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News and Notes

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SAFE babies

The ambitious two year smoke alarm giveaway program by the City of Winnipeg (Manitoba) Fire Department and the Kiwanis Club of Winnipeg, Inc has been honoured with the Rolf H Jensen Partners in Public Education Award from the US based National Fire Protection Association. From 1996 to 1998 SAFE (Smoke Alarms for Every) Baby distributed 26 000 fire and burn prevention kits. Before leaving hospital, every mother of a baby born in Winnipeg during that period (including many residents of rural Manitoba) received the kit containing a smoke detector, safety booklet, fire escape plan fridge magnet, and bath water thermometer. Babies also receive a birthday card on their first birthday with a reminder to mom and dad to change the battery in the smoke detector.

To determine SAFE Baby's effectiveness in raising public awareness, improving smoke detector use, and reducing fire and burn rates a three phase evaluation of the program is being conducted by IM-PACT, the injury prevention program of Winnipeg Children's Hospital. The first phase analyzed 2000 surveys collected by public health nurses on postnatal visits (one to two weeks postpartum) and found nearly universal coverage and a high level of awareness of the information provided. Phase 2 interviewed a random sample of mothers, whose babies were then 3 to 20 months old, and found that 71% to 80% of families had installed the smoke detector, most detectors were functioning, and nearly all families who had not installed the smoke detector said they already had one. Both phases, however, found much poorer results in Winnipeg's poorest neighbourhoods.

Phase 3 of the evaluation—an analysis of fire incidence and injury statistics after the program—will provide further information on the value of this kind of intervention.

IM-PACT's report on the first two phases of the evaluation includes this telling anecdote: one rural mother interviewed by telephone could not test her smoke detector as requested during the interview because the family had lost everything in a house fire. Everyone got out safely thanks to smoke detectors, including the one given away in the SAFE Baby program!

Car accidents kill 500 000 annually

Half a million people die each year in traffic accidents, most of them in developing countries where driver training is lax and road conditions are poor. Another 15 million are injured, according to the World Disaster Report issued annually by the International Federation of Red Cross and Red Crescent Societies. The report was released in New Delhi, where traffic accidents claim thousands of lives every year. The economic cost for developing countries is and estimated $53 billion annually.

In Ethiopia, traffic fatalities are a hundred times higher than in Japan and Australia. The gap reflects the difference in health facilities and traffic conditions, the report said. Roads in developing countries are cluttered with pedestrians, bicycles, and animals. Developing countries also lag behind the developed world in road safety campaigns, driver training and seat belt laws, it said. Nepal, Bangladesh, China, Swaziland, and India follow Ethiopia as countries with the largest number of accidents.

Airbag off switch not used

Associated Press reported that an infant who died in a pickup crash in Ohio in May may have been the first killed by an airbag that could have been turned off but wasn't. The 2 month old girl was in a rear-facing infant seat on the passenger side of a pickup that crashed into another pickup. It was the first known case of an inflating airbag killing an infant or young child when the airbag had an on-off switch, according to a federal official.

Since 1995, the National Highway Traffic Safety Administration has allowed cut off switches in pickup trucks, sports cars, and other autos with no back seat because of the potentially deadly consequences of placing rear-facing infant seats in front of airbags. There are 3.2 million vehicles on the road in the US with those switches.

EURORISC news

The second edition of the newsletter linked with the Glasgow-led EURORISC project (see Vol 4, 97, June 1998) reports that the first phase of the project—the collection of data on the epidemiology of injury and information on injury surveillance throughout the European Union (EU)—has been completed and the results analysed. In the second phase, evaluation criteria against which to assess surveillance activities are being drafted and discussed.

The newsletter highlights the huge percentage changes in injury mortality across the EU between 1984 and 1993. At one end of the spectrum mortality rates have decreased by over 25% in Austria, Netherlands and the UK, while Spain and Finland show increases. In absolute terms, rates of unintentional injury (for all age groups) in 1993 ranged from 34.7 deaths per 100 000 in Portugal and 34.3 in France to under 15 in the UK and the Netherlands.

For further information about EURORISC contact Anita Morrison, PEACH Unit, Royal Children's Hospital, Yorkhill, Glasgow G3 8SJ, UK (fax: +44 141 201 0837).

