Injuries in Child Day Care: An Overview

Abstract

Injuries in child day care are a microcosm of the overall problem of childhood injury. In 1985 the National Academy of Sciences characterized injury as the most important public health problem in America.1 Although infectious diseases account for substantial morbidity among children—including the needs for medical care and hospitalization—injury is the most common cause of serious disability and death to children. Over the last 25 years there have been remarkable reductions in morbidity and mortality from other causes of childhood death, particularly those from infections and more recently from childhood cancer.2 Unfortunately, the reduction in childhood death from injuries has been minimal.2 Thus, addressing injuries to children in child-care and other settings is a public health priority. INCIDENCE OF INJURIES Approximately 25% of children annually incur injuries requiring medical care, either in the emergency department or the physician's office.3 The most common injury event is a fall. Falls are a particular problem because they can result in head trauma and permanent disability. Falls are the main cause of traumatic brain injury in children and account for 55% of traumatic brain injury requiring admission to the hospital.4 Contrary to popular belief, outcomes from head injuries in children are worse than outcomes in adults.5 Comparison of injuries to children in out-of-home child care (OOHCC) and in home care (HC) requires the calculation of comparable incidence rates. All children in OOHCC also spend time in HC, so comparisons based on population denominators are not accurate. In addition, unlike most infectious diseases—for which illnesses occur following an incubation period—injuries occur immediately after the exposure.