02 Dec Childhood Falls May Be Decreased By Supervision and Safety Devices
Medical Research: What is the background for this study? What are the main findings?
Prof. Kendrick: More than 1 million US children aged 0-4 years attend emergency departments because of a fall each year. Approximately half of all ED attendances in this age group are for falls, and most of these are falls from furniture, most commonly from beds, chairs , baby walkers, bouncers, changing tables and high chairs. In the US around 18,000 0-4 year olds are admitted to hospital following a fall each year and in 2012 there were 31 deaths in the US in 0-4 year olds from falls. Healthcare costs for falls in the US were estimated at $439 million for hospitalised children and $643 million for ED attendances in 2005.
We found that children were more likely to attend hospital because of a fall from furniture in families that did not use safety gates across doorways or on stairs. For infants (aged 0-12 months) we found they were more likely to attend hospital because of a fall from furniture if they had been left on a raised surface (e.g. beds, sofas, work tops etc), had diapers changed on a raised surface or been put in a car seat or bouncing cradle on a raised surface. We also found that children aged over 3 years who had climbed or played on furniture were more likely to have a fall requiring a hospital visit than children who had not. Finally we found that children whose parents had not taught their children rules about climbing on objects in the kitchen were more likely to have a fall needing a hospital visit than children whose parents had taught these rules.
Medical Research: What should clinicians and patients take away from your report?
Prof. Kendrick: Our findings suggest some falls may be prevented by using safety gates across door ways and on stairs (note they are only recommended for use up to the age of two, by when children may be able to climb over them or open them) and by not leaving children on raised surfaces, not placing car seats or bouncing cradles on raised surfaces and not changing diapers on raised surfaces (e.g. changing them on the floor instead). Supervising children who are climbing or paying on furniture may help prevent some falls which occur this way. Teaching children about not climbing on objects may also help reduce falls.
Children develop and learn to do new things very quickly. It is important to anticipate what a child is likely to be able to do in the near future and adapt the home to suit them. Also children don’t always use furniture in the way it is intended to be used – e.g. drawers can be pulled open and used to climb on, so parents need to try and keep one step ahead and look at the home and it’s potential hazards in a way a child might. Also very young infants, who are not old enough to roll over, can still wriggle enough to fall from things such as beds, so even though a child is not yet mobile, they are still at risk of falls.
Prevention needs to focus on a range of strategies; no single strategy will prevent all falls in all circumstances. It’s important not to rely on single strategies because none are completely child-proof. For example, a safety gate on stairs will only protect from falls if it is always closed after use and if a child cannot open it or climb over it. Even with a safety gate, children still need to be taught to climb stairs safely and actively supervised whilst doing so. Some strategies are impossible to do 100% of the time – parent’s cannot be within arm’s reach of their children all day, every day; and things happen which distract parents from supervising, so it’s important to use other strategies as well as supervision e.g. having somewhere you can leave a child (e.g. playpen or stationary activity centre) whilst you need to do something else. Teaching children safety rules will only be effective if children understand those rules and follow them. Just because a child can repeat or remember a safety rule doesn’t mean they will always comply with that rule. Some families may not be able to make some changes to their home, for example, if they are renting their homes or cannot afford to buy safety equipment, so it also important that families are given advice that is tailored to their needs and circumstances and given support to enable the changes to be made that are needed. Some organisations offer home safety assessments and provide or fit free or low-cost safety equipment specific to the needs of individual families, so making these services more widely available and encouraging families to use these services is important.
There is useful advice about preventing falls at home from a range of agencies and charities such as CDC, Safekids Worldwide, the Child Accident Prevention Trust and the Royal Society for the Prevention of Accidents.
1. CDC: A National Action Plan for Child Injury Prevention:
Reducing Fall-Related Injuries in Children
Medical Research: What recommendations do you have for future research as a result of this study?
Prof. Kendrick: Further studies are required exploring the risk or protective role of items of nursery equipment such as baby walkers, playpens and stationary activity centres. We did not include sleeping in, climbing or playing on bunk beds as exposures in our study. Bunk beds are an important, but relatively uncommon cause of childhood falls from furniture, accounting for approximately 10% of all falls from beds. Further studies are required to quantify the risk of falls associated with bunk bed use.