Injuries are killing children, leading to more deaths in our country than all other causes combined, including disease. Many of those injuries happen at home.
"If a disease were killing our young people in the proportion that injuries are," said C. Everett Koop, the former surgeon general, "the public would be outraged and demand that this killer be stopped."

Children cannot be constantly supervised but changes can be made in a household to reduce the chance of injury.
The New York State Department of Health grounds its approach to injury prevention in the perspective that injuries are not "accidents" but can be predicted and therefore can be prevented.
"The tragedy of injury is that most of the resulting deaths, disabilities, and disfigurements need not happen at all," states the health department in "Injury Prevention in New York State," posted on its website. "With injury, there is a direct connection between prevention and outcome....
"Although the greatest cost of injury is in human suffering and loss, the financial cost is staggering as well both in health-care dollars and in losses to society. Despite these great costs, it is only within the past decade that the injury problem has been accorded sufficient national and state attention to make a lasting difference."

Each week, an average of 164 New York residents die from injury and another 3,023 are hospitalized. In one year, hospital charges alone for injuries occurring in New York totaled more than $1.6 billion, according to the health department.

The very young and the very old are particularly vulnerable. Seventy percent of fatal falls occur among persons aged 70 or older. Nonfatal falls among those over 70 are more frequent, more severe, and are increasing each year.

Fire is the leading cause of injury death for children one to four years old. Scalds are the second-leading cause of injury hospitalizations for children under the age of one.

Each year, more than 5,000 New Yorkers are hospitalized due to unintentional poisonings; more than 300 die.

The state’s Department of Health isolated for The Enterprise the top 10 causes of hospitalization due to unintentional injuries occurring in the home, based on the most recent figures available, from 2001 to 2003.

Falls are first, nearly 10 times as frequent as the second-ranked, with a mean annual frequency of 33,729. Second is poisoning, with a frequency of 3,470. Third is scalding at 1,470 and fourth is environmental at 1,187. Fifth is cutting or piercing at 872 and sixth is being struck at 787. Seventh is overexertion at 681 and eighth is fire or flame at 595. Ninth is suffocation at 325 and 10th is injury caused by machinery at 141.

The good news is that simple changes in the home can prevent these injuries from occurring. Advice follows, compiled from the United States Consumer Product Safety Commission, the Centers of Excellence funded by the National Center for Injury Prevention and Control, and the New York State Department of Health.

Window blinds
Window blinds top the "Most Wanted" list put out by the United States Consumer Product Safety Commission.

From 1991 to 2000, the commission received reports of 160 strangulations involving cords on window blinds; 140 strangulations involved the outer pull cords and 20 involved the inner cords that run through the blind slats.

In 1994, the commission worked with the window-covering industry to redesign new window blinds to eliminate the outer loop on the end of the pull cords and provide free repair kits so consumers could fix their existing blinds. Window blinds sold since 1995 no longer have pull cords ending in loops.

In 1999, the commission reviewed the deaths related to window blinds and found that children would also become entangled in the inner cords used to raise the slats of blinds. This happens when a young child pulls on an inner cord and it forms a loop that a child can hang in.

All of these deaths involved children in cribs or playpens placed next to windows. In most cases, the outer pull cords were placed out of reach, but the children still strangled when they pulled on the inner cords of the blinds. The strangulation victims ranged in age from nine months to 17 months.

As a result of the investigation, the industry has further redesigned window blinds; those sole since November of 2000 have attachments on the pull cords so that the inner cords can’t form a loop if pulled by a young child.

Consumers with blinds bought before November of 2000 should repair them. They can call 800-506-4636 for a free repair kit for each set of blinds. The repair kit includes small plastic attachments to prevent inner cords from being pulled loose; the repair can be done in minutes without removing the blind.

Old cribs
Old cribs are also on the commission’s "Most Wanted" list.

The commission advises that there should be no more than two-and-three-eighths of an inch, about the width of a soda can, between crib slats so a baby’s body cannot fit through the slats. There should be no missing or cracked slats.

No corner posts should be over one-sixteenth of an inch high so a baby’s clothing cannot catch.

