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ARTICLES:
Jieru Chen, Marcie-jo Kresnow, Thomas R. Simon, and Ann Dellinger
Injury-Prevention Counseling and Behavior Among US Children: Results From the Second Injury Control and Risk Survey
Pediatrics 2007; 119: e958-e965 [Abstract] [Full text] [PDF]
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[Read P3R] Pediatric injury prevention counseling
Ediriweera Desapriya   (23 April 2007)

Pediatric injury prevention counseling 23 April 2007
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Ediriweera Desapriya,
Research Associate
Department of Pediatrics, Centre for Community Child Health Research 4480 Oak Street V6H 3V4

Send letter to journal:
Re: Pediatric injury prevention counseling

edesap{at}cw.bc.ca Ediriweera Desapriya

Injuries are often preventable yet remain the most common cause of death in children ages 1 to 19 in North America and most of other countries in the world. As such, the American Academy of Pediatrics and national injury experts cite injury prevention as a priority area for counseling during routine health maintenance visits for young children. (1, 2)

A recent Randomized Controlled Trial (RCT) (3) demonstrates that the emergency department can be a venue for behavior change counseling if the right resources are available. Counseling was provided to teens following an accident that led to an emergency room visit. While at the emergency room, young people 12 to 20 were provided with a brief counseling session intended to change risky behavior. One behavior addressed within the counseling session was safety belt use, and the researchers found that the counseling was effective in increasing self-reported safety belt use later on. This is an effective strategy as children and adolescents continue to rely heavily on emergency services for their primary care needs. (4)

However, injury prevention counseling is associated with reported preventive safety practices among US children, but a relatively small proportion of households with young children report receiving such counseling. (3) Physicians may not receive adequate training in injury prevention during their medical education, and continuing education opportunities may be limited for physicians outside of urban centers. Accessible and relevant continuing medical education in novel formats is needed to address the gap between ideal and actual practice in injury prevention.

There is evidence to suggest that time constraints and other competing demands limit physicians’ abilities to deliver injury prevention counseling during routine health maintenance visits. (5, 6, 7) Priorities need to be defined so that the most important injury prevention topics and strategies are discussed effectively in the limited time available. In addition the frequency and impact of pediatric counseling can be further enhanced by experiential training that targets specific injury hazards (3).

Recent review by Gittelman and Durbin (8) has suggested that an emergency department visit for an injury represents a "teachable moment" for the patient and their family, which may make the injured more receptive to educational information.

REFERENCES:

(1). Cohen L.R., Runyan C.V., Downs S.M., Bowling J.M. Pediatric injury prevention counseling priorities. Pediatrics.1997; 99 :704 –710

(2).Committee on Injury and Poison Prevention. Office-based counseling for injury prevention. Pediatrics.1994; 94 :566 –567

(3). Johnston B.D., Rivara F.P., Droesch R.M., Dunn C., Copass M.K. Behavior change counseling in the emergency department to reduce injury risk: a randomized, controlled trial. Pediatrics. 2002; 110:267 -274

(4). Lehmann C.U., Barr J., Kelly P.J. Emergency department utilization by adolescents. J Adolesc Health. 1994; 15 :485 -490

(5). Yarnall K.S.H., Pollak K.I., Ostbye T. Krause K.M., Michener J.L. Primary care: is there enough time for prevention? Am J Public Health.2003; 93 :635 –641

(6).Quinlan K.P., Sacks J.J. Kresnow M. Exposure to and compliance with pediatric injury prevention counseling–United States, 1994. Pediatrics.1998; 102(5) . Available at: pediatrics.aappublications.org/cgi/content/full/102/5/e55

(7). Cohen L.R., Runyan C.W. Barriers to pediatric injury prevention counseling. Inj Prev.1995; 5 :36 –40

(8). Gittelman, M.A., Durbin, D. Injury prevention: Is pediatric Emergency Department the appropriate place? Pediatric Emergency Care 2005;27 (7) 460-467

Conflict of Interest:

None declared