Decreasing children's risk taking on the playground

A 10-Year Retrospective Review of Playground-Associated Craniofacial Injuries in the Pediatric Patient Population

This retrospective study utilized the National Electronic Injury Surveillance System (NEISS) database to identify pediatric emergency department (ED) patients with playground-associated craniofacial injuries between January 2012 and December 2021. A total of 25 414 patients were identified. The majority of injuries occurred in preschool and elementary school-age children (90.3%) and patients were more commonly boys (59.3%). Injuries most often involved the head/scalp (52.4%), face (30.4%), and mouth (11.9%). Infant (32.7%) and teen (40.0%) injuries most commonly involved swings, whereas preschool (23.1%) and elementary school (28.1%) injuries were mostly associated with slides and climbers, respectively. Most patients were treated in the ED and discharged to home (96.5%), a small portion required hospitalization (1.6%), and one death was reported. Although the majority of the injuries were relatively minor and resulted in same-day discharges, these injuries can result in serious physical harm, emotional stress, and unexpected financial burdens. Proper education and supervision regarding safe play is important to prevent these injuries.

A systematic review of the risk factors and interventions for the prevention of playground injuries

OBJECTIVES

The primary objectives of this work were to (1) identify the risk and/or protective factors associated with playground injuries among children less than 18 years of age and (2) identify interventions/programs/policies aimed at preventing playground-related injuries among children less than 18 years of age. Secondary objectives include a summary of the data that reflect alignment with current playground standards.

METHODS

For the primary outcome, 4 databases and 12 online resources were systematically searched to include observational and experimental studies examining risk and/or protective factors or interventions associated with playground injury or outcomes related to playground injury (e.g., risky playground behaviour). Data extraction included study design, participants, outcome, exposure or intervention, data analysis, and effect estimates. The quality of evidence for all studies was assessed using the Downs and Black criteria.

RESULTS

This review included studies of moderate quality, revealing a number of risk factors and effective interventions for playground injury. Risk factors included absence of handrails and guardrails on playground equipment, non-impact-absorbing surfacing, and critical fall heights. Effective interventions included modifying playground surfacing and reducing equipment height to less than 1.5 m.

CONCLUSION

Equipment- and structure-based playgrounds should adhere to and maintain playground standards in order to reduce the risk of serious injury. Organizations responsible for installing and maintaining playgrounds should consider alternative play spaces that allow children to play outdoors, in a natural environment that supports healthy child development and promotes physical activity.

School-based education programmes for the prevention of unintentional injuries in children and young people

BACKGROUND

Unintentional injuries are the leading cause of death in children aged four to 18 years and are a major cause of ill health. The school setting offers the opportunity to deliver preventive interventions to a large number of children and has been used to address a range of public health problems. However, the effectiveness of the school setting for the prevention of different injury mechanisms in school-aged children is not well understood.

OBJECTIVES

To assess the effects of school-based educational programmes for the prevention of injuries in children and evaluate their impact on improving children's safety skills, behaviour and practices, and knowledge, and assess their cost-effectiveness.

