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4102.0 - Australian Social Trends, 2005  
Previous ISSUE Released at 11:30 AM (CANBERRA TIME) 12/07/2005   
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Contents >> Health >> Children's accidents and injuries

Mortality and Morbidity: Children's Accidents and Injuries

The number of injury deaths of children aged 1-14 years declined over the past two decades, from 553 deaths in 1983 to 231 in 2003.

Children are much less likely to have long-term health conditions than adults, and infant and child death rates are generally declining and are at their lowest in a century. In 2003, 20% of the Australian population was aged 0-14 years (around 4 million children), while child deaths accounted for 1.3% of all deaths registered in that year (see Australian Social Trends, 2002, Infant mortality). But this does not fully reflect the range of issues affecting children's health. High rates of preventable injuries among children relative to other age groups are of concern to health professionals, the community and governments. In 2004, the Australian government identified children aged 0-14 as a priority injury issue. (endnote 1)


INJURY DEATHS

Most child deaths are of infants aged less than one year (68% of deaths of 0-14 year olds in 2003), and are related to perinatal and congenital factors. However, once the infancy period has passed, injury deaths (e.g. from transport accidents, drownings, or assaults) emerge as the leading cause of death for children. Over the five year period 1999-2003, 41% of deaths of children aged 1-14 years (i.e. excluding infants) were injury deaths (1,260 children). By comparison, injuries caused around 6% of deaths of people aged 15 years and over. The next most common cause of death of children of this age - malignant neoplasms, or cancer - caused less than half the number of child deaths over the same period (537 children). Over the last two decades, the number of child deaths due to injury declined substantially (from 553 in 1983 to 231 in 2003), while the number of cancer deaths declined at a slower rate, from 150 to 93.

Boys are more likely than girls to experience and die as a result of an injury. While half of all children are boys (at 30 June 2001, 51% of 1-14 year olds were boys), nearly two-thirds of injury deaths for this age group between 1999 and 2003 were boys (62%). This difference between girls and boys in relation to injury and deaths exists regardless of the child's age, and across all OECD countries. (endnote 2) It may relate to differences in behaviour, in the type of activities boys and girls engage in, and in the ways in which boys and girls are socialised from a young age. (endnote 3)


Injury deaths

Data on injury deaths are from the ABS Causes of Death Collection.

An injury is a trauma, poisoning, or other condition of rapid onset to which factors and circumstances external to the person contributed significantly. External causes of injury may be physical, chemical or psychological. Injuries may be unintentional, e.g. as a result of transport accidents, sports injuries or poisonings, or may be intentional, e.g. those resulting from assault.

Injury deaths are deaths where the underlying cause was classified to ‘External Causes of Morbidity and Mortality (V01-Y98)’ in the International Classification of Diseases (ICD-10).


Leading causes of death for children aged 1-14 years(a)

Graph: Leading causes of death for children aged 1-14 years(a)


...transport accidents

When infant deaths are included, there were 1,473 child injury deaths between 1999 and 2003. Children who had died from injuries were more likely to have died in transport accidents, than in any other way: 587 children aged 0-14 years (40%) died this way between 1999 and 2003. This was about twice as many as died from accidental drowning, the next most common cause of child injury death.

Boys were consistently more likely to have died in transport accidents than girls across all child age groups. The difference was greater among 10-14 year olds (150 boys compared with 77 girls) than among 1-4 year olds or 5-9 year olds.


In most deaths that were the result of a transport accident, the child was either the occupant of a motor vehicle (44% of deaths) or a pedestrian (35%). The remaining deaths were in accidents where the child was a pedal cyclist (5%) or motorcycle rider (4%), or were other transport accidents (12%). Children were much more likely than adults to have been a pedestrian in the accident (16% of people aged over 15 years).


The overall decline in injury deaths between 1983 and 2003 was partly driven by a decline in transport accident deaths. Many factors can contribute to such a decline, including accident prevention strategies (e.g. speed limit initiatives), improved car safety, improved emergency and medical response, or fewer children travelling on foot. (endnote 2)


...accidental drowning

Accidental drowning accounted for 19% of all child injury deaths between 1999 and 2003 (286 children). (See also Australian Social Trends 2000, Accidental drowning). Other accidental threats to breathing, such as suffocation or choking, accounted for 11% (163 children). The difference between boys and girls was marked in relation to accidental drowning for nearly all child age groups. More than twice as many boys as girls drowned over the period (193 boys; 93 girls).