Speak up

Objects removed from the ears of 191 Boston children, aged from 10 months to 17 years, included beads, plastic toys, pebbles, and insects. The greatest difficulty in removal, and greatest distress to patients, was experienced with live insects, usually cockroaches. Microscope immersion oil, topical anaesthetic solutions, and mineral oil were preferred to lidocaine to immobilise or kill the offenders before removal. The cases included seven children with putty in their ears, frequently recommended as ear plugs for protection against water for children with tympanostomy tubes. Removal is difficult because of the texture and consistency of the product (

).

Helmet campaign launched in UK

A new national charity promoting the use of cycle helmets was launched in July in London. Roads Minister, Baroness Hayman, joined the launch reflecting government concern about the need to tackle the 30 000 cycle related head injuries to children. The charity, Bicycle Helmet Initiative Trust (BHIT), has grown out of an award winning project in Reading, where paediatric trauma nursing sister Angie Lee has managed to increase helmet use among teenagers to 40%. In an original funding regime, the Departments of Health and Transport have jointly agreed to support the charity to test the promotional programme used in Reading in other parts of England over three years. Further details from Angie Lee, BHIT, PO Box 2612, Reading, Berkshire RG1 5XB, UK (tel: +44 118 987 8747, fax: +44 118 987 8746, e-mail: bhit{at}dial.pipex.com).


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Seat belts and child restraints leaflet

The UK's Department of the Environment, Transport and the Regions has published an updated 11 page leaflet with detailed information on the law on transporting people in cars, selecting the right child restraint, and giving advice for pregnant women. Available free from DETR Free Literature, c/o PO Box 236, Wetherby, West Yorkshire LS23 7NB, UK, quoting reference T/INF/251.

Product safety report from Finland

National and provincial inspections of consumer products and services in Finland revealed that more than a quarter failed to meet statutory requirements. In many cases, the failure was due to incomplete labelling. These results are presented in a report by Pirjo Tomperi of the National Consumer Administration. The items inspected included sunglasses, lifejackets, toys, furniture, playgrounds, and children's face paints. The report Market control performed in accordance with the Product Safety Act in 1997 is available from National Consumer Administration, Haapaniemenkatu 4, PO Box 5, 00531 Helsinki, Finland (fax: +358 (09) 7726 7557).

Injury prevention mandated for Ontario public health units

The Ontario Ministry of Health has issued mandatory guidelines for injury prevention services to be carried out by public health units throughout Canada's most populous province. The guidelines set year 2010 injury reduction objectives for designated priority areas: cycling crashes, motor vehicles (including boats, snowmobiles, and all terrain vehicles), falls in the elderly, and alcohol and other substance related injuries. Regional boards of health are required to work with local police, schools, and community coalitions in conducting public education campaigns, community events, and continuing education for health professionals. Copies of Mandatory Health Programs and Services Guidelines, December 1997 are available at the Publications and Public Health links of the Ontario government website, www.on.gov.ca.

Asian language resources

Safety information sheets for parents and carers in Bengali, Gujarati, Hindi, and Urdu (with English guidelines) are available from the Child Accident Prevention Trust (CAPT). Funding for the materials was provided from England's Department of Health Ethnic Minority Access Grant programme. Each sheet is divided into three sections: preventing burns and fires in the home, general home safety, and safety in the street. Information about child development completes the picture. Contact Nuzret Ali, CAPT, 18–20 Farringdon Lane, London EC1R 3HA, UK (fax: +44 171 608 3674, e-mail: nuz{at}capt.demon.co.uk).

CPSC product recalls

Product recalls by the US Consumer Product Safety Commission (CPSC) include:

  • 6000 novelty purses. The purses contain a petroleum distillate, used as a decorative liquid in the purse flap, that could be harmful or fatal if ingested.

  • About 127 800 children's anoraks. The anoraks have paint on the zipper pull that contains an unacceptable level of lead. While exposure to the defective zippers presents no immediate health danger, exposure to high levels of lead over an extended period of time presents a potential poisoning hazard to young children if ingested.

  • About 500 floating balls. These floating balls contain a petroleum distillate, similar to kerosene, that could be harmful or fatal if ingested.

  • About 80 000 children's sneakers. The teddy bear or heart metal clasps on the zippers of these shoes can come off, posing a choking hazard to young children.

