Product Safety Standard: Household Cots From October 1, 2000, there will be a mandatory safety standard which will cover all new cots, and parts of it will also apply to secondhand cots. Congratulations to the Ministry of Consumer Affairs! Look at the next edition of Safekids News for further information.

Influencing public policy and legislation: The key to effective child injury prevention?

What’s the most effective approach to reducing unintentional injury to children? Most of us would probably say prevention works best when we operate across a broad range of strategies. We might point to the Spectrum of Prevention with its continuum of strategies as a good, practical working model for successful prevention. But what if we were pressed to single out one strategy for special attention - to opt for one approach which offers the most far reaching opportunities for change across the broadest base? The answer for some of us would then have to be - influencing public policy and legislation.

What has been achieved?

At a national level...
Policies are important because they build safety into the environment and into the way society operates. The likelihood of success for all the other strategies on the Spectrum are dependent on a child safe culture created by child safe policies. There are plenty of examples of policy and legislation that have made a difference to child safety. The passing of compulsory child restraint and cycle helmet wearing legislation have increased children’s safety on the road. The Building Code (1992) introduced mandatory safety requirements (eg safety glass in high risk areas and tempering valves) that have contributed to a safer environment for new homes. Mandatory safety standards for products (child resistant lighters for example) have also helped to reduce risk of injury to children.

At a local level...
We can also draw on examples of policy making at a local body level that have advanced child safety. Several councils have adopted ‘First Call for Children’ which grants children first call on society’s resources. Others have adopted and implemented a Council strategy for children.

Councils have also had a vital policy role to play in increasing compliance of measures designed to increase child safety. Any policy or regulation is only as good as the systems put in place for its enforcement. If we can’t ensure compliance with legislation, it will not only be ineffective, but there is also always the possibility that it will be watered down or even over turned.

A good example of the importance of enforcement is the Fencing of Swimming Pools Act (1987) designed to reduce the high number of pre school drownings. The act is a complicated piece of legislation and many Councils charged with its interpretation are unclear on exactly what the law requires. Opponents of the legislation have been using the difficulty of enforcing the act, to lobby for its repeal.

Where to from here?

Now that we have reflected on what’s been achieved, the next step is to ask ourselves where do we go from here? Where should we, the child injury prevention workforce, be putting our energy if we want to further advance policy opportunities for child safety?

Let’s start with the bigger picture and the changing political climate. The present administration appears to be moving us away from the free market, hands off approach to government of recent years, to one that looks more kindly on intervention and regulation. This seems to present us with a little more opportunity to influence policy change in the direction we want.

There are currently also a number of opportunities to become involved in on going policy discussions on wider childrens’ issues. An agenda for developing a policy for children is underway. The Ministry of Youth Affairs is co ordinating a report on New Zealand’s implementation of the UN Convention on the Rights of the Child. New Zealand’s first Children’s Day is planned for October 29. Such initiatives provide an opportunity for us to get unintentional child injury on the broader agenda of decision makers.

All this activity raises the issue of the need for a national body with the responsibility for monitoring the impacts of policies and legislation on children. In the absence of such a body this responsibilty is shared out in a somewhat ad hoc fashion between Social Services and Youth Affairs. Under the UN Convention on the Rights of the Child, the Government has a responsibility to make the best interests of the child a primary consideration and to use their full powers to keep children safe.

A Ministry of Children’s Affairs?
Given all this, a key policy question is should we be advocating for a Ministry for Children that can co ordinate policies for children and monitor all decision making for its impact on children? Safekids would be very interested in hearing the views of the rest of you on this one.

And in child road safety…
What of the opportunities for policy change to reduce specific causes of injury to children? Road related injuries are a major cause of injury death for children. The Ministry of Transport is about to send out a document, Vision 2010, for consultation that will set their strategic direction for the next 10 years. This is an opportunity for getting child road safety issues on the political agenda. Just one example of a policy change to advocate for might be that approved restraints be required in vehicles including taxis and goods service vehicles where they are not currently mandatory.

