Send letter to journal:
Re: Paediatric head injury audit

Dear Editor,

In response to the recent article 'Accidents and resulting injuries in premobile infants', S.A Warrington et al. It was interesting to see that 97% of these injuries involved the head. Although they were predominantly trivial, the question is, how many of these injuries could be described as easily preventable?

I recently audited the numbers of babies under the age of 6 months who attended our Accident and Emergency department with a head injury during the last year.

I reviewed the case notes to ascertain the mechanism of injury.

The results showed that 25% of attendences were as a direct result of the baby not being strapped into either their pram, carrier chair, or car seat.

This unexpectedly large number has prompted a local awareness campaign with letters sent to local magazines and newspapers. We are also looking into funding a poster campaign aimed at the local GP surgeries.

Yours Sincerely

Send letter to journal:
Re: Accidents in pre-school children

We were interested to read the paper by S. Warrington C.Wright and the ALSPAC Study Team on accidents and resulting injuries in premobile infants in the August edition of ADC. The high incidence of falls in children less than six months old (22% of the cohort) is similarly seen in our clinical practice, as is the fact that the majority of children (78% in the study) do not sustain a significant injury.

The Birmingham Heartlands' Hospital is a busy district general hospital serving East Birmingham, Solihull and the surrounding area. We have recently performed a study (unpublished data) of injuries occuring in preschool children following "domestic" falls. Our study population consisted of children presenting to the Accident and Emergency department following a fall, and thus is a more selected group than that studied in the ALSPAC study; our results are however similar to theirs.

The study consisted of 1662 children seen in the Accident and Emergency Department following a fall over a 21 month period. 147 children were less than six months old at presentation (8.8% of the total); 116 of these had fallen off something such as a bed, settee or change table, 14 children had fallen downstairs and 17 had fallen over. Throughout the whole group serious injuries were uncommon, 882 children (53%) did not require any treatment. However 158 children (9.5%) sustained a fracture. Only 2 children less than six months old sustained a fracture (1.3% of that age group). One three month old child was being carried by his mother downstairs when she slipped and fell with him, he sustained a greenstick frature of his right didtal tibia, and a five month old child was dropped by his aunt and sustained a proximal ulna fracture. No child in this age group sustained a life threatening injury or a skull fracture. No child that fell off a bed, settee or change table had a serious injury.

Send letter to journal:
Re: Re: Accidents in pre-school children

We were pleased to read the comments made by Drs Wilne and Radd, reporting similar findings to those in our study. Dr Bint makes a useful point about prevention. To put into place effective accident prevention strategies, information needs to be available about the cause of injuries.

In our study of 11466 children, 2554 falls were reported. Only 26 of these were serious falls (i.e. resulting in fracture, concussion or admission to hospital). However of these, 6 falls were in a car seat or bouncy cradle, 2 infants were not strapped in and one fell in a carrycot. Although falls from baby chairs account for 5% of all falls, they are responsible for 23% of serious injuries (6/26).

The message for prevention is for seats not to be placed on raised surfaces as the potential for serious injury is great. Finally, since over 50% of falls were off beds and settees, awareness of potential mobility even below 6 months, is an important message for prevention.

Shirley Warrington
Paediatric Specialist Registrar, Royal Victoria Infirmary,
Newcastle upon Tyne NE1 4LP