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California Chapter 4, AAP, Injury Prevention Program Newsletter |  |
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Greetings! We are pleased to present our Summer 2005 newsletter in a new electronic format. This format allows us to provide early, acessible injury prevention information with links to valuable information. Please email us ideas for future article topics or events you would like us to showcase. The California Chapter 4, American Academy of Pediatrics Injury Prevention Program was developed in 2001. Our mission is to provide expertise and resources, and advocate for public policy to prevent childhood injuries. Funding for this program is provided by the Children and Families Commission of Orange County. Staff
Playgrounds are a fundamental part of the childhood experience. They should be safe havens for children. All of us have memories of playing on playgrounds in our neighborhood park and at recess in the schoolyard. Unfortunately, more than 200,000 children are treated in U.S. hospital emergency rooms each year for injuries associated with playground equipment. Most injuries occur when children fall from the equipment onto the ground. Over 75% occur on equipment designed for public use (schools and public playgrounds). The U.S. Consumer Product Safety Commission (CPSC), created its playground safety guidelines to help local communities, schools, day care centers, corporations, and other groups build safe playgrounds. The Handbook includes technical safety guidelines for designing, constructing, operating and maintaining public playgrounds. To highlight some of the most important safety issues for parents and community groups, CPSC also developed a “Public Playground Safety Checklist,” which can be seen below. Resources: Injuries and deaths associated with children's playground equipment
Violent injury and death continue to be one of the major health issues facing youth in this country and calls for increasing efforts on the part of the pediatric community. Homicide is among the leading causes of death for teenagers and young adults (both men and women) in the United States. Almost ¾ of all youth homicides in the 50 wealthiest countries in the world occur in the United States. In addition, youth of color are dramatically over- represented, at least in part related to the over- representation of these groups in the population living in poverty. The U.S. has experienced an epidemic of youth homicide in the past several decades. With a significant decline of deaths in recent years, it continues to stand out in international comparisons. Furthermore, while deaths have declined, there is clear evidence that the involvement in violence remains high, based on youth behavior surveys and the striking increase in arrest rates for violent crimes among girls. The factors that affect risk are clearly penetrating into a broader spectrum of youth resulting in serious consequences, not only for girls, but also for an increasingly younger age range of children and youth. We know a great deal about what influences risk and resiliency in children. Youth violence is very much part of the continuum of violence involving the life cycle. Moreover, there is a clear relationship between family violence and youth violence. Factors such as: early exposure to family violence, cultural values, media images, availability of guns, family dysfunction and physical punishment are well described elements of the problem. In turn, factors such as: family connectedness, nurturing, healthy parenting practices, presence of community connections, positive role models, and caring adults promote resiliency for most children that can counterbalance even some of the most damaging environmental elements. This knowledge establishes a solid base for pediatricians to play an important role in violence prevention and make a real difference for individual children and for communities. Connected Kids, a violence prevention protocol, was developed by members and staff of the American Academy of Pediatrics. It is being funded through the U.S. Department of Justice and due for public release in the Fall of 2005. This is one avenue for integrating this work into pediatric primary care. Developed with input from practicing pediatricians, parents, medical, public health professionals and youth, this protocol (modeled in part after TIPP), provides opportunities for prevention from birth through young adulthood. It focuses on nurturing assets and strengths rather than deficits and remediation. It also integrates many of the things already part of pediatric practice rather than adding yet more to an already overloaded agenda in primary care. Howard Spivak, M.D. will give a presentation at Grand Rounds, 8 a.m.-9a.m. Wednesday, September 21, 2005 at CHOC. He will also speak at the California Chapter 4 AAP Quarterly Dinner Meeting on September 20, 2005 at the OCMA. Dr. Spivak will review the epidemiology of youth violence, risk and resiliency factors. In addition, he will give us a preview of the Connected Kids protocol.
