Accidents in children

ChildhoodChildhood
IInjurynjury
((ACCIDENTS IN CHILDRENACCIDENTS IN CHILDREN))Dr mohammad nurul huq

InjuryInjury
is the intentional/un- damage to body fromis the intentional/un- damage to body from
ac. exposure to thermal, mechanical,ac. exposure to thermal, mechanical,
electrical, or chemical energy or from theelectrical, or chemical energy or from the
absence of such essentials as heat/O2absence of such essentials as heat/O2

I amI am HandleHandle
me withme with
care!care!

In HICsIn HICs
HIC: high income countryHIC: high income country

At the end of this you will learn …At the end of this you will learn …
 Impact of injury isImpact of injury is devastatingdevastating
 95%95% child injuries (CI) occur inchild injuries (CI) occur in L&MICsL&MICs
 DrowningDrowning is a great killer in L&MICsis a great killer in L&MICs
 Control ofControl of CICI waswas essential to achieve MDG4essential to achieve MDG4
 ID & malnutrition are controlled, butID & malnutrition are controlled, but CICI is clearly a bigis clearly a big
problemproblem
 Px program is a must in all child health initiativesPx program is a must in all child health initiatives
CI: child injuries.CI: child injuries. ID: inf. Diseases. Mn.: malnutrition.ID: inf. Diseases. Mn.: malnutrition. Px: preventionPx: prevention

 90% of CI are unintentional90% of CI are unintentional
 >2,000>2,000 U-18y dieU-18y die/d/d ofof CICI:: (=(= to death from DPT, measles, polioto death from DPT, measles, polio.).)
>50%:>50%: RTA ,RTA , drowningdrowning
– 720/d die from RTA720/d die from RTA
– 480 … from drowning.480 … from drowning. >>98% in L&MICs98% in L&MICs
– 260 … from burns260 … from burns
– 130 … from falls130 … from falls
– 125 … from poisoning125 … from poisoning
– homicidehomicide
World Figure of CI: >12% of disease burden

 CICI isis a significant MM since 1y agea significant MM since 1y age
 Tens of millions are admitted/y for non-fatalTens of millions are admitted/y for non-fatal CIs.CIs. A greatA great
number develop life-long disabilitiesnumber develop life-long disabilities
 It isIt is the leading c/of death for >9yoa childrenthe leading c/of death for >9yoa children
 Many HICsMany HICs have reducedhave reduced CIsCIs by 50%by 50%
 Effective Px measures can saveEffective Px measures can save >1,000/d child lives>1,000/d child lives
CICI has not received enough attention & the issue ishas not received enough attention & the issue is
often absent from child survival initiativesoften absent from child survival initiatives
MM: morbidity & mortality. Px: preventiveMM: morbidity & mortality. Px: preventive
World Figure …World Figure …

 Poor childrenPoor children face the greatest risk of CI:face the greatest risk of CI:
– reside in homes with open fires, unprotected windows,reside in homes with open fires, unprotected windows,
unsafe roofs & stairs, near dense fast-moving trafficunsafe roofs & stairs, near dense fast-moving traffic
– they have less access to protectionthey have less access to protection
– often lack spaces & facilities for safe playoften lack spaces & facilities for safe play
 Hazards are everywhere:Hazards are everywhere: cleaning chemicals, outlets,cleaning chemicals, outlets,
ovens, sharp corners, kerosene lamps & bodies ofovens, sharp corners, kerosene lamps & bodies of
water, to name a fewwater, to name a few
World Figure …World Figure …

Children are at Greater Risk of CIChildren are at Greater Risk of CI
Children live in a worldChildren live in a world built for adults:built for adults: strongstrong
association betweenassociation between CICI &&
– his age, developmental stagehis age, developmental stage
– his interactions & activitieshis interactions & activities
– lack of supervision, access to protective materialslack of supervision, access to protective materials
 World is dangerous for them: cleaning chemicals, outlets,World is dangerous for them: cleaning chemicals, outlets,
ovens, sharps, bodies of water, traffic, etc.ovens, sharps, bodies of water, traffic, etc.
 Px. strategies for adults may not work for childrenPx. strategies for adults may not work for children

CIs are strongly related to social determinantsCIs are strongly related to social determinants

Impact of CI is devastating!Impact of CI is devastating!
• Losing a child has a huge impact on familiesLosing a child has a huge impact on families
• Disabled children may have poor social dev.,Disabled children may have poor social dev.,
education, work, etc.education, work, etc.
• CIsCIs place significant strain on overstretchedplace significant strain on overstretched
health care systems in L&MICshealth care systems in L&MICs
Injury prevention is very cost-effective!Injury prevention is very cost-effective!

