Kyran P. Quinlan

Policy Statement—Child Passenger Safety

Child passenger safety has dramatically evolved over the past decade; however, motor vehicle crashes continue to be the leading cause of death of children 4 years and older. This policy statement provides 4 evidence-based recommendations for best practices in the choice of a child restraint system to optimize safety in passenger vehicles for children from birth through adolescence: (1) rear-facing car safety seats for most infants up to 2 years of age; (2) forward-facing car safety seats for most children through 4 years of age; (3) belt-positioning booster seats for most children through 8 years of age; and (4) lap-and-shoulder seat belts for all who have outgrown booster seats. In addition, a fifth evidence-based recommendation is for all children younger than 13 years to ride in the rear seats of vehicles. It is important to note that every transition is associated with some decrease in protection; therefore, parents should be encouraged to delay these transitions for as long as possible. These recommendations are presented in the form of an algorithm that is intended to facilitate implementation of the recommendations by pediatricians to their patients and families and should cover most situations that pediatricians will encounter in practice. The American Academy of Pediatrics urges all pediatricians to know and promote these recommendations as part of child passenger safety anticipatory guidance at every health-supervision visit.

Neck strains and sprains among motor vehicle occupants-United States, 2000

CONTEXT Motor vehicle (MV)-related injury is a leading cause of death and emergency department visits in the US. Information has been limited regarding the magnitude and types of injuries suffered by the survivors of MV crashes. OBJECTIVE To estimate the incidence and patterns of neck strain/sprain injury among MV occupants treated in US hospital emergency departments. DESIGN AND PARTICIPANTS Descriptive epidemiologic analysis of persons treated at a stratified, probability sample of US hospital emergency departments from 1 July to 31 December 2000. SETTING US. MAIN OUTCOME MEASURES Annualized national estimates of number and rate of neck strain/sprain injury among MV occupants overall and by patients age and sex. Rates were calculated per 100,000 population as well as per billion person miles traveled. RESULTS In 2000, an estimated 901,442 (95% CI 699,283-1,103,601) persons with neck strain/sprain injury were treated in US hospital emergency departments. For MV occupants, neck strain/sprain was the most frequent type of injury, comprising 27.8% of all injuries to MV occupants treated in emergency departments that year. The incidence (per 100,000 population) of neck strain/sprain was significantly lower in younger children and peaked in the 20-24-year age group. The incidence (per billion person miles traveled) peaked in the 15-19-year age group. Females tended to have a higher incidence of emergency department-treated neck strain/sprain than males. CONCLUSIONS Neck strain/sprain is the most common type of injury to MV occupants treated in US hospital emergency departments. Based on emergency department visits, these estimates suggest that the problem of neck injury may be larger than has been previously demonstrated using other surveillance tools. Further research is needed to determine contributory factors and prevention measures to reduce the risk of neck injury among MV occupants especially among those at higher risk such as females, older teenagers and young adults.

Firearm-Related Injuries Affecting the Pediatric Population

The absence of guns from children’s homes and communities is the most reliable and effective measure to prevent firearm-related injuries in children and adolescents. Adolescent suicide risk is strongly associated with firearm availability. Safe gun storage (guns unloaded and locked, ammunition locked separately) reduces children’s risk of injury. Physician counseling of parents about firearm safety appears to be effective, but firearm safety education programs directed at children are ineffective. The American Academy of Pediatrics continues to support a number of specific measures to reduce the destructive effects of guns in the lives of children and adolescents, including the regulation of the manufacture, sale, purchase, ownership, and use of firearms; a ban on semiautomatic assault weapons; and the strongest possible regulations of handguns for civilian use.