And in falls prevention…
Falls are easily the major cause of children being hospitalised. Falls from baby walkers and from playground equipment are just two areas that offer an opportunity for policy change. Baby walkers are the leading item associated with a fall in the first year of life. A ban on baby walkers is presently being advocated for by a coalition of child safety agencies. Playground injuries are the major cause of a fall injury for school age children. A desirable policy change to work for here might be to advocate for the NZ Playground Safety Standard to be mandatory in school and early childhood settings.

And more…
There are many other examples of opportunities to further child safety through policy change. Some are initiatives that are currently stalled, like expanding the list of medications that require dispensing in child resistant closures or mandatory safety standards on prams and strollers. We can also get in behind the present proposal from the Building Association of NZ for smoke alarms to be compulsory in all new homes and push for this to be extended to all homes regardless of age. Then there are all those areas where there are no proposals current, but where we all know there is need for a change.

Where we put our energy will depend on our own areas of interest. However to return to the Spectrum of Prevention, we all know that working together in coalitions and networks is far more effective. It’s always good to get a dialogue going with others in the same area and we at Safekids certainly welcome any opportunity to work with any of you to advance advocacy opportunities. So let’s continue our networking for policy change!

THE SPECTRUM OF PREVENTION

Action on baby walkers in New South Wales Finally something is being done about baby walkers! The NSW Department of Fair Trading, under its Minister John Watkins, has introduced a requirement that baby walkers sold in NSW must comply with the US ASTM Standard. The change is made under the Fair Trading (Product Safety Standards) Regulation 2000 and came into force on 1 September. Wholesalers must not order or supply baby walkers that do not comply with the standard after three months and retailers must not sell non-standard walkers after six months (i.e. after 1 March 2001). This is the first time a construction standard for baby walkers has been required in any Australian jurisdiction. As in New Zealand, no baby walkers are made in Australia. New South Wales is to be congratulated for leading the way on this issue! As you will all be aware, Safekids has been advocating for a ban on baby walkers for sometime, in partnership with the Community Paediatric Committee of the Paediatric Society of NZ; Plunket; Barnados; Starship Hospital; Children’s Issues Centre; Child Safety Foundation of NZ; Head Injury Society; NZ Burns Support Charitable Trust Inc; Pacifika Healthcare; Brain Injury Association of NZ Inc; Kidsafe Taranaki Trust and many other organisations. The Royal Australiasian College of Surgeons has also recently joined the call for action. Safekids is only sorry that New Zealand weren’t the Australasian regulatory trailblazers!.

FINGER ENTRAPMENTS This update has been provided by Alex Woodley and features finger entrapments

Hospitalisations

Hospitalisation data shows that in the years' 1994-1998, 2460 children aged 0-14 years were hospitalised due to entrapment injuries. These included entrapments from doors, hand tools, and objects such as washing machine ringers.

Injuries from entrapments appear to peak between the ages of one and two. Over half (56%) of the admissions were to children aged 3 years and under.

These admissions under-represent entrapment injuries as they do not include children presenting to Accident and Emergency Departments, GPs or those treated at home.

Finger Entrapments in Doors

A number of researchers, both within New Zealand and internationally, have focused specifically on finger entrapments from doors. A study at the Wanganui Hospital Accident and Emergency Department in 1996, for example, found that 90 children presented with finger jams from doors that year. Many of these injuries were extremely serious. Eleven of these children had fingers amputated. Other injuries included broken fingers (11), lacerations (7) and nails ripped from the bed (4).

The hinged side of the door presents a significant amputation risk if a child's finger is in the gap when the door closes as the leverage increases the pressure at this end of the door.

A new architectural trend towards installing pivoting doors in houses is particularly alarming. Builder Jason Frost from Create New Zealand Ltd says that these doors increase the risk of entrapment. "The gap between the hinged side of the door and the jam is larger than the gap in normally hinged doors. This allows not only fingers but hands to squeeze through the gaps. These doors present an even greater hazard to children and pets."