RTA:RTA: leading c/of death in 10-19yleading c/of death in 10-19y
• 720 children die/d720 children die/d
• 10 million non-fatally injured/y10 million non-fatally injured/y
• The biggest killer in 15-19yThe biggest killer in 15-19y
• RTA & falls are main c/of disabilitiesRTA & falls are main c/of disabilities
• HICs:HICs: most victims are occupants of vehiclesmost victims are occupants of vehicles
• L&MICs:L&MICs: most are pedestrians or cyclistsmost are pedestrians or cyclists
RTI: road traffic injury. RTA: - - accidentsRTI: road traffic injury. RTA: - - accidents

RTI: What works?RTI: What works? Road safetyRoad safety
 Helmets.Helmets. Minimum drinking-age laws. Lower BACMinimum drinking-age laws. Lower BAC
 Graduated driver licensing systemsGraduated driver licensing systems
 Seat-belts, child-restraints. Speed reduction (Seat-belts, child-restraints. Speed reduction (school,school,
residence, play areas)residence, play areas)
 Separating road users:Separating road users: bicycle & pedestrian lanesbicycle & pedestrian lanes
 Daytime running lightsDaytime running lights
 Enforce traffic law, straighten roadsEnforce traffic law, straighten roads
BAC: bloodBAC: blood alcoholalcohol concentrationconcentration

Falls:Falls: the leading c/of ED visitthe leading c/of ED visit
• For every fatal fall 690For every fatal fall 690
children miss schoolchildren miss school
• Falls are the leading c/ofFalls are the leading c/of
long term disabilitylong term disability
c/of: cause of. ED: emergency deptc/of: cause of. ED: emergency dept

Falls:Falls: World FactsWorld Facts
 130 die/d:130 die/d: 60% from a height60% from a height
 Non-fatal falls:Non-fatal falls: significant DALY lostsignificant DALY lost
 50% children ED visits may be for fall50% children ED visits may be for fall
Bangladesh:Bangladesh: fallsfalls are leadingare leading CICI
& 1 of the major c/of permanent disabilities& 1 of the major c/of permanent disabilities
 770 children are injured/d &770 children are injured/d & 5 die5 die
 Infants have the highest fatal fallsInfants have the highest fatal falls
DALY:DALY: Disability-adjusted life year: number of yrs. lost due to ill-health, disability orDisability-adjusted life year: number of yrs. lost due to ill-health, disability or
early death. It compares overall health & life expectancy of a countryearly death. It compares overall health & life expectancy of a country

Children playing on roofs is a common sight inChildren playing on roofs is a common sight in
many Asian countriesmany Asian countries

Commonest falls:Commonest falls:
– prams, baby walkers, changing tablesprams, baby walkers, changing tables
– cots, beds, lap,cots, beds, lap, bunk bedsbunk beds
– trees; sports, roofs, windowstrees; sports, roofs, windows
– stairs, playground equipmentsstairs, playground equipments
– cliffs, buildings, furniturecliffs, buildings, furniture
– jumping/diving into waterjumping/diving into water
 The rural roads & concrete slabs around tube-wellsThe rural roads & concrete slabs around tube-wells
become slippery when wetbecome slippery when wet
 Young children also fall when they learn how to walkYoung children also fall when they learn how to walk

Falls: What works?Falls: What works?
All should be careful about childrenAll should be careful about children
Redesigning nursery furnitureRedesigning nursery furniture
Safe playground: appropriate surface, material, height ofSafe playground: appropriate surface, material, height of
equipment & maintenanceequipment & maintenance
Legislating for stair, window, roof guardsLegislating for stair, window, roof guards
Multifaceted community programs:Multifaceted community programs: ‘Children can fly’/‘Children can fly’/ nornor
they are protected by angels!they are protected by angels!
Prevent them from climbing & slippery surfacesPrevent them from climbing & slippery surfaces
Hold children on rickshawsHold children on rickshaws
Ensure children’s shoes are not slipperyEnsure children’s shoes are not slippery

