James W. Nixon

Emotional Sequelae of Parents and Sibs Following the Drowning or Near-Drowning of a Child

This study reports the findings from an investigation to evaluate the intra-family dynamics that occurred with 111 cases of childhood drowning and near-drowning in the City of Brisbane in 1971-1975. Personal interviews were obtained with 77 of the families. 24 per cent of parent-dyads separated following the drowning of their child, whereas none of the 54 families of surviving children separated. Accident generated stresses within the studied families tended to persist for years after the incident. Parents volunteered the information that they drank more, experienced sleep disorders and nightmares, and reported significant anxiety states. 19 per cent of parents of drowned children received specialist psychiatric treatment following the drowning. Two cases of surviving children received specialist psychiatric therapy (these were both parents who had inflicted non-accidental injury on their child, and had attempted to drown their child in the bath). In one sense, a childs death is more honourable from societys point of view if the child dies from a chronic medical illness such as leukaemia. In the case of a childs death in the family bath tub or the backyard swimming pool, the extra society sanctions of culpability and accusation further intensified the likelihood of the normal grief process being transformed into a pathological variant.

Interventions associated with drowning prevention in children and adolescents: systematic literature review

Introduction Drowning remains a leading cause of preventable death in children across the world. This systematic review identifies and critically analyses studies of interventions designed to reduce fatal and non-fatal drowning events among children and adolescents or reduce the injury severity incurred by such incidents. Methods A systematic search was undertaken on literature published between 1980 and 2010 relating to interventions around fatal and non-fatal drowning prevention in children and adolescents 0–19 years of age. Search methods and protocols developed and used by the WHO Global Burden of Disease Injury Expert Group were applied. Results Seven studies fulfilled the inclusion criteria. Interventions were categorised into three themes of Education, Swimming Lessons and Water Safety, and Pool Fencing. All are possible effective strategies to prevent children from drowning, particularly young children aged 2–4 years, but very little evidence exists for interventions to reduce drowning in older children and adolescents. There were methodological limitations associated with all studies, so results need to be interpreted in the context of these. Conclusions Relatively few studies employ rigorous methods and high levels of evidence to assess the impact of interventions designed to reduce drowning. Studies are also limited by lack of consistency in measured outcomes and drowning terminology. Further work is required to establish efficacy of interventions for older children and adolescents. There is a need for rigorous, well-designed studies that use consistent terminology to demonstrate effective prevention solutions.

Children and bicycles: what is really happening? Studies of fatal and non-fatal bicycle injury

OBJECTIVES: The objectives of the study were to ascertain the causes of accidents, injuries, and deaths in children who ride bicycles. Fatality and injury rates were also studied in order to compare with other studies. METHODS: Two studies of children were undertaken in children aged less than 15 years. In the first (retrospective fatality study), children who died as a result of a bicycle incident during the period 1981-92 were reviewed. In the second (prospective injury study) data were obtained prospectively between April 1991 and June 1992 about children who were injured while riding a bicycle and treated at a public hospital in Brisbane. RESULTS: Study 1: fatality rates for boys were twice those for girls. The rate was highest for boys of 14 years in the metropolitan area at 6.23/100,000. All deaths involved vehicles, and the majority involved head injury or multiple injuries including head injury. Study 2: similar numbers of children were injured at onroad and off-road locations. Faculty riding was described by the rider or caregiver as the cause in 62.5% of cases. The most common time of injury was between 3 and 6 pm on both school and non-school days. Only 5.5% of all incidents involved a moving vehicle. CONCLUSIONS: Bicycle riding by children is a common cause of injury, particularly for boys. Equal numbers of injuries occurred on the road as at other locations. Faulty riding caused most accidents. Injury prevention for bicycle riders should involve not only compulsory wearing of helmets, but should also include education and training about safe riding habits, separation of motorised vehicles from bicycles, modified helmet design to incorporate facial protection, and improved handlebar design.

Neonaticide, infanticide and child homicide

A total population study of neonaticide, infanticide and child homicide is reported. There are seven defineable syndromes of unlawful child killing which include: neonaticide, infanticide, non-accidental injury, the deprivation-starvation syndrome, euthanasia, killing of family members followed by the suicide of the killer, and child murder. 49 such cases are reported from a base population of 2 million people, over a 10-year period of investigation. The syndromes of neonaticide and non-accidental injury each contribute some 20 per cent of cases in the full spectrum of unlawful child killing. 18 cases of fatal non-accidental injury were reported over this time. With modern crisis intervention facilities, standard hospital rules for the management of acute cases of non-accidental injury, and co-ordinated child abuse centres, approximately 2 per cent only of non-accidental injury cases should come to a fatal conclusion.

Community based programs to prevent poisoning in children 0–15 years

Objective: Community based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in preventing poisoning in children 0–15 years of age. Methods: A comprehensive search of the literature was performed using the following study selection criteria: community based intervention study; target population was children under 15 years; outcome measure was poisoning rates; and either a community control or an historical control was used in the study design. Quality assessment and data abstraction were guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies. Results: The review found only four studies, which met all the inclusion criteria. Only two studies used a trial design with a contemporary control and only one study provided convincing evidence of an effective community program for reducing poisoning in children. Conclusion: There is a paucity of research studies in the literature from which evidence regarding the effectiveness of community based childhood poisoning prevention programs can be obtained and hence a clear need to increase the effort on developing this evidence base.

