Childhood injuries (health and wellbeing needs in South Tyneside)

• Unintentional injuries in and around the home are a major cause of death and disability among children under five years in England. An average of 62 children died each year between 2008 and 2012 (Office for National Statistics).
• These injuries result in an estimated 452,200 visits to A&E departments (Department of Trade and Industry, 2002) and approximately 40,000 emergency hospital admissions among children of this age each year.
• In England home-related injuries account for 8% of deaths of the children aged 1 to 4 years (Office for National Statistics).

Definitions

• The guidance uses the term 'unintentional injuries' rather than 'accidents' as: "most injuries and their precipitating events are predictable and preventable". The term 'accident' implies an unpredictable and therefore unavoidable event. (NICE)

• "Unintentional" is used to refer to injuries that were unplanned. Unintentional injuries can be defined as events in which.  The harmful outcome was not sought:
  • Fall
  • Scalding or Burns
  • Sporting Injuries

• "Deliberate" is used to refer to injuries that were planned. A harmful outcome was sought.
  • Deliberate harm caused to a child (being pushed by another child or an adult)
  • Self-harm behaviour

• The key performance indicators are.
  • A&E attendance rate per 1,000 populations aged 0 - 4 years.
  • 2.07i - Rate of hospital admissions caused by unintentional and deliberate injuries in children aged 0 - 14 years per 10,000 resident populations

• Commissioners should ensure that childhood injury prevention in written into future contracts for health & social care services that work with families.
• Work should be undertaken to standardise the targeted support offered to families identified as being at risk based on evidence.
• Further work should be done to explore the cost effectiveness of providing free or discounted home safety equipment to those families deemed most at risk based on the latest evidence.

• The term 'vulnerable' is used to refer to children who are at greater than average risk of an unintentional injury due to one or more factors. As an example, they may be more vulnerable if they:
  • are under the age of 5 years (generally, under-5s are more vulnerable to unintentional injuries in the home)
  • are over the age of 11 (generally, over-11s are more vulnerable to unintentional injuries on the road)
  • have a disability or impairment (physical or learning)
  • are from some minority ethnic groups
  • live with a family on a low income
  • live in accommodation which potentially puts them more at risk (this could include multiple occupied housing and social and privately rented housing).
• 'NICE Guidance (2010) ; 'Unintentional injuries: prevention strategies for under 15s' (PH29)'

The following shows estimate of 'at risk' populations across South Tyneside:

• Total number of children under the age of 5 years
  • 9,970
• Total number of children over the age of 11 - 19
  • 14,513
• Total number of children who have a disability or impairment (physical or learning)
  • 4,476
• Total number of children estimated non- white British in South Tyneside
  • 2,335
• Total number of children live with a family on a low income
  • 9,860 households (after housing costs)
  • 6,120 households (before housing costs)
• Live in accommodation which potentially puts them more at risk (this could include multiple occupied housing and social and privately rented housing).
  • 5,538 households socially rented houses 2011 census.

• Nationally there is a correlation between deprivation and childhood injuries. The most deprived 30% of the county sees a significantly higher rate of unintentional injuries than the national average.
• 86% South Tyneside's 0 - 19 year olds live within the most deprived 30% of the country.

See Fig 1 Appendix

• Nationally there has been a small, but significant, decline in the rate of admissions since 2013 / 14.
• The current national rate is 104.2 per 10,000 children.

Local Admissions

• While there was an increase in admissions during 2013 / 14, and hospital analysis of the period confirms that South Tyneside has an above England average rate of hospital admission due to injuries in 0 - 14 year olds, indications are that a double counting of admissions has incorrectly led to a rate that is far higher than other local authorities in the North East.
• Where the rate of injuries in 0 - 14 year olds for 13 / 14 is currently 214.1 admissions / 10,000 children, the adjusted rate is more like 194 admissions / 10,000.  This adjustment would make South Tyneside the second highest in the country for admissions.
• The adjustment also brings South Tyneside back in line with its average performance since 2010 / 11, dampening the increase observed between 2012 / 13 and 2013 / 14.