SEARCH METHODS

We ran the most recent searches up to 16 September 2016 for the following electronic databases: Cochrane Injuries Group Specialised Register; Cochrane Central Register of Controlled Trials; Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations; Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R); Embase and Embase Classic (Ovid); ISI Web of Science: Science Citation Index Expanded; ISI Web of Science Conference Proceedings Citation Index-Science; ISI Web of Science: Social Sciences Citation Index; ISI Web of Science: Conference Proceedings Citation Index - Social Sciences & Humanities; and the 14 October 2016 for the following electronic databases: Health Economics Evaluations Database (HEED); Health Technology Assessment Database (HTA); CINAHL Plus (EBSCO); ZETOC; LILACS; PsycINFO; ERIC; Dissertation Abstracts Online; IBSS; BEI; ASSIA; CSA Sociological Abstracts; Injury Prevention Web; SafetyLit; EconLit (US); PAIS; UK Clinical Research Network Study Portfolio; Open Grey; Index to Theses in the UK and Ireland; Bibliomap and TRoPHI.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), non-randomised controlled trials (non-RCTs), and controlled before-and-after (CBA) studies that evaluated school-based educational programmes aimed at preventing a range of injury mechanisms. The primary outcome was self-reported or medically attended unintentional (or unspecified intent) injuries and secondary outcomes were observed safety skills, observed behaviour, self-reported behaviour and safety practices, safety knowledge, and health economic outcomes. The control groups received no intervention, a delayed injury-prevention intervention or alternative school-based curricular activities. We included studies that aimed interventions at primary or secondary prevention of injuries from more than one injury mechanism and were delivered, in part or in full, in schools catering for children aged four to 18 years.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Two review authors identified relevant trials from title and abstracts of studies identified in searches and two review authors extracted data from the included studies and assessed risk of bias. We grouped different types of interventions according to the outcome assessed and the injury mechanism targeted. Where data permitted, we performed random-effects meta-analyses to provide a summary of results across studies.

MAIN RESULTS

The review included 27 studies reported in 30 articles. The studies had 73,557 participants with 12 studies from the US; four from China; two from each of Australia, Canada, the Netherlands and the UK; and one from each of Israel, Greece and Brazil. Thirteen studies were RCTs, six were non-RCTs and eight were CBAs. Of the included studies, 18 provided some element of the intervention in children aged four to 11 years, 17 studies included children aged 11 to 14 years and nine studies included children aged 14 to 18 years.The overall quality of the results was poor, with the all studies assessed as being at high or unclear risks of bias across multiple domains, and varied interventions and data collection methods employed. Interventions comprised information-giving, peer education or were multi-component.Seven studies reported the primary outcome of injury occurrence and only three of these were similar enough to combine in a meta-analysis, with a pooled incidence rate ratio of 0.73 (95% confidence interval (CI) 0.49 to 1.08; 2073 children) and substantial statistical heterogeneity (I² = 63%). However, this body of evidence was low certainty, due to concerns over this heterogeneity (inconsistency) and imprecision. This heterogeneity may be explained by the non-RCT study design of one of the studies, as a sensitivity analysis with this study removed found stronger evidence of an effect and no heterogeneity (I² = 0%).Two studies report an improvement in safety skills in the intervention group. Likewise, the four studies measuring observed safety behaviour reported an improvement in the intervention group relative to the control. Thirteen out of 19 studies describing self-reported behaviour and safety practices showed improvements, and of the 21 studies assessing changes in safety knowledge, 19 reported an improvement in at least one question domain in the intervention compared to the control group. However, we were unable to pool data for our secondary outcomes, so our conclusions were limited, as they were drawn from highly diverse single studies and the body of evidence was low (safety skills) or very low (behaviour, safety knowledge) certainty. Only one study reported intervention costs but did not undertake a full economic evaluation (very low certainty evidence).

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine whether school-based educational programmes can prevent unintentional injuries. More high-quality studies are needed to evaluate the impact of educational programmes on injury occurrence. There is some weak evidence that such programmes improve safety skills, behaviour/practices and knowledge, although the evidence was of low or very low quality certainty. We found insufficient economic studies to assess cost-effectiveness.

Surf, sand, scrapes and stings: First aid incidents involving children at New Zealand beaches, 2007–2012

