Every year thousands of children are seriously injured and many die on the roads or at home. These injuries and deaths can be prevented by a range of simple, effective measures, according to the National Institute for Health and Care Excellence (NICE).

Unintentional injuries[1] are a leading cause of death and serious injury in children and young people under 15. Serious injury can lead to long term consequences such as disfigurement or disability and it can also impact on a child's education, affecting their attendance and performance at school. Each serious injury and death is a tragedy, yet many are avoidable. NICE's recommendations are based on evidence about the measures that work to save lives and protect children from serious injuries.

Today (24 November) NICE has published three pieces of complementary guidance which aim to help keep children and young people safe from serious harm. These consider: strategies to prevent unintentional injuries, home safety assessments and the provision of safety equipment and road design and modification.

Although minor injuries, such as bumps and bruises, are normal in day-to-day life, children and young people are still being seriously injured or dying from injuries which are preventable. This set of guidance is particularly aimed at children from disadvantaged backgrounds, as they are much more likely to die from an unintentional injury than those living in less disadvantaged circumstances[2]. Disadvantaged children include low income families and children living in multiple occupied, social or privately rented housing.

Below are the key recommendations for each piece of guidance:

1. Strategies to prevent unintentional injuries among under-15s

The recommendations cover:

• Planning and coordinating local activities.
• Workforce training and capacity building through professional standards and curricula.
• Injury surveillance to monitor the incidence of unintentional injuries among under-15s and to help plan preventive initiatives.
• Carrying out home safety assessments and fitting permanent safety equipment
• Outdoor play and leisure, including policies to ensure public play spaces are safe, and education and advice on water and firework safety.
• Road safety, including strategies to help reduce vehicle speed in areas near where children and young people are present and co-coordinating and managing road safety activities through road safety partnerships.

Heather Ward, Chair of the Programme Development Group (PDG) that developed the ‘Strategies' guidance; and Honorary Senior Research Fellow at Centre for Transport Studies, University College London, said:

“At the moment, there are many different people involved in unintentional injury prevention, so there needs to be coordination especially at local level. That's why this guidance recommends there is a local injury prevention coordinator.

“Their role would be to coordinate activities across a number of local organisations, such as highway authorities, fire and rescue services, housing and children's services, to help align policies and strategies in this area and encourage people to work together more effectively.

“This new guidance on ‘Strategies' also recommends some low cost measures that can be adopted by landlords in the home, for example installing a thermostatic mixing valve. This controls the temperature of the water coming into the bath. The idea is that it prevents very young children from being scalded when they are being bathed. It's already in the building regulations for new houses to be fitted with these valves but we would like to see them installed by landlords into existing properties where there are young children.

“Given that it can cost up to a quarter of a million pounds to treat a scalded child, not to mention the scarring for life that these children endure, then it's a very good measure to implement.

“Our aim is not to promote a nanny state where children can't have fun or lead normal lives. Exposing children and young people to challenges can be beneficial, helping them to learn, develop and mature, but it is vital to stop serious injuries and deaths, which are avoidable, from happening. We hope this new ‘Strategies' guidance will set a gold standard for everyone with responsibility for preventing unintentional injuries in young children.”

2. Home safety assessments and the provision of home safety equipment

The recommendations focus on providing home safety assessments, supplying and installing home safety equipment and providing education and advice when carrying out these activities. The guidance includes the following advice:

• prioritise households at greatest risk
• establish partnerships with local community organisations
• offer home safety assessments and advice
• offer appropriate safety equipment including door guards, cupboard locks, safety gates, smoke and carbon monoxide alarms, thermostatic mixing valves and window restrictors.

Professor Mike Kelly, NICE Public Health Director, said:

“Injuries in the home are the leading cause of unintentional injuries[3] for children aged under 5, including falls, burns and scalds, drowning, suffocation and poisoning.

“We recommend that help should be offered to parents and carers who may not necessarily have the appropriate information or tools to identify risks in their homes or may not have the money to buy and install the right equipment.

“Our guidance on home safety assessments is about identifying and offering help to households at greatest risk. We know that simple safety equipment, for example, stair gates, and smoke alarms are effective in preventing deaths and serious injuries.”

3. Road design and modification

The guidance covers 20mph limits, 20mph zones and engineering measures to reduce speed or make routes safer. The recommendations include advice on:

• How health professionals and local highways authorities can coordinate work to make the road environment safer.
• Introducing engineering measures to reduce vehicle speeds, in line with Department for Transport guidance.
• Making routes commonly used by children and young people safer. This includes routes to schools and parks.

Professor Catherine Law, Chair of the Public Health Interventions Advisory Committee (PHIAC) at NICE and Professor of Public Health and Epidemiology, at the University College London Institute of Child Health said:

“Road collisions are the biggest cause of deaths from unintentional injuries for children under 15, and yet many of these can be prevented with a range of relatively simple measures, such as city or town-wide 20mph limits and zones on appropriate roads or engineering measures, such as speed humps.

“There is a clear link between increasing speed and the risk of death in the event of a vehicle hitting a child. We also know children from poorer families are at high risk because they're more likely to be exposed to danger, for example, living in neighbourhoods with on-street parking, high-speed traffic and few or no off-street play areas.

