childhood trauma mar3,2008
Post on 16-May-2015
557 Views
Preview:
DESCRIPTION
TRANSCRIPT
Pediatric Injuries:Risks and Prevention Among Ages
<1-15 in Los Angeles County
James M. DeCarli, PhD Candidate, MPA, MPH, CHESResearch Analyst III/Behavioral SciencesInjury & Violence Prevention Program
Department of Public Health, Los Angeles County
Overview
Background: Overall Childhood Injury Among
Children Ages <1-15 in Los Angeles County
Specific Age Category (<1, 1-4, 5-12, 13-15):
Leading Causes of Injury Fatality & Hospitalization
Anatomical injuries Associated with Injury Mechanisms
Contributing & Protective Factors
Injury Prevention Planning Tools
Childhood Injury in Los Angeles County
Data Sources
Fatalities:California Department of Health Services, Vital Statistics Death Statistical Master File
Hospitalizations:California Office of Statewide Health Planning and Development, Patient Discharge
Childhood Injury in Los Angeles County
Injuries are the leading cause of death among 1-44 year olds in Los Angeles CountyInjuries are the leading causes of death among 2.5 million children in Los Angeles County (2006)In 2006, among ages <1-15:
159 injury deaths5,830 injury hospitalizations
Leading Causes of Injury–All Child Ages <1-15Los Angeles County, 2006
Hospitalizations
Sources:
[Fatalities] California Department of Health Services, Vital Statistics Death Statistical Master File
[Hospitalizations] California Office of Statewide Health Planning and Development, Patient Discharge
Falls61%
Pedestrian11%
MV Occupant
10%
MV Occupant17%
Drowning15%
Pedestrian11%
MTV Occup35%
Unint. Drown
29%
MVT Unspec
20%
MVT Ped16%
Fatalities
Fall60%
Suicide11%
MVT Occupant
10%
MVT Ped10%
Struck by Obj9%
Infants Age <1Leading Causes of Injury
Los Angeles County, 2006
Fatality (Freq)
Assault/Homicide 13
Untint-Suffocation 2
MVT Occupant 1
Hospitalization (Freq)
Fall 158
Assault/Homicide 42
Unint-Burn, Hot Obj. 30
Untint-Suffocation 30
Unint-Nat Env 19
Fatal InjuriesInfants Age <1
Los Angeles County, 2006
Fatal Assault/Homicides by CauseInfants Age <1
Los Angeles County, 2001-2006
HospitalizationsInfants Age <1
Los Angeles County, 2006
100%
Where are infants falling from?(Hospitalizations by Cause)
Los Angeles County, 2006
0
5
10
15
20
25
30
35
40
45
Stairs Bed Other Furniture One Lever to Another Other
Most common anatomical fall-related hospitalization among infants: TBI’s
(Hospitalizations)Los Angeles County, 2004
Traumatic Brain Injury (TBI)
80%90%
60%
77%
0%
20%
40%
60%
80%
100%
Stair Chair Bed From different level
Toddler Ages 1-4 Leading Causes of Injury
Los Angeles County, 2004
Fatality (Freq)
Drowning 10
Assault/Homicide 9
MVT Occupant 6
MVT Pedestrian 4
MVT-Unspecified 3
Pedestrian-Other 3
Hospitalization (Freq)
Fall 718
Unint-Burn, Hot Obj. 145
Poisoning 116
MVT Pedestrian 107
Unint-Nat Env 106
Fatal InjuriesToddlers Ages 1-4 Los Angeles County, 2004
Fatalities
Drowning28%
Homicide26%
Occupant17%
Pedestrian11%
MVT Unspecified
9%
Pedestian-Other9%
Where are toddlers drowning?(Fatalities)
