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Childhood Trauma Mar3,2008
 

Childhood Trauma Mar3,2008

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Pediatric injuries, epidemiology, risk, and prevention

Pediatric injuries, epidemiology, risk, and prevention

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    Childhood Trauma Mar3,2008 Childhood Trauma Mar3,2008 Presentation Transcript

    • Pediatric Injuries: Risks and Prevention Among Ages <1-15 in Los Angeles County James M. DeCarli, PhD Candidate, MPA, MPH, CHES Research Analyst III/Behavioral Sciences Injury & Violence Prevention Program Department of Public Health, Los Angeles County
    • Overview Background: Overall Childhood Injury Among Children Ages <1-15 in Los Angeles County Specific Age Category (<1, 1-4, 5-12, 13-15): Leading Causes of Injury Fatality & Hospitalization Anatomical injuries Associated with Injury Mechanisms Contributing & Protective Factors Injury Prevention Planning Tools
    • Childhood Injury in Los Angeles County Data Sources Fatalities: California Department of Health Services, Vital Statistics Death Statistical Master File Hospitalizations: California Office of Statewide Health Planning and Development, Patient Discharge
    • Childhood Injury in Los Angeles County Injuries are the leading cause of death among 1-44 year olds in Los Angeles County Injuries are the leading causes of death among 2.5 million children in Los Angeles County (2006) In 2006, among ages <1-15: 159 injury deaths 5,830 injury hospitalizations
    • Leading Causes of Injury–All Child Ages <1-15 Los Angeles County, 2006 Fatalities Hospitalizations Pedestrian 11% Struck by Obj 9% MVT Ped MV 10% Occupant MVT Ped 16% MVT 10% MTV Occup Occupant MVT 35% 10% Unspec 20% Suicide Fall 11% 60% Unint. Falls Drowning Drown Pedestrian 15% 29% 11% 61% MV Occupant 17% Sources: [Fatalities] California Department of Health Services, Vital Statistics Death Statistical Master File [Hospitalizations] California Office of Statewide Health Planning and Development, Patient Discharge
    • Infants Age <1 Leading Causes of Injury Los Angeles County, 2006 Fatality (Freq) Hospitalization (Freq) Assault/Homicide 13 Fall 158 Untint-Suffocation 2 Assault/Homicide 42 MVT Occupant 1 Unint-Burn, Hot Obj. 30 Untint-Suffocation 30 Unint-Nat Env 19
    • Fatal Injuries Infants Age <1 Los Angeles County, 2006
    • Fatal Assault/Homicides by Cause Infants Age <1 Los Angeles County, 2001-2006
    • Hospitalizations Infants Age <1 Los Angeles County, 2006 100%
    • Where are infants falling from? (Hospitalizations by Cause) Los Angeles County, 2006 45 40 35 30 25 20 15 10 5 0 Stairs Bed Other Furniture One Lever to Another Other
    • Most common anatomical fall-related hospitalization among infants: TBI’s (Hospitalizations) Los Angeles County, 2004 Traumatic Brain Injury (TBI) 100% 90% 80% 77% 80% 60% 60% 40% 20% 0% Stair Chair Bed From different level
    • Toddler Ages 1-4 Leading Causes of Injury Los Angeles County, 2004 Fatality (Freq) Hospitalization (Freq) Drowning 10 Fall 718 Assault/Homicide 9 Unint-Burn, Hot Obj. 145 MVT Occupant 6 Poisoning 116 MVT Pedestrian 4 MVT Pedestrian 107 MVT-Unspecified 3 Unint-Nat Env 106 Pedestrian-Other 3
    • Fatal Injuries Toddlers Ages 1-4 Los Angeles County, 2004 Fatalities MVT Pedestian- Unspecified Other Drowning 9% 9% 28% Pedestrian 11% Occupant Homicide 17% 26%
