Promoting Safety and Injury Prevention Ensuring a child remains safe from harm or injury parents in keeping their children safe. Many pro- during the long journey from infancy through fessional societies have bolstered these efforts by adolescence is a task that requires the participation recommending guidance to prevent injuries.1-3 of parents and the many other adults who care for Safety and injury prevention is a topic area that and help raise children. It also, of course, requires covers a wide array of issues for infants, children, the participation of the children themselves. and adolescents. These issues can be grouped into Health care professionals have long recognized 2 general categories. the importance of safety and injury prevention ■■ Unintentional injury counseling as a tool to help educate and motivate continues to be the lead- ing cause of death and morbidity among chil- dren older than 1 year, adolescents, and young adults. Serious unintentional injuries result from myriad causes, including motor vehicle crashes, falls, burns, poisoning, drowning, fire- arms, recreational activities, prescription or other drug overdose, and sports. Unintentional injuries take an enormous financial, emotional, and social toll on children and adolescents, their families, and society as a whole. Although the word accident is familiar, the word injury is preferred because it connotes the medical con- sequences of events that are both predictable and preventable. The causes of unintentional injury–related illness and death vary according to a child’s age, sex, race, environment, geo- graphic region, and socioeconomic status and depend on developmental abilities, exposure to potential hazards, and parental perceptions of a child’s abilities and the injury risk. Younger PROMOTING SAFETY AND PROMOTING I children, boys, Native Americans and Alaska PREVENTION NJURY Natives, adolescents, and children who live in poverty are affected at disproportionately higher rates than are other children and adolescents.4,5 ■■ Intentional injury, which results from behaviors that are designed to hurt oneself or others, is a multifaceted social problem and a major health hazard for children and youth. Homicide and suicide are particularly important for the health 235 BFG 4TH ED.indb 235 1/20/17 2:47 PM Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents care professional to consider because their Box 1 frequency increases as children grow older. In Emergency Preparedness Suggestions addition, in infants and very young children, for Parents intentional injury is a leading cause of mor- Health care professionals can suggest that parents bidity and mortality. Intentional injuries cover • Complete an American Heart Association or a wide array of mechanisms, and the effect on American Red Cross first aid and CPR program. children is great, no matter whether the violence • Have a first aid kit and know local emergency is directly experienced or is witnessed. The asso- telephone numbers and Web sites. The number ciation of early childhood exposure to violence for the national Poison Help line is 800-222-1222. The FEMA preparedness and subsequent violent behaviors has been planning Web site is www.ready.gov/ 6-9 established. The prevention of violence in make-a-plan. all its forms therefore follows a developmental • Know when to call a health care professional trajectory, beginning with infancy. To provide (counsel parents to call whenever they are not appropriate guidance and counseling, health sure what to do). • Know when to go to the emergency department care professionals need to be alert to the pos- (counsel parents on when to call 911). sible presence of violence in a family or to the effects of a violent environment on a child, Abbreviation: FEMA, Federal Emergency Management Agency. which may include seemingly unrelated physical concerns. Guidance on interventions and strategies to ensure Child Development and Safety safety and prevent injuries target 3 domains: Ensuring safety and preventing injuries must be an (1) the development and age of the child, (2) the ongoing priority for parents as their children prog- environment in which the safety concern or injury ress from infancy through adolescence. However, takes place, and (3) the circumstances surrounding the nature of their efforts evolves over time. Safety the event. The health supervision visit provides a issues in infancy relate primarily to the infant’s venue to assess the parents’ and the child’s current environment and interactions with parents. Parents safety strategies, encourage and praise their pos- must modify the environment to prevent suffoca- itive behaviors, provide guidance about potential tion, motor vehicle–related injuries, falls, burns, risks, and recommend community interventions choking, drowning, poisoning, violence, and other that promote safety.10 hazards. They also must maintain active supervi- The health supervision visit also is a good venue sion, which means focused attention and inten- in which to review emergency and disaster pre- tional observation of children at all times. As a paredness measures (Box 1). Information on han- young child’s independence emerges and mobility dling emergencies, how to access local emergency rapidly increases, new safety and injury prevention care systems, and CPR and first aid can be made challenges arise and necessitate further environ- available to all parents. Information on disaster mental modifications, or childproofing. Parents of preparedness includes knowing the risks and young children often underestimate the level of the hazards in the area, making a plan, preparing a child’s motor skill development (eg, age of ability to climb) and overestimate their cognitive and NJURY PREVENTION NJURY I kit of emergency supplies, and getting involved PROMOTING SAFETY AND PROMOTING in community readiness efforts.11 sensory skills (eg, assessing the speed of an oncom- ing car or being able to learn from past mistakes). Integrating injury prevention counseling with 236 BFG 4TH ED.indb 236 1/20/17 2:47 PM Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents developmental and behavioral discussions when information on this topic, see the Promoting Mental talking with the family can be an effective method Health theme.) Risk-reduction counseling is most of delivering this important information. likely to be effective when it is used in a repetitive, The middle childhood years are a period during multi-setting approach, rather than being isolated 14 which safety challenges at home begin to be aug- in the medical office. Partnering with the parent mented by those outside the home (eg, at school, and sharing strategies for how to promote positive in sports, and with friends). During middle child- youth development, address strengths, and reduce hood, increasing independence allows the child to risk-taking behaviors is an important collaborative broaden his world beyond that of the immediate approach as parents gradually decrease their super- family. This requires good decision-making skills visory responsibilities and help their child transi- 2 to stay safe and reduce the risk of injury. During tion to young adulthood. (For more information adolescence, decision-making about safety shifts to on this topic, see the Promoting Lifelong Health for choices the adolescent makes about his activities, Families and Communities theme.) behavior, and environment. Families and Culture in Safety and Parents have an important role to play in keeping their children and adolescents safe through main- Injury Prevention taining open lines of communication, balancing Parents often feel challenged as they try to set strong support with clear limits, and monitoring priorities among the many health and safety mes- closely. Strong support and close monitoring by sages that are given to them by the medical com- parents have been linked with positive outcomes munity. For some families, these messages may in children regardless of race, ethnicity, family conflict with their cultural or personal beliefs and structure, education, income, or sex.12,13 Health may result in parents disregarding the health and care professionals can help parents foster openness, safety recommendations on topics such as safe encourage communication with their child, and infant sleep or the safe storage of firearms. In addi- address concerns when they arise. tion, certain culturally derived medical or alterna- When a risky behavior is identified, counseling tive health practices may place children at risk of can be directed toward helping the parent and injury. Cultural or gender roles, in which women child with strategies to reduce or avoid the risk, are not able to tell men in the household what such as using appropriate protective gear (eg, seat to do, may limit women’s ability to enact a safety belts, helmets, hearing protection, and sports measure. In some communities, cultural beliefs equipment), not riding in a car or boat with some- dictate that the mother or parents are not the pri- one who has been drinking alcohol, locking up mary decision-makers or caregivers for their young children. Acknowledging the influential roles that SAFETY AND PROMOTING prescription drugs, and ensuring that firearms are I NJURY PREVENTION NJURY inaccessible to children and adolescents, especially older women (eg, grandmothers or mothers-in- those with suspected depression or other mental law) and other elders and spiritual leaders play