Home is where the hurt is

07 June 2018

Accidents at home are a leading cause of preventable death for children under five. Katrina Phillips, chief executive of the Child Accident Prevention Trust, asks how you should teach families to avoid harm in the home.


When Rosie Nicholson’s daughter was 12 months old, she swallowed a button battery, which can react with bodily fluids to create caustic soda. She survived, but not every child is so lucky: George Asan’s two-year-old daughter Francesca died after swallowing a spare button battery she found in a drawer. 

Every year in England, 55 children under five die from unintentional injuries in and around the home. There are also 40,000 emergency hospital admissions due to accidents at home among under-fives, and 370,000 visits to A&E departments (Public Health England (PHE), 2018).

After the neonatal period, unintentional harm is the top cause of death for Scotland’s children, responsible for 40% of all deaths of under-15s. One in eight emergency hospital admissions for children under 15 in Scotland are due to unintentional harm (Building Safer Communities, 2017).

While no data is collected on acquired disabilities, charities involved in post-injury rehabilitation report that children who suffer severe burns and scalds will require years of painful skin grafts and may still be scarred for life, while children with severe head injuries, for example after falls from a height, may suffer permanent brain damage.

There are strong associations between social deprivation and unintentional injuries. Children from the most deprived areas have hospital admission rates 37% higher than children from the least deprived areas (PHE, 2018).

Higher risk in the home

In both England and Scotland, children under five account for a disproportionately high number of emergency hospital admissions due to unintentional injury, providing a strong case for prioritising the early years within work on accident prevention (PHE, 2018; Building Safer Communities, 2017).

While parents and children occupy the same home environment, babies, toddlers and small children use their homes differently, as a place to play and to test their developing abilities. Their perceptions of risk and danger are different, as are their physical reactions: a baby might pull a nappy sack to their face but then lack the dexterity to remove it, while younger toddlers lack the reflex to immediately pull away from a heat source, leading to more severe burns.

PHE notes that action on the five most common causes of childhood accidents (see panel below) would make a significant contribution to reducing preventable childhood death and ill health (PHE, 2018).

These five accident types have different profiles. Some are often fatal, such as choking, strangulation and drowning. Others, such as burns and scalds, result in hospitalisations and sometimes serious long-term acquired disability, but rarely death.

In addition, accidents peak at different ages, which is linked to child development. For example, hot drink scalds peak at 12 months, as children grab for mugs left within their reach (PHE, 2018).

There is a balance to be struck between tackling longstanding and emerging risks to children. Hot drinks have been the number one cause of burns and scalds for under-fives for many years. New risks to the under-fives emerge as consumer products make life easier for adults: these include nappy sacks, liquid laundry capsules and button batteries.

Common Causes of Accidents

Opportunities for action

Community practitioners are uniquely placed to teach families about safety in the home and help reduce serious injuries to babies, toddlers and small children.

Early Years High Impact Area 5 sets out the key contribution of the health visiting service in terms of reducing accidents, with opportunities across the four levels of service from community action to complex needs (PHE, 2017a).

The Healthy Child Programme (0 to 5 years) provides a framework in which advice and support is provided to families, and in which key messages on preventing harm from unintentional injuries can be given.

For children up to two/two and a half years, universal reviews present structured opportunities to incorporate developmentally-specific safety advice and reinforce safety issues.

Home visits can present a good opportunity to discuss effective safety practices. A home safety checklist is a practical tool that can help empower parents. Education is more effective when combined with providing and fitting safety equipment.

The Ages and Stages Questionnaire and the Personal child health record, or ‘red book’, can help to link discussions about accidental injuries with child development in a natural way – slotting in safety messages while covering other issues.

In more intensive work, including the Universal Plus and Universal Partnership Plus aspects of the core health visiting service, the Making Every Contact Count approach is suitable for working on accident prevention.

Practitioners can also promote community involvement via local or national safety campaigns (PHE, 2017b).


