CHAPEL HILL, N.C. - Unintentional injuries are a leading cause of pain and death among young children. While injuries can range in severity - from cuts and burns to drownings and poisonings - clinicians agree that many are preventable.
A new study, led by researchers at Johns Hopkins Children's Center and done in coordination with colleagues at four academic medical centers in the United States, shows that an intervention program developed by the American Academy of Pediatrics (AAP) can dramatically reduce injuries in young children. The findings were published April 1 in the journal Pediatrics.
"This study shows that prevention counseling during regular checkups can play an important part in keeping young children safe and healthy," said Kori Flower, MD, MS, MPH, Division Chief and professor of general pediatrics and adolescent medicine at the UNC School of Medicine and a lead investigator at the research site at the University of North Carolina at Chapel Hill.
The Injury Prevention Program (TIPP) was developed by the AAP in 1983 and is used throughout the United States. The program provides pediatricians with guidelines on how to advise and educate parents about injury prevention, such as installing safety gates before children learn to walk to prevent falls.
While studies have shown that injury prevention programs can help parents gain knowledge and adopt safety practices, few studies have looked at whether this and other similar programs actually reduce injuries, as well as the type of injuries children experience or whether parents seek medical care.
To study TIPP's effectiveness, a research team led by Eliana Perrin, MD, MPH, the Bloomberg Distinguished Professor of Primary Care in the Department of Pediatrics at the Johns Hopkins University School of Medicine and School of Nursing, conducted a trial at four academic medical centers in the United States, including University of North Carolina at Chapel Hill, New York University/Bellevue Hospital Center, Vanderbilt University/Vanderbilt University Medical Center, and University of Miami/Jackson Memorial Medical Center.
At two of the centers, pediatrics residents were trained on TIPP and used the TIPP screening and counseling materials at all well-child checkups for patients from 2 to 24 months old. The two other centers did not use TIPP and instead implemented a separate, unrelated intervention program called the Greenlight Study. A total of 781 parent and infant pairs were enrolled in the study.
The majority of parents were Hispanic (51%) or Black (28%), and most were insured by Medicaid (87%).
Michael Steiner, MD, MPH, the Michael F. Durfee Distinguished Professor of Pediatrics and the Pediatrician in Chief at the UNC Children's Hospital, made substantial contributions to the study's conception and design.
Researchers found that as children aged from 2 months to 24 months, the number of injuries reported also increased. For example, 9% of parents reported injuries since the last well-child check when their child was 6 months old, compared with 40% who reported injuries at 24 months.
The most common injuries reported were falls, "other" miscellaneous injuries, such as scratches, and burns. Injuries requiring medical attention also increased over the two years of life, but were only 16% of all reported injuries.
The findings also show that sites using TIPP reported significantly fewer injuries in young children - with an estimated risk of reporting injuries across each of the well-child checkups of only 14% in the participants in the academic medical centers that used TIPP as opposed to more than double that (30%) in the control group. Researchers say their findings show that TIPP was able to significantly prevent injuries in young children, and that the benefits of TIPP improved as children got older.
"From this large study, we learned that a relatively simple intervention in pediatric offices really helps parents keep their children safe," said Perrin, who was the first and corresponding author of the study. "TIPP uses what we know about how children develop to tailor the advice we give to parents at each stage, and it works."
