1. Injury Prevention for Children How PT can help!

2. Topics to cover Playground Safety Bike Safety Water Safety Backpack Safety

3. Playground Safety 200,000 ER admissions each year secondary to playground injuries most associated with falling from equipment

4. Trampolines Only children older than 6 years old should use –Increase injury rate in younger children – 48% of injuries occurred in children under 9 years old –Overall more girls than boys –Most injuries occur on trampoline –Most frequent injuries were fractures: arm/leg most common –Second most frequent – sprains, strains and dislocations –Most admissions to hospital occur in the 5 to 9 age range

5. Common Injuries (Canadian Hospital Injury Report) Breakdown event and factors contributing to the injury* What happened Frequency Percent of Injuries –Attempted a maneuver, trick or flip: 27.3 –More than one person on trampoline at a time bumped into, hit or fell on top of another person jumping, playing on trampoline pushed or fell off trampoline : 21.7%

6. Prevention of injuries Adult supervision required Bare feet – better traction less slipping One child at a time (how realistic?) Net should have 250 pound limit

7. Trampolines Springs covered with padding Anchor trampoline into ground No flips AAP: trampolines are not toys – should only be used as training devices

8. What about mini-tramps? (Pediatrics, July 2005) 32% of mini-tramp injuries occur to children under 6 years old Most frequent injury – head laceration More females injured Most injuries are on trampoline not falling off Just has hazardous as full size

9. AS PTs Educate parents on trampoline safety –One child at a time on trampoline –Enclosures –No Flips or rough housing –Bare feet –Mini tramps need supervision as well

10. Other playground equipment

11. Making Playgrounds Safe Playgrounds should fit the child: Children under 5 years old should use equipment only designed for pre schoolers Surfaces: sand, pea gravel, wood chips, synthetic –Should be at least 12 inches deep –Extend surface at least 6 feet in all directions from equipment

12. Safe Play structures more than 30 inches high should be placed 9 feet apart Swings should not have metal or hard wood seats – swings should be at least 8 inches apart Clearance between bottom of swing and ground – 8 inches Look for dangerous hardware: hooks, bolts Make sure any spaces (i.e. ladder rungs) are less than 3.5 inches and more than 9 inches apart to avoid head entrapment –One publication recommended kids wear bike helmets on playground equipment to avoid heads getting trapped

13. Safe Drawstrings: can potentially strangle a child if they get caught – best to either remove from clothing or sew a seam in the middle of clothing so one side can not get pulled to far out

14. Pressure treated wood Many treated wood contains arsenic –Children should not eat food while playing on equipment built with pressured treated wood –Wash hands with soap and water after play –Arsenic can also “leak” into the ground

15. Sun exposure while on playgrounds 80% of skin damage from sun occurs before age 18 Wear sunscreen, hats, sunglasses

16. Infants Babies under age 6 months need to be kept out of direct sunlight and wear lightweight clothing that covers their body –Wide brim hats –Baby-sized sunglasses –Stay out of sun between 10 AM and 4 PM

17. As PTs Provide literature about playground safety in lobby Provide community playground checks Discourage trampoline usage unless proper supervision present and used a training tool for sporting events

18. Bike Safety

19. 85 million bike riders in US –70% of kids ages 5 to 14 years ride bikes More than 900 bike riders die each year: 50% are under 15 years old 85% killed were not wearing a helmet Where helmets are required – only 52% of kids wear 50% wearing helmets were not fitted properly 580,000 visit ER yearly: 67000 have head injuries 1/8 cyclists with reported injury has a head injury – 45 to 88% of head injuries can be prevented by helmet use Indirect cost due to not using helmet – 2.3 billion per year

20. Perspective Injuries per 1000 participants –Basketball: 21.2 –Football: 20.7 –Bicycling: 11.5 However, more bike riders treated in ER than other sports Among boomers, biking is the deadliest sport – boomers die from head injuries twice as often as children – however between ages of 5 and 15 injury rate is the highest Less than 50% of boomers wear helmets –Snowboarding: 11.2 –Skateboarding: 8.9 –Inline skates: 3.9

21. Amusing Stats Bike riding is less dangerous than skydiving, motorcycling, living, swimming and water skiing But more dangerous than airline flying, hunting, cosmic radiation from transcontinental flights, home living

22. Bike Death rate highest between 10PM - 1 AM – 8 times higher than during midmorning/early afternoon 32% of tested bicyclists who were killed had been drinking –One drink increases probability of serious bike accident by a factor of 6 Among children – most bike fatalities occur within 1 mile of home Among children 14 years and younger – accidents secondary to bicyclist’s behavior – i.e. running stop sign, riding against flow of traffic, etc

23. Helmet usage Between ages 4 to 15 could prevent –Between 135-155 deaths –Between 39000 and 45000 head injuries –Between 18000 and 55000 scalp and face injuries –Every dollar spent on bike helmets, saves society $30 in direct medical and other costs to society

24. Helmet usage If 85% of child bike riders wore helmets – lifetime medical cost savings would be between $109 million and $142 million Treatment for non-fatal bike injuries in children under 14 years cost an average of $218000 per injured child

25. Proper helmet use

26. PT State associations should push for legislation requiring helmet use Sponsor bike derbies – training in proper riding, correct fit of bike and helmet, helmet use, bike inspections, etc Encourage parents to buy helmets for their children – especially in rural areas (one study found almost 0% of kids wear helmets in rural areas) Helmet use increases with helmet campaign intensity Recommend children ride on sidewalks until they are 10 years old Avoid riding at night

27. Water Safety

28. Water safety Drowning is the second leading cause of unintentional death among children ages 14 and under Children ages 1-4 years are at the highest risk for drowning Young children can drown in as little as 1 inch of water

29. Drownings Occur quickly and silently with children 2 minutes after submersion, LOC occurs Irreversible brain damage occurs after 4 to 6 minutes Most drownings occur when children are left unattended by pool or tub or bucket of water (5 gallon)

30. Prevent drownings Stay with young children when they are in the bathtub – even if they are with an older sibling Empty buckets as soon as done with chores – if on break – place bucket where child can not reach Closely monitor children when swimming – always swim with a buddy Provide swimming lessons for all your children Learn CPR No children under 14 years old should use personal watercraft

31. Water craft safety

32. PTs Provide literature in lobby about water safety Take some time discussing safety issues with parents during treatment times Model good water safety if have therapy pool program

34. Backpacks Wear backpack over both not one shoulder Be sure backpack right size for child Use alternatives – packs with wheels – avoid athletic bags Encourage school to allow more frequent locker breaks through out the day so kids do not have to carry so many books