Safety legislation, public health policy and drowning prevention

The article presents a study on drowning as the major cause of mortality and morbidity of the children in Brisbane, Queensland. It states that the drowning death rates of young children, aging 0-4 years old, had decreased after the introduction of safety legislation. The study has shown that the drowning incidents of young children will continue to reduce with the introduction of safety legislation and enforced compliance, in combination with education for safety and ongoing advocacy.

Fifteen years of child drowning— A 1967–1981 analysis of all fatal cases from the Brisbane drowning study and an 11 year study of consecutive near-drowning cases

A total population study of childhood fresh water drowning accidents (fatalities) for the 15 year period, 1967-1981, is reported. These data are from the ongoing Brisbane Drowning Study which has now also analysed 255 fresh water child immersions (both fatalities and near-fatalities) over the eleven year period, 1978-1981, and as such forms a consecutive unselected series for over one decade. The annual fatality (drowning) rate is 3.53 per 100,000. Details of immersion accidents by site, sex and by outcome (survivors versus fatalities) are presented. An analysis of secular trends revealed that one epidemic peak of child drownings in swimming pools and domestic baths (noted in the mid 1970s in Australia and other countries) is now passed. Evidence is presented to suggest that a vigorous education, and public awareness campaign can reduce the incidence of serious child immersion accidents by one-third. Such a campaign may have influence on all types of childhood household drownings (pools, baths, garden ponds), irrespective of site. Survival rates for unsupervised children who lose consciousness in fresh water are site-dependent, only 21% of such potential victims surviving after losing consciousness in rivers and creeks, compared with the survival rate of 65% for those in potential drowning incidents in their own backyard. Violent death continues to account for more than half of all deaths in childhood up to the age of 14 years [Gratz, 1979; Mayer, Walker and Johnson et al., 1981].(ABSTRACT TRUNCATED AT 250 WORDS)

Swimming pool immersion accidents: an analysis from the Brisbane Drowning Study

An analysis of a consecutive series of 66 swimming pool immersion accidents is presented; 74% of these occurred in in-ground swimming pools. The estimated accident rate per pool is fives times greater for in-ground pools compared with above-ground pools, where pools are inadequately fenced. Backyard swimming pools account for 74% of pool accidents. Motel and caravan park pools account for 9% of childhood immersion accidents, but the survival rate (17%) is very low. Fifty per cent of pool accidents occur in the familys own backyard pool, and 13.6% in a neighbours pool; in the latter the survival rate is still low at only 33%. In only one of the 66 cases was there an adequate safety fence; in 76% of cases there was no fence or barrier whatsoever. Tables of swimming pool accidents by age, season, site, and outcome are presented.

Injury and frequency of use of playground equipment in public schools and parks in Brisbane, Australia

Objective: The purpose of this study was to determine the frequency of use of play equipment in public schools and parks in Brisbane, Australia, and to estimate an annual rate of injury per use of equipment, overall and for particular types of equipment. Methods: Injury data on all children injured from playground equipment and seeking medical attention at the emergency department of either of the two children’s hospitals in the City of Brisbane were obtained for the years 1996 and 1997. Children were observed at play on five different pieces of play equipment in a random sample of 16 parks and 16 schools in the City of Brisbane. Children injured in the 16 parks and schools were counted, and rates of injury and use were calculated. Results: The ranked order for equipment use in the 16 schools was climbing equipment (3762 uses), horizontal ladders (2309 uses), and slides (856 uses). Each horizontal ladder was used 2.6 times more often than each piece of climbing equipment. Each horizontal ladder was used 7.8 times more than each piece of climbing equipment in the sample of public parks. Slides were used 4.6 times more than climbing equipment in parks and 1.2 times more in public schools. The annual injury rate for the 16 schools and 16 parks under observation was 0.59/100 000 and 0.26/100 000 uses of equipment, respectively. Conclusions: This study shows that annual number of injuries per standardized number of uses could be used to determine the relative risk of particular pieces of playground equipment. The low overall rate of injuries/100 000 uses of equipment in this study suggests that the benefit of further reduction of injury in this community may be marginal and outweigh the economic costs in addition to reducing challenging play opportunities.

Social class and violent child death: An analysis of fatal nonaccidental injury, murder, and fatal child neglect

A total population study to analyse socio-economic status (SES) concomitants of violent and nonaccidental deaths involving children in Queensland, Australia is reported. Cases were traced from coronial files of the Institute of Forensic Pathology, Queensland. All children dying of nonaccidental injuries, neglect, and murder were included. Children were excluded where death was part of the neonaticide syndrome of pregnancy-parturition-concealment. Socioeconomic status scores were assigned to each case using the Congalton four point scale of occupational status. Of the 43 children in the study, 58% were girls. The age of greatest risk of death was in the 1st year of life. A second modal age at 3 years was evident for children who were murdered. Differences in age distribution and socioeconomic status were evident between children who died as a result of nonaccidental injury (N.A.I.), and those who were frankly murdered. All of the children who died as a result of N.A.I. were from lower socioeconomic groups. However, the socioeconomic status distribution for all violent deaths (N.A.I., murder and neglect) is not unlike the socioeconomic status distribution for the general population.