Comparing the Risk of Sudden Unexpected Infant Death to Common Causes of Childhood Injury Death.

In a secondary analysis of publicly available data, the rate of sudden unexplained infant death in the first year exceeded the peak rates of the leading causes of injury death for youth (≤19 years of age). The absolute risk of sudden unexplained infant death exceeded age-specific risks of the major causes of child injury mortality regardless of race or ethnicity.

Racial and ethnic disparities of sudden unexpected infant death in large US cities: a descriptive epidemiological study.

BACKGROUND: Sudden unexpected infant death (SUID) accounts for ~ 3400 deaths per year in the USA, and minimal progress has been made in reducing SUID over the past two decades. SUID is the sudden death of an infant that has occurred as a result of accidental suffocation in a sleeping environment, SIDS (sudden infant death syndrome), or from an unknown cause of death. Nationally, non-Hispanic Black (NHB) infants have twice the risk of SUID compared to non-Hispanic White (NHW) infants. In Chicago, this disparity is greatly magnified. To explore whether this disparity is similarly seen in other large cities, we analyzed SUIDs by race and ethnicity for a seven-year period from the 10 most populous US cities. SUID case counts by race and ethnicity were obtained for 2011-2017 from the 10 most populous US cities based on 2010 census data. For each city, we calculated average annual SUID rates (per 1000 live births) by race and ethnicity, allowing calculation of disparity rate ratios. FINDINGS: Nationally, from 2011 through 2017, there were 0.891 SUIDs per 1000 live births, with a rate of 0.847 for NHWs, 1.795 for NHBs, and 0.522 for Hispanics. In most study cities, the NHB and Hispanic SUID rates were higher than the corresponding national rate. Hispanic SUID rates were higher than NHW rates in 9 of the 10 largest cities. In every study city, the NHW SUID rate was lower than the national NHW rate. In Chicago, NHB infants had a SUID rate 12.735 times that of NHW infants. CONCLUSION: With few exceptions, the 10 largest US cities had higher NHB and Hispanic SUID rates, but lower NHW SUID rates, compared to the corresponding rates at the national level. Unlike the national pattern, Hispanic SUID rates were higher than NHW rates in 9 of the 10 largest cities. Prevention is currently hampered by the lack of detailed, accurate, and timely information regarding the circumstances of these tragic deaths. A national SUID surveillance system would allow greater understanding of the factors that lead to this disproportionately distributed and enduring cause of infant death.

Behaviors of young children around microwave ovens.

BACKGROUND: Scald burn injuries are the leading cause of burn-related emergency room visits and hospitalizations for young children. A portion of these injuries occur when children are removing items from microwave ovens. This study assessed the ability of typically developing children aged 15 months to 5 years to operate, open, and remove the contents from a microwave oven. METHODS: The Denver Developmental Screening Test II was administered to confirm typical development of the 40 subjects recruited. All children recruited and enrolled in this study showed no developmental delays in any domain in the Denver Developmental Screening Test II. Children were observed for the ability to open both a push and pull microwave oven door, to start the microwave oven, and to remove a cup from the microwave oven. RESULTS: All children aged 4 years were able to open the microwaves, turn on the microwave, and remove the contents. Of the children aged 3 years, 87.5% were able to perform all study tasks. For children aged 2 years, 90% were able to open both microwaves, turn on the microwave, and remove the contents. In this study, children as young as 17 months could start a microwave oven, open the door, and remove the contents putting them at significant risk for scald burn injury. CONCLUSIONS: Prevention efforts to improve supervision and caregiver education have not lead to a significant reduction in scald injuries in young children. A redesign of microwave ovens might prevent young children from being able to open them thereby reducing risk of scald injury by this mechanism.

A firm recommendation: measuring the softness of infant sleep surfaces.

