The efficacy of safety barriers for children: absolute efficacy, time to cross and action modes in children between 19 and 75 months

Drowning Accidents in a Spanish Pediatric Intensive Care Unit: An Observational Study for 29 Years

INTRODUCTION

Drowning is one of the most frequent accidents in children. We aimed to describe demographic and epidemiological characteristics of drowned children who required admission to a pediatric intensive care unit (PICU) to identify risk factors to guide possible preventive measures to avoid severe drowning.

METHODS

We conducted an observational study for 29 years (retrospective between 1991 and 2004; prospective between 2005 and 2019) that included all children (0-15 years old) requiring PICU admission after drowning. Data regarding patient characteristics, accident circumstances, and neurological outcomes at PICU discharge were analyzed.

RESULTS

A total of 160 patients were included, with no significant decrease over the study period. There was a predominance of males (75%), young age (60%; 1-5 years), summer months (91.1%; May-September), tourists (14.12 [95% confidence interval, 9.2-21.7] times higher risk of drowning than residents), swimming pool accidents (88.8%), and inadequate supervision (77.9%). The mortality was 18.7%, and 7.5% of admitted children had severe neurological sequelae. The initial resuscitation maneuvers by accident witnesses were incorrect in nearly half of the patients in whom these could be analyzed.

CONCLUSIONS

Emphasis should be placed on implementing preventive measures, focused on the described risk groups, and insisting on adequate supervision, swimming training programs, and training of the general population in safe rescue and cardiopulmonary resuscitation.

BASE: Pragmatic Injury Prevention for Practitioners

Unintentional injury remains a leading health problem in developed nations, making injury prevention imperative. Practitioners are primary stakeholders in the injury prevention process but rarely can devote significant time to complicated prevention efforts. Furthermore, theory-based approaches to support injury prevention are less common than atheoretical approaches. We propose a simple method for injury prevention grounded in concepts found in antecedent models. Barriers, attitudes, social context, and environmental factors (or BASE) are suggested as a simple injury prevention model practitioners can follow when working with patients. We present each component of BASE and offer examples of how the approach can be applied to risk factors associated with several types of injury risk behavior.

Infant Drowning Prevention: Insights from a New Ecological Psychology Approach

Drowning causes significant mortality and morbidity globally, and infants (0-4 years of age) are disproportionately impacted. In a groundbreaking approach to pediatric drowning prevention, ecological psychology has been used to investigate the relationship between infants' perceptual-motor development and their behavior around bodies of water. In this review, we summarize recent research findings in the field of ecological psychology and apply these to the prevention of infant drowning. Studies have linked infants' avoidance of falls into the water with locomotor experience and type of accessway into bodies of water. Through crawling experience, infants learn to perceive the risk of falling into water and start adapting their behavior to avoid drop-offs leading into water. Infants tend to enter deep water more when the access is via a slope than via a drop-off. We propose that ecological psychology can enhance infant drowning prevention interventions. The aim is to create an additional layer of protection, the perceptual information layer, in addition to existing strategies, such as supervision and barriers. This new protective layer can be a powerful tool to further highlight the risk of entering the water and reduce infant drowning-related mortality and morbidity.

Crossing safety barriers: influence of children's morphological and functional variables

Thirty-three children between 3 and 6 years of age were asked to climb four different types of safety barriers. Morphological and functional variables of the children, which were expected to influence climbing or passing through skills, were collected. The influence of those variables on children's success rate and time to cross was tested. No barrier offered a total restraining efficacy. The horizontal bars barrier was crossed by 97% of the children. In the group of children that succeeded in crossing the four barriers, mean time to cross the most difficult barrier was 15 s. Age was the best predictor for success in crossing most barriers but morphology and strength were important predictors of time to cross. The influence of anthropometric variables in time to cross was dependent upon the characteristics of the barrier. A good design of safety barriers should consider children's age, morphology and strength.

Perceiving children's behavior and reaching limits in a risk environment

The purpose of this study was to investigate the accuracy of parents' perception of children's reaching limits in a risk scenario. A sample of 68 parents of 1- to 4-year-olds were asked to make a prior estimate of their children's behavior and action limits in a task that involved retrieving a toy out of the water. The action modes used for reaching, accuracy of estimates, and error tendency were investigated. Several morphological variables, walking experience, and swimming program experience were analyzed as predictors of maximum and estimated maximum reachability. Most children sat to retrieve the toy out of the water and fell in while attempting to grasp beyond their reaching limit. Nearly 80% of the parents correctly predicted their children's behavior when the toy was unreachable. Parents were cautious in predicting their children's maximum reachability (>50% underestimates). Mothers were more accurate than fathers in estimating their children's reaching limit. The prediction of children's capabilities was based partially on body dimensions and proportions.