Preventing Finger Jams in Doors

Most studies recommend the use of safeguards to doors to help prevent or reduce damage to fingers. For example a plastic cover can be fitted to the hinged side of the door to reduce access. Sponge or rubber can be fitted on the door and frame surfaces to reduce damage when the door is closed.

It has been suggested that bevelling the door and door jam may also help to prevent injuries.

A father whose daughter's finger was badly injured in the hinged side of a door has recommended that doors in houses could be made less dangerous by rounding the door corners and bevelling the door jams. (See the diagram).

Safekids will be approaching door manufacturers to discuss safety options and encourage them to make the hinged side of doors in houses less dangerous.

An integral part of Safekids' strategy for injury prevention is to provide a solid base of information about child unintentional injury and how it can be prevented. The Information Centre is a professional library service with a comprehensive collection of material on these subjects.

The purpose of the Information Centre is to serve the needs of the injury prevention and health promotion workforce as well as public health providers, the media, and those in a position to influence child safety issues.

National and international material includes:

• academic literature - journal articles, research reports
• books on injury prevention, health promotion and programme development
• journals and newsletters from prevention agencies
• examples of prevention programmes and campaign literature, pamphlets and posters • training resources, teaching kits, information kits
• education resources, including videos
• newspaper clippings
• sample copies of New Zealand child safety resources

– Do you have questions about child safety, unintentional child injury and its prevention?

– Do you need resource material?

– Are you planning interventions, educational training sessions or campaigns?

If so, please do not hesitate to contact Simon at the Information and Resource Centre

Ph. (09) 820 1193 fax: (09) 820 1191or e-mail: safekids@iconz.co.nz

A lot of good information is also available online at http://www.safekids.org.nz Visit (or re-visit) this site and have a look!

A welcome to the Injury Free Counties Manukau Co-ordinators

Injury Free Counties Manukau is the new name for the Counties Manukau Community Injury Prevention Project (and a much shorter, more palatable one at that!). The project has been going for just on a year now, however the project co-ordinator - Shayne Nahu - has only been on board since November. Since this time the project has also brought on board a Pacific Persons Co-ordinator - Iani Nemani - and is just about to sign up with a Maori provider for the development and delivery of a Maori component.

With staff like Shayne and Iani already on board, we expect to see great things of the Injury Free Counties Manukau Project! Shayne has been active in child injury prevention for some time now, and is well known and respected for his skills and energy - and for being great fun to work with! Iani is new to the injury prevention field although already he is finding his feet. He will soon be very well known, particularly across Pacific Island networks. Already he is taking on the co-ordination of a major regional radio campaign aimed at improving child safety amongst Pacific Peoples. Safekids looks forward to continued work with the Injury Free Counties Manukau staff!

Shayne had the following to say about Injury Free Counties Manukau

For further information please call Injury Free Counties Manukau Project Co-ordinator Shayne Nahu Ph 09 262 8964 Pacific Peoples Co-ordinator Iani Nemani Ph 262 8900 x 8731

Regional Action Planning in Auckland For those of you that may not be aware, Safekids co-ordinates a Regional Action Plan for child injury prevention entitled "Keeping Kids Safe: An Action Plan for the Auckland Region 1999-2001". Many organisations have contributed their work to this plan. We are halfway through the time period of the Action Plan and it seems timely to update the injury prevention workforce on some of the exciting initiatives that are happening in the Auckland Region.