Burns:Burns: onlyonly CI commoner in girlsCI commoner in girls

Burns: World FactsBurns: World Facts
 260260 die from burn/ddie from burn/d
– x11 in L&MICsx11 in L&MICs
 Infants are at highest riskInfants are at highest risk
 Smoke inhalation alone can be fatalSmoke inhalation alone can be fatal
 25%25% from fire,from fire, 75%75% from hot liquids, steam, electricity, etcfrom hot liquids, steam, electricity, etc
 Many children are disfiguredMany children are disfigured

Burns in BangladeshBurns in Bangladesh

Risk Factors for Burn in BangladeshRisk Factors for Burn in Bangladesh
 Young children are the most vulnerableYoung children are the most vulnerable
 Rural children: >4 times at riskRural children: >4 times at risk
 Homes are the most common placeHomes are the most common place
 The kitchen is the most hazardousThe kitchen is the most hazardous
 KupiBatiKupiBati (kerosene lamp): 10% of the total flame burns(kerosene lamp): 10% of the total flame burns

Burns: What works?Burns: What works?
 Laws for smoke alarmsLaws for smoke alarms
 Child-resistant lightersChild-resistant lighters
 Laws for tap water temperatureLaws for tap water temperature
 Educating publicEducating public
 Caution in transporting hot water, drinksCaution in transporting hot water, drinks
 Rx at a dedicated burns centreRx at a dedicated burns centre

Poisoning:Poisoning: World FactsWorld Facts
 Death:Death: 125/d.125/d. Highest for U-1y, but peaks again at 15y &Highest for U-1y, but peaks again at 15y &
older (experiment with substances)older (experiment with substances)
 Fatal poisoning is x4 in L&MICs: commonest are paraffin,Fatal poisoning is x4 in L&MICs: commonest are paraffin,
household products & drugshousehold products & drugs
 In HICs: OTC drugs, householdIn HICs: OTC drugs, household
products, prescription drugsproducts, prescription drugs

Substances found in & around home are mostSubstances found in & around home are most
commonly involved in childhood poisoningcommonly involved in childhood poisoning
• Many millions of calls are made to poison control centres,Many millions of calls are made to poison control centres,
most resolved over the phonemost resolved over the phone

Poisoning: What works?Poisoning: What works?
 Child-resistant packagingChild-resistant packaging of drugs & poisonsof drugs & poisons
 Packaging drugs in non-lethal quantityPackaging drugs in non-lethal quantity
 Toxin free home.Toxin free home. Removing the toxic agentRemoving the toxic agent
 Store out of reach of childrenStore out of reach of children
 Air pollution, smoking, arsenic mitigationAir pollution, smoking, arsenic mitigation
 Poison control centresPoison control centres

 U-5 MR from ID is now low:U-5 MR from ID is now low: CICI is ais a major killermajor killer
 CI:CI: 14% of all death: 5/10,000 (53% among 5-17y)14% of all death: 5/10,000 (53% among 5-17y)
 CI: U-18y MortalityCI: U-18y Mortality:: 30,000/y30,000/y
– Drowning:Drowning: 17,000 (46 /d)17,000 (46 /d)
– RTA 3,400RTA 3,400
– Animal bite 2,600Animal bite 2,600
– SuicideSuicide 2,200 (15-17y; 6/d)2,200 (15-17y; 6/d)
– OthersOthers 4,8004,800

U-18y CI morbidity:U-18y CI morbidity: 9,55,500/y9,55,500/y (30% of all morbidity}:(30% of all morbidity}:
CI:CI: Bangladesh ScenarioBangladesh Scenario

U-18y CI morbidity:U-18y CI morbidity: 9,55,500:9,55,500: 13,000 permanent13,000 permanent
disabilitydisability
– FallFall 2,81,5002,81,500
– BurnBurn 1,73,0001,73,000
– CutCut 1,22,5001,22,500
– RTARTA 1,11,5001,11,500
– Near drowningNear drowning 68,80068,800
– OthersOthers 1,98,2001,98,200
Bangladesh …Bangladesh …