See Fig 2 Appendix

• For every 100 children in South Tyneside, each year:
  • 3 boys aged 0 - 4,
  • 2 girls aged 0 - 4,
  • 2 boys aged 5 - 14 and
  • 1 girl aged 5 - 14 are admitted to hospital for an injury. 
• The profile of injuries in South Tyneside is largely consistent with detailed analysis of childhood injuries at a national level.  Most injuries occur at home for 0 - 4 year olds and either at home or at school for 5 - 14 year olds. 

• The most common causes of injuries in South Tyneside are given below:
  • 0 - 4 year olds:
    • Falls (50%)
    • Striking against an object (20%)
    • Accidental poisoning (12%)
  • 5 - 14 year olds:
    • Falls (44%)
    • Striking against an object (15%)
    • Road traffic accident (12%)
    • Intentional self-poisoning and self-harm (8%)

• The analysis shows that "deliberate" injuries do not play a significant role in the "unintentional and deliberate injuries in 0 - 14 year olds" cohort.  There is, however, a indication that in the older age range,  self-harm that becomes the most dominant form of injury in 15 - 24 year olds. 
• The majority of admissions are due to head injuries, followed by fractures of the arm and leg. 

Hospital Admissions by Ward

• There is a large amount of variation across geographies in South Tyneside.  Boldon Colliery has the most injuries on average while Harton has the fewest as a proportion of their child population sizes. 
• The number of injuries in Harton is still higher than the English average.
• There is no noticeable trend related to deprivation in terms of rate, though the majority of the borough is within the most deprived 30% of the country. Fifteen of the boroughs wards are within the most deprived 30% of the country, three wards, Cleadon and East Boldon, Westoe, and Whitburn and Marsden are not.
• 86% South Tyneside's 0 - 19 year olds live within the most deprived 30% of the country.

See Fig 2 & 3 Appendix

CIPFA Comparators

• The majority of South Tyneside's CIPFA nearest neighbours are also significantly higher than the national rate, however there are a few exceptions.

See Fig 4 Appendix

• Between 2016 and 2037 South Tyneside is projected to have a small reduction in the number of 0 - 14 year olds living in the borough. If the rate remains the same this would equate to a 10 person decline in the number of admissions due to an accident.

What we currently provide in South Tyneside to reduce injuries

• Road Safety Team
  • A comprehensive program of prevention is offered to a high proportion of Primary schools covering safe walking and cycling to school . All Year 6 children are invited to the 'Reducing Accidents at Play' workshop which covers water, fire, gas, road, and electrical safety.
• Trading Standards Team
  • Implementing preventative campaigns and enforcement with regards to high risk products such as dishwasher tablets or lithium batteries.
• School Crossing Patrol
  • School crossing patrols operate in busy areas to support children crossing busy roads when travelling to and from school.
• St Johns Ambulance
  • They refer schools to Safety Works- a project in Newcastle that educates around childhood injuries
• Health Visiting Service
  • Health visitor's work with children and their families until the child is five. As part of the mandated contacts a Health Visitor can offer advice and guidance about home safety. After three attendances at A&E a health visitor home visit is triggered. Health visitors offer a home safety check and give advice about safety equipment
• Children Centres
  • Children Centres offer support to parents with a child under 5 they offer home safety advice as part of their home visits.
• School Nursing
  • Similar to home visiting- 3+ visits trigger targeted support to a family.
• Family Nurse Partnership
  • The Family Nurse Partnership (FNP) is a voluntary home visiting programme for first time young mums, aged 19 years or under. A specially trained family nurse visits the young mum regularly, from the early stages of pregnancy until their child is two.
• Schools
  • As part of the Healthy Schools programme schools are asked to deliver comprehensive programmes of Personal, Health & Social education (PHSE) which covers safety & risk taking.
• Children's Social Care
  • Due to the acute nature of statutory Children's Social Care- social workers would not proactively undertake accident prevention work unless this was part of the reason for social care referral or was identified as part of an assessment. Children's social cares have a role in protecting children from intentional injuries or injuries as a result of neglect.
• Early Help Team
  • Early Help is a family-orientated intervention that works closely with families to provide the right support at the right time. Early Help outreach workers would offer help & advice about parenting and safety.
• Safestop
  • SafeStop is an initiative working collaboratively with Police across South Tyneside to identify vulnerable young people and take them to an identified safe place where a brief screening is undertaken to determine if further intervention is required. By intervening early especially where alcohol may be a factor then children are prevented from taking further risks.
• Midwifery
  • Midwives give care and support to pregnant women and their babies, before, during and after childbirth. As part of their routine appointments midwives offer safety advice about preventing SIDS and safe sleep. They also advise about animal safety, especially dogs in the household, car seat use, feeding and general infant safety.
• The Matrix Young Persons Drug & Alcohol Service.
  • The MATRIX works with young people under 18 in South Tyneside, their families and carers. The service provides help, support and advice to those whose lives have been affected by drug and alcohol misuse. This package of support includes information around harm minimisation.
• South Tyneside Lifecycle Primary Care Mental Health Service
  • A tier two emotional health service which provides information and support for young people to minimise their risk in relation to self-harm.
• Emotional Resilience Group
  • A group of professionals who meet quarterly to work on an action plan aimed at improved emotional resilience in young people who live in South Tyneside.
• South Tyneside Mental Health Champions
  • A termly meeting of staff who work with young people aimed at upskilling staff to identify and respond to young people's emotional health.

