A guide for health professionals working with
immigrant and refugee children and youth

Injury Prevention

Key points

  • Child and youth injuries are a major public health issue, but there is limited data on the prevalence of injury among young newcomers to Canada.
  • Child injuries are strongly related to social determinants of health.
  • Most child injuries are preventable. In Canada, the leading causes of unintentional death due to injury are suffocation (in babies <1 year of age) and motor vehicle collisions (in children and youth 1 to 24 years of age).
  • Identifying the risk factors, barriers and facilitators associated with unintentional injuries is essential to developing effective prevention strategies.

All children have the right to a safe environment and to protection from injury and violence.

- UN Convention on the
Rights of the Child

Child injuries are a major public health issue worldwide. An estimated 2,000 children and youth die from injuries every day,1 and many more require hospitalization or experience lifelong disability.2 In Canada, injury is the leading cause of death among children, adolescents and adults up to 44 years of age.2 For all categories of unintentional injury, boys die more often than girls, with the exception of fire-related burns.1

The burden of injury in the immigrant and refugee population

There is little data on the prevalence of injury among young newcomers to Canada. Some research suggests that children who are immigrants have a reduced risk of injury, but the reasons for this are not clear. Being less culturally integrated appears to help protect children from risk of injury.3

Some international data suggest that burn injury rates among immigrant children may be higher than for the general population:

  • A Danish study found that children of non-Western origin had a higher occurrence of scalds by hot water, oil and tea, and burns by hot irons and fireworks.4
  • A Swedish study found that children of mothers born in a non-Western country were more likely to be admitted to hospital because of scald injuries, but less likely to be admitted for a fall or non-drug poisoning.5
  • A U.S. study on hospital admissions for burns among children 0 to 5 years of age found that 63% of scald burns occurred in Hispanic children. The majority of their families were living at or below the poverty line and in areas with high immigration from Mexico.6

Injury and social determinants of health

Certain conditions can make children more susceptible to injury, including their age or stage of development, gender, and particularly poverty and environment.1 Studies have shown a higher risk of burn injury associated with low economic status and living in stressful circumstances.6 Recent immigrants are more likely to be among the working poor than native-born Canadians.7

Other factors that can increase a child’s risk of injury include:

  • Cultural background
  • Maternal age and education
  • Financial difficulties
  • Housing conditions
  • Overcrowding
  • Lack of supervision
  • Inadequate safety precautions
  • Unfamiliarity with Canadian climate
  • Unawareness of Canadian safety laws and benefits (e.g., booster seats)

Despite the clear association between socioeconomic factors and risks of childhood injury,8 targeted prevention measures for economically disadvantaged children are still lacking.

Causes of injury among newcomer children and youth

Although the causes of injury in young newcomers to Canada are not well-documented, global and Canadian data provide some insight. Worldwide, the leading causes of death due to injury are road traffic injuries, drowning, burns, falls and poisoning (in children and adolescents 1 to 20 years of age).1

Table 1 shows the leading causes of injury among all Canadian children by age group.

Table 1: Leading causes of unintentional injury deaths in Canada, 2007

 

#1 Cause

#2 Cause

#3 Cause

Under 1 year

Threat to breathing (54%)

Motor vehicle traffic crash (18%)

Drowning (15%)

1 to 4 years

Motor vehicle traffic crash (22%)

Drowning (21%)

Threat to breathing (19%)

5 to 9 years

Motor vehicle traffic crash (58%)

Drowning, fall, contact with fire/flame (6%)

Threat to breathing (5%)

10 to 14 years

Motor vehicle traffic crash (55%)

Drowning (13%)

Fall (7%)

15 to 19 years

Motor vehicle traffic crash (71%)

Poisoning (7%)

Drowning (6%)

Source: Canadian Paediatric Society, Injury Prevention Committee, 2012. Child and youth injury prevention: A public health approach. Based on a Public Health Agency of Canada analysis of mortality data from Statistics Canada (unpublished).

 

A preventable injury

A new immigrant mother of 5 children had to work evenings. She left her oldest child, an 11-year-old girl, to care for 4 younger siblings.

While this daughter was preparing dinner over a small BBQ in the kitchen, the 2-year-old pulled a pot of hot soup off the countertop, which spilled over her and caused a severe scald burn.

Learning points

  • Helping a newcomer family to find community support and age-appropriate babysitters might have prevented this injury.
  • Burns are the only injury to occur more commonly in girls than boys.
  • Scald burns frequently occur in the kitchen, when children spill a hot substance, or in the bathroom, when water from the faucet is too hot.
  • Physicians should ask newcomer families about, and counsel against, the following hazards:
    • fire and burns from using auxiliary heating units because of inadequate heating in a home,
    • carbon monoxide poisoning from using charcoal briquettes indoors, and
    • scald burns from the main water heater being set too high. A maximum safe temperature setting for household use is 49°C (120°F).

What health professionals can do

Include injury prevention in your practice

To help prevent injury among young Canadians, health professionals need to know what factors put children at greater risk and what protective strategies keep them safer.

The Canadian Paediatric Society (CPS) recommends that health professionals include injury prevention messages in their practice.2 Advising newcomers of preventive measures is especially important because they may not be aware of Canadian safety regulations or the benefits of following them.  Regulations and attitudes may differ from those in their country of origin. For example, it is important to emphasize that car and booster seats are required by law almost everywhere in Canada (though there may be variations among the laws).

Practitioners should advise immigrant and refugee families of the importance of preventive measures, such as:

  • Using appropriate car seats, child restraints and seat belts when driving.
  • Wearing motorcycle and bicycle helmets.
  • Wearing personal flotation devices.
  • Home safety measures (e.g., fire alarms, extinguishers, and safe storage of toxic substances).