    • Where are toddlers drowning? (Fatalities) Los Angeles County, 2000-2004 70% 63% 60% 50% Percent 40% 30% 20% 14% 11% 10% 6% 2% 2% 2% 0% Unspec Pool Reservoir Bathtub Fall into Fall into Bathtub Water Open Pool
    • Fatal Assault/Homicides by Cause Toddler Ages 1-4 Los Angeles County, 2000-2004 50 46% 45 40 35 29% 30 Percent 25 20% 20 15 10 5% 5 0 Abuse & Cut/Pierce Firearm Other Neglect
    • Hospitalizations Toddlers Ages 1-4 Los Angeles County, 2004 Hospitalizations Nautral-Env MVT Ped 9% 9% Poisoning 10% Falls 60% Burns 12%
    • P e r c e n ta g e 0 5 10 15 20 25 30 1 E s c a la t o r 7 S t a ir 2 Ladder 6 B u ild in g /S t ru c t u re 1 In t o H o le P la y g ro u n d 11 E q u ip m e n t 0.1 C lif f 11 C h a ir (Hospitalizations) Los Angeles County, 2004 24 Bed 6 O t h e r F u rn it u re Where are toddlers falling from? 13 D if f e re n t L e v e l 18 Sam e Level
    • Common anatomical fall-related hospitalizations: Upper Extremity & TBI Toddler Ages 1-4 Los Angeles County, 2004 80 71 68 69 70 60 54 Upper Extremity Percentage 50 40 36 39 TBI 30 20 10 0 Level-Trips Chair Playground Bed Equipment Different Level Same
    • Children Ages 5-12 Leading Causes of Injury Los Angeles County, 2004 Fatality (Freq) Hospitalization (Freq) Assault/Homicide 11 Fall 1033 Drowning 8 MVT Pedestrian 236 MVT Occupant 7 MVT Occupant 191 MVT Pedestrian 7 Unint-StruckByObject 154 MVT-Unspecified 6 Bicyclist, Other 144
    • Fatal Injuries Children Ages 5-12 Los Angeles County, 2004 Fatalities MVT Unspecified 15% Homicide 28% Pedestrian 18% Occupant Drowning 18% 21%
    • Fatal Assault/Homicides by Cause Children Ages 5-12 Los Angeles County, 2000-2004 80 69% 70 60 50 Percent 40 30 24% 20 10 5% 2% 0 Abuse & Cut/Pierce Firearm Other Neglect
    • Where are children drowning? Children Ages 5-12 Los Angeles County, 2000-2004 50 44% 45 40 35 Percentage 30 25 19% 18% 20 13% 15 10 6% 5 0 Bathtub Pool Open Reservoir Unspec Water
    • Hospitalizations Children Ages 5-12 Los Angeles County, 2004 Hospitalizations Bicyclist, Struck by other object 8% 9% MTV Occupant 11% Fall MVT Ped 59% 13%
    • Where are children falling from? Children Ages 5-12 Los Angeles County, 2004 40% 35% 35% 30% 25% Percent 25% 18% 20% 15% 8% 10% 6% 1% 3% 1% 2% 2% 5% 0% Building/Structure Into Hole Stair Chair Playground Bed Equipment Other Furniture Ladder Same Level Different Level
    • Common anatomical fall-related hospitalizations: Upper & Lower Extremity Children Ages 5-12 Los Angeles County, 2004 90 84% 80 70 61% 57% 60 Upper Extremity Percent 50 Lower Extremity 40 TBI 30 21% 18% 20 10% 8% 10 4% 6% 0 Playground From Different Same Level-Trip Level
    • Adolescent Ages 13-15 Leading Causes of Injury Los Angeles County, 2004 Fatality (Freq) Hospitalization (Freq) Assault/Homicide 10 Fall 718 MVT Occupant 9 Suicide 145 MVT-Unspecified 6 Assault/Homicide 116 Suicide 4 Struck-By-Object 107 Drowning 3 MVT Occupant 106
    • Adolescent Ages 13-15 Leading Causes of Injury Los Angeles County, 2004 Fatalities Drowning 4% Fall Pedestrian 4% Suicide 4% MVT 9% Unspecified 9% Homicide 57% Occupant 13%
    • Common weapon of choice (Fatal Assault/Homicides) Adolescent Ages 13-15 Los Angeles County, 2000-2004 90 84% 80 70 60 P ercent 50 40 30 20 7% 10 1% 1% 4% 3% 0 Riflt/S hotgun (m urder, Handgun S harp Object Hang/S trangul, Unspec Other Firearm m ansl) S uffocat.