Aims: In spite of the popularity of beaches for family recreation, little is known about childhood injuries sustained at beaches. It is the purpose of this study to analyse data from incidents necessitating first aid treatment from reports compiled by surf lifeguards on New Zealand beaches.Method: A retrospective analysis of first aid incidents involving children (<16 years) was conducted using data obtained from Surf Life Saving New Zealand incident report forms during five summer seasons from 2007 to 2012. In addition to demographic data, the incident reports included such detail as the type of injury, the activity and location prior to injury, the injury outcome, and the first aid equipment used.Results: Children (n = 4407) accounted for one-half (52%) of all injuries; of these, 55% were male, and incidence peaked in the 11- to 15-year age group (24%). Most incidents (90%) required minor treatment, with lacerations (44%) the most common injury. Marine stings accounted for one-quarter (24%) of injuries and were most frequent among younger children (<10 years). Injuries to the extremities were frequently noted in the incident reports, the feet (33%) and hands (8%) being common sites.Conclusions: Although most (90%) injury incidents were minor in nature, their frequency (880 cases per season) suggests that greater emphasis on prevention rather than cure would be efficacious. Ways of promoting child beach safety via greater care giver awareness, the use of protective clothing and footwear, and child safety promotion via health professionals and safety organisations are discussed.

Playground injuries in children

Background

Rapid urbanization and unplanned population development can be detrimental to the safety of citizens, with children being a particularly vulnerable social group. In this review, we assess childhood playground injuries and suggest safety mechanisms which could be incorporated into playground planning.

Methods

Inclusion criteria were “children” as the focus group, “playground” as the main field of study, and “unintentional injury” and “safety” as the concepts of study. The keywords used for the PubMed search were “playground”, “children”, and “injury”. Initially we 182 articles. After screening according to inclusion criteria, 86 articles were found, and after reading the abstracts and then the full text, 14 articles were finally included for analysis. The papers reviewed included four case-control studies, three case studies, three descriptive studies, two interventional studies, one retrospective study, one cross-sectional study, and one systematic review.

Results

Playground-related fractures were the most common accidents among children, underscoring the importance of safety promotion and injury prevention in playgrounds, lowrisk equipment and playing hours (week days associated with higher risk), implementation of standards, preventing falls and fall-related fractures, and addressing concerns of parents about unsafe neighborhoods. With the exception of one study, all of the reviewed papers had not implemented any practical safety plan. Safe engineering approaches were also ignored.

Conclusion

We recommend a systematic safety approach based on the “safety circle” which includes three main areas, ie, equipment, environment, and children.

Preventing Unintentional Injury: A Review of Behavior Change Theories for Primary Care

Many injuries are preventable, and most have a behavioral component on their causal pathway. However, far more effective use of theory-based approaches to behavioral risk management is needed, which remains a challenge for practitioners. This review discusses theories and applications of behavioral change principles for use in primary care and community health settings. Injury-related behaviors cannot be separated from the environments in which they take place. Preventing unintentional injuries requires an understanding of patient knowledge, attitudes, and behaviors, as well as community norms, that lead to injuries. In addition to the role clinicians have in counseling for lifestyle change to prevent injuries, reducing exposure of patients to hazardous products and environments, and fostering social and organizational change to improve public policy, legislation, and enforcement to prevent injuries are equally important. Challenges lie ahead in testing the applicability of these theories in primary care settings and in predicting and understanding injury-related behaviors of patients. Training more medical practitioners in the epidemiology of injury and the science of injury control is an urgent priority. Success will partly depend on how behavioral theories can be integrated into practice and adapted through clinical experience to benefit patients.

Injuries in preschool classrooms

Purpose

The primary purpose of this paper is to examine the kinds of injuries that preschool teachers working in Indiana, USA, believed to be the most common in their preschool (3‐6 year olds) classrooms, the causes of such injuries, and the most important precautions they take to prevent them. Also examined are the measures the teachers take when an injury occurs.

Design/methodology/approach

A total of 155 preschool teachers take part in the research by completing a questionnaire. The data are analyzed using basic descriptive statistics.

Findings

On the question of what constituted the most important classroom injury prevention measure, 26 percent of the respondents report “close supervision of children”, 24 percent select “ensuring classroom safety”, 23 percent pick “cautioning children”, 17 percent choose “setting and enforcing rules” in the classroom, 7 percent select “modeling for social behavior” and 3 percent “safe gross motor activities”. With respect to action taken when an injured occurs, 36.1 percent of the respondents report “first aid”, 15.5 percent “comforting children”, 11.6 percent “referring children to school nurse” and “writing injury report”, 10.3 percent “cautioning against running and pushing”, 8.4 percent “explaining injury to children” (8.4 percent) and 6.5 percent “checking the nature of injury”.