Expanding the National Electronic Injury Surveillance System to Monitor All Nonfatal Injuries Treated in US Hospital Emergency Departments

STUDY OBJECTIVE Injury is a major cause of morbidity and mortality in the United States. Although the National Vital Statistics System provides data on injury-related deaths, a national surveillance system is needed for timely identification of emerging nonfatal injury problems and continuous monitoring of severe nonfatal injuries. This work assesses the feasibility of expanding the National Electronic Injury Surveillance System (NEISS) to monitor all types and causes of nonfatal injuries treated in US hospital emergency departments and reports national estimates generated by a pilot study of this system. METHODS At a stratified sample of US hospital EDs, persons receiving first-time treatment for an injury were monitored from May 1 through July 31, 1997. National estimates of the annual number and rate of ED-treated injuries overall, by patient characteristics, injury diagnosis, and external cause of injury were generated, and the sensitivity of the system for detecting ED-treated injuries was assessed. RESULTS An estimated 29. 1 million injuries were treated in US EDs in 1997 (rate of 108.6/1, 000 population). The leading causes of injury were falls, being struck by or striking against an object or person, cutting or piercing, and motor vehicle traffic. Of 593 cases of injury detected by investigators from the Centers for Disease Control and Prevention during visits to 6 of the 21 NEISS hospitals in the study, 490 were also detected by NEISS coders for an overall sensitivity of 82.6%. CONCLUSION Expanding the NEISS is a feasible means of timely and continuous monitoring of all types and causes of nonfatal injuries treated in US hospital EDs.

Preventing Unintentional Scald Burns: Moving Beyond Tap Water

OBJECTIVE. The goal was to examine in detail the mechanisms of significant scald burns among children <5 years of age, to discover insights into prevention. METHODS. Medical records for children <5 years of age who were admitted with scald burns between January 1, 2002, and December 31, 2004, were identified through the University of Chicago Burn Center database. Demographic data and details of the circumstances and mechanisms of injury were extracted from the medical records. RESULTS. Of 640 admissions to the University of Chicago Burn Center during the 3-year study period, 140 (22%) involved children <5 years of age with scald burns. Of the 137 available charts reviewed, 118 involved unintentional injuries. Of those unintentional injuries, 14 were tap water scalds and 104 were non–tap water scalds. Of the non–tap water scalds, 94 scalds (90.4%) were related to hot cooking or drinking liquids. Two unexpected patterns of injury were discovered. Nine children (8.7%) between the ages of 18 months and 4 years were scalded after opening a microwave oven and removing the hot substance themselves. Seventeen children (16.3%) were scalded while an older child, 7 to 14 years of age, was cooking or carrying the scalding substance or supervising the younger child. CONCLUSIONS. Current prevention strategies and messages do not adequately address the most common mechanisms of scald injury requiring hospitalization. Easy access to a microwave oven poses a significant scald risk to children as young as 18 months of age, who can open the door and remove the hot contents. An engineering fix for microwave ovens could help protect young children from this mechanism of scalding. Involvement of older children in a subset of scald injuries is a new finding that may have prevention implications.

Policy Statement—Prevention of Drowning

Drowning is a leading cause of injury-related death in children. In 2006, fatal drowning claimed the lives of approximately 1100 US children younger than 20 years. A number of strategies are available to prevent these tragedies. As educators and advocates, pediatricians can play an important role in the prevention of drowning.

Policy statement - Child fatality review

Injury remains the leading cause of pediatric mortality and requires public health approaches to reduce preventable deaths. Child fatality review teams, first established to review suspicious child deaths involving abuse or neglect, have expanded toward a public health model of prevention of child fatality through systematic review of child deaths from birth through adolescence. Approximately half of all states report reviewing child deaths from all causes, and the process of fatality review has identified effective local and state prevention strategies for reducing child deaths. This expanded approach can be a powerful tool in understanding the epidemiology and preventability of child death locally, regionally, and nationally; improving accuracy of vital statistics data; and identifying public health and legislative strategies for reducing preventable child fatalities. The American Academy of Pediatrics supports the development of federal and state legislation to enhance the child fatality review process and recommends that pediatricians become involved in local and state child death reviews.

