Home Injury Prevention in Children: Attitude & Awareness of the Caregivers at King Abdul-Aziz Medical City - Pediatric Emergency, Riyadh, KSA

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1 British Journal of Mdicin & Mdical Rsarch 18(11): 1-10, 2016; Articl no.bjmmr ISSN: , NLM ID: SCIENCEDOMAIN intrnational Hom Injury Prvntion in Childrn: Attitud & Awarnss of th Cargivrs at King Abdul-Aziz Mdical City - Pdiatric Emrgncy, Riyadh, KSA Mohammd Al Mutairi 1*, Nsrin Al Harthy 1, Abdullah Al Qahtani 1, Samah Al Fahmi 1, Badr Al Zidi 1 and Ruqaya Essa Jaffr 1 1 King Abdullah Spcializd Childrn s Hospital, King Abdullah Intrnational Mdical Rsarch Cntr, Riyadh, Saudi Arabia. Authors contributions This work was carrid out in collaboration btwn all authors. Author MAM was th principal invstigator of th rsarch projct, rsponsibl for dsigning of th ntir rsarch work and ovrall writ-up. Author NAH was rsponsibl for computing rsults. Author AAQ was involvd in suprvising th fllows and collction of data. Authors SAF, BAZ and REJ wr th Pdiatric Emrgncy fllows, King Abdullah Spcialist Childrn Hospital, who wr involvd in proposal writing and data collction. All authors rad and approvd th final manuscript. Articl Information DOI: /BJMMR/2016/29832 Editor(s): (1) Anglo Giardino, Txas Childrn s Hospital, Houston, Txas And Pdiatrics, Baylor Collg of Mdicin, Houston, TX, USA. Rviwrs: (1) Aruna Chandran, Johns Hopkins Bloombrg School of Public Halth, USA. (2) Bata Rybojad, Mdical Univrsity of Lublin, Poland. Complt Pr rviw History: Original Rsarch Articl Rcivd 30 th Sptmbr 2016 Accptd 16 th Novmbr 2016 Publishd 24 th Novmbr 2016 ABSTRACT Introduction: Hom injuris in childrn ar considrd as avoidabl vnts, providd th prvntabl and risk factors idntifid. In ordr to assss th awarnss and attitud of th cargivrs who visitd pdiatric mrgncy dpartmnt of a quatrnary hospital, a survy was conductd rgarding cargivr s prcption about th risk and prvntiv factors and its rlation to various hom injuris in childrn. Mthodology: A validatd slf-rport qustionnair with 55 clos ndd qustions was distributd to th 579 cargivrs, who visitd th pdiatric mrgncy dpartmnt. Rsults: Cargivrs ar wll awar about th mortality and morbidity rlatd hom injuris in childrn. Though thir knowldg about hom injuris in childrn is considrd to b adquat, thir attitud towards injury prvntion nds to b addrssd. Th prcptions about incidnts lik falls at hom (33.9%), toxin ingstion (5.7%), burns (15.7%), drowning (8.1%), baby walkr *Corrsponding author: mutairi072@yahoo.com;

2 (19.5%) and tlvision (TV) fall injuris (6.9%) ar found to b statistically significant with rlatd prvntabl and risk factors. Conclusion and Rcommndation: It is concludd that parnts and cargivrs ar willing to b, and nd to b, bttr ducatd about various prvntiv and risk factors of hom injuris in childrn. Thy nd to b furthr ducatd for attnding workshops on injury prvntion as 97.4% of th car givrs hav nvr bn to any workshop. This study also urgs th nd for injury prvntion outrach programs across th country. Educational fforts and prvntiv masurs mad at intrnational lvl for parntal awarnss of hom injuris and safty masurs ar provd to hav a major impact on th cargivrs practic and knowldg toward hom safty masurs. Kywords: Hom injury; cargivrs; childrn. 1. INTRODUCTION Halthy childrn ar considrd th building block for a nation s dvlopmnt and it follows th rsponsibility of vry parnt to contribut by safguarding thir childrn. Th famous Bnjamin Franklin axiom an ounc of prvntion is worth a pound of cur is applicabl hr whn it is about injury prvntion in childrn. Unintntional injuris ar th major caus of dath in childrn agd 1 to 19 yars and ar th fifth notabl caus of dath amongst infants in USA [1]. In youngr childrn from Brazil, most injuris happn at hom, whr thy spnd most of thir tim [2]. Many hom injuris that involv childrn undr 5 yars old (Canada) ar causd by fall from hights, burns, scalds and poisonings and ar prvntabl by th rmoval of particular hazards [3]. It was obsrvd from a study of 0-14 yars of ag group that, 51.9% of injuris took plac at hom and th