CI: oneCI: one/2min!/2min!
 Lack of care/supervision are main reasonsLack of care/supervision are main reasons
 Caregivers are often preoccupied (poor, both parentsCaregivers are often preoccupied (poor, both parents
working, living in cities, lack of knowledge)working, living in cities, lack of knowledge)
 Low awareness of or indifference to risksLow awareness of or indifference to risks
 Harmful practices often make situations worse withHarmful practices often make situations worse with
absence of first-aid knowledgeabsence of first-aid knowledge
Bangladesh …Bangladesh …

Impact of CI (BD)Impact of CI (BD)
 38,000 are orphaned/y38,000 are orphaned/y
 36/d are disabled36/d are disabled (bleak future, trapped in poverty, denied(bleak future, trapped in poverty, denied
for Rx, education, protection; can’t cope with environ.)for Rx, education, protection; can’t cope with environ.)
 It brings devastation for the poorIt brings devastation for the poor
 Many families are pushed to poverty or even familyMany families are pushed to poverty or even family
dissolution due to Rx & rehab. costdissolution due to Rx & rehab. cost
 RTA loses 2% GDPRTA loses 2% GDP

Why must we act now?Why must we act now?
 Burden ofBurden of CICI is on riseis on rise
 We have better/more resources,We have better/more resources, health knowledgehealth knowledge
 We can make our roads safe for children; plan cities,We can make our roads safe for children; plan cities,
caution against flood or mud flows, desertification,caution against flood or mud flows, desertification,
droughts, or rises in sea leveldroughts, or rises in sea level

RecommendationsRecommendations
 Child InjuryChild Injury prevention policyprevention policy
 IntegrateIntegrate CICI to all child health programsto all child health programs
 EnhanceEnhance datadata forfor CICI preventionprevention
 Priorities forPriorities for researchresearch
 InvestInvest forfor CICI preventionprevention

CI Prevention is Cost-effectiveCI Prevention is Cost-effective
Total 143 $Total 143 $

Child injuries are preventableChild injuries are preventable
 12 Proven interventions can save >1000 children/d12 Proven interventions can save >1000 children/d
 Many HICs have been able to reduceMany HICs have been able to reduce CICI deaths by 50%deaths by 50%

Proven interventions inProven interventions in CICI preventionprevention
Road safetyRoad safety
 Enforce minimum drinking-age lawsEnforce minimum drinking-age laws
 Lower blood alcohol conc. for novice driversLower blood alcohol conc. for novice drivers
 HelmetsHelmets
 Seat-belt, child-restraintSeat-belt, child-restraint
 Low speed around schools, residence, play areasLow speed around schools, residence, play areas
 Separate different types of road userSeparate different types of road user
 Daytime running lights for automobilesDaytime running lights for automobiles
 Graduated driver licensing systemsGraduated driver licensing systems

DrowningDrowning
 Remove/cover water hazardsRemove/cover water hazards
 Fence around swimming poolsFence around swimming pools
 Personal flotation devicePersonal flotation device
 Ensure immediate resuscitationEnsure immediate resuscitation
BurnsBurns
 Enforce laws on smoke alarmsEnforce laws on smoke alarms
 Child-resistant lightersChild-resistant lighters
 Enforce hot tap water temp., & educate publicEnforce hot tap water temp., & educate public
 Dedicated burns centreDedicated burns centre

FallsFalls
 Redesign nursery furniture & other productsRedesign nursery furniture & other products
 Playground standards: depth of appropriate surfacePlayground standards: depth of appropriate surface
material, ht. of equipment & maintenancematerial, ht. of equipment & maintenance
 Window guardsWindow guards
 Multifaceted community programs like ‘Children can’t fly’Multifaceted community programs like ‘Children can’t fly’
PoisoningPoisoning
 Remove the toxic agentRemove the toxic agent
 Child-resistant packaging of medicines & poisonsChild-resistant packaging of medicines & poisons
 Package drugs in non-lethal quantitiesPackage drugs in non-lethal quantities
 Poison control centersPoison control centers

