| Child injury prevention Aotearoa |  |
| SAFE KIDS - a child safety service of Starship Children's Health |
NEWS Issue 9 June 2000 |
 This issue of Safekids News focuses on the alarming rates of accidental childhood poisoning. Childhood is a time for our "little people" to explore their world, a time for fun and laughter. By reducing the rate of accidental poisonings and making their homes a little safer, we can all help to keep our children smiling. Poison scene kindly enacted by 18 month old Alex Te Kohiwi Rapana |
| I N S I D E . . . |
| Childhood Poisonings: | 
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Childhood Poisonings: A cause for concern
Despite moves over the last few years to tighten regulations to prevent child poisonings, the incidence of accidental poisonings continue at an alarming rate. Examination of hospitalisation discharge data reveals that accidental poisoning is the second leading cause of child hospitalisation for unintentional injury for children aged 0-4 years. While these statistics paint a grim picture, they do not tell the whole story as it is estimated that some 90% of poisonings do not result in hospital admission.
In the five-year period from 1994-1998, 5398 children aged 0-14 years were hospitalised as a result of accidental poisoning. This represents an average of 1079 children each year. Children aged 0-4 years are particularly over-represented. There is a sharp and steady decrease in the rate of accidental poisonings in children over 5 years.
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The most common substances involved the accidental poisoning of children under 5 years are pharmaceutical drugs including paracetamol, tranquilizers, and anti-depressants. Pharmaceutical drugs, foodstuffs and poisonous plants continue to play a role in the accidental poisoning of children aged between 5 and 9. However in children aged between 10 and 14, hospitalisation data suggests the possible effects of the developing adolescent's attempts to manage their changing social environment, with pharmaceutical and other drugs, along with alcohol being the leading cause of accidental poisoning. |
A common point in the hospitalisation figures for all children aged 0-14 years reveals a bias in both gender and ethnicity, with males and European/Pakeha children being over-represented in the hospitalisation data2.
The high rate of accidental poisoning in children under 5 years and particularly in children aged between 1 and 2, can be related to their developmental stage. The development of fine motor skills and increased mobility combined with their heightened curiosity, imitation of adult behaviour and a willingness to be separated from caregivers places these children at greater risk. Despite their young age, children have proved very resourceful often climbing onto shelves and cabinets to reach medicines or other toxins stored in high places, or alternatively seeking out medicines from bags belonging to visitors or family members. Other scenarios may involve an older sibling or playmate "sharing" the toxic substance with younger children. However there does appear to be a differential within the 0-4 age group, with children over 2 years of age being hospitalised more often for poisoning involving pharmaceutical drugs, while younger children were admitted more often for poisonings occurring as a result of ingesting cleaners or chemicals within the home3.
There is a consensus within the available literature that a large proportion of accidental poisoning occurs when the child is removed from their routine environment. For example, while up to three-quarters of poisoning incidents occur at home, many of these are not in the family home but occur in the home of other caregivers. Typically these incidents involved toxic substances that were either in use, or were not returned to safe storage after use and were left lying around the home.
As alarming as these poisonings statistics are, they fail to highlight the real tragedy that lies behind the figures. The hospitalisation rates do not illustrate the anguish of a small child, the terror and guilt of their parents or caregivers, nor the possible long-term consequences that may follow hospitalisation. This point is perhaps best illustrated by taking the example of a small child who has swallowed caustic automatic dishwasher powder, the consequences of which can result in oesophageal ulceration, which in the long-term leads to subsequent operations and bougienage (swallowing rubber tubes) to keep the oesophagus open.
Given these types of scenarios the importance of child resistant closures cannot be underestimated, particularly in light of the fact that a recent study conducted by Safekids revealed that 80% of all poisoning cases involved children ingesting substances that were not contained in a child resistant closure.
Child resistant closures, or caps are a form of packaging that is designed to be significantly difficult for most children under 5 years of age to open within a reasonable amount of time. The greatest misconception surrounding child resistant caps is that they are childproof, when in fact they are merely designed to delay the time in which a child is able to open a toxic substance thereby increasing the probability of an adult intervening before the child ingests the contents.