youngr th child, th highr th frquncy of houshold injuris in Argntinas [4]. Th National Saf Kids Campaign in th Unitd Stats rportd that 40% of daths and 50% of non-fatal unintntional injuris occur in and around th hom [5]. Accidnts that occur at hom ar considrd as a major caus of mortality and morbid injuris in childrn (UK) [6,7]. Diffrnt typ of injuris, thus far rportd from Saudi Arabia ar traumatic had injuris [8], traumatic injuris [9]. Educational fforts and prvntiv masurs mad at intrnational lvl for parntal awarnss about hom injuris and safty masurs ar provd to hav a major impact on cargivrs practic and knowldg towards hom safty masurs [10,11]. With a broad approach domstic injuris analysis can rflct th charactr and lifstyl of popl. It was found that hom is th most common injury sit followd by road traffic accidnts in pdiatric patints, in thos who wr prsntd to Saudi Arabian mrgncy dpartmnts [12]. Undrstanding th mchanisms of hom injury in childrn is a ky concrn for cargivrs, thr is a darth of data assssing th knowldg and attitud of cargivrs rgarding various aspcts of hom injury. W bliv that on of th confounding factor for childrn s hom rlatd injuris includ lack of knowldg of cargivrs in using hom safty masurs. Prvntion of hom injury in childrn should b considrd as a nation s dvlopmntal goal. In ordr to obtain th lvl of awarnss and attitud of th cargivrs who visitd pdiatric mrgncy dpartmnt of King Abdulaziz Mdical City (KAMC), w did a survy during last wk of January, 2014 to Fbruary third wk, 2014 that lookd cargivr s prcption about th risk and prvntiv factors and its rlation to various hom injuris in childrn. 2. METHODOLOGY Institutional Rviw Board of King Abdullah Intrnational Mdical Rsarch Cntr, Ministry of National Guard Halth Affairs, had givn th thical claranc for th study. This cross sctional survy was conductd in th pdiatric mrgncy dpartmnt of KAMC, which is a lvl 1 trauma car cntr and on of th largst spcializd pdiatric mrgncy dpartmnt in th Arab gulf rgion. A validatd slf-rport qustionnair was dvlopd to assss parnts awarnss and attitud toward hom injury prvntion. Th validation of th qustionnair was don into two stps: (1) Initially w askd two pdiatric mrgncy consultants who wr xprts in trauma scincs to valuat th qustionnair rlvancy to th outcoms that ndd to b masurd and also accuracy and clarity of qustions. (2) Th scond stp includd asking two of th pdiatric mrgncy fllows to rad it and assss th simplicity and clarity of 2

3 qustions and giv indpndnt rports. Th survy consistd of 55 clos ndd qustions with rspons of "ys" or "no" for most of th qustions (56 prcnt). It valuatd parnts awarnss and attitud rlatd to falls at hom, toxin ingstion, drowning, baby walkr and tlvision (TV) fall injuris and sourcs for hom injury prvntion information. Informd consnt was obtaind from th participating parnts. Pdiatric mrgncy physicians (rsidnts, fllows and consultants) distributd th qustionnairs to th cargivrs of patints of 0 to 14 yars of ag group, arrivd th mrgncy dpartmnt. All non-dirct cargivrs wr xcludd from th study. Th sampl siz calculatd was 566 with a confidnc lvl of 95 prcnt and confidnc intrval of 4 prcnt. 10 prcnt of th sampl siz was addd to ovrcom incomplt qustionnairs. Statistical Packag for th Social Scincs (SPSS) Vrsion 20 was usd for statistical analysis. Th catgorical variabls on th qustionnair wr prsntd as frquncis and prcntags. Logistic rgrssion analysis was usd to prdict th outcom variabl by th risk factors. Chi squar analysis was also don to tst th statistical significanc of th association btwn diffrnt typ of injuris and various factors. A valu of lss than 0.05 was takn as significant. 