Below is a summary of some of these activities

In the area of 'building a childsafe culture', we have seen significant progress. We have seen:	significant increases in the use of advocacy as a strategy within injury prevention, with many injury prevention groups preparing submissions on national, regional and local issues. the development of a Waitakere City Council Safety Strategy. Within this Strategy an annual action plan will be developed. the development of a Waitakere City Inter-agency Safety Plan with 22 agencies contributing.
A 'stronger regional infrastructure for child injury prevention' has also been developing with:	the establishment of the Injury Free Counties Manukau Community Injury Prevention Programme. an increase in road safety funding targeting specific Maori and Pacific Island programmes. better access to regional data. Safekids has obtained NZHIS data and resources to analyse child injury data nationally, regionally and locally. the development of a Strategic Plan by the North Harbour Injury Prevention Group. the development of a Strategic Plan by Injury Free Counties Manukau.
In the area of 'pedestrian injury prevention', a number of campaigns have taken place, including:	the successfully piloted Gladstone Primary school 'Zippy School Bus' programme to increase child pedestrian safety on the journey to and from school. the continuation of Safe Routes to Schools in high-risk areas. the development of an intersection-behaviour campaign on the North Shore. It is recommended that more emphasis be placed on strategies to address speed and driver behaviour, as integral components of the pedestrian injury picture in the Auckland Region.
In the area of 'bicycle injury prevention':	many strategies are planned by Auckland agencies and intersectoral groups to support National Bike Week, a regional forum was held on bicycle issues focusing on engineering and motorist awareness issues. safe cycling is a focus for Kidsafe Week 2000 with many strategies planned by the Kidsafe Week Coalitions in the Auckland Region.
In the area of 'motor vehicle passenger injury prevention':	the Plunket car seat restraint resource was launched in the Auckland Region. combined Police and Coalition enforcement campaigns took place during KSW 1999. Options for large families in restraining their children still need addressing, and more initiatives to promote child restraints to communities with low restraint use are needed.
In the area of 'falls prevention':	Health Promoting Schools - Waitemata Health, initiated a School Injury Report Form trial. Safekids and other agencies actively advocated for a product ban on baby walkers. Kidsafe Week 2000 is coming up, with many strategies planned by the Kidsafe Week Coalitions in the Auckland Region. More focus is also required to target injuries in the sporting world.
In the area of 'drowning prevention':	Kidsafe Week 1999 focussed on water safety for children under 5 years old, and many coalitions undertook many differing strategies. many Kidsafe Week coalitions were also involved in advocacy around the Fencing of Swimming Pools legislation. Watersafe Auckland is currently completing a water hazard identification programme in Waitakere City. Safe Waitakere has also developed guidelines for around stormwater detention ponds. Safe Waitakere also worked with Universal Homes to develop a set of guidelines for silt ponds in new subdivisions, which have been adopted by Universal Homes.
In the area of 'burns and scalds prevention':	the "Ambassador's" train the trainer programme developed by Manukau Fire Service. the launch of the ‘Fire Wise’ programme developed by NZ Fire Service which contain both a fire safety and scalds prevention component. funding has been achieved to re-print the school-based Safe Waitakere Burns and Scalds Kit and promote via Public Health Nurses to all primary schools in Waitakere City. More focus is still required around scalds prevention particularly targeting hot liquids and vapours, and caregivers of pre-schoolers in the Auckland Region.
In the area of 'cutting and piercing prevention':	The revised standard NZS:4223 aims to improve safety glass requirements in high-risk areas in new homes. However, this is an area which is of concern within the Auckland Region, as little action is occurring.
In the area of 'poisoning prevention':	Poisoning is also an area of concern. Latest injury rate analysis is highlighting poisoning as a major issue, and yet few resources, and strategies are developed in this area.

A challenge for the Auckland Region now, is to look at some of the areas where little work is happening (particularly cutting and piercing and poisoning) to determine what we can do to increase activity.

We would also love to hear from people from other parts of the country of their initiatives or co-ordination efforts. If anyone would like to share their strategies, or if anyone is interested in receiving a copy of the Auckland Regional Action Plan, please contact Rachel Algar at email:rachela@ahsl.co.nz or phone (09) 820 1198.