Child resistant packaging includes both non-recloseable and recloseable packaging. Non-recloseable packaging generally contains a single tablet in either aluminium foil (strip packaging) or opaque laminated plastic (blister packaging), and is not considered suitable for toxic substances. Recloseable packaging involves a container fitted with a recloseable top, or a child resistant cap such as the Palm-n-Turn or Clic-Loc variety. The use of child resistant caps has proven to be very effective in reducing the rates of accidental poisonings overseas, with many countries now adopting child resistant caps on a number of toxic substances.
Currently in New Zealand, Pharmac funds child resistant caps for oral liquid preparations of the so-called "dirty dozen" medications. As of 1 November 1997 it is a requirement under the Pharmacy Contractors Section 51 Advice Notice that child resistant caps will be distributed with paracetamol, salicylates/NSAIDs, anticonvulsants, thyroxine, antidepressants, narcotics, beta-2-agonists, benzodiazepines, theophylline, iron salts, digoxin, cardiac drugs, phenothiazines including sedating antihistamines.
While the introduction of child resistant caps to these pharmaceutical medications may be considered a start to reducing the rates of childhood poisonings, clearly they do not go far enough. Many of the tablets listed in these categories are not dispensed in foil or blister packaging, presenting significant risk to children. Clearly, as revealed by the hospitalisation data, there are a number of other pharmaceutical drugs that must be included if we are to make significant in-roads to reducing the alarming rate of accidental poisonings of our young children.
The most effective ways of preventing childhood poisonings are those that require least effort by the consumer and put a barrier between children and the medicine. Child resistant packaging, such as safety caps, is an example of such a method. In addition to lobbying for their expansion to include other drugs, the current use of child resistant caps must coincide with other prevention strategies such as the education of caregivers and the public at large as to the importance of the safe storage of poisons around the home. Furthermore the National Poisons Centre must be given greater prominence in the community through the provision of an 0800 free phone number, so that parents may use the centre as their "first port of call" in an emergency situation.
OVERSEAS DATA
HAS REVEALED:
Reference: Dr WA Temple, 1994 |
| Accidental child poisoning is a very real cause for concern. For further information on preventing accidental poisoning, please contact the Safekids Information Centre. | Article written by Marina Johnson who is studying injury prevention. Marina is currently working at Safekids. |
REFERENCES
1. Royal New Zealand Plunket Society (1994).
2. Health Information Services, Ministry of Health 1994-1998.
3. Coyte, D. (1995), Article on Childhood Poisoning for NZ Practice Nurse, Communications Manager, Safekids.
| Child Injury Prevention Aotearoa |
ADVOCACY UPDATE |
Positive Changes to Road Safety Announced
On June 8th 2000, the Minister of Transport and the Minister of Police announced a road safety package, which they believe will significantly reduce New Zealand's high rate of road injury and death. The package includes a more than doubled amount of funding being made available for community road safety projects. Half of the additional funding will be distributed in the usual way, through Local Authorities. The other half will be allocated through Regional LTSA Offices, and it will be targeted directly to Maori and Pacific Island community projects.
The road safety package also includes an emphasis on enforcement, with a new 225 strong 'Highway Patrol', of dedicated traffic police to be established. Also announced was the following:
- An end to the hidden speed camera pilot.
- More compulsory breath testing - particularly in high-risk areas.
- Tougher enforcement of speed restrictions and seat belt rules.
- Improvements in monitoring of commercial vehicles.
At a meeting of Mark Gosche, Minister of Transport and Judith Tizzard, Associate Minister of Transport and members of the road safety community in Auckland on Saturday 10th June, the news was extremely well received. The Ministers were keen to talk about the road safety package, but were equally keen to hear from those involved in grass roots road safety work.
"It was unusual to attend a meeting with MPs and Ministers, and have them want to listen to you - rather than talk themselves," says Poni Dowding SafeKids Strategist who attended the meeting. "It was great to be able to tell them what is being done for road safety in communities out there. They were really interested! It was great!"
Safekids is welcoming the changes, although we are asking for clarification on several issues from the Minister of Transport.
Shelley Hanifan (Safekids Director) says:
"Clearly we are delighted that more funding will be available to support the work of local communities in road safety. We hope that those allocating resources will ensure that child road safety is given the priority which it should be, based on the increased risk which children face in comparison to other age groups.