3. RESULTS Out of th 579 rspondnts, 46.6% of cargivrs wr parnts (both fathr and mothr), 24.5% of th cargivrs wr fathrs, 24% of thm wr mothrs and th rmaining 4.9% wr grandfathrs and othr rlativs. Th dmographic charactrs ar dtaild in Tabl 1. Majority of thm (77.5%) wr agd btwn 20 to 40 yars. Forty on and thr tnths prcnt of thm wr ducatd up to high school lvl and 39.9% of thm wr univrsity graduats (Fig. 1). Sixty thr and svn tnths prcnt of thm had a monthly family incom ranging from 3000 Saudi riyals up to Saudi riyals. Th majority of thm (53.9%) wr rsiding in apartmnts and 40.8% of thm wr in villas. Cargivr s knowldg lvl about causs of dath was analyzd and it was obsrvd that 30.1% of thm markd trauma as th lading caus, 23.3% with various illnss, 20.4% with congnital disass and 26.2% of thm wr not sur about th causs of dath in childrn (Fig. 2). Whn th rspondnts awarnss lvl on causs of hospitalization of childrn was assssd, it was rvald that 48% of th cargivrs rspondd to fall injuris as th common caus, 25.4% of thm rspondd unintntional poisoning as th rason, 16.2% wr not sur about th causs, 6.4% rspondd burns as th caus and 4% of thm rportd drowning as th rason for hospitalization (Fig. 3). Th survy assssd injury prvntion practics by th rspondnts and obsrvd that 97.4% of th cargivrs bliv that laving childrn alon at hom is unsaf, whras 2.6% do lav thm alon. Elvn and six tnths prcnt of th rspondnts admittd that thir babysittr is youngr than 14 yars of ag, which is not a saf practic. Thr is no lgislativ law that statd th youngst ag allowd for baby sitting in th country, howvr; w slct this ag according to th cultur of Saudi Arabia for commitmnt and capability to do babysitting. Eighty svn and two tnths prcnt of thm visitd th hospital for lss than 5 tims du to injury, whras 12.8% of thm hav visitd for mor than 5 tims (Fig. 4). Dscriptiv statistics of history of various injuris rportd at hom prsntd 33.9% with fall injuris, 5.7% with toxic ingstion, 15.7% with burns, 8.1% with drowning injuris, 19.5% with baby walkr rlatd injuris and 6.9% with TV fall injuris (Fig. 5). A logistic rgrssion was prformd to ascrtain th ffct of car givr s ag, ducation, monthly incom, typ of housing, laving th child alon at hom and babysittrs youngr than 14 yars of ag on th liklihood that childrn hav fall injury. Th logistic rgrssion modl was statistically significant (Chi squar= , p valu= 0.003). Th car givr s ag was associatd with th child xhibiting fall injury [p valu= 0.009, Odd s Ratio (OR) = 3.3 and Confidnc Intrval (CI) = (1.341, 7.955)]. Sinc th majority (75%) of th sampl siz with fall injury falls in yars of ag group, furthr risk factors wr analyzd and found to b statistically not significant. A Chi squar tst was prformd to assss th rlationship btwn rportd history of fall and prsnc of gats at th ntranc to stairways. It was obsrvd that childrn living in houss with no gats at th ntranc to stairways had 2 tims mor risk for falls than thos with gats, which was found to b statistically significant [Chi squar= , p valu =0.001, OR= 2, CI = (1.402, 2.919)]. Statistical significanc was also found btwn rportd history of fall and prsnc of window guards. [Chi squar= , p valu =0.001, OR= 2, CI = (1.402, 2.919)]. Toxin ingstion was rportd in 5.7% of childrn. Logistic rgrssion 3

4 P r c n t a g Blow high school High school Education Univrsity dgr 5.2 Highr duication Fig. 1. Bar diagram showing ducational status of cargivrs P r c n t a g Congnital disasss Various illnss Trauma Don t know Prcption on childhood dath Fig. 2. Bar diagram showing prcption of cargivrs rgarding childhood daths analysis showd that childrn lookd aftr by babysittrs of ag lss than 14 yars wr at high risk for toxin ingstion [p valu= 0.005, OR = 3.2, CI = (1.41,7.49) ]. Majority (60.6%) of th toxin ingstion insults happnd in villas whras 30.3% occurrd in apartmnts and 9.1 % in traditional houss which was found to b statistically significant (Chi squar= 7.906, p valu = 0.019). Svnty ight and ight tnths prcnt of th childrn with toxin ingstion had ldrs at hom, taking mdicins (Chi squar= 6.581, p valu = 0.010). Statistical significanc was also found btwn rportd toxin ingstion and not discarding old mdicins. Thirty and thr tnths prcnt of th toxin ingstion was du to not discarding th old mdicins (Chi squar = , p valu = 0.001).. Othr factors lik, chmicals kpt at hom, whthr th toxins ar rachabl to childrn and safty caps on bottls of mdicin wr not statistically significant. Thos factors wr not considrd as risk for toxin ingstion in th rspondrs viw which Contradict th litratur proof and mandat mor organizd prvntion ducational program. Fiftn and svn tnths prcnt of th rspondnts rportd th history of burns with 4

