Preventing accidents to pre-school children: A health visitor's view

Abstract

'Prevention' and 'safety' suffer from a major handicap: they are undramatic and, often downright boring. Compare this with the drama of an accident which is often horrifying or tragic, but which is at least interesting and usually newsworthy. Another disadvantage suffered by the concepts of prevention and safety is that the solutions so often seem obvious and just common sense, so that safety advice is unremarkable and therefore often goes unheeded. These are major problems for us, as health workers trying to get across the safety message, so accidents continue to happen most tragically when some simple action could have prevented them. Accidents are the largest single cause of death in childhood after the age of one in the western world today. In the UK, road traffic accidents form the largest single group of deaths, but home accidents far outnumber those on the road in terms of non-fatal accidents. We cannot, however, lump all children together as far as accidents are concerned. Children have different types of accidents at different stages of development: at one, two and three years, children suffer falls, scalds and poisonings; at five and six they have accidents while playing and on the road; and adolescents tend to have accidents while doing some adventurous activity, like climbing, or while riding motorbikes. We have particular problems with children and accidents for a number of reasons, all of which have a strong bearing on the direction our advice should take: children are naturally inquisitive and need to explore, and consequently appear to misuse articles; neither are they able to anticipate danger and indeed often seem quite fearless. While jumping off a high wall into Dad's arms can be safe and fun; jumping off that same wall on to a concrete path is quite another matter. The aims of safety education should be: (1) To change attitudes towards safety. (2) To increase knowledge of accidents and their prevention. (3) To encourage changes in behaviour which will lead to a safer environment, in turn reducing accident mortality and morbidity. (4) Safety education must be seen as a long term approach to the accident problem. These theoretical points, however, are likely to remain just that unless we examine the attitudes and beliefs that people hold about accidents and their prevention. In this, l am indebted to Pam Laidman whose research on preventing accidents to children, for the Child Accident Prevention Trust has recently been launched by the HEA. An accident has been defined by the WHO l as 'an event unpremeditated by man which results in recognisable damage'. Thus, it could be argued that an accident is something impossible to guard against; the notion of randomness and unpredicability puts it beyond control. There is also a strong sense of the existence of a protective aura, as instanced in the feeling that 'it could not happen to me or to my child'. If an accident subsequently occurs, the parents often have tremendous guilt to deal with, needing support from people like ourselves rather than blame.