Injury Prevention for Injury Prevention for ChildrenChildren

Injury Prevention for Injury Prevention for ChildrenChildren

How PT can help!How PT can help!

Topics to cover• Playground Safety• Bike Safety• Water Safety• Backpack Safety

Playground Safety• 200,000 ER admissions each year

secondary to playground injuries• most associated with falling from

equipment

Trampolines• Only children older than 6 years old should use

– Increase injury rate in younger children – 48% of injuries occurred in children under 9 years old

– Overall more girls than boys– Most injuries occur on trampoline– Most frequent injuries were fractures: arm/leg

most common– Second most frequent – sprains, strains and

dislocations– Most admissions to hospital occur in the 5 to 9

age range

Common Injuries (Canadian Hospital Injury Report)

• Breakdown event and factors contributing to the injury* What happened Frequency Percent ofInjuries – Attempted a maneuver, trick or flip: 27.3 – More than one person on trampoline at a time

bumped into, hit or fell on top of another personjumping, playing on trampolinepushed or fell off trampoline : 21.7%

Prevention of injuries• Adult supervision required• Bare feet – better traction less

slipping• One child at a time (how realistic?)• Net should have 250 pound limit

Trampolines• Springs covered

with padding• Anchor trampoline

into ground• No flips• AAP: trampolines

are not toys – should only be used as training devices

What about mini-tramps? (Pediatrics, July 2005)

• 32% of mini-tramp injuries occur to children under 6 years old

• Most frequent injury – head laceration• More females injured• Most injuries are on trampoline not

falling off• Just has hazardous as full size

AS PTs• Educate parents on trampoline

safety– One child at a time on trampoline– Enclosures– No Flips or rough housing– Bare feet– Mini tramps need supervision as well

Other playground equipment

Making Playgrounds Safe

• Playgrounds should fit the child: Children under 5 years old should use equipment only designed for pre schoolers

• Surfaces: sand, pea gravel, wood chips, synthetic– Should be at least 12 inches deep– Extend surface at least 6 feet in all directions

from equipment

Safe• Play structures more than 30 inches high

should be placed 9 feet apart• Swings should not have metal or hard wood

seats – swings should be at least 8 inches apart• Clearance between bottom of swing and

ground – 8 inches• Look for dangerous hardware: hooks, bolts• Make sure any spaces (i.e. ladder rungs) are

less than 3.5 inches and more than 9 inches apart to avoid head entrapment– One publication recommended kids wear bike

helmets on playground equipment to avoid heads getting trapped

Safe• Drawstrings: can potentially

strangle a child if they get caught – best to either remove from clothing or sew a seam in the middle of clothing so one side can not get pulled to far out

Pressure treated wood• Many treated wood contains arsenic

– Children should not eat food while playing on equipment built with pressured treated wood

– Wash hands with soap and water after play

– Arsenic can also “leak” into the ground

Sun exposure while on playgrounds

• 80% of skin damage from sun occurs before age 18

• Wear sunscreen, hats, sunglasses

Infants

• Babies under age 6 months need to be kept out of direct sunlight and wear lightweight clothing that covers their body– Wide brim hats– Baby-sized sunglasses– Stay out of sun between

10 AM and 4 PM

As PTs• Provide literature about playground

safety in lobby• Provide community playground

checks• Discourage trampoline usage unless

proper supervision present and used a training tool for sporting events

Bike Safety

Bike Safety• 85 million bike riders in US

– 70% of kids ages 5 to 14 years ride bikes• More than 900 bike riders die each year: 50% are

under 15 years old• 85% killed were not wearing a helmet• Where helmets are required – only 52% of

kids wear• 50% wearing helmets were not fitted properly

• 580,000 visit ER yearly: 67000 have head injuries• 1/8 cyclists with reported injury has a head injury –

45 to 88% of head injuries can be prevented by helmet use

• Indirect cost due to not using helmet – 2.3 billion per year

Perspective• Injuries per 1000 participants

– Basketball: 21.2– Football: 20.7– Bicycling: 11.5

• However, more bike riders treated in ER than other sports

• Among boomers, biking is the deadliest sport – boomers die from head injuries twice as often as children – however between ages of 5 and 15 injury rate is the highest

• Less than 50% of boomers wear helmets

– Snowboarding: 11.2– Skateboarding: 8.9– Inline skates: 3.9

Amusing Stats• Bike riding is less dangerous than

skydiving, motorcycling, living, swimming and water skiing

• But more dangerous than airline flying, hunting, cosmic radiation from transcontinental flights, home living

Bike • Death rate highest between 10PM - 1 AM – 8

times higher than during midmorning/early afternoon

• 32% of tested bicyclists who were killed had been drinking– One drink increases probability of serious bike

accident by a factor of 6• Among children – most bike fatalities occur within

1 mile of home• Among children 14 years and younger – accidents

secondary to bicyclist’s behavior – i.e. running stop sign, riding against flow of traffic, etc

Helmet usage• Between ages 4 to 15 could prevent

– Between 135-155 deaths– Between 39000 and 45000 head injuries– Between 18000 and 55000 scalp and face

injuries

– Every dollar spent on bike helmets, saves society $30 in direct medical and other costs to society

Helmet usage• If 85% of child bike riders wore

helmets – lifetime medical cost savings would be between $109 million and $142 million

• Treatment for non-fatal bike injuries in children under 14 years cost an average of $218000 per injured child

Proper helmet use

PT • State associations should push for legislation requiring

helmet use• Sponsor bike derbies – training in proper riding, correct

fit of bike and helmet, helmet use, bike inspections, etc• Encourage parents to buy helmets for their children –

especially in rural areas (one study found almost 0% of kids wear helmets in rural areas)

• Helmet use increases with helmet campaign intensity• Recommend children ride on sidewalks until they are

10 years old• Avoid riding at night

Water Safety

Water safety• Drowning is the

second leading cause of unintentional death among children ages 14 and under

• Children ages 1-4 years are at the highest risk for drowning

• Young children can drown in as little as 1 inch of water

Drownings• Occur quickly and silently with children• 2 minutes after submersion, LOC occurs• Irreversible brain damage occurs after

4 to 6 minutes• Most drownings occur when children

are left unattended by pool or tub or bucket of water (5 gallon)

Prevent drownings• Stay with young children when they are in the

bathtub – even if they are with an older sibling• Empty buckets as soon as done with chores –

if on break – place bucket where child can not reach

• Closely monitor children when swimming – always swim with a buddy

• Provide swimming lessons for all your children• Learn CPR• No children under 14 years old should use

personal watercraft

Water craft safety

PTs• Provide literature in lobby about

water safety• Take some time discussing safety

issues with parents during treatment times

• Model good water safety if have therapy pool program

Backpacks• Wear backpack over both not one shoulder• Be sure backpack right size for child• Use alternatives – packs with wheels –

avoid athletic bags • Encourage school to allow more frequent

locker breaks through out the day so kids do not have to carry so many books