BACKGROUND: Approximately 3600 sudden unexpected infant deaths (SUID) occur annually in the United States, and a quarter of SUIDs are caused by unintentional suffocation and strangulation in bed, with soft bedding use being a significant risk factor. Therefore, The American Academy of Pediatrics (AAP) recommends infants sleep on a "firm" surface, though neither an objective definition nor national standard has been established. The purpose of this study is to report on the performance of a device that measures mattress softness and to provide quantitative values of softness for various infant sleep surfaces. METHODS: In collaboration with the authors and a national child product safety organization (Kids in Danger), University of Michigan engineering students designed and validated a device that measures the vertical depression (softness) of a simulated 2-month-old's head on a sleep surface. A total of 17 infant sleep surfaces - 14 household surfaces and 3 hospital mattresses - were measured between April 2019 and January 2020. The average softness of each surface was calculated. Surfaces were also measured with soft bedding, which included an infant fleece blanket, and firm and soft pillows. RESULTS: The average softness for the 14 household sleep surfaces ranged from 7.4-36.9 mm. The 2019 cribette playard and the 2018 infant spring had similar softness (21 mm) as the 2018 and 2019 adult foam and 2015 sofa. An infant's fleece blanket folded once added an additional 2.3-6.5 mm of softness, folded twice added 4.8-11.6 mm, and folded three times added 11-21.8 mm. Using a firm pillow added 4.0-20.9 mm of softness while using a soft pillow added 24.5-46.4 mm. The softness for the 3 hospital sleep surfaces ranged from 14 to 36.9 mm, with the infant bassinet being the firmest and the pediatrics mattress being the softest. CONCLUSIONS: We found a wide range of softness among sleep surfaces, with some infant mattresses as soft as some adult mattresses. Adding blankets and pillows to mattresses measurably increased softness. Quantifying sleep surface softness will advance our understanding of how softness relates to SUID risk. We hope this new information will further inform safe infant sleep recommendations and improve mattress safety standards nationally.

Making Microwave Oven Doors Child Resistant to Protect Young Children From Severe Scalds.

Most severe child scalds in the United States involve food and beverages. The wide variety of burn mechanisms, however, makes prevention challenging. Over the past 15 years, we have worked toward protecting young children from 1 specific mechanism: children opening microwave oven doors themselves and spilling the heated contents, resulting in often severe scalds. In our published research, we documented the frequency and severity of these cases and the vulnerability of young toddlers to be burned in this way. We have presented our findings and ideas for prevention at multiple national meetings and enlisted college engineering students to design microwave doors that would thwart a young child from opening them. In 2017, we became active members of a national task group convened by Underwriters Laboratories to address this issue, and two authors became voting members on the Underwriters Laboratories Standards Technical Panel for microwave ovens. We worked with microwave manufacturers and others for >1 year to address concerns of the industry, including those related to potential impacts on older adults. This effort resulted in the task group proposing a change in the standard, requiring "two distinct actions" to open the door of a microwave oven. On September 17, 2018, the panel voted to pass the measure, which will require child-resistant doors for all new microwave ovens in 2023. This report highlights how research can inform and support child injury prevention advocacy. Children will now be protected from this type of scald as microwaves with child-resistant doors replace current models.

Factors Associated With Unrestrained Young Passengers in Motor Vehicle Crashes.

: media-1vid110.1542/5984244682001PEDS-VA_2018-2507Video Abstract BACKGROUND AND OBJECTIVE: Unrestrained child passengers are at significant risk of crash-related injury. Previous researchers using nationally representative crash data from 1992 to 1993 found an association between driver and passenger safety-belt use. Our objective in this study is to investigate factors associated with young, unrestrained passengers in fatal and nonfatal motor vehicle crashes using updated national crash data. METHODS: We analyzed 2011-2015 Fatality Analysis Reporting System and National Automotive Sampling System data and included vehicles with a young passenger (≤19 years old) in a crash. Driver and passenger characteristics were compared by using bivariate analyses separately for fatal and nonfatal crashes. Logistic regression analyses were performed on a combined data set to predict passenger restraint use. RESULTS: In unadjusted bivariate models, unrestrained drivers had a higher probability of having an unrestrained passenger across all passenger age groups for both fatal and nonfatal crashes. In multivariate logistic regression models that included both fatal and nonfatal crashes and were adjusted for several driver and passenger characteristics, unrestrained drivers had a higher risk of having an unrestrained young passenger across all age groups. CONCLUSIONS: In both fatal and nonfatal crashes, a driver being unrestrained is a strong predictor of the child passenger also being unrestrained. Policy and regulation to better ensure that drivers are properly restrained (eg, expanding primary seat-belt laws to all states) may serve as effective means for increasing rates of proper child-occupant-restraint use.

