A zero-tolerance approach to safety is needed to reduce the number of accidents involving children, writes Áine Kerr
A policy of zero tolerance in many areas of child safety enforcement could help diminish our reputation as a country with twice the number of road fatalities as that of our Swedish counterparts, according to a leading child safety expert.
Recent statistics show that every year in the Republic some 75 children die, 15,000 are admitted to hospital and 150,000 attend accident and emergency departments as a result of unintentional injuries.
Priority must be given to reducing the number of road-traffic accidents involving children, in tandem with improving safety measures in the home, says Dr Alf Nicholson, consultant paediatrician and chairman of the European Child Safety Alliance.
He believes the public perceives injuries as inevitable and preventative measures as unproven. There is also a prevailing attitude that changing road behaviour is impossible and there is no solution to the road deaths epidemic, he adds.
Recent studies suggest that only a quarter of the children involved in road-traffic accidents had an appropriate seatbelt or baby chair.
Dr Seán Walshe, a consultant in emergency medicine at Our Lady's Hospital for Sick Children in Crumlin, says a seven-year audit in the hospital showed road-traffic accidents and burns to be the leading causes of injury to children.
"It's very important that children are restrained properly in a car. We have seen cases in which children were belted up or in seats but were not sufficiently protected at the time of the accident.
"When parents acquire a child's seat, it is important to ensure it is fitted properly and adjusted to suit the age of the child," he says.
Dr Nicholson says solutions that could prove effective include adopting a "zero-tolerance" attitude to child restraint in cars, providing adequate play facilities in poor areas and compelling children to wear bicycle helmets. In the home, smoke detectors, spill-resistant mugs, window guards and the safe packaging of drugs and household poisons could reduce the number of unintentional injuries.
Child pedestrian deaths occur mainly in urban areas during the evening, with a significantly higher number of children in the most deprived districts experiencing injuries. "Higher traffic volume, lower income and younger age are all associated with pedestrian injuries," says Dr Nicholson.
He adds that international models should be examined by the Irish authorities. These include the "stick approach" in Australia and the "carrot approach" in Sweden, where the "safety in community model" emphasises that parental vigilance is not always enough to prevent accidental injuries.
The Swedish model advises parents to implement simple measures such as installing a temperature regulator on baths and protective guards surrounding cooking areas, locking medicine cabinets and having smoke alarms in all rooms.
The Republic has implemented legislation in a range of areas, including child safety seats, seatbelt wearing by children, speed limits in urban areas and smoke detectors in the home. A ban on children driving tractors has also been implemented, but many key areas are not legislated for.
Legislation providing for the compulsory wearing of bicycle helmets, child-resistant packaging on pharmaceuticals, barrier-fencing at domestic swimming pools and a ban on the sale of fireworks to children have not been introduced.
A particular phenomenon giving rise to concern is that of trampoline accidents. In a study of 88 children who were admitted to Waterford General Hospital between April and September of last year for injuries sustained from "trampolining", researchers found that most accidents occurred while those involved were bouncing on the trampoline.
It had been commonly assumed that injuries were more likely to occur from falls off the trampoline, but in fact only 34 children in the study were injured in this manner.
Dr Cian McDermott of St James's Hospital said the injured children had been supervised in only 35 cases. In 31 cases, the injury sustained was related to the presence of others on the trampoline. A total of 36 children required surgery.
The results of the study strongly suggest the need for "clear guidelines on safe and responsible use of domestic trampolines", Dr McDermott says.
Such guidelines have been set out in the US in policy statements of the American Academy of Paediatrics. These include advice to parents on the hazards of recreational trampolining, supervision of play and prohibiting the use of the trampoline by more than one person at a time.
The Waterford hospital study indicates that such guidelines are not being observed in the Republic, with no adult supervision evident in 53 cases and 31 injuries related to the presence of others on the trampoline.