Health visitor numbers affect hospital visits

The more health visitor (public health nurse) hours available at family doctor surgeries, the fewer emergency admissions to hospital. This is a key conclusion of research from Queen Mary and Westfield College, London. The result is attributed to the health visitors' ability to help families manage minor symptoms, develop networks, and use health services appropriately. The study was carried out in a deprived area of East London where families often move home frequently and have only a transient relationship with family doctors. Does the provision of practice based preventive child health services decrease the use of hospital services? by Sally Hull et al is available from the Department of General Practice and Primary Care, Queen Mary and Westfield College, Mile End Road, London E1 4NS, UK.

New CDC director

Dr Jeffrey P Koplan is the new director of the Centers for Disease Control and Prevention (CDC). Dr Koplan has served as a consultant to the World Bank and the World Health Organization on public health programs in China, Finland, Hungary, the Caribbean, and other nations. Recently he was Visiting Professor of Community Health at Emory University School of Medicine and Clinical Professor of Community Medicine at Morehouse Medical School. Dr Koplan replaced Dr David Satcher, now US Surgeon General.

Search for previously recalled portable cribs and play yards

In June, the CPSC urged consumers to search for and stop using previously recalled child products, in particular the Playskool Travel-Lite portable crib, manufactured by Kolcraft from 1990 to 1992 and recalled in 1993. In May, a Chicago toddler died after a Playskool Travel-Lite portable crib collapsed.

Manufacturers of portable cribs and play yards have joined in the effort to warn consumers and childcare providers to stop using the more than 1.5 million portable cribs and play yards that have been recalled in past years. Top rail hinges must be turned to set up the cribs and play yards. These top rails can collapse, entrapping children and suffocating them. Twelve children have died from suffocation in collapsed play yards and portable cribs manufactured by various firms. Current production play yards have top rails that automatically lock into place when the play yards are fully set up.

Kolcraft has gone to great lengths to renew their recall efforts. Kolcraft offered a $60 refund to consumers for the return of the Travel-Lite portable cribs. They have also notified pediatricians and childcare providers about the recall.

Minor injuries research

To overcome the gap in knowledge of the normal frequency, pattern, and nature of minor injuries to children, and the context and circumstances in which they occur, research funded by England's Department of Health is starting at London's Institute of Education. The main aims of the study are to identify and provide a profile of the normative experience of injuries at different ages in childhood, investigate the association between particular contexts or activities and identifiable patterns of injury to children, and investigate the association of different levels of parental supervision, and minor injuries to children.

The sample will comprise a total population of families with children aged under 8 years of age, drawn from family doctor lists in a number of different locations including inner city and non-metropolitan areas. Pilot work will be carried out to establish the most accurate and reliable method of collecting information on minor injuries sustained by children. Incident diaries and daily telephone calls (and combinations of these methods) will be tried. Information will be collected from each family over a nine or 10 day period. At the end of this, a short interview will be conducted with the caretaking parent, during which standardised measures of child behaviour, parent affect, and stress will be completed. Approximately a quarter of parents will be interviewed more extensively to investigate differences in parental behaviour, attitudes or expectations, particularly in relation to supervision and safety measures.

The researchers expect the results of this study to have relevance to an understanding of non-accidental and unintentional injury. In addition, information on the normative pattern and frequency of minor injuries to children will provide guidance for those who have to make decisions about whether observed injuries are within the normal range, and consistent with an adequate level of care and supervision. For further information contact Dr Marjorie Smith, Thomas Coram Research Unit, 27/28 Woburn Square, London WC1H 0AA, UK (fax: +44 171 612 6927, e-mail: m.smith{at}ioe.ac.uk).

Safety commendation to the National SAFE KIDS Campaign

The CPSC announced in June that Chairman Ann Brown had awarded the Chairman's Commendation to the National SAFE KIDS Campaign and its state and local coalitions for their outstanding efforts to increase public awareness of safety and prevent injuries to children. “It is certainly appropriate to honor SAFE KIDS for the excellent work the group has done to prevent deaths and injuries to our nation's children”, said Brown. “There is no other organization I know of that has done this more effectively”.