Guidance for specific injury prevention counselling for the paediatric population is available in the following records:

Many newcomers would prefer to receive culturally sensitive prevention instructions in their native language, in small groups through established community agencies.6 Prenatal and community health classes should be encouraged to include injury prevention topics.

Provide handouts for parents and caregivers

Understand specific challenges for newcomers

Clinicians need to be aware of the specific challenges newcomers may face when trying to act on injury prevention advice. For example:11

  • Living in rental accommodations or sharing a home with extended family, which may make modifications for safety reasons difficult or impossible.
  • Limited access to safe play or community spaces outside.
  • The cost of installing safety equipment or making repairs (e.g., installing smoke alarms).
  • Social isolation and a lack of family or friends to help with child care.
  • Differences in child safety norms in their new country compared with the country of origin.
  • Mistrust of officials and concern about accusations of neglect, which may prevent parents from asking about injury prevention or seeking medical help for an unintentionally injured child.
  • Language barriers.
Table 2: Summary of potential barriers and facilitators to reduce injury in the home

Level of Intervention

Facilitators

Barriers

Individual

  • Education in child development
  • Tapping into parents’ ongoing safeguarding efforts
  • Two-way learning about cultural expectations of good parenting
  • Building trust in officials via peer education
  • Teaching children about safety
  • Social isolation
  • Fear of accusations of abuse or neglect
  • Poor relationship with partner/household decision-maker
  • Language barriers

Physical and environmental

  • Provision of equipment that is durable, and easy to maintain
  • Ongoing support in use of safety equipment
  • Mistrust of officials
  • Fear of strangers’ motives
  • Perceived cost

External and organizational

  • Strong safety legislation
  • Making links between different service providers
  • Training community members to carry out interventions
  • Culturally sensitive information and advice
  • Policy drivers enforcing compliance and providing resources to achieve adherence
  • Living with relatives or lack of control in the home
  • Poor quality housing
  • Lack of or badly timed information
Source: Adapted with permission from BMJ Group Limited. Smithson J, Garside R, Pearson M. “Barriers to, and facilitators of, the prevention of unintentional injury in children in the home: A systematic review and synthesis of qualitative research”. Inj Prev 2011;17(2):123.

 

Multi-tiered approach to injury prevention

The most effective strategy for injury prevention is one that includes facets of public health, such as education, as well as improving and enforcing legislation, and better engineering.2

Numerous data support the need for a national, multi-tiered approach to injury prevention in Canada:

  • One Canadian Paediatric Surveillance Program survey found that serious injuries (e.g., concussions and fractures) involving strollers, cribs and baby walkers still occur, despite the last device being banned in Canada since 2004.12
  • A 2-year population study found that 25% of Canadian children in motor vehicle collisions who experienced seat belt syndrome (i.e., injuries to intestinal viscera and lumbar spine) became paraplegic.13

The majority of injuries sustained by children and youth are preventable.2 Countries with the greatest reductions in childhood injury rates and severity have used a combination of approaches to prevention.

Selected resources

References

  1. WHO-UNICEF. World report on child injury prevention 2008. Geneva, Switzerland: WHO, 2008:iii.
  2. Canadian Paediatric Society, Injury Prevention Committee. Child and youth injury prevention: A public health approach. Paediatr Child Health 2012;17(9):511.
  3. Schwebel DC, Brezausek CM. Language acculturation and pediatric injury risk. J Immigr Minor Health 2009;11(3):168-73.
  4. Laursen B, Møller H. Unintentional injuries in children of Danish and foreign-born mothers. Scand J Public Health 2009;37(6):577-83.
  5. Hjern A, Ringbäck-Weitoft G, Andersson R. Socio-demographic risk factors for home-type injuries in Swedish infants and toddlers. Acta Paediatr 2001;90(1):61868.
  6. Rimmer RB, Weigand S, Foster KN, et al. Scald burns in young children--a review of Arizona burn center pediatric patients and a proposal for prevention in the Hispanic community. J Burn Care Res. 2008 Jul-Aug;29(4):595-605. doi: 10.1097/BCR.0b013e31817db8a4
  7. Fleury D, Human Resources and Social Development Canada. A study of poverty and working poverty among recent immigrants to Canada: Final report, 2007.
  8. Faelker T, Pickett W, Brison RJ. Socioeconomic differences in childhood injury: A population-based epidemiologic study in Ontario Canada. Inj Prev 2000;6(3):203-8.
  9. Rourke L, Leduc D, Rourke J, Constantin E. Health supervision from 0 to 5 years using the Rourke Baby Record 2006. Paediatrics and Child Health 2006;11(8): 487-8.
  10. Greig A, Constantin E, Carsley S, Cummings C. Preventive health care visits for children and adolescents aged 6 to 17 years: The Greig Health Record – Technical Report. Paediatr Child Health 2010;15:157-9.
  11. Smithson J, Garside R, Pearson M. Barriers to, and facilitators of, the prevention of unintentional injury in children in the home: a systematic review and synthesis of qualitative research. Inj Prev 2011;17(2): 119-26.
  12. Skinner R, Ugnat A-M; Canadian Pediatric Surveillance Program. Baby products injury. February 2010: www.cpsp.cps.ca/uploads/surveys/baby-products-injury-survey-results.pdf.
  13. Santschi M, Lemoine C, Cyr C. The spectrum of seat belt syndrome among Canadian children: Results of a two-year population surveillance. Paediatr Child Health 2008;13(4):279-83.

Editor(s)

  • Danielle Grenier, MD

Last updated: June, 2014

Also available at: http://www.kidsnewtocanada.ca/health-promotion/injury
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Caring for Kids New to Canada is a resource for health professionals. The information here is not a substitute for medical advice, nor does it indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate.

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