    • Hospitalizations Adolescent Ages 13-15 Los Angeles County, 2004 Hospitalizations Occupant Struck by 10% Fall object 38% 13% Homicide Suicide 18% 21%
    • Percent 0 5 10 15 20 25 30 35 40 Curb 1% Stairs 6% Ladder .5% Building/Structure Into Hole 4% Storm Drain 1% .5% Playground 7% Chair Los Angeles County, 2004 Bed Adolescent Ages 13-15 Other Furniture .5% .5% .5% Different Level 24% Where are adolescents falling from? Same Level-Trip 36% Sports Activity 19%
    • Common anatomical fall-related hospitalizations: Upper & Lower Extremity Adolescent Ages 13-15 Los Angeles County, 2004 45 42 42% 40% 40 34% 35 30 29 30 Upper Extremity Percent 25 Lower Extremity 20 13% 14% 13% TBI 15 10 5 0 Sports From Same Level- Activity Different Trip Level
    • Common methods of choice for suicide- related hospitalizations: pain relievers Adolescent Ages 13-15 Los Angeles County, 2004 70 59% 60 50 Percent 40 30 18% 16% 20 10 2% 1% 2% 1% 1% 0 Analgesics/Antipyretics Corrosive Agents Tranquilizers Chemicals Other Drugs/Chemicals Hanging Gas Vapor Cut/Pierce
    • Review Leading Causes of Injury Ages Fatality Hospitalization <1 Assault/Homicide Falls 1-4 Assault/Homicide Falls Drowning 5-12 Assault/Homicide Falls Drowning 13-15 Assault/Homicide Falls Suicide
    • Contributing Factors Assault/Homicide & Suicide Intimate Partner Violence/Domestic Violence Parental abuse of alcohol & drugs Use of alcohol & drugs among youth Personality Disorders/Mental Health Depression Lack of resources/access to care Gang Activity Malnutrition-aggression & violence behaviors
    • Childhood Exposure to IPV Children observe traumatic events (IPV-family violence) to varying degrees: Home Environment: May see mothers use violence in self-defense or see both parents trading self-defense See parents occasionally slap, shove, and throw things Observes violence or threats, while the victim does not leave the home or report to police or public agencies (Straus & Gelles, 1990)
    • Symptoms of Children Exposed to IPV 29 different studies of children who witnessed IPV Behavioral Emotional Social Cognitive Physical (Kolbo, Blakely, & Engleman, 1996)
    • Behavioral Effects Aggression Tantrums "acting out" Immaturity Truancy and Delinquency (Davies, 1991; Dodge, Pettit, & Bates, 1994; Graham-Bermann, 1996c; Hershorn & Rosenbaum, 1985; Hughes & Barad, 1983; Jouriles, Murphy, & O'Leary, 1989; Sternberg, Lamb, Greenbaum, Cicchetti, Dawud, Cortes, et al., 1993)
    • Emotional Effects Anxiety Anger Depression Withdrawal Low self-esteem (Carlson, 1990; Davis & Carlson, 1987; Graham-Bermann, 1996c; Hughes, 1988; Jaffe, Wolfe, Wilson, & Zak, 1986)
    • Social Effects Poor social skills Peer rejection Inability to empathize with others (Graham-Bermann, 1996c; Strassberg & Dodge, 1992)
    • Cognitive Effects Language lag Developmental delays Poor school performance (Kerouac, Taggart, Lescop, & Fortin, 1986; Wildin, Williamson, & Wilson, 1991).