Teaching tips

A practical guide published by PHE in collaboration with the Child Accident Prevention Trust (CAPT) offers an at-a-glance overview of the five main causes of serious accidents to under-fives, providing data, safety advice and safety messages for parents that fit in with the timing of the health reviews at birth, nine months and two/two and a half years (PHE, 2017b).

The guide emphasises the importance of ‘slotting in’ safety advice in natural ways with parents to equip them with an understanding of how babies and young children develop to anticipate future risks and stay ‘one step ahead’.

This approach forms the basis of the training for health visitors and community nursery nurses offered by CAPT. Delegates have reported that it has helped them appreciate ways to weave child safety into their already busy schedules and to deliver the safety aspects of development checks in more effective ways.

The guide notes that the most effective home safety interventions are delivered by professionals who have had specific training in child accident prevention. A framework for continuing professional development, supported by the Department of Health and Health Education England, includes standards for reducing accidents developed in collaboration with CAPT (Bishop et al, 2015).


Child Safety Week

Child Safety Week is CAPT’s flagship community education campaign, held annually – this year from 4 to 10 June. It gives people a chance to have fun, elevate their own levels of child safety awareness and have an entertaining time while raising discussion ideas and encouraging people to talk.

One of the objectives of Child Safety Week is to equip professionals with information and resources that enable them to deliver effective safety messages to families. CAPT supplies a free downloadable poster, action pack and parents pack, plus regular emails and Facebook posts to share.

The Child Safety Week action pack offers a range of practical activity ideas to help community practitioners run engaging sessions with parents and carers. Thanks to funding from the Scottish Government, community practitioners in Scotland can sign up to receive free printed copies of resources.

Simple measures such as displays or films in waiting rooms, a conversation offering practical solutions to common risks such as hot drink scalds or hair straightener burns, or multi-agency events with 
activities and demonstrations to attract the wider community can all help to raise awareness among local families and keep 
their children safe.  


Home safety: activity ideas

Button batteries

Demonstrate the damage a button battery can do if stuck in the throat by placing one in a slice of ham several hours before and show how the caustic soda has eaten into the ham.  

Choking risk

Show how cutting grapes into quarters lengthways (not across) makes them safer for young children.  

Safe storage

Talk to parents about storing the following safely – liquitabs, brightly coloured cleaning product bottles, medications, blister packs of painkillers, e-cigarettes and refills.  

Growing pains

Encourage parents to think about the next stage in their child’s growing-up: rolling, crawling, standing and climbing, and how their child may surprise them.  

Tub tips

Babies can drown in as little as 5cm of water. To demonstrate this, draw three lines, one at 2cm, one at 5cm and one at 10cm. Use a doll in the bath to illustrate the point.

For more information, visit childsafetyweek.org.uk




Building Safer Communities, (2017) Unintentional harm thematic paper: children and young people. See: bsc.scot/uploads/1/9/0/5/19054171/bsc_phase_2_unintentional_harm_-_thematic_paper_-_children_and_young_people.pdf (accessed 16 May 2018).

Child Accident Prevention Trust. (2018a) Child safety week action pack. See: capt.org.uk/csw-action-pack (accessed 16 May 2018).

Bishop P, Gilroy V, Stirling L. (2015) A national framework for continuing professional development for health visitors – standards for the high impact areas for early years. See: https://ihv.org.uk/wp-content/uploads/2015/09/iHV_Framework-for-CPD_-HIA-Revision-AW-WEB.pdf (accessed 16 May 2018).

Public Health England. (2018) Reducing unintentional injuries in and around the home among children under five years. See: gov.uk/government/publications/reducing-unintentional-injuries-among-children-and-young-people (accessed 16 May 2018).

Public Health England. (2017a) Early years high impact area 5: managing minor illness and reducing accidents. See: assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/563925/Early_years_high_impact_area5_managing_minor_illness.pdf (accessed 16 May 2018).

Public Health England. (2017b) Preventing unintentional injuries: a guide for all staff working with children under five years. See: gov.uk/government/publications/unintentional-injuries-prevention-in-children-under-5-years (accessed 16 May 2018).

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