Childhood injuries: the other epidemic

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“If a disease were killing our children at the rate that unintentional injuries are, the public would be outraged and demand that this killer be stopped.”  — C. Everett Koop, former U.S. surgeon general

Every November 18, in cities across the country including here in the Twin Cities, landmarks like bridges, tall skyscrapers, and sports stadiums are lit green to mark National Injury Prevention Day. The goal each year is to highlight the importance of preventing injuries in children. Injuries remain the leading cause of death and potential life lost for children over a year of age and the third-leading cause of death for children under a year of age. 

More children die from injuries than all other causes combined. Unfortunately, injuries and injury prevention often take a back seat to other health concerns in most people’s minds. 

Data from the Centers for Disease Control and Prevention (CDC) show that in 2019, 13,384 children 0-19 died from injuries: 

  • 7,444 were from unintentional injuries 
  • homicide accounted for 2,770 deaths 
  • suicide accounted for 2,756 deaths 
  • 36 children were killed by the police

The estimated costs to society of injuries runs in the hundreds of billions of dollars. However, the cost to children and their families is immeasurable.

As with many other health concerns, there continue to be significant disparities in injury rates for children of color. African American, Native American, and Alaska Native children are more likely to die from intentional and unintentional injuries than are children from other ethnic backgrounds. 

There are multiple reasons for these disparities, which are complex and varied. They include structural racism, poverty, and the legacy of redlining and disparities in access to care.

I would like to highlight three types of injuries where these disparities in injury rates are particularly concerning. These are sudden unexplained infant death (SUID), drowning, and firearm-related injuries.

Sudden Unexplained Infant Death

Each year on average 3,400 infants die due to SUID. Native American and African American babies are much more likely than White babies to die from SUID. 

The American Academy of Pediatrics has made recommendations regarding safe infant sleep practices. While these practices help reduce sleep-related infant deaths, adherence to these recommendations remains inadequate. 

There are multiple reasons for this, including cultural practices, parent choice, concerns about the baby’s safety, and misinformation. However, the impact of adverse social determinants of health including poverty and the residual impact of redlining are a notable cause of these increased infant deaths. We will discuss SUID further in an upcoming article.

Drowning 

African American and Native American children are more likely to drown than are White children. In 2019 there were 3,692 people who died due to drowning, including 861 children from birth to 19 years of age. Rates are highest for kids one-to-four years old. Native American and African American youth disproportionately have the highest mortality rates from drowning.

For every child who dies from drowning, an additional eight are treated in an emergency department for non-fatal drowning. These nonfatal drowning injuries can cause severe brain damage.

Violence and firearm-related injuries

Youth violence disproportionately impacts African American youth and young adults, who are at higher risk for the most harmful forms of violence. Our Black teenage sons are more likely to die from firearm violence than other children. 

In 2019 there were 39,707 firearm-related deaths in the United States. This included 3,390 children and youth under the age of 19 years. Homicide is the third-leading cause of death for ages 10-24 and the leading cause of death for non-Hispanic African American youth. 

Each day, more than 1,000 youth are treated in emergency rooms for physical assault-related injuries. Additionally, LGBTQ teens are more likely to experience multiple forms of violence compared to their heterosexual and cisgender peers. 

There are many reasons for this disproportionate impact of violence. Underlying this is environmental and systemic racism. Also playing a significant role are poverty, toxic stress, impoverished neighborhoods, food insecurity, exposure to violence in the home, and exposure to gang violence.

Prevention

So, what can we do? The solutions are several-fold but begin with prevention. They start in our own homes. Following the safety advice given by your child’s pediatrician is a good place to start. These include recommendations on safe sleeping practices, water safety and firearm safety.

Enrolling our children in swimming lessons such as those offered by your local YMCA or YWCA will also help to reduce the chances that our kids will drown.

For older kids who drive, encouraging safe driving practices, including advice about when not to enter a motor vehicle, is important. 

Violence prevention requires an all-hands-on-deck approach including collaboration between different groups that may not always work together comprised of public health experts, legislators, law enforcement, youth services, schools, churches, and neighborhood groups. 

There are many other things that we can do collectively as a society, including working with our local and state governments to ensure true investment in the communities in which we live through provision of green spaces, updated playgrounds, swimming facilities in our communities, adequately funded schools and after-school programs, among other things. These investments in the infrastructure in poor communities are key.  

However, more important is to advocate for fundamental changes with regards to a living wage and fundamental changes to our neighborhoods to help overcome the legacy of redlining and structural racism. 

Dr. Kiragu is an associate of the Children’s Respiratory and Critical Care Specialist’s group and provides pediatric critical care at Children’s of Minnesota. Dr. Kiragu is a passionate advocate for children and is immediate-past president of the MN Chapter of the American Academy of Pediatrics and a past president of the Minnesota Association of Black Physicians. He is an associate professor of pediatrics at the University of Minnesota.