Los Angeles County, 2000-2004
11%2%
63%
2% 2%
14%6%
0%
10%
20%
30%
40%
50%
60%
70%B
atht
ub
Fall
into
Bath
tub
Pool
Fall
into
Pool
Ope
nW
ater
Res
ervo
ir
Unsp
ec
Perc
ent
Fatal Assault/Homicides by CauseToddler Ages 1-4
Los Angeles County, 2000-2004
29%
20%
5%
46%
05
101520253035404550
Abuse &Neglect
Cut/Pierce Firearm Other
Perc
ent
HospitalizationsToddlers Ages 1-4
Los Angeles County, 2004
Hospitalizations
Falls60%Burns
12%
Poisoning10%
MVT Ped9%
Nautral-Env9%
Where are toddlers falling from?(Hospitalizations)
Los Angeles County, 2004
1
72
61
11
0.1
11
24
6
1318
05
1015202530
Esca
lato
r
Stai
r
Ladd
er
Bui
ldin
g/St
ruct
ure
Into
Hol
e
Play
grou
ndEq
uipm
ent
Clif
f
Cha
ir
Bed
Oth
er F
urni
ture
Diff
eren
t Lev
el
Sam
e Le
vel
Perc
enta
ge
Common anatomical fall-related hospitalizations: Upper Extremity & TBI
Toddler Ages 1-4Los Angeles County, 2004
68 71
36
54
69
39
01020304050607080
Play
grou
ndEq
uipm
ent
Bed
Diffe
rent
Leve
l
Sam
eLe
vel-T
rips
Cha
ir
Perc
enta
ge
Upper ExtremityTBI
Children Ages 5-12Leading Causes of Injury
Los Angeles County, 2004
Fatality (Freq)
Assault/Homicide 11
Drowning 8
MVT Occupant 7
MVT Pedestrian 7
MVT-Unspecified 6
Hospitalization (Freq)
Fall 1033
MVT Pedestrian 236
MVT Occupant 191
Unint-StruckByObject 154
Bicyclist, Other 144
Fatal InjuriesChildren Ages 5-12
Los Angeles County, 2004
Fatalities
Homicide28%
Drowning21%
Occupant18%
Pedestrian18%
MVT Unspecified
15%
Fatal Assault/Homicides by CauseChildren Ages 5-12
Los Angeles County, 2000-2004
69%
24%
5%2%0
10
20
30
40
50
60
70
80
Abuse &Neglect
Cut/Pierce Firearm Other
Perc
ent
Where are children drowning?Children Ages 5-12
Los Angeles County, 2000-2004
13%
44%
19%
6%
18%
05
101520253035404550
Bathtub Pool OpenWater
Reservoir Unspec
Perc
enta
ge
HospitalizationsChildren Ages 5-12
Los Angeles County, 2004
Hospitalizations
Fall59%MVT Ped
13%
MTV Occupant
11%
Struck by object
9%
Bicyclist, other8%
Where are children falling from?Children Ages 5-12
Los Angeles County, 2004
6%1% 3% 1%
35%
2%8%
2%
18%25%
0%5%
10%15%20%25%30%35%40%
Stai
r
Ladd
er
Build
ing/
Stru
ctur
e
Into
Hol
e
Play
grou
ndEq
uipm
ent
Chai
r
Bed
Oth
er F
urni
ture
Diffe
rent
Lev
el
Sam
e Le
vel
Perc
ent
Common anatomical fall-related hospitalizations: Upper & Lower Extremity
Children Ages 5-12 Los Angeles County, 2004
84%
61% 57%
4% 8%
21%
6% 10%18%
0102030405060708090
Playground From DifferentLevel
Same Level-Trip
Per
cent Upper Extremity
Lower ExtremityTBI
Adolescent Ages 13-15Leading Causes of Injury
Los Angeles County, 2004
Fatality (Freq)
Assault/Homicide 10
MVT Occupant 9
MVT-Unspecified 6
Suicide 4
Drowning 3
Hospitalization (Freq)
Fall 718
Suicide 145
Assault/Homicide 116
Struck-By-Object 107
MVT Occupant 106
Adolescent Ages 13-15Leading Causes of Injury
Los Angeles County, 2004
Fatalities
Homicide57%
Suicide9%
Occupant13%
MVT Unspecified
9%
Drowning4% Pedestrian
4%
Fall4%
Common weapon of choice(Fatal Assault/Homicides)
Adolescent Ages 13-15Los Angeles County, 2000-2004
84%
1%7%1% 4% 3%0
102030405060708090
Hang
/Stra
ngul
,Su
ffoca
t.