Children aged less than five years are most vulnerable to drowning: 80% of child drowning deaths were of children aged under 5 years (229 children). Most of these were 1-4 year olds, who are more mobile than infants but are still developing motor skills and not of an age to judge hazards. The death rate from accidental drowning for 1-4 year olds (3.9 per 100,000) was higher than for all age groupings for both children and adults.


The events leading to drowning were also different for young children - who tended to drown following a fall into water, while older children were more likely to have drowned once already in water. For example, most children aged less than 5 years who drowned in a swimming pool fell into the pool (78%).


The most common location of infant drowning was in the bath (62% of children aged less than 1 year). Drowning deaths of older children (aged 1-14 years) most
commonly occurred in a swimming pool (42%), or a body of natural water such as a lake, river, stream or the open sea (24%).

INJURY DEATHS, CHILDREN AGED 0-14 YEARS - 1999-2003

Age
(years)

Total child deaths
0-14 years
Proportion that were males
Under 1
1-4
5-9
10-14

no.
no.
no.
no.
no.
%
%

Transport accidents
17
182
161
227
587
39.9
59.8
Accidental drowning
29
200
35
22
286
19.4
67.5
Other accidental
threats to breathing(a)
88
45
12
18
163
11.1
62.6
Assault
39
44
30
15
128
8.7
54.7
Exposure to
mechanical forces(b)
10
25
13
16
64
4.3
68.8
Intentional self-harm
0
0
n.p.
n.p.
56
3.8
58.9
Smoke, fire, flames
7
21
14
8
50
3.4
58.0
Falls
3
12
11
7
33
2.2
48.5
Accidental poisoning
3
10
n.p.
n.p.
25
1.7
52.0
Other injury deaths
17
22
19
23
81
5.5
55.6
All injury deaths
213
561
299
400
1 473
100.0
60.8

(a) Includes accidental suffocation, strangulation, and hanging as well as selected other separate causes.
(b) Includes animate mechanical forces and inanimate mechanical forces.

Source: ABS Causes of Death Collection.

...other types of injury death

Assault accounted for 9% of child deaths (128 children) between 1999 and 2003. Young children were more likely to have died from assault than older children. Two thirds (65%) of child deaths from assault were of children aged less than 5 years (83 children). More boys than girls died from assault between 1999 and 2003 (70 compared with 58). (See also Australian Social Trends 2003, Child protection).

Other types of injury death each individually accounted for less than 5% of child deaths over the five year period. This included 64 children who died in accidents resulting from exposure to mechanical forces, and 50 who died in fires. A further 4% of children who died from injuries, died through intentional self-harm (56 children), most of whom were aged 13 or 14 years.



RECENT INJURIES


While fatal outcomes are rare, the ABS 2001 National Health Survey found that many more Australian children than adults had recently been injured. In 2001, 18% of children aged 0-14 years had received an injury in the previous four weeks for which some action had been taken. This proportion declined with age (ranging from 17% of 15-24 year olds to 6% of people aged 65 years and over).


While this included injuries needing minor first aid (e.g. applying a bandaid), it extended to more serious events that required medical advice or hospitalisation. Injuries are the main reason children are hospitalised. In 2002-03, there were 68,000 hospitalisations of children aged 0-14 years for injury.


Consistent with mortality patterns, boys are more likely to be injured than girls (19% of boys had recently been injured in 2001, compared with 16% of girls). Boys were also hospitalised for injury more often than girls. In 2002-03, there were 42,600 hospitalisations for injuries of boys, and 25,400 of girls. Boys aged 10-14 years had the highest rate of hospitalisation among all boys. In contrast, hospitalisation for injury for girls peaked among girls aged 1-4 years. Thus, the difference between boys and girls was most marked among 10-14 year olds - boys this age had more than twice as many hospitalisations for injury as girls in 2002-03 (16,600 and 7,300 respectively).


The average length of stay in hospital of injured children is generally lower than that of adults who have been injured. In 2002-03, the average length of stay in hospital was 1.7 days for 1-4 year olds and 5-9 year olds, and 1.9 days for 10-14 year olds. Average length of stay for injury then increased with age (e.g. it was 5.8 days for 65-69 year olds). However, the average length of stay in hospital for infants aged less than one year was higher than for other children: 2.4 days.