    • Physical Effects Failure to thrive Problems sleeping Eating problems Regressive behaviors Poor motor skills, and Psychosomatic symptoms (eczema, bed wetting, etc.) (Jaffe, et al., 1990; Layzer, Goodson, & Delange, 1986)
    • Specific Signs & Symptoms: Toddler/Preschooler (<5) Become more aware of their environment (easily aroused) Sleeping & Eating Disorders Somatic Complaints Stomachaches Headaches Separation Anxiety (clinging to mother/victim) Speech, motor skill & cognitive delays Depression & anxiety Difficulty in expressing emotions-but anger (National Resource Center on Domestic Violence, 2002)
    • Specific Signs & Symptoms: Childhood (5-12) Poor in School-Exhibit few options/low success Self esteem limitations Frequent mood swings Erratic attendance Inability to concentrate Poor social skills Conflicts with classmates & teachers Excel in School-Try to overcome & suppress family dysfunction Seek approval by doing well in structured school environment Perfect student Making many friends However: Live with unpredictable home environments Conflict-loving/hating their parents Experience guilt, depression, sadness, powerlessness Unable to relax/sleep Signs of PTSD (National Resource Center on Domestic Violence, 2002)
    • Specific Signs & Symptoms: Adolescence (13-15) Eating difficulties resulting in anorexia, bulimia, or obesity Academic difficulties-leading to dropping out Feeling powerless, fear, delinquency, substance abuse, suicide Intimate partner relationships Without proper intervention-exhibit sex roles and communication patterns learned from dysfunctional home environment-contributing to the generational cycle of violence (National Resource Center on Domestic Violence, 2002)
    • Contributing & Protective Factors Falls Risks: Infant changing and sleeping locations Preschool aged children-greatest risk of fall-related fatalities 50% occurring among children <4 80% fall related injuries among children <4 occur at home and mostly during noontime and early evening (playtime) Prevention: Supervision (home & playground) Changing tables & beds-use of rails Use of safety gates leading to different levels/stairs Avoid asphalt, concrete, grass or soil surfaces under playground equipment-use of mulch, rubber, etc.
    • Contributing Factors Drowning Seasonal: 72% occur during summer months Location: 51% occur in private swimming pools Age: Infants and toddlers: 88% occur in private swimming pools 70% of these children were not expected to be in or at the pool, but somewhere in the home Lack of “Active” Supervision: SAFE KIDS Worldwide study: 90% of children who had drowned, had been supervised by an adult Child wading and inflatable pools: Carry similar risks
    • Protective Factors Drowning “Active” Supervision (Lifeguard) Barrier Fencing Self-closing/Self-latching gates (open outward) Locks and Alarms on all windows/doors (leading to pool area) Wading/Inflatable pools: Smaller: Empty/turn over after use Larger: Require fencing/Electrical requirements
    • Contributing & Protective Factors MVT-Occupant Riding improperly restrained-greatest risk factor Currently 85% misuse rate (Child Passenger Safety) 63% seat belt not anchored tightly 33% harness straps not snug 20% harness straps improperly routed 11% forward-facing before age 1 and 20 lbs More than 80% of the children under 4 years old killed in car crashes in California since 1990, would have survived if buckled properly When used properly CPS can reduce the risk of fatal injury by 70% for infants, 55% for toddlers, and 59% booster seats
    • Contributing & Protective Factors Bicycle Poorly fitted helmets=twice the risk of head injury in a crash compared with children whose helmet is properly fitted Children who wear their helmets tipped back on their heads have a 52% greater risk of head injury than those who wear their helmets centered on their heads. Bicycle helmets have been shown to reduce the risk of TBI by as much as 88%
    • Contributing & Protective Factors Pedestrian Walking too close to a school bus at drop off zones Walking between cars and school busses Not obeying traffic pedestrian laws Children <12 not to walk without an adult
    • Contributing & Protective Factors Seasonal-Summer Months Childhood injuries increase during summer months both nationally and in Los Angeles County 51% childhood injuries in Los Angeles County occur between June-August 72% drowning 56% bicycle 41% pedestrian 38% MVT-occupant
    • Summary Leading causes of injury fatality & hospitalizations Specific pediatric ages at-risk of injury Contributing & Protective Factors
    • Conclusion Five Handouts (Injury Prevention Planning Tools): 1. Behavioral & developmental factors by age 2. Review of anatomic and physiologic factors that contribute to pediatric injury 3. Pediatric Injury Prevention Project Planning Worksheet 4. Haddon Matrix sample 5. Haddon Matrix template
    • Preventive Resources Injury & Violence Prevention Program (IVPP) Website: www.lapublichealth.org/ivpp Contact Information: jdecarli@ladhs.org (213) 351-7888