Challenges in CI Px. in BangladeshChallenges in CI Px. in Bangladesh
 Perception that CI is a chance/luck!Perception that CI is a chance/luck!
 Lack ofLack of datadata
 Lack ofLack of political willpolitical will
 Poor collaboration & cooperation betweenPoor collaboration & cooperation between agenciesagencies
 LackLack ofof fundfund, human, human resources,resources, appropriateappropriate technologytechnology

WHO
“The cost of doing nothing for CI is
unacceptable”
It would be tragic to achieve significant gains
in child survival only to lose to CI
Make CI top PH policy & practice
PH: public health

World Child Health ProjectsWorld Child Health Projects
Convention on Rights of a Child:Convention on Rights of a Child: 19891989
 Protect childrenProtect children. They have the right to the best health. They have the right to the best health
care & a safe environment, free from injury &care & a safe environment, free from injury &
violenceviolence
WHA resolutionsWHA resolutions
 Children are frequently mentioned in allChildren are frequently mentioned in all resolutionsresolutions
8 MDGs: 48 MDGs: 4thth
 To cut 2/3To cut 2/3rdsrds
U-5MR; not attainable ifU-5MR; not attainable if CICI is not controlledis not controlled

UNGA:UNGA: A world fit for childrenA world fit for children (including(including CI)CI)
Child SurvivalChild Survival is an important issue globally. It is “theis an important issue globally. It is “the
most pressing moral dilemma”most pressing moral dilemma”
The Bellagio PapersThe Bellagio Papers
 CICI Px should be integrated into all child health initiativesPx should be integrated into all child health initiatives
 2/32/3rdsrds
of 11million U-5MR can be reduced by adding 23of 11million U-5MR can be reduced by adding 23
proven cost-effective interventions forproven cost-effective interventions for CICI

DrowningDrowning
andand
Near DrowningNear Drowning

 Drowning: death within 24 hrs of
submersion
 Near drowning: survival after 24h
of submersion (may die later)

Drowning: World FactsDrowning: World Facts
 480 children die/d.480 children die/d. >98% in L&MICs, usually in open>98% in L&MICs, usually in open
water bodies; most in & around the homewater bodies; most in & around the home
 3 million/y get into trouble in water3 million/y get into trouble in water
 11stst
mortality in 1-4yoa,mortality in 1-4yoa, 44thth
among 4-14y, 11among 4-14y, 11thth
in U-5in U-5
 U-5 children are at greatest risk – infants can drown in aU-5 children are at greatest risk – infants can drown in a
few centimeters of waterfew centimeters of water
 In HICs: most drowning happen in swimming poolsIn HICs: most drowning happen in swimming pools

Bangladesh ScenarioBangladesh Scenario
 Drowning is number 1 killer in 1-4y age. 40/dDrowning is number 1 killer in 1-4y age. 40/d
 2007 flood:2007 flood: 87% of U-5MR was from drowning87% of U-5MR was from drowning
 In pre-vax. era, it was equal to measles as killerIn pre-vax. era, it was equal to measles as killer
Most Drowning OccurMost Drowning Occur in pools:in pools:
>75% within 20 meters of house, in the monsoon>75% within 20 meters of house, in the monsoon,, duringduring
flood; between 9am to noon:flood; between 9am to noon: mother is busy!mother is busy!
 46% were <4y:46% were <4y: cant swimcant swim

Male Female RatioMale Female Ratio
overalloverall 3:13:1
TeenagersTeenagers 10:110:1
Age of drowningAge of drowning

<1 y<1 y 5%5%
 1-4y1-4y 37%37%
 5-9y5-9y 15% Total 100%15% Total 100%
10-14y10-14y 15%15%
15-19y15-19y 28%28%
Age 1-4 y: most drowning occur in residential poolsAge 1-4 y: most drowning occur in residential pools

PlacesPlaces
 PondsPonds
 Bath tubsBath tubs
 BucketsBuckets
 Swimming poolsSwimming pools
 LakesLakes
 StreamsStreams
 FloodFlood
 RiverRiver
 Ocean beachesOcean beaches
Infants mostly drown in bathtubs, buckets, or toiletsInfants mostly drown in bathtubs, buckets, or toilets
Bucket drowning is 24% of all toddler drowningBucket drowning is 24% of all toddler drowning