Hospital separations for injury(a) - 2002-03

Graph: Hospital separations for injury(a) - 2002-03


Recent injuries

Recent injury data are from the ABS 2001 National Health Survey (see also National Health Survey: Injuries, (ABS cat. no. 4384.0). A recent injury is an accident, harmful incident, exposure to harmful factors, or other incident, occurring in the 4 weeks prior to interview and resulting in an injury, and in one or more of the following actions being taken:

  • consulting a health professional
  • seeking medical advice
  • receiving medical treatment
  • reducing usual activities
  • other treatment, e.g. taking medications, using a bandage, band aid, heat pack or ice pack
Although people could report a large number of such events, detailed data were only reported for the three most recent events.

Hospitalisations

Hospitalisation data were accessed from the Australian Institute of Health and Welfare's (AIHW) National Hospital Morbidity Database.

Hospitalisations
refer to hospital separations, which are episodes of care in hospital. A separation can be a total hospital stay (from admission to discharge, transfer or death), or a portion of a hospital stay beginning or ending in a change of type of care (e.g. from acute to rehabilitation). Out-patient treatment at a casualty or emergency department is not included in hospital separations.

...activity and location when injured

Physical activity is considered crucial to development in children, and Australian children are generally physically active. For example, the ABS 2003 Survey of Children's Participation in Selected Culture and Leisure Activities shows two thirds (67%) of school aged children (5-14 years) had participated in organised sport or dancing (outside of school) in the past 12 months. Similarly, 66% of children this age had undertaken the active leisure activities of bike riding, skateboarding or rollerblading in the previous two weeks.


In 2001, 498,000 children aged 5-14 years reported being injured recently. The most common activities these children had been undertaking at the time of injury were leisure activities (e.g. playing non-organised sport or games, reading, watching videos), and organised sports. In 2001, half of all recent injuries for children this age (51%) occurred during leisure activities, and around a third (27%) while children were playing sports. A further 17% occurred while attending school. (endnote 4)

The most common locations at which 5-14 year olds received injuries were outside their own or someone else's home (32%), at school (30%), at a sports facility (20%), or inside their own or someone else's home (16%).

At a broader level, international studies have suggested that the likelihood of a child being injured or dying from injury may be associated with a range of socioeconomic factors, such as poverty, poor housing, single parenthood, low maternal education, low maternal age at birth, and parental alcohol or drug abuse. (endnote 2) Demographic factors may also influence injury rates. Children living in regional and remote areas of Australia are more likely to die from injury than those living in major cities. (endnote 5) This could be because children in different areas have different socioeconomic characteristics, are exposed to different hazards, or have different access to various health services. (endnote 5)

...events leading to injury

In 2001, 11% of all children aged 0-14 years were injured in a fall, 3% in a collision (hitting something or being hit by something), 2% by a bite or sting, and 0.6% in an attack by another person. Patterns in the types of injuries children receive tend to vary substantially in relation to the age of the child and their stage of development. That is, as children begin to learn the particular physical and cognitive skills associated with a given stage of development, they become more vulnerable to the physical risks associated with that stage, until they master those skills. (endnote 7)

Falls caused the greatest proportion of recent injuries for children (61%). Of children injured in falls, most were injured in a low fall of one metre or less (93%), rather than a high fall from more than 1 metre (7%), and most were engaged in sporting or leisure activities at the time (75%).

Collisions were the next most common cause of recent injury for children (17%). Boys were more likely to be injured this way than girls (20% of recently injured boys, and 13% of girls in 2001). As with falls, sports and leisure activities were the most common activities being undertaken at the time of the collision. Of children injured in collisions, 41% were participating in leisure activities (38% of boys and 46% of girls), and 34% were involved in sports (37% of boys and 29% of girls).

Of children recently injured, 12% were injured by a bite or sting (including bites from animals such as dogs and snakes, and some insects and spider bites). Children were more likely than any other age group to have been injured this way. Half (51%) of children who were bitten or stung were outside their own or someone else's home at the time.