We are also delighted that there will be a dedicated
'Highway Patrol', although the name suggests that these dedicated traffic officers will be
based on highways, rather than local roads. This may do little to reduce the rates of
child pedestrian and cyclist injuries, which tend to happen on local and feeder roads -
not 'highways'. We will be talking with Mark Gosche about this and asking for
clarification.
In particular, we are happy to see a commitment to tougher enforcement of speed
restrictions and seat belt rules. Speed is a major contributing factor to our high rates
of child pedestrian injury, and to motor vehicle crashes which injure child passengers.
Child car restraints are also extremely important and low restraint use in particular
communities does need addressing."
Congratulations to Mark Gosche and the present government for making these positive moves, which will make a difference to road safety. We hope that you remain interested in community road safety work, and you will continue to listen to those doing the work.
| SAFEKIDS NEWS ACTION NOTE: If you'd like to congratulate the Minister of Transport for his evident commitment to improving road safety, write to: Hon. Mark Goshe, Minister of Transport, Parliament Buildings, Wellington. No stamp will be required. |
| Safekids will be visiting with Mark Gosche soon to remind him that children are a key group that have a high risk of road injury. We will be taking the injury data to him that shows the extent of our child road safety problems in New Zealand, and we will be asking for assurance that child road safety will be directly benefited by the changes and for information about how this might be expected. |  |
Concerns over the NZ Health Strategy
The New Zealand Health Strategy Discussion Document is now out for comment, and it can be found at www.moh.govt.nz/nzhs.html.
The strategy calls for the health sector to work co-operatively towards common goals, rather than competing for the largest share of the health dollar. The NZ Health Strategy aims to set the direction for action on health by providing a unifying nation-wide framework within which the health sector will develop. These are worthy and lofty intentions!
The document outlines a number of goals (9), with corresponding objectives (50 in total). The most important goal for injury prevention is goal number 7, of 'Fewer Injuries', although other goals also will affect safety and injury rates. The objectives aligned to the goal of 'Fewer Injuries' include the following:
- To reduce the incidence and impact of road traffic injuries.
- To reduce the incidence and impact of falls in older people.
- To reduce the incidence and impact of injuries (other than traffic) in children and youth.
- To reduce the incidence and impact of violence in interpersonal relationships, families, schools and communities.
It is positive to see that unintentional injury prevention has been recognised and prioritised within the Strategy, with three objectives written around it. However none of the unintentional injury objectives (the first three in the list) has been highlighted as an objective for immediate action. The only injury prevention objective highlighted for immediate action is the final objective outlined above, 'To reduce the incidence and impact of violence in interpersonal relationships, families, schools and communities'.
The reasons for selecting this objective as a priority are given as follows within the strategy:
"In many countries violence is recognised as a key public health issue. Child abuse, sexual violence, school bullying and elder abuse are all preventable forms of harm and social disruption."
Those of you that are on the email discussion group will already have seen some discussion around this objective. The question was asked: Has the right objective been selected?
The suggestion was made, which Safekids strongly supports, that a priority objective should be "To reduce the incidence and impact of injury on children and youth". It was suggested that this objective should be left broad to include both traffic injury and other unintentional injury and intentional injury also.
Safekids is undertaking data analysis to look at this proposed objective further. We will provide further information via the injury prevention email network.
| SAFEKIDS NEWS
ACTION NOTE: Get a copy of 'The New Zealand Health Strategy Discussion Document' now. It has a list of scheduled times and dates for consultation, which we should all attend. If you aren't able to access a copy yourself via the Internet, contact Simon at the Safekids Info Centre and he will organise a copy for you. The time frame for completing a submission is quite short! Submissions are due by 5pm on Friday 28th July. Safekids' submission will be completed by Friday 21st July, and we will put it on the Injury Prevention Email Network. If you'd like a copy, and you aren't on the email network please call our office, and Rhonda Jordan will send a copy to you as soon as it is completed. |
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Foxy is a new road safety mascot about to start work in Waitakere City. Starting in Kelston as a part of the Safe Routes to School project Foxy will encourage parents and children to use safe practices on and near the roads. Rebecca says: "Foxy is about positive messages, reinforcement and encouragement." At present Rebecca is trying to find the ideal person to fill the suit. The job description includes modeling and encouraging good road safety behaviour and handing out rewards to children who display good road safety behaviour. |
| Rebecca Williams (Safe Routes to School Facilitator) cuddles road safety mascot Foxy, while Foxy's designer Denise Westcott looks on. (Photo provided by West Weekly photographer Jason Dorday). |
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Simon Whitlock has recently started
working in the Safekids Information & Resource Centre. He started working with
Safekids in late April, 2000. He has recently graduated from Victoria University of
Wellington with a Master of Library and Information Studies degree (MLIS) and will be
managing the Information and Resource Centre and further developing this service, which
extends nation-wide. "We are enjoying having Simon as part of the team" says Shelley "he is friendly and approachable. We are sure that everyone will enjoy their contact with him." |
The main objective of the Information and Resource Centre is to increase the visibility of unintentional injury among children as an important issue, through the provision of relevant information, resources and services to a wide variety of clients. The Info Centre aims to provide a solid base of information about child unintentional injury and prevention in order to support the work of people involved in this field.
