childhood trauma mar3,2008
DESCRIPTION
Pediatric injuries, epidemiology, risk, and preventionTRANSCRIPT
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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
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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
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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
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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
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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%
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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
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Fatal InjuriesInfants Age <1
Los Angeles County, 2006
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Fatal Assault/Homicides by CauseInfants Age <1
Los Angeles County, 2001-2006
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HospitalizationsInfants Age <1
Los Angeles County, 2006
100%
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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
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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
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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
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Fatal InjuriesToddlers Ages 1-4 Los Angeles County, 2004
Fatalities
Drowning28%
Homicide26%
Occupant17%
Pedestrian11%
MVT Unspecified
9%
Pedestian-Other9%
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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
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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
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HospitalizationsToddlers Ages 1-4
Los Angeles County, 2004
Hospitalizations
Falls60%Burns
12%
Poisoning10%
MVT Ped9%
Nautral-Env9%
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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
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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
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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
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Fatal InjuriesChildren Ages 5-12
Los Angeles County, 2004
Fatalities
Homicide28%
Drowning21%
Occupant18%
Pedestrian18%
MVT Unspecified
15%
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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
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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
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HospitalizationsChildren Ages 5-12
Los Angeles County, 2004
Hospitalizations
Fall59%MVT Ped
13%
MTV Occupant
11%
Struck by object
9%
Bicyclist, other8%
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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
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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
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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
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Adolescent Ages 13-15Leading Causes of Injury
Los Angeles County, 2004
Fatalities
Homicide57%
Suicide9%
Occupant13%
MVT Unspecified
9%
Drowning4% Pedestrian
4%
Fall4%
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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
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HospitalizationsAdolescent Ages 13-15
Los Angeles County, 2004
Hospitalizations
Homicide18%
Struck by object13%
Occupant10% Fall
38%
Suicide21%
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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
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urni
ture
Diff
eren
t Lev
el
Sam
e Le
vel-T
rip
Spor
ts A
ctiv
ity
Perc
ent
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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
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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
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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
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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
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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)
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Symptoms of Children Exposed to IPV
29 different studies of children who witnessed IPV
BehavioralEmotionalSocialCognitivePhysical
(Kolbo, Blakely, & Engleman, 1996)
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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)
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Emotional Effects
AnxietyAngerDepressionWithdrawal Low self-esteem
(Carlson, 1990; Davis & Carlson, 1987; Graham-Bermann, 1996c; Hughes, 1988; Jaffe, Wolfe, Wilson, & Zak, 1986)
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Social Effects
Poor social skillsPeer rejectionInability to empathize with others
(Graham-Bermann, 1996c; Strassberg & Dodge, 1992)
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Cognitive Effects
Language lagDevelopmental delaysPoor school performance
(Kerouac, Taggart, Lescop, & Fortin, 1986; Wildin, Williamson, & Wilson, 1991).
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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)
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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)
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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)
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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)
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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.
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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
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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
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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
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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%
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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
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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
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Summary
Leading causes of injury fatality & hospitalizations
Specific pediatric ages at-risk of injury
Contributing & Protective Factors
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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
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Preventive Resources
Injury & Violence Prevention Program (IVPP) Website:
www.lapublichealth.org/ivpp
Contact Information:
[email protected](213) 351-7888