Risks Factors of DrowningRisks Factors of Drowning
Lack of supervision:Lack of supervision:
most victimsmost victims were last seen in home in care ofwere last seen in home in care of
parents withinparents within <5min!<5min!
 Water recreation, alcohol, illicit drugsWater recreation, alcohol, illicit drugs
 EpilepsyEpilepsy (x13 rise)(x13 rise)
 Child abuseChild abuse
Most pediatric drowning victims drown silentlyMost pediatric drowning victims drown silently

Recreation waters:Recreation waters: majority in >15y. Boating:majority in >15y. Boating:
hypothermia, trauma, CO poisoning, etchypothermia, trauma, CO poisoning, etc..
Alcohol:Alcohol: inin 25-50% of teenager & adult drowning (not in25-50% of teenager & adult drowning (not in
Bangladesh)Bangladesh)
 affects balance, coordination, judgmentaffects balance, coordination, judgment
 effect iseffect is ⇑⇑ by sun & heatby sun & heat
Epilepsy:Epilepsy: drowning is the greatest c/of death (bathtubdrowning is the greatest c/of death (bathtub
highest risk)highest risk)

PathophysiologyPathophysiology
Immediate hypoxiaImmediate hypoxia
– cardiac arrest (? catechol. induced fatal arrhythmia):cardiac arrest (? catechol. induced fatal arrhythmia):
ischemia to all tissuesischemia to all tissues
LaryngospasmLaryngospasm
Pulmonary aspirationPulmonary aspiration (absent in 15%)(absent in 15%)
HypothermiaHypothermia
ComaComa
Terminal apneaTerminal apnea (medullary depression)(medullary depression)

HeartHeart
– Cardiac arrestCardiac arrest
– Initial tachycardia, severe hypertensionInitial tachycardia, severe hypertension⇒⇒
bradycardia &bradycardia & arrhythmiasarrhythmias
CNSCNS:: fails in 3min of hypoxiafails in 3min of hypoxia
– Cerebral edemaCerebral edema
– Increased ICPIncreased ICP
LiverLiver:: raised transaminasesraised transaminases

LungsLungs
– ARDS; aspiration pn. (gastric, caustic, fluid)ARDS; aspiration pn. (gastric, caustic, fluid)
– Pulmonary edemaPulmonary edema
Kidneys:Kidneys: ATN, cortical necrosisATN, cortical necrosis
CirculationCirculation:: DIC, hemolysis, low plateletDIC, hemolysis, low platelet
GITGIT:: abrasions, bloody stools, infxabrasions, bloody stools, infx..
PancreasPancreas:: raised serum enzymesraised serum enzymes

Fluid & Electrolyte ImbalanceFluid & Electrolyte Imbalance (uncommon)(uncommon)
– Sea waterSea water:: hemoconcentration,hemoconcentration, hypernatremiahypernatremia
– Fresh waterFresh water:: water intoxicationwater intoxication
 hemodilution, hyponatremiahemodilution, hyponatremia
 hemolysis: ARF, hyperkalemiahemolysis: ARF, hyperkalemia
– SIADHSIADH
Temperature:Temperature: commonly hypothermiacommonly hypothermia

ResuscitationResuscitation
 Clear airwaysClear airways
 Don’t press abdomen!Don’t press abdomen! Vomits commonlyVomits commonly
 M2M/M2N breathingM2M/M2N breathing
 IntubationIntubation
 Temp. maintenanceTemp. maintenance
 Venous catheterVenous catheter
 ECGECG
 Correction ofCorrection of hypoglycemiahypoglycemia

Prognosis: depends onepends on
– Circumstances of the incidentCircumstances of the incident
– Duration of submersionDuration of submersion
– Speed of rescueSpeed of rescue
– Effectiveness of resuscitationEffectiveness of resuscitation
Cardiac arrest requires aggressive prolongedCardiac arrest requires aggressive prolonged
resuscitationresuscitation

AAdult supervisiondult supervision
 Must watch children with a distance of an arm’s lengthMust watch children with a distance of an arm’s length
 Look in the pool first if a child is missingLook in the pool first if a child is missing
 Get aGet a lifeguardlifeguard for social gatheringsfor social gatherings
Prevention: ABCDPrevention: ABCD

Adult supervision is critical!Adult supervision is critical!
 A lapse of <5min is seen in most drowningA lapse of <5min is seen in most drowning
 May drown in 1-2 in. of waterMay drown in 1-2 in. of water
 Frequently occurs in bath tubs, buckets, toilets, diaper pailsFrequently occurs in bath tubs, buckets, toilets, diaper pails
& wading pools& wading pools
 Taking an eye off aTaking an eye off a
child in water forchild in water for
2 sec puts a child at risk!2 sec puts a child at risk!

