The relationship between childhood injuries and child development is very complex. Developmental challenges and changing capabilities can lead to particular childhood injuries (e.g., infant grasping and mouthing behavior can lead to choking on small objects). In turn, an injury can affect a child's development (e.g., a near-drowning experience could instill a fear of swimming). Children learn attitudes about safety from the adults in their lives (e.g., when adults protect children, the children learn to protect themselves; when adults do not adequately protect children, the children might learn to place themselves at risk for injuries). Children can also learn from an injury (e.g., a child whom a dog bites on the face might learn not to put his face near unfamiliar dogs).

From your own experience with children, can you think of examples in which:

a child's developmental stage might have led to an injury?

a child's injury might have affected the child's development?

a child learned unsafe attitudes and practices from an adult?

a child learned safer practices after getting injured?
"Understanding Childhood Injuries: [Key Concepts, Background Information]." Safety First: Preventing & Managing Childhood Injuries. Training Guides for the Head Start Learning Community. HHS/ACF/OHS/NCH. 2000. English.

Related to child development:

Injuries result from a child's growing, developing, and exploring the environment.
Risk and preventative measures differ according to age and development.

Injuries are one of the most serious health, social, and economic problems across all groups in the United States. Injuries lead to one in four emergency room visits, one in eight hospitalizations, and comprise the second highest lifetime health care expense.

Childhood injuries-from motor vehicle crashes to falls, burns, poisoning, drowning, choking, and violence-are of special concern. Injury is the leading cause of death and disability in children over one year of age, accounting for more than half of childhood deaths. And deaths represent only the "tip of the iceberg." For every fatal injury, it is estimated that there are over 100 non-fatal injuries, many of which result in significant disability and suffering for children and families.

For several decades, the United States has been making great progress in preventing injuries. Safety education and interventions-such as child car seats, seat belts, child-proof medicine containers, safe playground equipment design, bicycle helmets, and swimming pool fencing-have reduced childhood injury rates dramatically. In fact, all major causes of childhood death (both injury and disease) have declined over the past 30 years except one-violence. Homicide of young children has doubled; and homicide and suicide of older children has nearly tripled. The United States Public Health Service and Centers for Disease Control and Prevention have identified violence as a major public health crisis.

From a scientific perspective, injuries can be understood according to the model of diseases. They result from the interaction of three factors: the child, the cause (or agent), and the environment.

Injuries are caused by an unsafe interaction between the child and the cause of the injury (e.g., the peanut that a child chokes on or a fire that burns the child). The cause of injury comes into contact with the child because of factors in the surrounding physical and social environment (e.g., lack of adult supervision, no fence around a hazard, or bad weather).

The relationship between these three factors is described as the "Injury Triangle:"

A hurt child, his or her environment, and the cause - each on one point of a triangle.

Analyzing the interactions among the child, the cause, and the environment can help to identify the specific factors that lead to an injury.

For example: A three-year-old child is playing ball on the sidewalk in the early evening. When his ball bounces into the street, he darts out to retrieve it, is hit by a speeding car with a drunk driver, and sustains a serious head injury.

The unsafe factors include:
Specific Factors

child

focus on playing with the ball

limited awareness of traffic

limited understanding of hazards and safety rules

high physical energy and agility

cause (driver and car)

drunk driver

speeding car

poor visibility at night

environment

no adult supervision

no enclosed play area

Understanding the specific factors that cause an injury can help identify the measures needed to prevent the injury. This three-year-old child's injury could be prevented by adult supervision, playing in a fenced area, safety rules, and police enforcement of driving safety laws.

Common Risk Factors for Injury

Injuries can happen in any setting. However, certain factors lead to higher risk for childhood injuries:

Child:

Developmental or physical abilities that are typical for the child's age.

Developmental or physical abilities that are atypical for the child's age: unusual physical ability, developmental delay, sensory deficits (e.g., hearing, vision, touch), movement disorders, seizures, relational difficulties, and extensive care needs.

Temperamental characteristics: curiosity, risk-taking, high physical activity level, impulsivity, and distractibility.

Causes:

Adult equipment or items that should be inaccessible to unsupervised children: motor vehicles, farm equipment, firearms, knives, cigarette lighters and matches, stoves, chemicals, plastic bags, and medicines.

Child items that should be inaccessible to younger children: climbing structures, toys, and food.

Surfaces that should be inaccessible for children to fall onto or into: pavement, concrete or hard-packed dirt, and water.

Environment:

Places and facilities: bodies of water, swimming pools, cliffs, playgrounds, kitchens, bathrooms, open windows, garages, and construction sites.

Natural disasters: floods, tornados, hurricanes, blizzards, earthquakes, or extreme cold or heat.

Activities and times of day: late morning, late afternoon, and evening when children are tired and hungry, during transitions between activities, when the routine is disrupted (e.g., field trips, absent teacher, sick or injured child), and while adults are busy doing other things (e.g., cooking dinner, socializing, attending to another child).

