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SPLINTERS & FRAGMENTS
  1. Jan Shield
  1. Royal Children's Hospital Safety Centre, Melbourne, Australia

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    Randomised controlled trial of general practitioner safety advice

    This study, in which 165 families attending a British general practice were randomly assigned to intervention and control groups, was designed to assess the effectiveness of office based child safety advice on the subsequent use of safety equipment and adoption of safe practices at home. Low income families were provided with safety equipment. At six weeks after the intervention, significantly more families in the intervention group used fireguards, smoke alarms, power point covers, cupboard locks for storing cleaning products, and devices to prevent doors slamming. Some safety practices also improved, and the authors note that the population approach was equally effective across socioeconomic strata. How generalisable such a program would be is open to speculation, but the results are positive in demonstrating a role for family doctors in delivering safety information and providing low cost safety equipment to families with young children (

    ).

    Parents' perceptions of safe practices

    Fewer than half of the 412 Florida parents and caretakers believed most injuries to be preventable when they were surveyed to determine their home safety practices, perceptions of risks to their children, and their learning needs. This belief correlated with educational level. The vast majority of parents knew how to telephone emergency services, as did most older children. Child car seats and seat belts were commonly used, and most homes had smoke alarms installed. The principal learning need was for cardiopulmonary resuscitation (CPR) training, indicating that they wished to be prepared for an emergency. Parents of younger children were highly motivated to learn about childhood diseases, injuries, and child care which encouraged the hospital to expand its community education programs to include CPR, water safety, use of bicycle helmets, and home safety (

    ).


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    Trampolines revisited

    Preventive action was taken in the US in the 1970s with the banning of trampolining from national collegiate athletic competition, issuing of a voluntary standard, the US Consumer Product Safety Commission's (CPSC) fact sheet, the American Academy of Pediatrics' (AAP) statement on injury risk, and the subsequent elimination of trampolines from most schools. A 1981 revision of the AAP statement suggested a trial of trampolines could be conducted in schools, but recommended against their use at home or for recreation. Trampolines seem to have enjoyed a revival in popularity: in the six years of the study, overall injuries almost doubled, and increased 114% among children under 5 years (despite US CPSC recommendations for trampolines not to be used by children under 6 years of age). An estimated 249 400 trampoline injuries to children, 93% of which occurred at home, resulted mainly in injuries to upper extremities, with fractures and dislocations being the principal causes of hospital admission. The author believes that current prevention strategies are inadequate, that children should not use trampolines at home, that the sale of trampolines for private recreational use be prohibited, and proposes a trade-in campaign to decrease the number of existing trampolines (

    ).

    Burns prevention programs work

    A long term Israeli school based burns prevention program involved 250 000 children and 10 000 teachers in 460 selected schools in one geographical region. Children's knowledge and beliefs improved significantly, and schools assessed the program positively. More importantly, in southern Israel there was also a reduction in the numbers of children hospitalised with burns (

    ). In Turkey, analysis of 5264 cases of thermal injuries shows that scalds are the principal type of paediatric burn. The traditional method of tea preparation using one narrow based pot atop another was the principal cause of scalds overall and the authors recommend modifying this hazardous practice (

    ). Similarly in Greece, a case-control study reveals the principal risk for childhood burn injury to be scalds from hot liquids in the kitchen, with an increased risk for children of gypsies and recent immigrants. Interestingly, a “high burn avoidance index appears to be a highly significant predictor of burn occurrence, whereas more active children appear to be at lower risk”, but the authors advise caution in generalising this finding to other contexts (

    ).

    Are boys inherently more danger seeking than girls?

    It would seem so: they certainly take more risks, according to Ontario researchers. Children (148 boys and 142 girls aged 6–11 years) were asked to assess the likelihood of injury, how often they were injured, what they believed caused the injuries, and their skill level for the activity as shown in four drawings of each of four common activities depicting varying degrees of risk. Two versions of each drawing, with contrasting facial expressions described as confident and wary (that is, 32 drawings for each child), were used. Boys were more likely to attribute injuries to bad luck and to rate injury risk lower than girls, suggesting that “girls assign greater significance to contextually based `evidence' indicating injury-risk in a situation (that is, a peer communicating uncertainty about an activity)” and “since boys are more inclined than girls to adopt beliefs reflecting an optimism bias, they are less inclined than girls to assume that a peer's apparent concern about executing an injury-risk activity has implications for how successful they themselves would be in so doing”. The research pinpoints “the potential role of cognitive-based factors for understanding children's risk taking and reveals the influence on risk appraisal of nonverbal communications by peers modeling risk-taking behaviors” (

    ).

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