Injuries and their relation to potential hazards in child day care

Compliance of camps in the United States with guidelines for health and safety practices

OBJECTIVE

To determine the compliance of US camps with guidelines for health and safety practices as set forth by the American Academy of Pediatrics and the US Department of Homeland Security.

METHODS

An electronic questionnaire was distributed to US camps during the summer of 2012 as identified by 3 online summer camp directories.

RESULTS

Analysis was performed on 433 completed questionnaires. Fourteen percent of camps were considered medically related. Ninety-three percent of camps have established relationships with community emergency medical services, 34% with local orthodontists, and 37% with local mental health professionals. Camps reported the immediate availability of the following: automated external defibrillators (75%), respiratory rescue inhalers (44%), epinephrine autoinjectors (64%), cervical spine collars (62%), and backboard with restraints (76%). Camps reported the presence of the following written health policies: dehydration (91%), asthma and anaphylaxis (88%), head injuries (90%), seizures (78%), cardiac arrest (76%), and drowning (73%). Although 93% of camps have a disaster response plan, 15% never practice the plan. Sixty-eight percent of camps are familiar with community evacuation plans, and 67% have access to vehicles for transport. Camps reported the presence of the following written disaster policies: fire (96%), tornadoes (68%), arrival of suspicious individuals (84%), hostage situations (18%).

CONCLUSIONS

Areas for improvement in the compliance of US camps with specific recommendations for health and safety practices were identified, such as medically preparing campers before their attendance, developing relationships with community health providers, increasing the immediate availability of several emergency medications and equipment, and developing policies and protocols for medical and disaster emergencies.

Unintentional injuries in child care centers in the United States: a systematic review

The study systematically reviewed all types of unintentional injury and injury prevention research studies occurring within child care centers in the United States. A total of 2 reviewers searched 11 electronic databases to identify 53 articles meeting inclusion criteria. No studies used trauma registries or randomized control trials. Data were not pooled for further analysis because studies lacked standardized definitions for injury, rates, severity, exposure, and demographics. The following child care center injury rates were reported: (0.25-5.31 injuries per 100,000 child-hours); (11.3-18 injuries per 100 children per year); (6-49 injuries per 1000 child-years); (2.5-8.29 injuries per child-year); (2.6-3.3 injuries per child); (3.3-6.3 injuries per 100 observations); (635-835 medically attended injuries per year per 100,000 children and 271-364 child care center playground injuries per year per 100,000 children); and (3.8 injuries per child per 2000 exposure hours). Child care center injury rates were comparable to injury rates published for schools, playground, and summer camp. Most injuries were minor, while most severe injuries (fractures and concussions) were falls from playground structures. Future studies need to use standardized injury definitions and injury severity scales, focus efforts on preventing severe playground injuries in child care centers, and report child care parameters for inclusion in national injury databases.

Compliance of child care centers in Pennsylvania with national health and safety performance standards for emergency and disaster preparedness

OBJECTIVES

To determine the preparedness of child care centers in Pennsylvania to respond to emergencies and disasters based on compliance with National Health and Safety Performance Standards for Out-of-Home Child Care Programs.

METHODS

A questionnaire focusing on the presence of a written evacuation plan, the presence of a written plan for urgent medical care, the immediate availability of equipment and supplies, and the training of staff in first aid/cardiopulmonary resuscitation (CPR) as delineated in Caring for Our Children: National Health and Safety Performance Standards for Out-of-Home Child Care Programs, 2nd Edition, was mailed to 1000 randomly selected child care center administrators located in Pennsylvania.

RESULTS

Of the 1000 questionnaires sent, 496 questionnaires were available for analysis (54% usable response rate). Approximately 99% (95% confidence interval [CI], 99%-100%) of child care centers surveyed were compliant with recommendations to have a comprehensive written emergency plan (WEP) for urgent medical care and evacuation, and 85% (95% CI, 82%-88%) practice their WEP periodically throughout the year. More than 20% of centers did not have specific written procedures for floods, earthquakes, hurricanes, blizzards, or bomb threats, and approximately half of the centers did not have specific written procedures for urgent medical emergencies such as severe bleeding, unresponsiveness, poisoning, shock/heart or circulation failure, seizures, head injuries, anaphylaxis or allergic reactions, or severe dehydration. A minority of centers reported having medications available to treat an acute asthma attack or anaphylaxis. Also, 77% (95% CI, 73%-80%) of child care centers require first aid training for each one of its staff members, and 33% (95% CI, 29%-37%) require CPR training.

CONCLUSIONS

Although many of the child care centers we surveyed are in compliance with the recommendations for emergency and disaster preparedness, specific areas for improvement include increasing the frequency of practice of the WEP, establishing specific written procedures for external disasters and urgent medical emergencies, maintaining the immediate availability of potentially life-saving medications, and ensuring that all child care center staff are trained in first aid and CPR.

