COVID-19: how lockdown affects children’s risk of home accident injury
Spending more time at home means parents must be even more vigilant
- Household accidents represent major hazards for children, with 90% of accidents happening to under fives in the home
- Anecdotal evidence suggests fewer emergency department admissions for children driven by home accidents under lockdown, but more serious injuries sustained
- Less contact with children through hospital admissions could raise safeguarding concerns
The home is a hotspot for accidents in children and, due to the COVID-19 pandemic, families are spending more time there than usual.
For under-fives, the home is the location of 90% of accidents, according to the Child Accident Prevention Trust.
While older children are at greater risk outside the home – on the roads and in water – many of them will still get injured in the home or garden.
Educating parents on the risks of children's accidental injuries
Most childhood accidents are minor, but across England each year an average of 132 children aged 14 and under die as a result of accidents, statistics from the Royal Society for the Prevention of Accidents (RoSPA) show.
More than 100,000 children are admitted to hospital because of accidental injuries, of whom 50% are under five.
The alarming frequency of these events makes education about preventing accidents at home an important part of the work of emergency and primary care nurses.
Since the lockdown to cut the spread of transmission of COVID-19, most nurseries, preschools, schools and colleges have closed. While a gradual reopening is expected from the beginning of June onwards, most children will still not be attending.
Dangers from different areas of the home
RCN professional lead for children and young people's nursing Fiona Smith has previously urged children’s nurses to use telephone or video communication to help prevent harm.
‘Parents will have much to worry about, but it’s important not to forget the many risks in the household if children are left unsupervised for even a minute,’ she told RCNi in April.
In homes, the largest number of accidents happen in the living and dining room. But the most serious accidents happen in the kitchen and on the stairs, where falls, poisoning and burns can all have a devastating impact, according to RoSPA.
Every year more than 67,000 children experience an accident in the kitchen and almost 60,000 children have accidents on the stairs.
Volume and severity of children's accidents
children aged 14 and under die as a result of accidents, per year
But while children are spending much more time at home, there has not been an increase in visits to emergency departments (EDs), nurses say.
‘We have seen the number of attendances drop considerably in paediatric ED,’ says Lorrie Lawton, consultant nurse in paediatric emergency medicine at King's College Hospital, London. ‘The cases we are seeing have serious injuries, rather than minor ones. So, either children are not getting so many injuries or parents are managing them more at home because they are worried about coming to hospital with COVID-19.’
Paediatric emergency nurse practitioner at University Hospital of Wales Rob Buchanan says child ED and minor injury attendances have roughly halved during the pandemic.
But injuries such as burns, from baking and making toffee, and those related to cycling have increased or stayed the same as families have turned to different ways to fill their time. There have also been quite a few dog bites, he says.
‘We are still receiving quite a few ingestions, where children have swallowed Calpol, tablets and cleaning products, and we have had some falls from sofas and trampolines,’ Mr Buchanan says.
‘We’ve had a few injuries from online workouts, where people have been following the routines in a restricted space, but it is a good thing that children are exercising.’
Causes of most serious home accidents
Institute of Health Visiting (iHV) director of policy Alison Morton says that harm from accidents could be significantly reduced by focusing on the five causes of the most serious home accidents.
When it comes to children under five, 90% of the most serious injuries relate to threats to breathing (including choking, strangulation or suffocation), falls, poisoning, burns and drowning.
These should be the focus of education from nurses, including emergency nurses, health visitors and other children’s nurses, she says.
‘Parents should be advised that keeping ahead of a young child’s developmental stage is crucial to reducing risk, she says.
‘The solution is often simple. For example, put up stair gates before children can move independently, or keep medicines and household products out of reach.’
It is a good idea for parents to ‘crawl’ around the home and get an idea of where dangers to their child may lie, iHV safety advice says.
Further advice from iHV includes keeping cleaning chemicals in a locked cupboard, having at least one smoke alarm, and keeping medicines out of children’s reach.
children admitted to hospital because of accidental injuries, per year
When it comes to burns and scalds, hot drinks are one of the most common causes. Parents are advised to remember to always keep hot drinks well out of reach of your baby or toddler and never hold a hot drink while also holding your baby. Ensure hot drinks are kept away from the edge of tables and worktops.
Hot dishes, kettles and drinks should never be passed over anyone, especially a child. A hot drink can scald a baby’s skin 15 minutes after it was brewed.