“It's natural that children will act spontaneously, for example, run across the road to see their friend, so we need to reduce danger, by for example, slowing down traffic along routes commonly used by children.”

Katrina Phillips, Chief Executive of the Child Accident Prevention Trust (CAPT) said:

“We welcome the publication of the NICE public health guidance today. Thousands of children, especially those from less well-off homes, are seriously injured each year, with huge emotional costs for the families involved and huge social and financial costs for local councils and the NHS.

“Yet many of these deaths and serious injuries can be prevented through the measures NICE recommends - better data, stronger local partnerships, staff training, home safety assessments and safety equipment, slowing down traffic speed and prioritising those families at greatest risk.

“Parents tell us they worry about their child having a bad accident and want to know more about how to stop their child being badly hurt.

“We look forward to working with NICE to help local councils and the NHS put these recommendations into practice.”

Errol Taylor, Deputy Chief Executive of The Royal Society for the Prevention of Accidents (RoSPA) said:

“RoSPA is delighted with the publication of this guidance from NICE. In particular, it reinforces the urgent need to tackle home accidents which are blighting so many young lives. We fervently hope that everyone who has a part to play in reducing home accidents takes this guidance to heart and acts on it quickly.”

Julie Townsend, Campaigns Director at road safety charity Brake, said:

“We welcome this guidance recommending that authorities to do more to slow vehicle speeds in communities. Brake sees first-hand the appalling devastation that child road casualties cause to thousands of families every year. Yet these casualties are preventable. One of the key ways we can safeguard children on roads is to reduce vehicle speeds - at 20mph a driver has a good chance of stopping in time should a child run out three car lengths ahead, so we believe that 20 is the appropriate speed limit around schools, homes and shops. Throughout Brake's Road Safety Week we are urging drivers to slow down to 20mph in communities to protect children.”

Mike Hagen, Deputy Chief Executive and Deputy Chief Fire Officer at Merseyside Fire and Rescue Service said:

“We have carried out more than 700,000 home fire safety checks over the last decade on Merseyside and they are making a substantial difference to people being safer from fires.

“They have contributed to a 33% fall in accidental home fires, a 60% drop in fire casualties and fire deaths have reduced from 20 plus to single figures annually during that decade.

“What is also remarkable about the delivery of that service is that we have had a fantastic response on peoples' doorsteps and almost no complaints from the public despite all those contacts with our staff.”

Brian Tytherleigh, Director of Business Performance and Development at the Children's Workforce Development Council said:

“The Children's Workforce Development Council (CWDC) recognises the importance of effective workforce guidance, standards and training on reducing unintentional injuries among children and young people.

“For everyone working with children, young people and their families, in all sectors and at all levels, the guidance will help safeguard the health and wellbeing of children and young people through a collaborative approach to injury prevention.”

Notes to Editors

Useful statistics

1. Unintentional injury is a leading cause of death among children and young people aged 1-14[4]. Around 200 children die from unintentional injuries each year in England and Wales - about four children every week[5].

2. In 2009, 65 under-15s were killed and 2267 were seriously injured in road collisions in Great Britain[6].

3. While the largest number of childhood deaths from unintentional injuries occur on the road, a substantial number also die at home or in leisure environments. For example, in 2008, 55 children died from choking, suffocation, or strangling, 17 from drowning and 10 from smoke, fire and flames in England and Wales[7].

4. In the UK, unintentional injury (in all environments) results in more than two million visits to accident and emergency (A&E) departments by children every year. Half of these injuries occur in the home[8].

5. Children whose parents have never worked (or are long-term unemployed) are more likely to die from an unintentional injury compared to children whose parents are in higher managerial or professional occupations.[9]

About the guidance

6. On Wednesday 24 November 2010 NICE issued final guidance on strategies to prevent unintentional injuries among children and young people aged under 15. It should be read in conjunction with two pieces of related intervention guidance published at the same time. These focus on the provision of home safety equipment and home risk assessments; and road design and modification.

7. The strategies guidance is for commissioners and providers of health services, local authority children's services, local authorities and their strategic partnerships, local highway authorities, local safeguarding children boards, police, fire and rescue services, policy makers, professional bodies, providers of play and leisure facilities, and schools. It is also for other public, private, voluntary and community organisations and services which have a direct or indirect role in preventing unintentional injuries among under-15s.

8. The guidance on home safety assessments and providing home safety equipment is for commissioners and providers of health services, environmental health services, housing services and associations, local authority children's services, local authority health and wellbeing boards, local authorities and their strategic partnerships, local safeguarding children boards, police, fire and rescue services, Sure Start and children's centres. It is also for practitioners who visit families and carers with children and young people aged under 15 (including GPs, midwives, social workers and health visitors).

9. The guidance on road design is for local highway authorities, local strategic partnerships, directors of public health, health professionals who have a responsibility for preventing or treating unintentional injuries affecting children and young people aged under 15, and school travel planners. It may also be of interest to road users, children, young people, their patents and carers and other members of the public.

10. Although NICE public health guidance is not statutory, the NHS, local authorities and the wider public, private, voluntary and community sectors are expected to follow it. NICE public health guidance applies in England only.

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