Inadequate adult supervision: insufficient adult-child ratio, lack of knowledge of child development and safety, fatigue, alcohol and other drug use, mental illness, history of abuse, or family stress (e.g., problems with relationships, finances, employment, health, remarriage, birth of a sibling, incarceration).

Infants (birth to one year) are...
(e.g., almost totally dependent upon adults, not very mobile, changing quickly, exploring the world by putting things in their mouth, etc.)

Toddlers (ages one to three years) are...
(e.g., exploring their independence, walking, climbing, running, very curious, imitating older children and adults, not understanding dangers, etc.)

Preschoolers (three to five years) are...
(e.g., exploring their independence, vigorous, running fast, climbing high, throwing hard, imitating older children and adults, thinking they can do more than they can, having strong emotions and intense interactions with others, etc.)

Points to Consider:

Caregivers of children help prevent injuries among children through their roles as protectors, role models and teachers.
Prevention measures must be tailored to each child's developmental stage, capabilities, temperament, and interests.
Across all ages and developmental stages, common measures for preventing childhood injury include:
setting up and maintaining a safe environment;
establishing and teaching children the safety rules;
supervising children closely;
enforcing the safety rules.
Adults who supervise children must be constantly aware of the hazards children face and constantly taking measures to prevent them from being injured. This can be stressful. Some strategies to reduce the stress of preventing injuries include:
ensuring that the environment is developmentally-appropriate and as safe as possible;
enlisting the help of other adults in supervising the children; and
clarifying who is responsible during transitions between activities.

To prevent children's injuries, adults must:

understand children's development and the hazards they face; and
follow safety practices as protector, role model, and teacher.

Active supervision requires focused attention and intentional observation of children at all times. Educators (all Head Start staff who care for children) position themselves so that they can observe all of the children: watching, counting, and listening at all times. They also use their knowledge of each child's development and abilities to anticipate what he/she will do, then get involved and redirect them when necessary. This constant vigilance helps children learn safely.

Strategies to Put Active Supervision in Place

The following strategies allow children to explore their environments safely. Infants, toddlers, and preschoolers must be directly supervised at all times. This includes daily routines such as sleeping, eating, and changing diapers or using the bathroom. Programs that use active supervision take advantage of all available learning opportunities and never leave children unattended.

Set Up the Environment

Educators set up the environment so that they can supervise children at all times. When activities are grouped together and furniture is at waist height or shorter, adults are always able to see and hear children. Small spaces are kept clutter free and big spaces are set up so that children have clear play spaces that educators can observe.

Position Staff

Educators carefully plan where they will position themselves in the environment to prevent children from harm. They place themselves so that they can see and hear all of the children in their care. They make sure there are always clear paths to where children are playing, sleeping, and eating so they can react quickly when necessary. Educators stay close to children who may need additional support. Their location helps them provide support, if necessary.

Scan and Count

Educators are always able to account for the children in their care. They continually scan the entire environment to know where everyone is and what they are doing. They count the children frequently. This is especially important during transitions, when children are moving from one location to another.

Listen

Specific sounds or the absence of them may signify reason for concern. Educators who are listening closely to children immediately identify signs of potential danger. Programs that think systemically implement additional strategies to safeguard children. For example, bells added to doors help alert educators when a child leaves or enters the room.

Anticipate Children's Behavior

Educators use what they know about each child's individual interests and skills to predict what he/she will do. They create challenges that children are ready for and support them in succeeding. But they also recognize when children might wander, get upset, or take a dangerous risk. Information from the daily health check (e.g., illness, allergies, lack of sleep or food, etc.) informs educators' observations and helps them anticipate children's behavior. Educators who know what to expect are better able to protect children from harm.

Engage and Redirect

Educators use active supervision skills to know when to offer children support. Educators wait until children are unable to solve problems on their own to get involved. They may offer different levels of assistance or redirection depending on each individual child's needs.

The relationship between childhood injuries and child development is very complex. Developmental challenges and changing capabilities can lead to particular childhood injuries (e.g., infant grasping and mouthing behavior can lead to choking on small objects). In turn, an injury can affect a child's development (e.g., a near-drowning experience could instill a fear of swimming). Children learn attitudes about safety from the adults in their lives (e.g., when adults protect children, the children learn to protect themselves; when adults do not adequately protect children, the children might learn to place themselves at risk for injuries). Children can also learn from an injury (e.g., a child whom a dog bites on the face might learn not to put his face near unfamiliar dogs).

From your own experience with children, can you think of examples in which:

a child's developmental stage might have led to an injury?

a child's injury might have affected the child's development?

a child learned unsafe attitudes and practices from an adult?

a child learned safer practices after getting injured?
"Understanding Childhood Injuries: [Key Concepts, Background Information]." Safety First: Preventing & Managing Childhood Injuries. Training Guides for the Head Start Learning Community. HHS/ACF/OHS/NCH. 2000. English.