Falls are the main cause of accidents at home, and even small babies can wriggle and kick enough to fall off a raised surface. Children should be strapped into a high chair at feeding time, and stair gates fitted and closed properly each time they are opened.
Safety tips to pass on to parents and carers
The Child Accident Prevention Trust recommends a quick check of each room for:
Healthcare professionals have seen an increase in burns during lockdown, so styling tools should be kept high up when in use and cooling down
Choose a safe spot in the kitchen and living room for hot drinks
Pills and pods
Put items such as medication and cleaning products high up out of harm’s way
Lithium coin cell batteries the size of a 5p piece can be potentially fatal if swallowed by a child. Parents should look out for them in products around the home and put any spare batteries out of reach
Source: Child Accident Prevention Trust
Having conversations with parents about child safety
Ms Lawton says there are information leaflets to give parents, but a conversation is also vital.
‘We get a lot of children who come in when they have just started rolling and they fall off the bed or something,’ she says.
‘Then we explain to parents that they need to start changing their children on the floor, and don’t leave them unsupervised somewhere they could fall. There is a lot to go through, depending on what the health education is.’
This advice includes telling parents that children should be wearing helmets on scooters and bikes.
‘Even if that child is having a tantrum, you tell the parent they must get that helmet on. I understand you need to pick your battles with children, but not on whether they are going to wear a helmet. For some parents it takes their child to get an injury for them to realise they should have insisted on it,’ she says.
Spotting safeguarding issues during lockdown
Most parents are receptive to this kind of advice when in an ED with their children, Ms Lawton says. When they are not, this may indicate a problem.
‘If a parent gets angry about the advice, this can be a safeguarding issue,’ she says. ‘Parents have a responsibility to check that their children are as safe as can be. When a parent doesn’t seem to agree, that has to be highlighted.’
Emergency nurses need to be absolutely clear on how an accident has happened to assess the risk to a child.
‘Until you are clear on the mechanism of injury, all children can have potential safeguarding concerns,’ Ms Lawton says.
This is another reason why the drop in cases under lockdown is slightly worrying, Ms Lawton says.
‘There is an increased risk of safeguarding issues going missing or not being seen because schools and nurseries are closed,’ she says. ‘So there may be children who are injured and are being neglected, as they are not seeking medical help.’
Impact on lower socio-economic groups
of children admitted to hospital due to accidental injuries are under five
Children living in poverty are 13 times more likely to die in preventable accidents and three times more likely to be admitted to hospital with serious injuries, according to the Child Accident Prevention Trust.
This fact could be due to living in poor or overcrowded homes, or homelessness. Safety equipment may be unaffordable, and families may buy cheaper products that do not comply with safety standards.
‘Being in London, we see a lot of injuries from families from low socio-economic groups,’ Ms Lawton says.
‘For example, if you have an overheating radiator in your own place and young children, you would get it sorted. But if you are in poor standard rented accommodation, you have to wait for the landlord to sort it out.’
Ms Morton says essential prevention conversations are more difficult as health visiting services are restricted by COVID-19.
But the impact of injuries can be devastating. ‘I have seen how minor lapses of concentration from parents can lead to lifelong consequences for the child and family,’ she says.
‘They never expected anything like this to happen. When they woke up on the day of the accident, it was a normal day. Prevention is so much better than cure.’
‘Don’t have the attitude that "it won’t happen to me"’
Beth Dando's seven-month-old son Maison Amison suffocated on a nappy sack in 2013.
‘I went into Maison’s bedroom to wake him up,' she recalls.
'He was lying in his cot with a handful of nappy sacks scattered around him and one was covering his face. From that moment it was all a painful blur, but I know that 999 was called and my house was full of paramedics desperately trying to save my baby’s life. I knew he was gone and it was too late.
‘I urge all parents, grandparents and carers to think about the possible dangers before they become a problem’
‘Like many people, our changing stand had been placed next to the cot. Months earlier, I had placed some nappy sacks in the pockets of the stand. Maison had never crawled. He could sit, but only if you placed him that way, but that day he must have learned to stand for the first time.
‘Since Maison’s death I have found out that nappy sacks have claimed the lives of at least 16 babies. I urge all parents, grandparents and carers to think about the possible dangers before they become a problem. Are there nappy sacks in reach? Are nappy sacks in a zipped changing bag? Whatever happens, don’t have the attitude that "it won’t happen to me", because when tragedy strikes it leaves you heartbroken forever.’