Childhood is a time of special vulnerability for children. The risk is, in part, a reflection of the cognitive and behavioral features of childhood that impact the child’s attention, planning and anticipation risk. More mature skills can help a child avoid injuries. Children with developmental problems have an altered pattern of growth in their capacities that accentuates their risks to both intentional and unintentional injury. A number of recent reports and studies have begun to address the particular vulnerabilities of children with disabilities. This report will highlight some of these concerns. Children in preschool are often experiencing their first substantial social interactions. A recent review of preschool injury logs show that disabled children are nearly twice as likely to experience multiple injuries in the setting of the school. Such children are injured twice as fast on average once entering the preschool. The circumstances of the injury are typically different between disabled and non-disabled preschoolers. Children without disabilities are five times as likely to be injured while running or on playground equipment (31% vs. 6 %). The children with disabilities, on the other hand, are injured in a dispute with a peer six times more often than the children developing normally. Studies of injury-prone preschoolers reveal two important findings. First, preschool children injured so severely as to need hospitalization were twice as likely to have a difficult infant temperament before 1 year of age. Second, children often injured in the preschool years are substantially more likely to be multiply-injured in elementary school. One group of children with special needs that seems to have a clear vulnerability to injury is children with ADHD. These children have 50% more bike injuries than other children. The injuries are often severe. Children with ADHD are more likely to require intensive care for their hospital-based injury care. They are more likely to need an extended rehabilitation stay after acute hospitalization after their injuries. Some investigators have tried to rank the relative contribution of behavior style to injury risk. Not only ADHD, but also other disruptive behaviors linked to aggression are linked to heightened injury risk. Drivers with ADHD perform worse than nondisabled peers on both driving simulators and during on-road studies. Teenagers with ADHD are involved in automobile accidents 3 times more often than non- ADHD peers. This is of particular concern as motor vehicle crashes are the leading cause of deaths among adolescents. Young drivers with ADHD are two to four times more likely to have traffic crashes, three times as likely to have injuries, four times as likely to be at fault in car crashes, and four to eight times more likely to have their driver license suspended when compared to non-ADHD adolescents. Studies of the impact of ADHD stimulant medications show a positive impact on driving performance. Daniel Cox of the University of Virginia, has conducted a number of investigations on driving performance with patients who are given immediate release and extended release methylphenidate or placebo. His findings document a paradoxical impact of stimulants on driving (young adults with ADHD improve when treated, whereas controls without ADHD drive worse after methylphenidate). Impaired driving variables, reflecting errors such as missing stop signs, driving fast or erratically and inappropriate braking were seen more in ADHD teens. These variables improved when stimulants are active during the driving sequence. Overall, these studies point out the impact of age, developmental level, behavior and temperament on a child’s risk for an injury event. Specific interventions matched to each child’s special needs may help to reduce injury rates and reduce the health, social and societal impact of these injuries. References:
If Jack and Jill sustain head trauma from a fall, travel unrestrained in a motor vehicle, burn down their legendary hill, or can’t get up the hill because they are overweight and physically unfit, they’re prime candidates to sustain a fatal or cognitive and/or physical disability requiring special education services. Whether it was because of concern for Jack and Jill or for other good reasons, California voters in 1998 wisely passed a statewide ballot initiative, Proposition 10, adding a $.50 sales tax to tobacco products sold in California. Revenues from Prop 10 — approximately $700 million annually — provide funding for local programs that promote early childhood development to ensure school readiness. Orange County’s Prop 10 agency is the Children and Families Commission of Orange County (CFCOC). Its strategic plan to implement Prop 10 included increasing the number of children growing up in healthy and safe environments and reducing the number of child deaths and disabilities due to preventable causes. Documenting injury as the leading cause of death and disability among young children, our Systematic Childhood Injury Prevention Program (SCIPP) — a customizable integrated injury prevention service delivery system — was funded. California’s Chapter 4 of the American Academy of Pediatrics was subsequently designated the lead organization for implementing the countywide Injury Prevention Program Collaborative. Our continuing