5 thir childrn. Logistic rgrssion analysis showd that childrn lookd aftr by babysittrs of ag lss than 14 yars ar having 2 tims mor risk to gt burns than othrs. [p valu= 0.044, OR = 2, CI = (1.02,3.50)]. Oth r factors wr not statistically significant (p > 0.05). Chi squar tst was usd to find th association btwn injury du to burns and risk factors. Th variabls lik smokrs at hom, allowing childrn lss than 6 yars in kitchn during cooking, kping lctric quipmnt out of childrn s rach and lockd wr statistically significant (p <0.05). Th Chi squar tst also showd statistical significanc btwn injury du to burns and prvntiv factors lik kping cigartts and matchs out of childrn s rach, kping th handls of pots & pans out of childrn s rach, chcking th tmpratur of hot watr, and nsuring a closd gas cylindr. Tabl 2 shows th Chi squar valu, OR, 95% CI for OR and p valu for various risk factors and prvntiv factors of burns. Drowning was rportd in 8.1% of childrn. Statistical significanc was found btwn history of drowning and babysittrs of ag lss than 14 yars. [p valu= 0.039, OR = 2, CI = (1.04, 4.81)]. Factors lik prsnc of bath tub, laving th child alon in bath tub and lack of suprvision wr statistically not significant. Although th findings contradict rports availabl in th litratur, our obsrvation might b du to lss numbr of cass availabl. Nintn and fiv tnths prcnt of th cargivrs mntiond baby walkr injuris. It was found that 29% (33/113) of th injuris du to baby walkr was Fig. 3. Pi diagram showing awarnss of causs of hospitalizationss N o : o f h o s p i t a l v i s i t s <5 tims 5-10 tims >10 tims Prcntag Fig. 4. Bar diagram showing th numbr of hospital visits of childrn 5

6 associatd with lack of suprvision which was statistically significant with Chi squar = , p valu= 0.001, OR = and CI = (1.997, 5.401). TV fall injury was rportd in 6.9% of childrn. Logistic rgrssion analysis showd that thos car givrs who ar poorly ducatd had an incrasd liklihood of childrn injurd by TV fall (p valu = 0.010) with an OR of 3 and CI (1.139, 4.913). Fifty fiv prcnt (22/40) of th TV fall injuris occurrd whn it was on th stand with Chi squar = and p valu < 0.05 (0.019) which was statistically significant. Significanc was also found btwn typ of TV and injury. Fifty svn and fiv tnths prcnt cass rportd th fall of old havy TV (Chi squar= , p valu= 0.001). Th car givrs rportd that 54.1% of thm rcivd th information about injury prvntion through mdia, 43.5% got th information from physicians and 2.4% gathrd information through slf-sarch. Majority (97.4%) of th cargivrs hav nvr bn to any workshops on injury prvntion in childrn whras 2.6% of thm hav attndd workshops on injury prvntion. Prcntag distribution of causs of injury and injury typs ar shown in Fig % 19.50% 8.10% 5.70% 15.70% 33.90% Fall Burn Drowning Babywalkr Tlvision Toxin ingstion Fig. 5. Pi diagram showing th distribution of unintntional injuris Tabl 1. Dmographic charactristics of cargivrs Variabl Ag (in yars) Blow Abov 60 Frquncy Prcntag Education Blow high school High school Univrsity dgr Highr ducation Monthly incom (in SAR) < ,000 10,000-20,000 20,000-30,000 >30,000 No answr Hous typ Villa Apartmnt Traditional hous Total

7 Tabl 2. Rportd risk and prvntiv factors of burn injury Variabl Burn injury Total Chi p OR 95% CI Ys No squar valu No: % No: % No: % Smokr at hom Ys (1.12,2.79) No Allowing childrn < 6 yars in kitchn during cooking Ys (1.17,2.90) No Iron box rachabl to childrn Ys (1.59,8.31) No Kping lctric quipmnt out of childrn Ys (1.11,3.18) No Kping cigartts & lightrs out of childrn Ys (1.12,3.77) No Kping th handls of pots & pans out of childrn Ys (1.08,3.49) No Chcking th tmpratur of hot watr Nvr Somtims Always Total Ensur closing gas cylindr Ys (1.76,6.02) No Total % T y p o f i n j u r y ( % ) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Fall Baby walkr Tlvision Causs of injury Lacrations & Contusions Fracturs Chst & Abdominal injury Had injury Fig. 6. Prcntag bar diagram showing th caus of injury and typ of injuris 7