Hand
gun
Riflt
/Sho
tgun
Oth
er F
irear
m
Shar
p O
bjec
t
Unsp
ec(m
urde
r,m
ansl
)
Per
cent
HospitalizationsAdolescent Ages 13-15
Los Angeles County, 2004
Hospitalizations
Homicide18%
Struck by object13%
Occupant10% Fall
38%
Suicide21%
Where are adolescents falling from?Adolescent Ages 13-15
Los Angeles County, 2004
1%6%
.5%4%
1% .5%7%
.5% .5% .5%
24%
36%
19%
05
10152025303540
Cur
b
Stai
rs
Ladd
er
Bui
ldin
g/St
ruct
ure
Into
Hol
e
Stor
m D
rain
Play
grou
nd
Cha
ir
Bed
Oth
er F
urni
ture
Diff
eren
t Lev
el
Sam
e Le
vel-T
rip
Spor
ts A
ctiv
ity
Perc
ent
Common anatomical fall-related hospitalizations: Upper & Lower Extremity
Adolescent Ages 13-15 Los Angeles County, 2004
30 29
4240%34%
42%
13% 14% 13%
05
1015202530354045
SportsActivity
FromDifferent
Level
Same Level-Trip
Per
cent Upper Extremity
Lower ExtremityTBI
Common methods of choice for suicide-related hospitalizations: pain relievers
Adolescent Ages 13-15Los Angeles County, 2004
59%
2%
18%
1% 2% 1% 1%
16%
010203040506070
Ana
lges
ics/
Antip
yret
ics
Tran
quili
zers
Oth
er D
rugs
/Che
mic
als
Chem
ical
s
Cor
rosi
ve A
gent
s
Gas
Vap
or
Hang
ing
Cut/P
ierc
e
Perc
ent
ReviewLeading Causes of Injury
Ages Fatality Hospitalization
<1 Assault/Homicide Falls
1-4 Assault/HomicideDrowning
Falls
5-12 Assault/HomicideDrowning
Falls
13-15 Assault/Homicide FallsSuicide
Contributing FactorsAssault/Homicide & Suicide
Intimate Partner Violence/Domestic ViolenceParental abuse of alcohol & drugsUse of alcohol & drugs among youthPersonality Disorders/Mental HealthDepressionLack of resources/access to careGang ActivityMalnutrition-aggression & violence behaviors
Childhood Exposure to IPV
Children observe traumatic events (IPV-family violence) to varying degrees:
Home Environment: May see mothers use violence in self-defense or see both parents trading self-defense See parents occasionally slap, shove, and throw thingsObserves violence or threats, while the victim does not leave the home or report to police or public agencies
(Straus & Gelles, 1990)
Symptoms of Children Exposed to IPV
29 different studies of children who witnessed IPV
BehavioralEmotionalSocialCognitivePhysical
(Kolbo, Blakely, & Engleman, 1996)
Behavioral Effects
AggressionTantrums "acting out" ImmaturityTruancy and Delinquency
(Davies, 1991; Dodge, Pettit, & Bates, 1994; Graham-Bermann, 1996c; Hershorn & Rosenbaum, 1985; Hughes & Barad, 1983; Jouriles, Murphy, & O'Leary, 1989; Sternberg, Lamb, Greenbaum, Cicchetti, Dawud, Cortes, et al., 1993)
Emotional Effects
AnxietyAngerDepressionWithdrawal Low self-esteem
(Carlson, 1990; Davis & Carlson, 1987; Graham-Bermann, 1996c; Hughes, 1988; Jaffe, Wolfe, Wilson, & Zak, 1986)
Social Effects
Poor social skillsPeer rejectionInability to empathize with others
(Graham-Bermann, 1996c; Strassberg & Dodge, 1992)
Cognitive Effects
Language lagDevelopmental delaysPoor school performance
(Kerouac, Taggart, Lescop, & Fortin, 1986; Wildin, Williamson, & Wilson, 1991).
Physical Effects
Failure to thriveProblems sleepingEating problemsRegressive behaviorsPoor motor skills, and Psychosomatic symptoms (eczema, bed wetting, etc.)