Outcomes after injury prevention counselling in a paediatric office setting: a 25-year review.

OBJECTIVE: Injury is the leading cause of death and acquired disability in children. Primary care providers routinely provide age-appropriate injury prevention (IP) counselling during healthcare visits. The objective was to review evaluations of the effectiveness of office-based paediatric IP counselling research. DESIGN: This review identified studies from July 1991 to June 2016 of children <5 years and their caretakers to determine the effectiveness of office-based counselling on IP knowledge, behaviours and outcomes. Studies were included if they had: (1) an intervention for a family with a child <5 years of age; (2) an unintentional injury mechanism addressed during counselling; (3) one or more mechanisms recommended to be discussed for children <5 years in the 2007American Academy of Pediatrics Policy Statement; (4) counselling occurring in the office setting; (5) an assessment of an outcome (eg, change in knowledge, behaviour or injury occurrences); and (6) English-language publication. Study characteristics (whether the study was controlled, randomised and/or blinded), target safety behaviours, the sample size, outcomes assessed (injuries, behaviour changes and/or education changes) and demonstrated effects were summarised. RESULTS: Sixteen articles met inclusion criteria. Twelve articles were randomised controlled trials, three were non-randomised trials and one was a pretest and post-test study. Fourteen articles measured a change in knowledge or reported behaviour, four included observed behaviour change and five measured change in injury outcomes. Thirteen of the 16 studies had positive effects demonstrated for certain outcomes, including for fall, poisoning, burn, fire, traffic injury and drowning prevention, while 10 showed no differences between study groups for other outcomes. CONCLUSIONS: Published outcomes-based IP-related counselling research in the primary care setting for young children is infrequent, and additional research is necessary to further describe the effectiveness of these primary prevention efforts.

You can have your breastmilk and safe sleep too: a preliminary analysis of infant safe sleep data in a Midwestern home visiting program.

BACKGROUND: Sudden unexpected infant death (SUID) accounted for approximately 3700 infant deaths in the US in 2015. SUID risk factors include prone sleeping, bed-sharing, soft bedding use, and maternal smoking. Infant safe sleep data in at-risk communities are difficult to obtain and home visiting programs can add to what we know. This study's purpose is to determine how often caregivers enrolled in home visiting programs provide safe sleep environments for their infants in relation to breastfeeding status and tobacco use. METHODS: Female caregivers in at-risk communities were prospectively enrolled in Midwestern home visiting programs. Those that had infants < 365 days old and completed a safe sleep survey between October 1, 2016 and May 18, 2017 were included. Caregivers' responses (always, sometimes, or never) to three safe sleep questions were compared by breastfeeding status, caregiver tobacco use, and household tobacco use using Pearson's chi-squared or Fisher's exact test. RESULTS: The characteristics of the 289 eligible female caregivers included 120 (42%) ≤ 21 years old, 137 (47%) black, 77 (27%) breastfeeding, and 60 (22%) with household tobacco use. Two hundred forty-six (85%) caregivers always placed infants in the supine position, 148 (51%) never bed-shared, and 186 (64%) never used soft bedding. Ongoing breastfeeding caregivers never bed-shared more often than those who never breastfed or weaned (66% vs. 53% vs. 39%, p = 0.003). Households with tobacco use placed infants in the supine position less (75% vs. 88%, p = 0.03), bed-shared more (62% vs. 44%, p = 0.04), and used soft bedding more (50% vs. 32%, p = 0.004) relative to those without tobacco use. CONCLUSIONS: In this group of at-risk young mothers, those who breastfed bed-shared less than mothers who were not breastfeeding; this finding has implications toward reducing the SUID risk in similar populations. This study also demonstrated that infants living with a tobacco user are less likely to be sleeping safely. This suggests that a multifaceted approach to safe sleep counseling may be needed.