8 4. DISCUSSION This survy was a first of its kind in th Kingdom of Saudi Arabia to assss parnts prcptions about various typs of hom injury. W lookd into th domstic factors lik typ of cargivr, lvl of ducation, monthly incom, and typ of housing. Ths domstic factors wr rlatd into as risk and prvntiv factors of injury. Worldwid, falls that occur at hom wr rportd as th most common childhood injury tratd at hospitals [13]. This was in accordanc with th rsult of our study, whr th majority of th cargivrs (48%) corrctly idntifid fall as th primary caus of hospitalization. Thy also rportd that risk of falls is mor in houss with no gats at th ntranc to stairways, as wll as in houss without window guards, which ar in association with th findings of Harris t al. [14] and Zilinski t al. [15]. Toxin ingstion was anothr srious concrn that was obsrvd in this survy. Th rspondnts statd that toxin ingstion in childrn wr closly associatd with babysittr s ag, typ of housing, ldr prsons on mdication and disposal of xpird mdications. Th significant association of drug inducd toxicity in childrn that thy rportd in our survy was on par with th findings of Mutlu M t al. [16] and Wrnck G. L t al. [17]. Though no significant toxic ingstion of hous hold chmicals was obsrvd, it could b accountabl if thy ar kpt in bathrooms and kitchns, rachabl for childrn. It has to b notd that babysittrs nd to b ducatd proprly about risk and prvntiv factors associatd with toxic ingstion. Burns ar dbilitating condition accompanid by svr pain and frquntly by long trm illnss that causs morbidity not just for th child but for th family and community too. In our survy, th rspondnt s prcption was laving th child with baby sittrs of lss than 14 yars of ag carris a high risk towards burn injury, than othr factors. Th cargivrs also bliv that, factors lik smokrs at hom, allowing childrn in kitchn during cooking, irons and othr lctrical quipmnt in rach of childrn carris a high risk for burns in childrn. Thy also bliv that factors lik kping cigartts, lightrs and hot pans out of childrn s rach, hot watr tmpratur chck and nsuring th closur of gas cylindrs considrably prvnts th incidnc of burns. Th cargivrs rspons about laving th child with baby sittrs of lss than 14 yars of ag and a history of drowning was closly associatd. Though factors lik prsnc of bath tub, laving th child alon in bath tub and lack of suprvision ar not closly associatd with drowning incidnts, parnts nd to focus on ths aras too to avoid unxpctd vnts. Baby walkrs ar usd commonly for small babis, and about quartr of ths infants xprinc an injury rlatd to thir us [18]. In our survy, th cargivrs prciv a clos association btwn lack of suprvision and baby walkr injuris and this rquirs attntion bcaus, vn with adult suprvision th rat of baby walkr injuris was vry high as rportd by Smith t al. [19]. Injuris rlatd to TV falls can lad to significant mortality and morbidity in childrn. In our survy, th rspondnts rportd thir prcption that chancs of TV fall injuris ar mor with typ of TV and position, if TV is placd on TV stand rathr than on wall. This obsrvation is on par with th findings of Rutkoski JD t al. [20], who rportd ths incidncs as a rsult of poor coordination, whil pulling th furnitur. Attitud and awarnss of parnts toward injuris and thir prvntability in childrn nds to b considrd as a high alrt ara of this survy. It was obsrvd that majority of th cargivrs had an insight about injury prvntion in childrn from ithr mdical profssional or from othr sourcs. It was a shocking rvlation that almost all of th cargivrs hav nvr bn to any workshops on injury prvntion. This is prhaps du to lack of spcific workshops conductd. Hnc th nd of ducational and awarnss programs ar highly mphasizd and is in accordanc with Pdn M t al. [21], who rportd that rductions in child injury mortality hav bn accomplishd in som countris with th application of vidnc-basd programs basd on intnsiv rsarch and priority-stting, this has no rlvanc in th local st up. Also th rspondnts nd for ducational programs as mntiond is supportd by th findings of Rhmani R t al. [22]. Educational fforts and prvntiv masurs mad at intrnational lvl for parntal awarnss at th about hom injuris and safty masurs provd to hav a major impact on th cargivrs practic and knowldg toward hom safty masurs [10,11]. 5. CONCLUSION Most of th cargivrs ar wll awar about th mortality and morbidity rlatd hom injuris in childrn. Though thir knowldg about hom injuris in childrn is considrd to b adquat, thir attitud towards injury prvntion can b improvd by xtnsiv lcturs. Th knowldg 8