Toys in food (again)

Intuitively it seemed that chocolate eggs containing tiny toys would be hazardous for youngsters and an Israeli case report of two children who inhaled parts of small plastic toys contained inside chocolate eggs confirms this suspicion (

). The authors note that the packaging of these products usually carries a warning that they not be given to children under 3 years of age. However these boys were aged 4 and 5 years leading to the recommendation that toys should not be contained in chocolate sweets marketed for children.

Babywalkers make headlines in UK

Child Safety Review, the newsletter of CAPT, reports that the dangers of babywalkers became headline news in April. Several national UK newspapers reported on findings by Liverpool trading standards that many of the leading brands of babywalkers had failed safety tests. The investigation was prompted by Joan Robson, a consultant at Alder Hey Children's Hospital, Liverpool, after she became concerned at the number of injuries involving babywalkers.

Ten models failed for reasons ranging from not carrying the required safety warnings to crotch straps being below the minimum width and frames not being stable. However, manufacturers of babywalkers and the organisation that represents them, the Baby Products Association (BPA), stood by their products claiming that the walkers met with relevant safety standards and that the tests were unreliable.

The then Consumer Minister Nigel Griffiths urged suppliers to take urgent action or risk losing public confidence in their products. The BPA was reported to have threatened legal action against Liverpool trading standards and suggested that accidents involving babywalkers were caused by lack of proper supervision rather than design or manufacture.

CAPT, like many safety organisations, advises against babywalkers because:

  • They cause more injuries to young children than any other single item of nursery equipment: in 1996 almost 3000 children under a year old were injured in the UK while using them.

  • There is no evidence to suggest that they help a baby to walk earlier. In 1997, the Chartered Society of Physiotherapy raised concerns that babywalkers may slow down physical development.

  • Accidents occur because babies are able to move around in them much faster than they would otherwise manage for their age, tipping themselves downstairs or into fireplaces and reaching things like hot drinks on low tables.

... while in the US, better news

CPSC is informing consumers of the availability of a new generation of safer babywalkers. These new walkers have features that will reduce the stair fall injuries associated with traditional babywalkers.

CPSC notes that more children are injured with babywalkers than with any other nursery product—in 1997, walkers were involved in over 14 000 injuries to children under 15 months needing treatment in hospital emergency rooms. Walkers also have been involved in 34 deaths since 1973. Most children sustained injuries when their walker fell down stairs.

To make walkers safer, CPSC worked with the industry to develop a new standard. Each walker meeting the new standard and certified by the Juvenile Products Manufacturers Association must meet one of two requirements: it must be too wide to fit through a standard doorway, or it must have features, such as a gripping mechanism, to stop the walker at the edge of a step.

If consumers choose to use babywalkers, CPSC strongly recommends that they replace their old walkers with a new generation babywalker, which meets the requirements of the standard. Consumers should look for the “Meets New Standard” label. An alternative is the stationary activity center, which does not have wheels. Whichever new product they choose, consumers should follow these safety tips when using a babywalker or an activity center:

  • Close the door or gate at the top of the stairs.

  • Keep children within view.

  • Keep children away from hot surfaces and containers.

  • Beware of dangling appliance cords.

  • Keep children away from toilets, swimming pools, and sources of water.

CPSC said that without the new standard, babywalker related injuries would increase to as many as 32 000 injuries in 2002. With CPSC's intervention in getting the new standard in place, the number of babywalker related injuries is estimated to decrease to less than 10 000 per year by 2002.

First aid in schools

A good practice guide for operating first aid services in schools in Wales has been published by the Welsh Office. It identifies the responsibilities and statutory requirements of different bodies and individuals, presents advice on risk assessment for first aid needs, considers qualifications and equipment, and highlights the needs for good record keeping. The guidelines are available (in English and Welsh) from Schools Administration Division 1, Welsh Office, Cathays Park, Cardiff CF1 3NQ, UK (fax: +44 1222 826111).

Acknowledgments

Contributors to these News and Notes: Anara Guard, Barry Pless, Jan Shield, David Sleet, Kathy Weber, and Amy Zierler. Contributions have been edited by Michael Hayes. Items for the June 1999 issue should be sent to Michael Hayes at Child Accident Prevention Trust, 18–20 Farringdon Lane, London EC1R 3HA, UK (fax: +44 171 608 3674, e-mail: mh{at}capt.demon.co.uk) by 1 March 1999.

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