(Jaffe, et al., 1990; Layzer, Goodson, & Delange, 1986)
Specific Signs & Symptoms:Toddler/Preschooler (<5)
Become more aware of their environment (easily aroused)Sleeping & Eating DisordersSomatic Complaints
StomachachesHeadaches
Separation Anxiety (clinging to mother/victim)Speech, motor skill & cognitive delaysDepression & anxietyDifficulty in expressing emotions-but anger
(National Resource Center on Domestic Violence, 2002)
Specific Signs & Symptoms:Childhood (5-12)
Poor in School-Exhibit few options/low successSelf esteem limitations
Frequent mood swingsErratic attendanceInability to concentrate
Poor social skillsConflicts with classmates & teachers
Excel in School-Try to overcome & suppress family dysfunctionSeek approval by doing well in structured school environment
Perfect studentMaking many friends
However:Live with unpredictable home environmentsConflict-loving/hating their parentsExperience guilt, depression, sadness, powerlessnessUnable to relax/sleepSigns of PTSD
(National Resource Center on Domestic Violence, 2002)
Specific Signs & Symptoms:Adolescence (13-15)
Eating difficulties resulting in anorexia, bulimia, or obesityAcademic difficulties-leading to dropping outFeeling powerless, fear, delinquency, substance abuse, suicideIntimate partner relationships
Without proper intervention-exhibit sex roles and communication patterns learned from dysfunctional home environment-contributing to the generational cycle of violence
(National Resource Center on Domestic Violence, 2002)
Contributing & Protective FactorsFalls
Risks:Infant changing and sleeping locationsPreschool aged children-greatest risk of fall-related fatalities50% occurring among children <480% fall related injuries among children <4 occur at home and mostly during noontime and early evening (playtime)
Prevention:Supervision (home & playground)Changing tables & beds-use of railsUse of safety gates leading to different levels/stairsAvoid asphalt, concrete, grass or soil surfaces under playground equipment-use of mulch, rubber, etc.
Contributing FactorsDrowning
Seasonal: 72% occur during summer monthsLocation: 51% occur in private swimming poolsAge: Infants and toddlers:
88% occur in private swimming pools 70% of these children were not expected to be in or at the pool, but somewhere in the home
Lack of “Active” Supervision: SAFE KIDS Worldwide study: 90% of children who had drowned, had been supervised by an adultChild wading and inflatable pools: Carry similar risks
Protective FactorsDrowning
“Active” Supervision (Lifeguard)Barrier FencingSelf-closing/Self-latching gates (open outward)Locks and Alarms on all windows/doors (leading to pool area)Wading/Inflatable pools:
Smaller: Empty/turn over after useLarger: Require fencing/Electrical requirements
Contributing & Protective FactorsMVT-Occupant
Riding improperly restrained-greatest risk factorCurrently 85% misuse rate (Child Passenger Safety)
63% seat belt not anchored tightly33% harness straps not snug20% harness straps improperly routed11% forward-facing before age 1 and 20 lbs
More than 80% of the children under 4 years old killed in car crashes in California since 1990, would have survived if buckled properlyWhen used properly CPS can reduce the risk of fatal injury by 70% for infants, 55% for toddlers, and 59% booster seats
Contributing & Protective FactorsBicycle
Poorly fitted helmets=twice the risk of head injury in a crash compared with children whose helmet is properly fittedChildren who wear their helmets tipped back on their heads have a 52% greater risk of head injury than those who wear their helmets centered on their heads.Bicycle helmets have been shown to reduce the risk of TBI by as much as 88%
Contributing & Protective FactorsPedestrian
Walking too close to a school bus at drop off zonesWalking between cars and school bussesNot obeying traffic pedestrian lawsChildren <12 not to walk without an adult
Contributing & Protective FactorsSeasonal-Summer Months
Childhood injuries increase during summer months both nationally and in Los Angeles County51% childhood injuries in Los Angeles County occur between June-August
72% drowning56% bicycle41% pedestrian38% MVT-occupant
Summary
Leading causes of injury fatality & hospitalizations
Specific pediatric ages at-risk of injury
Contributing & Protective Factors
Conclusion
Five Handouts (Injury Prevention Planning Tools):
1. Behavioral & developmental factors by age2. Review of anatomic and physiologic factors that
contribute to pediatric injury3. Pediatric Injury Prevention Project Planning
Worksheet 4. Haddon Matrix sample5. Haddon Matrix template
Preventive Resources
Injury & Violence Prevention Program (IVPP) Website:
www.lapublichealth.org/ivpp
Contact Information:
jdecarli@ladhs.org(213) 351-7888
top related