to create a climate of caring
and respect)
• Implement selected activities for students at
higher risk
• Encourage Students' Feelings of
Connectedness to School.
Recommendation 2:
Physical environment

• Provide a Physical Environment, Inside and

Outside School Buildings, That Promotes Safety
and Prevents Unintentional Injuries and Violence.
– Maintain Structures, Playground and Other
Equipment, School Buses and Other Vehicles, and
Physical Grounds;
– Make Repairs Immediately Following Identification of
Hazards.
– Ensure That the School Environment, Including School
Buses, is Free from Weapons.
 Recommendation 3:
Health education curricula

• Implement Health and Safety Education Curricula.

– Schools can teach students the skills needed to promote
safety and prevent unintentional injuries, violence, and
suicide while at home, at work, at play, in the community,
and throughout their lives.
– Schools can teach about unintentional injury and violence
prevention using health education methods grounded in
theory and with scientific evidence of effectiveness.
 Recommendation 4:
Safe physical education

• Provide Safe Physical Education and Extracurricular

Physical Activity Programs.
• Schools can improve the safety of their physical
education and other physical activity programs by
– developing and enforcing safety rules,
– promoting unintentional-injury prevention and
nonviolence,
– requiring the use of protective equipment,
– ensuring the safety of the physical environment,
– and properly training all physical education staff members
Recommendation 5:
Health, counseling

Provide Health, Counseling, Psychological, and

Social Services to Meet the Physical, Mental,
Emotional, and Social Health Needs of Students.
Direct schoolwide prevention activities;
– Conduct classroom-based education regarding risks for
unintentional injury, violence, and suicide;
– Help students identify triggers that cause them and
others to become violent or aggressive; and
– Help students become aware of behaviors that might be
precursors of violence or suicidal behavior in others.
 Recommendation 6:
Crisis and emergency response

Schools need to be responsive to crises and disasters that

could affect the school community, including
– environmental disasters (e.g., fires, floods, tornadoes,
blizzards, and earthquakes);
– death or serious injury of a student or staff member in a car
or bus crash, suicide, or a violent event at school;
– a suicide attempt;
– terrorism, including bioterrorism; hazardous chemical
spills; explosions; radiation; mass illness or injury;
– or other situations that threaten the safety of persons in the
school or community.
Recommendation 7:
Involvement of families and communities

• Integrate School, Family, and Community Efforts to Prevent

Unintentional Injuries, Violence, and Suicide.
• Schools cannot prevent unintentional injuries, violence,
and suicide in isolation from the communities and families
they serve. Schools, communities, and families can provide
each other with reciprocal benefits.
• When parents are involved in school, violent and antisocial
behavior decreases.
• Family members can be invited to participate in all areas of
education; and unintentional injury, violence, and suicide
prevention training could be offered to families.
 Recommendation 8:
Staff development

• For All School Personnel, Provide Regular Staff with the

Knowledge, Skills, and Confidence to Effectively Promote
Safety and Prevent Unintentional Injury, Violence, and
Suicide, and Support Students in Their Efforts to Do the Same.
• Staff members who understand how to prevent unintentional
injury, violence, and suicide for students and for themselves
can transmit this information to students.
• Staff members who act to prevent unintentional injuries,
violence, and suicide for themselves and others can be
positive role models for students
Healthy People 2010 sets an agenda for
health promotion and disease prevention
for the United States
 To achieve the outcome of reduced morbidity and
mortality caused by unintentional injuries, violence, and
suicide, Healthy People 2010 includes objectives to

• increase use of safety belts, motorcycle helmets,

bicycle helmets, smoke alarms, and sports-related
protective gear;
• reduce the proportion of adolescents who engage in
physical fighting, carry weapons, and ride with a
driver who has been drinking alcohol;
• increase the number of states that have adopted
graduated driver licensing laws; and
• increase the proportion of schools that provide
comprehensive school health education to prevent
unintentional injury, violence, and suicide. .
Behavioral change is a necessary component of even
the most effective passive strategies (e.g., personal
protective equipment must be used properly and
depth and quality of playground surface materials
must be maintained regularly)
Legislation must be supported by the public and
enforced by local authorities
The most effective injury-prevention efforts use
multiple approaches simultaneously. For example,
legislation requiring use of bicycle helmets would
be accompanied by an educational campaign for
children and parents, police enforcement, and
discounted sales of helmets by local merchants