Collaboration is the Key to National Child Restraint Project Sponsored by ACC

A small regional initiative has grown into a national project that proves working together at all levels is achievable. Not only is it achievable, but it has been an excellent way to promote child safety to a very wide audience with little effort. Forty-three Refuges have received two brand new car restraints for use in transporting families in need.

The project idea was first conceived when a local refuge outreach worker asked Community Injury Prevention Turanganui A Kiwa to donate two car restraints for her work in transporting families in need. "Of course we were delighted to do that", says Molly Pardoe, Community Injury Prevention Turanganui A Kiwa, "and hence the idea to do it as a national project evolved."

A letter was sent to all refuges with an overwhelming response from 98% of the refuges who had outdated restraints, or more transport needs than restraints on hand, or as in the case of the Gisborne worker, no restraint at all.

ACC Injury Prevention supported the project, generously sponsoring the Child Car Restraints, which were supplied and delivered to the Women's Refuges by Britax Childcare Products. ACC Injury Prevention Cultural Strategies Programme Manager Joyce-Anne Hankins was pleased to support this project, as it clearly endorsed the 'closing the gaps' policy and the need for organisations to work in collaboration.

“We purposely timed this project to coincide with National Women's Refuge week in order to ensure that our health promotion approach to injury prevention and child safety is more than just providing families with a child restraint.” says Molly Pardoe, “If our children are going to grow up proud and strong they need to be safe in all aspects of their growth and development. We are proactively supporting safe environments for children with this initiative, which is an example of how creative health promotion can work.”

A fact sheet was also prepared by Injury Prevention Turanganui A Kiwa to accompany each seat. An evaluation will be undertaken with each refuge in six months to evaluate the project.

The photograph (courtesy of Gisborne Herald) shows the key players who have joined forces to make the child restraint project work. ACC Injury Prevention general manager Keith McLea and ACC corporate services general manager Gerard McGreevy both from Wellington, Ci Hoerara Gisborne Women's Refuge, Sergeant Ross Smith from Gisborne Police, Britax Childcare Products General Manager John Highsted, Tairawhiti car seat co-ordinator Kiri Simpson, Vaughan Greening Gisborne ACC Injury Prevention, Patricia Mill-Poi Gisborne Women's Refuge, ACC Injury Prevention cultural programme manager Joyce-Anne Hankins and Turanganui A Kiwa Community Injury Prevention Molly Pardoe.   A note from Safekids News: Congratulations to all those involved, on the excellent project! Please let us know the results of the evaluation.

Thanks to those of you who responded to the questions we asked you in the last issue of Safekids News about training in child injury prevention. It was especially pleasing to get replies from across the country, from as far south as the Bluff in fact! A reminder to others, its not too late to respond. You can even access and answer the questions on line through our web site.

We thought you'd be interested in a summary of responses to date. Everyone who responded felt there was a need to develop a training package on child injury prevention. While this might mean those who don't see a need didn't respond - it still seems a pretty positive message!

We asked you what areas should be included in a generic training package. All the options given, except using statistics as a resource for child injury prevention, were chosen by more than half of you. The most popular choice was the role of child development in injury prevention. Only a little less popular were the theory of injury prevention barriers to effective prevention, and advocacy for child safety.

We also asked you to think of your own training needs and what specific prevention issues you'd like covered. Safety at home was the most popular choice, followed by safety at play, safety issues for Maori and safety in particular settings. Safety on the road was the topic chosen by the least number of respondents.

While it's very early days in terms of planning the delivery of any training, we also wanted to know what would be key to getting your involvement. More than half of you mentioned the importance of where the training would take place. You wanted it delivered locally. Keeping costs low and having input into the development of the training were other factors mentioned by several respondents.

What came through most clearly from your responses is the enthusiasm you feel for the idea of some child injury prevention training, "great idea", "good initiative" were typical comments.

So where to from here? The answer has to be, we're not sure! At a minimum we are committed to using the information you've given us to develop a basic training module for a workshop(s) on child injury prevention. Whatever we do we'll continue to seek your input and keep you informed, so stay in touch.