mission is to provide expertise and resources, and to advocate for public policy that will prevent and otherwise reduce the number and severity of childhood injuries. Our strategies include integration of AAP injury prevention policies and guidelines into all health, education, childcare and social services for the 0-5 year old population. Our outstanding publication, “Profile of Childhood Injuries 0-5 Years,” guides program efforts. Many collaborators worked with us in developing and testing our culturally and linguistically appropriate multimedia parent materials (Spanish, Vietnamese and English). Our Injury Prevention Resource Tool Kit includes “Keeping Your Child Safe” 0-5 years parent brochures, the “Keeping Children Safe” video/DVD, our “Child Safety Seat Growth Chart,” a poster and take home sheet, and a Practitioner Users Guide. Over 50 Orange County designated SCIPP sites receive the services of our health educators who make site visits, provide materials at no cost and offer technical assistance. Points of contact include physician offices, clinics, home visitation programs, school nurses, school readiness program sites, family resource centers and childcare facilities. In the next two years we will increase our coverage to 100 sites. Our Car Safety Seat Growth Chart poster was distributed at the AAP NCE 2004 meeting. Materials are available and may be ordered on our web site, http://www.ockeepkidssafe.org. We have presented our program at national, state and local venues. We plan to use streaming video to provide online education to families and professionals. New materials are developed as we determine the need. For example, one of our recent additions is the Pool Safety Poster addressing the leading cause of death of not only OC, but all California children age 1-4 years. Advocacy for system change and public health policy is an integral part of our strategy. Working with our District executive director, Ms. Kris Calvin, we advocate for legislative policies to promote safety and mitigate injury. Ms. Calvin also provides continuous consultation and guidance to our program. What can other chapters do? We urge pediatricians to advocate for enhanced injury prevention services in other California counties. Our program model, guidelines, presentations and materials are available to all AAP chapters. We may not be able to rewrite the nursery rhyme script for Jack and Jill, but working together we can surely make the real-life Jacks and Jills safer and more ready for school and life.
The California Chapter 4, American Academy of Pediatrics, has been awarded a $295,000 grant to improve the quality of care provided by a group of local school nurses. The purpose of this grant is to create a linkage between Orange County, California School Readiness Nurses and pediatricians. Project staff will support the professional development of the cadre of newly hired nurses, and AAP physicians will provide consultation as the School Readiness Nurses are conducting developmental screens. A formal communication process has been developed between the School Readiness Nurses and their students’ medical homes. A working team will be established between AAP physicians, school nurses and up to 12 Orange County school districts. The primary project goal is to improve the health and school readiness of children, aged 0-6 years. The grant may be extended for up to three years in the future. Initial implementation of the project began in March of 2005 in the Newport-Mesa Unified School District. An additional school district will be added in the fall, and 4–6 school districts will be added each year.
More than 900 U.S. children under the age of 15 drowned in swimming pools (2002). In addition, 2,700 children nearly drowned that year, many of which resulted in permanent brain damage. Drowning is the leading cause of injury-related death among Orange County children under the age of 5 years. Most drowning incidents occur in residential pools or spas. Since January 1, 2005, 6 children under the age of 5 years have drowned. Furthermore, there have been 11 near drownings. All of these incidents occurred in pools or spas. The California Chapter 4, American Academy of Pediatrics Injury Prevention Program has developed a new full color pool safety poster available for use by health and child care providers. The new poster contains the key prevention messages for pool safety, including:
The 18”x 24” posters are available at the California Chapter 4, AAP office at 12465 Lewis St., Ste. 101 Garden Grove, CA. A PDF version is available for printing at the IPP website (http://www.ockeepkidssafe.org ). Please call the Chapter offices at (714) 971-0695 for ordering information.
The first 5 years of life are the opportune time to develop healthy habits of regular and age-appropriate physical activity. The following presentation discussed normal physical and cognitive milestones as related to physical/sport activity. It outlines specific activities appropriate for each age and developmental stage, and also reinforces appropriate safety guidelines. The goal of the program is to develop a positive image of physical activity-encouraging families of young children to develop skills and impressions that will hopefully stimulate them throughout their entire lives.
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