Over the last few months, since March, 2000, Safekids has acquired over 100 different items which have been catalogued and added to the collection. Listed below is a small selection of some examples of these:
| ADVOCACY NZ | DROWNING NZ | |
Produced in Maori and English (bound together) This booklet is designed to help those writing a submission to a select committee to produce it in a form that is easily read and understood by members of the committee. This will enable a submission to be more effective. The booklet also covers how to present an oral submission and provides general information on select committees.
This booklet outlines the following: What is a petition? Who can petition? How to prepare a petition; Presenting a petition; What happens to a petition? |
This is a resource written by children, for children and starring children! This 14 minute video was written and presented by children from Tahatai Coast School, Papamoa, and Tawa Primary School, Wellington. It presents four (4) separate stories based on real life water safety incidents that are researched, scripted and performed by the children. The four incidents portrayed cover four areas where children can drown: • The River • The Beach • The Home pool • During a flood This video is suitable for all class levels. |
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| HOME ENVIRONMENT NZ | NURSERY EQUIPMENT NZ | |
This is a resource which was developed by Safekids. It contains 5 laminated posters which illustrate common home hazards in New Zealand homes and yards. The posters are designed to be easily photocopied. The posters are designed to be used in groups for parent and caregiver education, but they could be also useful with individuals in the home or with groups of older children and students who are training for careers in childcare. N.B. Safekids makes this set of four laminated posters available for purchase at a cost of $30.00 per set. |
This resource booklet outlines the fact that babies and young children are at risk from a wide range of potential hazards and some of these involve everyday items such as nursery equipment and furniture. Each of these common items of nursery equipment is included and for each item there is a safety checklist and notes on safe use. |
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| CONTACT SIMON ON (09) 820 1193 FOR MORE INFORMATION |
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KIDSAFE WEEK INFORMATION AND PLANNING DAYS COMPLETED
Safekids has just completed convening the Regional Kidsafe Week Information and Planning Days for Kidsafe Week 2000. Fifteen Regional Days were held throughout the country, with three new areas covered, these being Invercargill, the West Coast and Taupo.
"It's been great getting out and meeting with the Kidsafe Week Coalition members," Sue reports. "Everyone is so enthusiastic and committed. The community networks are definitely the strength of Kidsafe Week!"
If you were unable to get to one of the Information Days and would like a Kidsafe Week 2000 Information Pack please contact the Kidsafe Week Info Line on 09 828 0503. |
Re-vitalised Coalition in Greymouth
 The Kidsafe Week information session for the West Coast held in Greymouth |
Greymouth and other communities on the West Coast are gearing up for Kidsafe Week 2000. Last year Kidsafe Week was a fairly low key affair on the Coast. However, a really motivated group came together for the first ever Kidsafe Week Information and Planning Day held on the Coast and it looks as though "Coasters" will well and truly be aware of Kidsafe Week 2000! |
Hannah Macdonald, who works as a health promoter for Crown Public Health in Greymouth, has taken over the role of coalition co-ordinator, and is working with others from Westport, Reefton, and Hokitika on planning and implementing Kidsafe Week 2000. We wish the West Coast lots of luck and look forward to hearing how they get on!
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| We welcome your contribution to Safekids News. If there is an issue, information or programme which you’d like to tell other child injury prevention people about, just call Rhonda to discuss including it in Safekids News on (09) 820 1190 |