Alcohol-impaired driving among U.S. adults, 1993-2002.

BACKGROUND: Motor vehicle-related injury is the leading cause of death in the United States for people aged 1 to 34 years. In 2002, 17,419 (41%) of 42,815 traffic deaths were alcohol related. OBJECTIVE: To estimate trends in alcohol-impaired driving among U.S. adults from 1993 through 2002. DESIGN, SETTING, AND PARTICIPANTS: The Behavioral Risk Factor Surveillance System, a random-digit telephone survey of adults aged >/=18 years in all states (and the District of Columbia). MAIN OUTCOME MEASURES: The percentage of respondents who reported alcohol-impaired driving (AID) in the past month, total estimated annual number of AID episodes, and annual rate per 1000 adult population. RESULTS: The estimated annual number of episodes of AID in the United States declined from 123 million in 1993 to 116 million in 1997, but then increased to 159 million in both 1999 and 2002. In varying magnitudes, this increase was observed among most subgroups of the population. In each study year, over 80% of total AID episodes were reported by people who also reported binge drinking (more than five drinks on a single occasion). CONCLUSIONS: After a general decline in the United States in the mid-1990s, self-reported AID increased substantially by the turn of the century. AID is strongly associated with binge drinking. Effective interventions to prevent AID and binge drinking should be widely adopted.

Neck strains and sprains among motor vehicle occupants-United States, 2000.

CONTEXT: Motor vehicle (MV)-related injury is a leading cause of death and emergency department visits in the US. Information has been limited regarding the magnitude and types of injuries suffered by the survivors of MV crashes. OBJECTIVE: To estimate the incidence and patterns of neck strain/sprain injury among MV occupants treated in US hospital emergency departments. DESIGN AND PARTICIPANTS: Descriptive epidemiologic analysis of persons treated at a stratified, probability sample of US hospital emergency departments from 1 July to 31 December 2000. SETTING: US. MAIN OUTCOME MEASURES: Annualized national estimates of number and rate of neck strain/sprain injury among MV occupants overall and by patient's age and sex. Rates were calculated per 100,000 population as well as per billion person miles traveled. RESULTS: In 2000, an estimated 901,442 (95% CI 699,283-1,103,601) persons with neck strain/sprain injury were treated in US hospital emergency departments. For MV occupants, neck strain/sprain was the most frequent type of injury, comprising 27.8% of all injuries to MV occupants treated in emergency departments that year. The incidence (per 100,000 population) of neck strain/sprain was significantly lower in younger children and peaked in the 20-24-year age group. The incidence (per billion person miles traveled) peaked in the 15-19-year age group. Females tended to have a higher incidence of emergency department-treated neck strain/sprain than males. CONCLUSIONS: Neck strain/sprain is the most common type of injury to MV occupants treated in US hospital emergency departments. Based on emergency department visits, these estimates suggest that the problem of neck injury may be larger than has been previously demonstrated using other surveillance tools. Further research is needed to determine contributory factors and prevention measures to reduce the risk of neck injury among MV occupants especially among those at higher risk such as females, older teenagers and young adults.

Providing car seat checks with well-child visits at an urban health center: a pilot study.

OBJECTIVE: To evaluate a pilot program of providing child restraint system (CRS) checks by certified technicians with well-child care in an urban health center serving a low-income community. METHODS: During well-child care, nationally certified child passenger safety technicians assessed CRS use, educated care givers, corrected misuse, and provided a new CRS if necessary. The program's effect was assessed at a subsequent medical visit. RESULTS: A total of 3650 CRS checks were performed. CRS non-use was found for 307 (17%) infants, 604 (50%) toddlers, and 593 (88%) booster seat-sized children. Exposure to the program was associated with a significant positive effect on CRS use (p<0.001) and significant improvements in the major components of misuse (p<0.05) months later. CONCLUSIONS: This urban health center has high rates of CRS non-use and near-universal misuse. Providing CRS checks by certified technicians during well-child care is a promising means of promoting sustained and improved CRS use.