Preventing injury in childhood
Authors: Graham Kirkwood, Allyson Pollock
Journal: BMJ (2008)

UK Child Safety Week will be launched by the Child Accident Prevention Trust on 23 June this year. Its aim is to raise awareness of childhood accidents and prevention strategies. 

Unintentional injury accounts for around one in five of all deaths in children and adolescents in the European Union with the highest injury rates occurring in Greece, Estonia, and Belgium.1 In the United Kingdom, unintentional injury is a leading cause of death and illness in children and is the most common cause of hospital admission—it accounts for around two million visits to accident and emergency departments each year, at a cost to the NHS of around £146m (€182m; $288m).2 Injury in childhood is strongly associated with poverty, and death rates from unintentional injury in the UK are around three times higher in children from the poorest families than in those from the least poor families; little is known about this topic in other countries.3 4 5 Children of parents in the UK who have never worked or who are long term unemployed are 13 times more likely to die from unintentional injury and are 37 times more likely to die as a result of exposure to smoke and fire than children of parents with higher managerial and professional jobs.2

Most injury is avoidable. For example, if Scotland matched Sweden in death rates for children and adolescents from unintentional injury then 62 lives a year—more than 40% of the total lives lost—would be saved.1

Injury surveillance systems are essential for monitoring risk and developing and evaluating community based initiatives aimed at preventing injury in children. They can motivate policy makers and communities to participate in prevention activities.6 However, like many countries in Europe, the UK has no comprehensive surveillance system for documenting childhood injury, so the causes, risk factors, and short term and long term consequences of injury are unknown. This hinders development and implementation of evidence based strategies to prevent injury.

The Audit Commission, Healthcare Commission, and the European Child Safety Alliance have criticised the fragmented nature of injury policy in the UK and the lack of progress in setting up geographical population based surveillance systems. The UK Department of Trade and Industry’s surveillance system of accidents at home and leisure (based on hospital samples) was discontinued in 2002. Wales is the only UK country that routinely surveys injuries in children in accident and emergency departments using the All Wales Injury Surveillance System.7 Scotland is the only UK member of the “EuroSafe” Child Safety Action Plan project under the European Commission’s Public Health Programme, which aims to “enhance child and adolescent safety by increasing awareness of the injury issue and uptake of proven prevention strategies.” However despite the pioneering work of the Information Services Division (NHS Scotland), which has incorporated the World Health Organization’s international classification of external causes of injuries into the National Clinical Dataset Development Programme, Scotland has yet to identify the resources to develop and implement a surveillance system in NHS accident and emergency departments.

Part of the difficulty is that responsibility for children is shared across numerous sectors and agencies. So what should be done? The Accidental Injury Task Force, which advised the chief medical officer in England on how to reduce the rates of death and serious injury from accidents, recommended that public health observatories and their counterparts in local government should play a key role in injury surveillance. The public health observatories have established a virtual Injury Observatory of Britain and Ireland—which acts as a central resource for data on injuries, prevention strategies, and collaborative work—but little political support exists to develop the surveillance systems required to monitor childhood injury at country level.

The 2012 London Olympics and Paralympics and the 2014 Glasgow Commonwealth games should act as a catalyst. Around one in five non-fatal unintentional injuries in children result from sport or recreational activities and almost a third occur in places used for sport, play, or recreation.8 The government hopes that the billions of pounds being invested in the games will help reverse the decline in physical activity and fitness and the high levels of childhood obesity. However, the benefits have to be weighed against the risks—more than half the benefits of physical exercise may be lost through injuries, which can result in sports activity being abandoned completely.9

Injury surveillance systems and prevention strategies could be used to help children participate in “safe” sport and reduce inequalities in rate of injury across social classes. Sweden, the Netherlands, and Denmark have developed well established, area based, population injury surveillance systems to inform intervention and prevention strategies.10 All three countries have the lowest mortality from unintentional injury in children and adolescents in Europe1 and high levels of participation in sport—Sweden has the highest rate of participation in Europe and half the levels of obesity seen in the UK.11 12

For UK governments to improve the health and wellbeing of children and to reduce inequalities, much more is needed. The creation of a UK all party parliamentary group to champion the cause of accident prevention is a small beginning. UK governments must now find the resources to develop population based injury surveillance systems so that the true incidence, causes, risk factors, and long term sequelae of injuries can be used to inform evidence based intervention.