Originality/value

This study sheds light on injury causation in preschool classrooms as well as management of such injuries. Results from this data can be used in helping to improve preschool teachers' knowledge of injury in general and of classroom injury in particular.

The Stamp-in-Safety Program: A Behavioral Intervention to Reduce Behaviors that Can Lead to Unintentional Playground Injury in a Preschool Setting

OBJECTIVE

To introduce and evaluate the Stamp-in-Safety program, a behavioral intervention designed to increase the quality of supervision by teachers on preschool playgrounds and to reduce the risk of unintentional child playground injury.

METHODS

A quasi-experimental time series design was used, with observational techniques, to evaluate behavior on the playground before, during, and after the intervention as well as during a 6-month post-intervention assessment.

RESULTS

Both applied behavior analysis techniques and inferential statistics suggest that the Stamp-in-Safety program resulted in behavioral changes likely to reduce the risk of child injury on the playgrounds of childcare centers.

CONCLUSION

Results indicate promise for the Stamp-in-Safety program as a low-cost, easily implemented intervention to reduce pediatric playground injury risk at childcare centers. Suggestions for future research are offered.

Teaching safety skills to children to prevent gun play

Research has shown that children often engage in gun play when they find a firearm and that this behavior is often involved in unintentional firearm injuries. Previous research has shown existing programs to be ineffective for teaching children safety skills to reduce gun play. This study examined the effectiveness of a behavioral skills training (BST) program supplemented with in situ training for teaching children safety skills to use when they find a gun (i.e., don't touch, leave the area, tell an adult). Eight 4- to 5-year-old children were trained and assessed in a naturalistic setting and in a generalized setting in a multiple baseline across subjects design. Results showed that 3 of the children performed the skills after receiving BST, whereas 5 of the children required supplemental in situ training. All children in the study learned to perform the skills when assessed in a naturalistic setting and when assessed in a generalization setting. Performance was maintained at 2- to 8-week follow-up assessments.

A neglected risky behavior among children and adolescents: underage driving and injury in New South Wales, Australia

PROBLEM

Among different causes of injury, roads and traffic-related incidents contributed most to all child deaths. The majority of childhood and adolescent traffic-related deaths are young people killed as pedestrians or bicyclists. Underage driving is a particular risky behavior much neglected. This study aimed to describe some characteristics related to motor-vehicle crashes and crash-related injury in which the vehicle was driven by a young person who was under the legal age of obtaining a learner license in New South Wales, Australia.

METHODS

Data used in this study were made available from the Roads and Traffic Authority of NSW for the period between 1996 and 2000. Crash information was collected and reported by NSW police at the scene of these motor-vehicle crash incidents.

RESULTS

There were 526 crashes involving an underage driver recorded within the study period. The majority (79.5%) of these underage drivers were males with slightly more than half (58.0%) aged 15 years, and nearly 30% aged 14 years. Among these, 83.6% involved the driver of the vehicle being killed or injured. Among the injured or killed passengers, 128 (73.6%) were nonadult passengers under the age of 18 years. Seventy of these crashes occurred while the car was in pursuit by police. The adjusted relative risk of injury to at least one occupant in the vehicle should a crash occur for female underage drivers was two times (OR=2.01, 95% CI=1.27-3.20) as compared to male underage drivers.

DISCUSSION

Underage driving poses a serious problem in terms of crash outcomes. Experimental driving and late-night outings for adolescents should be discouraged. Well-designed studies are required to further investigate the relationship between underage driving and on road risk-taking behavior among licensed adolescents.

IMPACT ON INDUSTRY

Data obtained from this study indicate that adults, particularly parents, should discourage underage adolescents from experimenting driving and should actively cultivate a positive attitude toward driving.