Annual risk of death resulting from short falls among young children: less than 1 in 1 million

OBJECTIVE

The objective of the work was to develop an estimate of the risk of death resulting from short falls of <1.5 m in vertical height, affecting infants and young children between birth and the fifth birthday.

METHODS

A review of published materials, including 5 book chapters, 2 medical society statements, 7 major literature reviews, 3 public injury databases, and 177 peer-reviewed, published articles indexed in the National Library of Medicine, was performed.

RESULTS

The California Epidemiology and Prevention for Injury Control Branch injury database yielded 6 possible fall-related fatalities of young children in a population of 2.5 million young children over a 5-year period. The other databases and the literature review produced no data that would indicate a higher short-fall mortality rate. Most publications that discuss the risk of death resulting from short falls say that such deaths are rare. No deaths resulting from falls have been reliably reported from day care centers.

CONCLUSIONS

The best current estimate of the mortality rate for short falls affecting infants and young children is <0.48 deaths per 1 million young children per year. Additional research is suggested.

Evaluation of North Carolina child care safety regulations

INTRODUCTION

The goal of this study was to track any changes in injuries and injury hazards during the first 3.5 years of implementation of the North Carolina Child Care Commission's 1996 playground safety regulations.

METHODS

All reports (n=5402) of medically attended injuries in regulated child care settings in North Carolina during the period 1 January 1997 through 30 June 2000 were reviewed and analyzed. A total of 294 playground safety inspections were conducted in November and December 1998 in randomly selected North Carolina child care centers, and the playground safety inspections were repeated in 76 child care centers in August 2000. Finally, in 1999 a 1992 child care center director self assessment of safety features in classrooms was sent to the directors of 291 of the 294 centers.

RESULTS

The annual rate of reported, medically attended injuries occurring in regulated child care facilities in North Carolina declined by 22% from 1997 to 1999. The playground safety inspections in the year 2000 revealed that, for nine of 10 playground concerns and 12 of 18 playground safety hazards, average ratings were equal to or better than those of 1998. Finally, the director surveys revealed no dramatic changes in classroom safety hazards since 1992.

DISCUSSION

This study represents the first time that the authors are aware of that a significant decline in state-wide child care injury rates has been associated with improved regulation of playground safety in the US.

Use of a statewide system to improve health and safety in child care facilities

BACKGROUND

The Early Childhood Education Linkage System (ECELS) in Pennsylvania (PA) models ideals of the national Healthy Child Care America (HCCA) Campaign. Little is known about how child care providers use these newly developed statewide systems and about how users compare with nonusers of such a system.

OBJECTIVES

Our objectives were 1) to assess knowledge and use of ECELS among child care providers in PA, 2) to compare users and nonusers of ECELS with regard to health concerns, advice-seeking preferences, and infant sleep positioning, and 3) to assess satisfaction among users of ECELS.

METHODS

Cross-sectional telephone survey of directors of 400 licensed child care centers (CCCs) and providers of 400 registered family child care homes (FCCHs) in PA.

RESULTS

The proportion of children with certain special health care needs mirrored the prevalence in the national child population. Of the facilities surveyed, 88% of CCCs and 71% of FCCHs had heard of ECELS. Among these, 85% had used ECELS's services in the previous 12 months. Significantly more nonusers than users consulted doctors, whereas more users consulted health professionals from government agencies and used printed materials. Of those who enrolled infants, 46% of users and 41% of nonusers reported placing infants on their backs only to sleep. Users who placed infants on their backs were more likely than nonusers to have a written policy about the correct practice (55% and 26%, respectively; P =.02). Overall, 46% of users and 28% of nonusers reported having a sleep position policy (P =.02). Users were at least 95% satisfied with ECELS's services.

CONCLUSION

This statewide system reached most child care providers surveyed: more outreach is needed to providers in FCCHs. The health concerns, safety practices, and advice-seeking preferences of child care providers described in this article can inform others who are developing similar collaborative services in each state. Further research on the impact of HCCA programs on health and safety practices (such as correct infant sleep positioning) is warranted.

Studying injuries with case-control methods in the emergency department

To study factors that cause or prevent injuries, it can be efficient to use a case-control study design and select both cases and controls from patients seen in the ED. Bias in case ascertainment can be reduced by studying exposures that, aside from their influence on the risk of injury, are unrelated to the use of emergency care. The ideal control group often includes persons generally not seen in an ED: for example, those who experience the injury-producing event, such as a bicycle crash, but who do not sustain serious injury. However, the exposure experience of the underlying population at risk sometimes can be closely approximated with information from selected persons seeking emergency care. With careful attention to the selection of study subjects, valid case-control studies of the causes of some injuries can be conducted in the ED.