A swimming teacher teaches children to swim

BBarriersarriers
 A non-climbable (4Ft) fence for pool/spa. No itemsA non-climbable (4Ft) fence for pool/spa. No items
usable for climbing near fenceusable for climbing near fence
 Self-closing gates to pool/spaSelf-closing gates to pool/spa
 Secure locks for all openings to pool/spa when not in useSecure locks for all openings to pool/spa when not in use
 Doors & windows could be alarmed when openedDoors & windows could be alarmed when opened
 Power operated pool safety covers:Power operated pool safety covers:

Fence keepsFence keeps
childrenchildren
away fromaway from
waterwater
Use of waistUse of waist
bellsbells

CClasseslasses (swimming, CPR)(swimming, CPR)
 SwimmingSwimming by an instructor. Teach children toby an instructor. Teach children to
– leave the water when adult leavesleave the water when adult leaves
– enter the water only with a swim suitenter the water only with a swim suit
– first enter the water in the shallow endfirst enter the water in the shallow end
 Teach adultsTeach adults CPR,CPR, rescue techniques,rescue techniques, risks ofrisks of
– Bath tubs, buckets, commodes, washing machineBath tubs, buckets, commodes, washing machine
– Close toilet & bath doorsClose toilet & bath doors
– Cover commodeCover commode

DDevicesevices
 Poolside emergencyPoolside emergency phonephone
 Install aInstall a life saving ring,life saving ring,
shepherd's hook & CPR postershepherd's hook & CPR poster
by the poolby the pool
 Children must wear Personal Flotation Device (PFD)Children must wear Personal Flotation Device (PFD)
when at water siteswhen at water sites
 Wear PFD while inWear PFD while in
a boata boat

Also, never…Also, never…
 …… leave full bucket/tubs, norleave full bucket/tubs, nor leave a child alone nearleave a child alone near
water/let swim alone, nor use "floaties“/inflatablewater/let swim alone, nor use "floaties“/inflatable
toys as life jackets. No substitutes fortoys as life jackets. No substitutes for supervisionsupervision
 …… leave toys in or around the pool/spaleave toys in or around the pool/spa
 …… consider a child asconsider a child as ''drown-proofdrown-proof'' despitedespite
swimming skills, or experienceswimming skills, or experience
 …… use alcohol or drugsuse alcohol or drugs
 …… swim in thunder or lightningswim in thunder or lightning
 …… dive into unfamiliar or shallow bodies of waterdive into unfamiliar or shallow bodies of water

MessagesMessages
 Children have the right to a safe environmentChildren have the right to a safe environment
 Child-friendly ED can reduce consequences ofChild-friendly ED can reduce consequences of CICI
 Enforce safety laws: child-resistant packagingEnforce safety laws: child-resistant packaging
 Modify stairway railings, so children will not try toModify stairway railings, so children will not try to
squeeze through or get stuck in the gapssqueeze through or get stuck in the gaps
 Fence around poolsFence around pools
 Public awareness campaigns aboutPublic awareness campaigns about CICI preventionprevention

MCQMCQ
 Drowning is the greatest injury-death among childrenDrowning is the greatest injury-death among children
 Near drowning means there is no aspiration in the lungsNear drowning means there is no aspiration in the lungs
 Drowning in sea water causes water intoxicationDrowning in sea water causes water intoxication
 The brain can tolerate hypoxia up to 9 minThe brain can tolerate hypoxia up to 9 min
 Most children in this country drown in out door poolsMost children in this country drown in out door pools
 Preventing drowning can achieve MDG4Preventing drowning can achieve MDG4

Accidents in children

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