Recognizing that accidents are one of the biggest killers of children in India is paramount to preventing thousands of hospital admissions, hundreds of deaths and disabilities every week, in children. Understanding that many of these are avoidable is important to provide a safe environment to nurture our children before they are scarred for ever. With the objective of ensuring a safe and healthy environment for our children and to enable them to lead more active lives, Dr Supraja Chandrasekar, an oncosurgeon in Bangalore and Ilaunched the Safe Children Mission. Our plan of action includes increasing awareness among caregivers, providing safety measures and instructions for quick remedial action.

Magnitude of the challenge
Based on 1 year data from the Bengaluru Injury Surveillance Programme (BISP), 5509 children were admitted with injuries among whom 209 died. There was one death for every 27 non-fatal injuries. Male deaths were thrice as common when compared to females. A majority of the children belonged to average socioeconomic groups and were studying in schools. Worldwide, accidents kill more than 2000 children per day and 75-90% of these accidents could have been avoided through better awareness and prevention.

The BISP was initiated by NIMHANS as part of its work in the WHO collaborating centre for Injury prevention and Safety Promotion and has been active since early 2000. The programme encompasses various aspects of safety on safety like road safety, fire safety, etc. and has collaborated with all big and small trauma centers in Bangalore to form a database. The published data from the Department of Epidemiology, NIMHANS is here www.nimhans.kar.nic.in/epidemiology/epidem_who2.htm

What are the common childhood injuries?
    * The most common causes of injuries among young children are falls: for example, from a table, bed or ladder, or falling over when running (for eg., not noticing a step or going too fast to stop safely).
    * Other common injuries among children are from swallowing poisons, burns from hot water or fire, drowning or severe sun burns.
    * Children might also get hurt in the process of acquiring a new skill, such as riding a bike, or when they try to use something that belongs to an older child (for eg., a skate board).

Understanding danger
    * Young children cannot understand danger. They cannot understand that they might get hurt or even killed even when they have been educated about the danger.
    * Young children can understand “stop” or “no”, but they cannot understand “Do not run onto the street because you will get hit by a car”. They are too busy concentrating on running without falling over and anyway, they did not get hit by a car last time they ran on the road. Toddlers may understand “no” but they may not have learned to follow it.
    * Young children only look at where they are going to (chasing a ball, running to a friend) – they have ‘tunnel vision’.
    * They cannot judge whether something, such as a car, is moving, or how fast it is moving.

Keeping children safe
It is the responsibility of adults to work out what might hurt a child, and to work out how to keep young children safe. There is a set of steps that you can follow in order to best protect a child.

Get rid of the danger. If you have been using chemicals in the garden, throw away any chemical that is left over.

Change the hazard so that it is not so dangerous. For instance:
    * Many children are hurt when they fall off bunk beds. Put the top-level bed down onto the floor so you have two low beds.
    * Lie your ladder down on the ground.
    * Avoid keeping table and stool next to the balcony parapet or windows.
    * Make the child’s outside play area a long way from where the car goes.

Block access to the danger. For example:
    * Store medicines and cleaning chemicals in a locked cupboard, and take the key out (or use a ‘child-proof’ cupboard).
    * Always remove keys from your vehicle.

Change the habits of the child so that the risk is lowered. This may sound strange but it means things like:
    * Making sure that the child always wears a helmet when riding a bike, or wrist and knee protectors when skating.
    * Use sun-protecting clothes.

Always do things the safe way yourself like following traffic rules while driving and also as pedestrians. Children often learn from what you do! Help them learn skills so that they do things the right way. For instance:
    * If you have a tree that ‘needs’ to be climbed, help them learn how to climb down again.
    * Help them learn how to use a knife safely.

Teach them by telling them what to do and what not to do
    * Even though small children cannot understand all you say, eventually they will learn to control their own behaviour. Talk to them about stopping at the traffic lights, pushing the button and moving only when the walk sign turns green.
    * However, even if small children can tell you all the precautions, you must be around or accompany them.

Finally, if they are doing something you think is dangerous, stop it
    * Pick them up and put them somewhere safe (you are the adult, and you are bigger).
    * If they are too far away, shout something very simple, very loudly, like STOP!!! Don’t say any more words – you need them to concentrate on stopping.

Reminders
    * Have emergency numbers near the phone such as:
          o Police, ambulance, fire
          o Your doctor or hospital
    * Have a first aid kit in the house and vehicle.
    * Check that homes and public places you visit with your child are safe.
    * Do a first aid course which includes emergency resuscitation, so that you will know what to do.

Unintented childhood injuries constitute nearly 30-40% of admissions in the ICU. As most of these accidents are easily avoidable, doctors who are associated with the PeopleTree Foundation, (a non-profit organization in Bangalore) initiated the Safe Children Mission for young parents, school teachers and others involved in the care of children. We want to raise awareness about the magnitude of the problem of avoidable child accidents and simple ways to tackle it. We have conducted workshops in software firms, preschools, Rotary clubs and apartment complexes and are keen to continue this activity. We have also received “Vocational Excellence Award” from Rotary Whitefield for creating awareness about child safety.

Let us remember that child safety is not our choice, it is our responsibility.