Injury Prevention

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.

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:

• The Rourke Baby Record, for the first 5 years⁹
• The Greig Record, for 6 to 17 years¹⁰

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

• Parachute Canada: Culturally adapted parent resources on injury prevention in multiple languages, including car safety and home safety.
• Transport Canada: Multilingual handouts on correct use of car and booster seats.
• Canadian Paediatric Society: Information sheets for parents on car seat safety, helmet use in sport, water safety and other topics.

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.

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

• Canadian Collaborative Centres for Injury Prevention: www.cccip.ca
• Canadian Paediatric Society, Caring for Kids website: www.caringforkids.cps.ca/handouts/kidssafe-index
• Child Safety Good Practice Guide (Canadian edition): www.parachutecanada.org/downloads/research/reports/ChildSafetyGoodPracticeGuide-CanadianEdition.pdf
• Health Canada’s home safety resources: www.hc-sc.gc.ca/cps-spc/pubs/cons/child-enfant/safe-securite-eng.php. See also the Joint Statement on Safe Sleep: Preventing sudden infant deaths in Canada: www.phac-aspc.gc.ca/hp-ps/dca-dea/stages-etapes/childhood-enfance_0-2/sids/pdf/jsss-ecss2011-eng.pdf
• IWK Health Centre (Halifax, N.S.) Child Safety Link  www.childsafetylink.ca
• Parachute Canada has multilingual and culturally appropriate resources on child passenger safety and home safety: www.parachutecanada.org/resources
• Public Health Agency of Canada, 2009. Child and youth injury in review, 2009 edition – spotlight on consumer product safety: www.phac-aspc.gc.ca/publicat/cyi-bej/2009/index-eng.php
•  Transport Canada offers multilingual tip sheets on car seats and booster seats for families: www.tc.gc.ca/eng/roadsafety/safedrivers-childsafety-car-index-873.htm
• World Health Organization’s Violence and Injury Prevention:  www.who.int/violence_injury_prevention/en/

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.