In 2001, around 25,000 children had been injured in an attack by another person in the four weeks prior to interview - accounting for 4% of recent child injuries. Children were more likely than adults to have experienced injury from attack in the previous four weeks (0.8% of children aged 5-14 years compared with 0.2% of people aged 15 years and over). Most 5-14 year olds recently injured in an attack, had been at school at the time (72%). (endnote 5) Boys in this age group had been injured in an attack by another person at three times the rate of girls (1.2% and 0.4% respectively). (See also Australian Social Trends, 2003, Child protection, pp.50-54).

Events leading to recent injury(a) - 2001
Graph: Events leading to recent injury(a) - 2001
(a) As a proportion of the total population in that age group.
Source: ABS 2001 National Health Survey.


HOW DO CHILD INJURIES AFFECT LIVES?

In 2001, of those with a recent injury, school aged children (5-14 year olds) had taken time off work or study at twice the rate of people aged 15 years and over (2.9% and 1.7% respectively). However, while children are injured at higher rates than other age groups, they are much less likely to receive injuries that lead to long term health conditions or disability. In 2003, 0.2% of 0-14 year olds had a disability that was the result of an injury, and the proportion increased with age (from 1.3% of 15-24 year olds to 6.4% of people aged over 85 years). However, where children are seriously injured the resulting physical, cognitive or psychological disabilities can seriously affect not only the child's quality of life but that of their family. (endnote 3) Families are often also profoundly affected by the death of a child through injury. (endnote 2)

The 2001 UNICEF report, Child deaths by injury in rich nations notes that "children's judgement of potential dangers and of their own physical ability is developed through pushing the boundaries of their experience, developing their own sense of risk and danger, and taking progressive responsibility for their own lives." (endnote 2) This report also notes that children's activities may be becoming increasingly curtailed in response to concern about accidents and other threats. (endnote 2) For example, concern about transport accidents may lead to fewer children cycling, walking or otherwise being active.


Child safety and injury prevention

By its nature, injury prevention can involve many different levels of community, business and government operation, covering such areas as research, policy, public education, legislation, manufacturing practice, and environmental and road system modification. For example, selected injury prevention measures mentioned in the 2001 UNICEF report, Child deaths by injury in rich nations, include reducing:
  • traffic deaths through legislative change, safer car design, wearing of cycle helmets
  • fire deaths through smoke alarms, flame resistant nightwear, electrical safety standards
  • poisoning and ingestion deaths through use of childproof packaging of pharmaceuticals and safety standards for toys and games
  • falling deaths through safety glass, stair gates, window bars, and playground safety standards
  • drowning deaths through learn to swim campaigns and fencing swimming pools

In Australia, there are a range of community organisations and government initiatives with a focus on child safety, for example: KidSafe (The Child Accident Prevention Foundation of Australia); FarmSafe Australia; the federal government's Strategic Injury Prevention Partnership initiative; and the Australian Injury Prevention Network.

The KidSafe NSW website provides guidelines for four focus areas: home, playground, road, and water safety; and for ten common injury areas: car passenger; pedestrian; drowning; house fires; falls; nursery furniture; scalds; poisoning; bicycles; and in-line skates and skateboards. (endnote 8)


ENDNOTES

1 Department of Health and Ageing 2004, Draft National Injury Prevention Plan: 2004 Onwards Priorities for 2004 <http://www.health.gov.au/internet/wcms/publishing.nsf/Content/Injury+Prevention-5> accessed 16 June 2005.

2 United Nations Children's Fund 2001, A League Table of Child Deaths by Injury in Rich Nations, Innocenti Report Card, Issue no.2, UNICEF Innocenti Research Centre, Florence.

3 Australian Institute of Health and Welfare 2002, Australia's children: their health and wellbeing 2002, AIHW, Canberra.

4 Clapperton, A, Cassell, E, Wallace, A 2003, 'Injury to children aged 5–15 years at school', Hazard, edition no. 53, pp.1–16.

5 Australian Institute of Health and Welfare 2003, Rural, Regional and Remote Health: A study on mortality, Rural Health Series No.2, AIHW, Canberra.

6 Moller, J Kreisfeld, R 1997, 'Progress and current issues in child injury prevention', Australian Injury Prevention Bulletin, no. 15, AIHW, National Injury Surveillance Unit, Adelaide.

7 ABS2003 Survey of Disability Ageing and Carers.

8 Kidsafe NSW, Inc. <http://kidsafensw.org> accessed 9 March 2005.

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