And, there should be no cut-outs in the headboard or foot board so a baby’s head cannot get trapped.

The crib’s mattress should be firm and tight-fitting, and, to prevent suffocation, there should be no stuffed toys or pillows in the crib.

For mesh-sided cribs or playpens, the mesh openings should be smaller than one-quarter of an inch in size, smaller than the tiny buttons on a baby’s clothing. The mesh should not have tears, holes, or loose threads that could entangle a baby. And the mesh should be securely attached to the top rail and floor plate.

Also, the top rail cover should have no tears or holes and staples should not be missing, loose, or exposed.

Preventing falls

To prevent falls, households with children should have safety gates on stairways.
Window guards are the most effective tool for preventing children’s falls from windows. The New York City Health Department’s "Children Can’t Fly" program reduced window falls by 50 percent.

Infants should never be left unattended on a table, bed, or other elevated surface. And safety straps should be used to secure children in strollers, shopping carts, and infant carriers.

Children should be given only stationary walkers. The number of injuries associated with mobile infant walkers led the American Academy of Pediatrics to call for a ban on their manufacture and sale.

To help avoid falls for any age group, but especially the elderly, handrails should be installed on stairways. And a step-stool and grab bar should be used to reach objects on high shelves.

Common-sense safety

Firearms and bullets should be stored in a locked cabinet or safe when not in use.

Knives and sharp utensils, frequently found in kitchens, should be kept out of reach of children. Knife blades should be pointing down when placed in a dishwasher’s cutlery basket. Safety locks should be installs on drawers that contain sharp or hazardous items.

Shelving, bookcases and heavy furniture should be secured. Heavier items should be placed on lower shelves and in bottom drawers.

Swimming pools should be surrounded by four-sided fences to prevent drowning.

Glass doors should have decals to avoid collision injuries.

Toilet safety locks keep children from falling in and drowning.

Non-skid strips in bathtubs and showers avoid slipping.

Wall outlets should have plug protectors when not in use. And ground-fault interrupters should be installed for electrical circuits in bathrooms and kitchens to avoid electrical shock when in contact with water.

Scalding and burning

To avoid scalding, the thermostat on the hot-water heater should be set no higher than 120 degrees Fahrenheit. It takes just three seconds to sustain a third-degree burn at 140 degrees.

Risk factors for scalds include bath water that is too hot and hot pans and pots on front burners of stoves. Back burners should be used when cooking and pot handles should be turned towards the back of the stove.

Hot foods and liquids should be kept away from children. The vast majority of microwave burns among children are scald burns.

The very old and the very young are at the highest risk for serious burn injuries.

Functional smoke detectors can prevent smoke inhalation deaths. A smoke detector effectively provides early warning of a fire and is the single most cost-effective measure for reducing fire-related injuries and deaths. Working alarms should be installed on each level of the home and they should be tested regularly; batteries should be replaced once a year.

Detectors for the colorless and odorless carbon monoxide also save lives.

Poisons

Locked cabinets should be used to store medicines. Even items that may seem harmless, like nail polish, can be dangerous. Whenever possible, child-resistant packaging should be used.

Toddlers are at the highest risk for poisoning as they learn to walk and explore their surroundings; males are at greater risk than females. Children in this age group are most frequently poisoned by medicines, particularly those containing iron and pain relievers; toxic plants, flowers, and berries; household cleaning products; alcohol, including liquor, cosmetics, and liquid cough and cold medicines; pesticide residues found along baseboards and on rugs.

Poisonous house plants should be kept out of the reach of children. This includes English ivy and philodendron, which can cause skin reactions, diarrhea, vomiting, and convulsions.

About 70 percent of poisonings in New York State are routinely treated safely and effectively over the telephone by trained poison information specialists in the six regional poison control centers.

Proven prevention strategies include: use of child-resistant packaging; proper disposal of old medicines; secure storage of medications, alcohol, and pesticides; education about reading all labels and following directions for property use of chemical products; age-appropriate poison prevention counseling by primary-care providers; and first-aid supplies to combat poisonings.

A list of emergency contacts such as doctors, poison control, fire departments, police, and neighbors should be kept by the phone.