2 Public health need and practice
Unintentional injury is a leading cause of death among children and young people aged 1–14 (Audit Commission and Healthcare Commission 2007). In England and Wales in 2008, 208 children and young people aged 0–14 died from such injuries (Office for National Statistics 2009).
In the UK, unintentional injury (in all environments) results in more than two million visits to accident and emergency (A&E) departments by children every year. Half of these injuries occur in the home (Audit Commission and Healthcare Commission 2007). In 2002, nearly 900,000 children and young people in the UK aged under 15 attended hospital following an unintentional injury in the home (Department of Trade and Industry 2002).
Children and young people who survive a serious unintentional injury can experience severe pain and may need lengthy treatment (including numerous stays in hospital). They could be permanently disabled or disfigured (Child Accident Prevention Trust 2008) and their injuries may have an impact on their social and psychological wellbeing.
Children and young children are vulnerable to a range of unintentional injuries in the home including falls, burns and scalds, drowning, suffocation and poisoning (Child Accident Prevention Trust 2008).
In the UK between 2000 and 2002, falls were the major cause of unintentional injury in the home among those aged under 15, according to home accidents surveillance system (HASS) data (Department of Trade and Industry 2002). 'Drowning and submersion' and 'other accidental threats to breathing' led to the most deaths in the home among this group between 2002 and 2005 (Office for National Statistics 2009). On average, 1200 children a year under the age of 11 are injured – and 35 are killed – in fires in the home (Directgov 2008).
Treating unintentional injuries among children and young people costs UK A&E departments approximately £146 million a year. Further treatment costs are significant, for example, it can cost £250,000 to treat one severe bath water scald (Child Accident Prevention Trust 2008). The indirect costs include enforced absence from school and the need for children and young people to be supervised during their recovery (which could involve family and carers taking time off from work).
Epidemiological data indicate that the risk of an unintentional injury is greatest among households living in the most deprived circumstances. Children and young people from lower socioeconomic groups whose parents have never worked (or who are long-term unemployed) are 13 times more likely to die from such an injury than those whose parents are managers and professionals (Edwards et al. 2006).
The evidence also suggests that a range of interrelated factors can lead to a higher risk of injury. Apart from a low income and overcrowded housing conditions, they include a lack of safety equipment. Other factors include gender, age, culture, ethnicity and the household's level of control over their home environment. Although not necessarily the direct cause of injury, these factors can increase children and young people's risk of exposure to a potential hazard.
Local strategic partnerships and local safeguarding children boards have a duty to promote children and young people's health, wellbeing and general welfare. In addition, local area agreements provide an opportunity for local authorities, in partnership with the NHS and other organisations, to focus on unintentional injuries in the home. Practice is variable, but some areas are taking innovative approaches to home safety.
In February 2009, the Department for Children, Schools and Families launched 'Safe at home: the national home safety equipment scheme' (2009). The 3-year, £18 m scheme is being developed and evaluated by the Royal Society for the Prevention of Accidents (RoSPA). Local organisations, working in partnership with RoSPA, will provide home safety advice and information and equipment to the most disadvantaged families in 141 areas of England with the highest accident rates.