• Play, sport and exploration is an important part of child development and must be recognised but measures can be taken to reduce the incidence and or severity of injuries. (NICE)

• Short- Term Average healthcare cost of Individual Injury - £2,494 (Pollinder et al, 2008)
• Wider costs of a serious home accident - £33,200 (Walter, 2010).
• Traumatic Brain Injury - £4.89m

• See below link to cost effectiveness and outline of evidence for home safety equipment.
• NICE: Unintentional injuries in the home: interventions for under 15s

Evidence for Further Intervention

• Approaches to preventing unintentional injuries range from education (providing information and training) to product or environmental modifications and enforcement (regulations and legislation).
• It has been suggested that the most effective strategies use a combination of approaches (British Medical Association 2001). Experience from European countries with the best safety records show that positive leadership, together with concerted efforts to provide safer physical and social environments, can reduce unintentional injuries (Sethi et al. 2008).

• For injuries in the home setting successful interventions to reduce injuries have included:
  • The provision of smoke alarms (however effectiveness depends on regular use and maintenance of alarms)
  • The provision and use of other home safety devices (cupboard catches, window locks, stair guards)
  • Safety education programmes (sometimes combined with home safety devices)
  • Child health and social care providers should provide home safety interventions including education and access to free, low cost or discounted safety equipment as part of their child health and well-being programmes'.

• For sports and leisure injuries successful interventions to reduce injuries have included:

  • Reducing the height of playground equipment
  • Modifying playing surfaces
  • The use of protective sports equipment
  • Use of skills training programmes for young sports player

During the production of this Needs Assessment the views of A&E staff were sought. The author visited the A& E department at South Tyneside District Hospital to elicit their views about the data. The staff narratives focussed more on the attendances rather than admissions.

The staff made the following comments:

• In terms of injuries, the staff had no concerns about intentional injuries to the under 5s. They felt that generally, the children attending A&E were injured as a normal part of growing up and exploring. They stated that children are generally injured in unfamiliar setting such as shops / cafes.
• The staff felt that staff working with young people were generally well informed about first aid and weren't sending children inappropriately.
• The staff discussed the threshold used during 111 calls. They felt that people were presenting at A&E inappropriately after being sent by 111. They felt some work could be done about these thresholds.
• Staff explained that parents bring their children to A&E as a result of not being able to access their G.P in a timely manner. They also described incidents where G.Ps or Practice staff had advised them to attend A&E inappropriately.
• Staff expressed concerns about young people being admitted to A&E following alcohol or substance misuse. They explained that substances go in and out of trends whereas alcohol remains a constant. The staff did say that prom season/ end of school year time was particularly busy.
• A&E staff described a rise in young people who self-harm or self-poison with an intent to harm. They mentioned young people's mental health as a general concern for numbers being admitted.
• Another interesting point which was not captured in any of the above information was that of passive smoking. Staff described young people being admitted to hospital for respiratory issues following exposure to second hand smoke.
• As another interesting point, staff expressed concerns about childhood obesity. As part of the process of administering medication- children need to be weighed. The staff explained that they felt this was a missed opportunity for a teachable moment with children who were overweight or obese.

• The same needs assessment for the 14 - 18 year olds.

Last Updated:  August 2017