Child passenger safety for inner-city Latinos: New approaches from the community

Objective: Motor vehicle crashes injuries, the leading cause of death for Latino children in the United States, can be reduced by the correct use of child safety seats. This study evaluated the ability of a community health worker education program to improve proper child safety seat usage in urban low income Latino families. Methods: At a series of check events, proper child safety seat usage in families who had received an education intervention was compared with similar families who had not. The education intervention, provided by Latino community health workers trained as child passenger safety technicians, used videos and an office demonstrator. Members of the target community initiated the study and participated in its subsequent design and implementation. Results: The families that participated in the study were primarily Mexican with low income, education, and acculturation levels. Forty six rear facing and 44 forward facing child safety seats were checked. Families exposed to the intervention were more likely to have their child’s seat within the manufacturer’s recommended weight/height range, their child facing the correct direction, the harness straps positioned properly, to have not been in a crash, the harness straps snug, the harness retainer clip used correctly, the seat belt routed correctly, and the seat belt locked. Conclusions: Exposure to an educational intervention provided by community health workers trained as child passenger safety technicians was associated with child safety seats being used more properly than seats of families not exposed to the intervention in an urban low income Latino community.

Providing car seat checks with well‐child visits at an urban health center: a pilot study

Objective: To evaluate a pilot program of providing child restraint system (CRS) checks by certified technicians with well-child care in an urban health center serving a low-income community. Methods: During well-child care, nationally certified child passenger safety technicians assessed CRS use, educated care givers, corrected misuse, and provided a new CRS if necessary. The program’s effect was assessed at a subsequent medical visit. Results: A total of 3650 CRS checks were performed. CRS non-use was found for 307 (17%) infants, 604 (50%) toddlers, and 593 (88%) booster seat-sized children. Exposure to the program was associated with a significant positive effect on CRS use (p<0.001) and significant improvements in the major components of misuse (p<0.05) months later. Conclusions: This urban health center has high rates of CRS non-use and near-universal misuse. Providing CRS checks by certified technicians during well-child care is a promising means of promoting sustained and improved CRS use.

Not child's play: National estimates of microwave-related burn injuries among young children.

BACKGROUND Previous studies have shown that children as young as 18 months can open a microwave and remove its contents causing sometimes severe scalds. Although this mechanism may be uniquely preventable by an engineering fix, no national estimate of this type of child burn injury has been reported. METHODS We analyzed the Consumer Product Safety Commissions National Electronic Injury Surveillance System data on emergency department–treated microwave-related burn injuries from January 2002 through December 2012 in children aged 12 months to 4 years. Based on the narrative description of how the injury occurred, we defined a case as a burn with a mechanism of either definitely or probably involving a child himself or herself opening a microwave oven and accessing the heated contents. National estimates of cases and their characteristics were calculated. RESULTS During the 11 years studied, an estimated 10,902 (95% confidence interval, 8,231–13,573) microwave-related burns occurred in children aged 12 months to 4 years. Of these, 7,274 (66.7%) (95% confidence interval, 5,135–9,413) were cases of children burned after accessing the contents of the microwave themselves. A total of 1,124 (15.5%) cases required hospitalization or transfer from the treating emergency department. Narratives for children as young as 12 months described the child himself or herself being able to access microwave contents. The most commonly burned body parts were the upper trunk (3,056 cases) and the face (1,039 cases). The most common scalding substances were water (2,863 cases), noodles (1,011 cases), and soup (931 cases). CONCLUSION The majority of microwave-related burns in young children occur as a result of the child himself or herself accessing the microwave and removing the contents. More than 600 young children are treated in US emergency departments annually for such burns. Children as young as 12 months sustained burns caused by this mechanism of injury. These burns could be prevented with a redesign of microwaves to thwart young children from being able to open the microwave oven door. LEVEL OF EVIDENCE Epidemiologic study, level III.