9 of th spakrs in th workshop will hav influnc on addrssing attitud and chang in bhavior. It can b concludd from this study that th parnts and cargivrs ar willing to b, and nd to b, bttr ducatd about various prvntiv and risk factors of hom injuris in childrn. It can also b concludd that to rduc th incidnc of hom injuris thr is a nd for injury prvntion outrach programs across th country. Comprhnsiv awarnss campaigns, along with govrnmntal and non-govrnmntal organizations for a halthy public policy for child safty nvironmnt would fostr th dvlopmnt of a cultur of safty for childrn in Saudi Arabia. Educational fforts and prvntiv masurs mad at intrnational lvl for parntal awarnss about hom injuris and safty masurs provd to hav a major impact on th cargivrs practic and knowldg toward hom safty masurs [10,11]. 6. RECOMMENDATION Child safty and injury prvntion is not th sol rsponsibility of parnts and familis, bcaus, w cannot xclud th rol of ldr brothrs and sistrs, maids in sharing th rsponsibility of parnts qually. W rcommnd a national hom injury prvntion program supportd by various organizations and govrnmnt to b involvd, that focus on th awarnss and attituds toward improving hom safty masurs. COMPETING INTERESTS Authors hav dclard that no compting intrsts xist. REFERENCES 1. Cntrs for Disas Control and Prvntion (CDC). Vital signs: Unintntional injury daths among prsons agd 0 19 yars Unitd Stats, MMWR Morb Mortal Wkly Rp. 2012;61: Macil W, Pas CE. Riscos no ambint domstico m aras d lazr In: Campos JA, Pas CE, Blank D, Costa DM, Pfiffr L, Waksman RD. Manual d Sguranca da Crianca do Adolscnt. Socidad Brasilira d Pdiatria/Nstl Nutricao. 2004; Choinir R, Robitaill Y. Mthodological considrations and ovrall profil of mortality, hospitalizations and mrgncy room visits. In: Bauln G, ditor. For th safty of Canadian childrn and youth, Ottawa: Public Halth Agncy of Canada. 1997; Waisman I, Nunz JM, Sanchz J. Epidmiologia d los accidnts n la infancia n la Rgion Cntro Cuyo. Rv Chil Pdiatr. 2002; National Saf Kids Campaign [onlin factsht] Availabl: df/kidssafty_pamphlt.pdf (Accssd at 9th August 2014) 6. Royal Socity for th Prvntion of Accidnts; hom safty factsht. Availabl: (Accssd August 2013) 7. Dowswll T, Townr EML, Simpson G, Jarvis SN. Prvnting childhood unintntional injuris what works? A litratur rviw. Inj Prv. 1996;2: Al-Habib A, A-Shail A, Alaql A, Zamakhshary M, Al-Bdah K, Alqunai M, Al-Enazi S. Causs and pattrns of adult traumatic had injuris in Saudi Arabia: Implications for injury prvntion. Ann Saudi Md. 2013;33: Alghnam S, Alklya M, Al-Bdah K, Al- Enazi S. Burdn of traumatic injuris in Saudi Arabia: Lssons from a major trauma rgistry in Riyadh, Saudi Arabia. Ann Saudi Md. 2014;34(4): PMID: Kndrick D, Barlow J, Hampshir A, Polnay L, Stwart-Brown S. Parnting intrvntions for th prvntion of unintntional injuris in childhood. Cochran Databas of Systmatic Rviws (Onlin). 2007;4:CD Brown KJ, Robrts MC, Mays S, Bols RE. Effcts of parntal viwing of childrn's risk bhavior on hom safty practics. Journal of Pdiatric Psychology. 2005;30(7): Rhmani R. Childhood injuris sn at an mrgncy dpartmnt. JPMA Th Journal of th Pakistan Mdical Association. 2008;58(3): Bangdiwala SI, Anzola-Prz E, Romr CC, Schmidt B, Valdz-Lazo F, Toro J, t al. Th incidnc of injuris in young popl: I. Mthodology and rsults of a collaborativ study in Brazil, Chil, Cuba and Vnzula. Int J Epidmiol. 1990;19: Harris, Vaughn A, Lynn M. Rochtt, Gary A. Smith. Pdiatric injuris attributabl to falls from windows in th 9

10 Unitd Stats in Pdiatrics. 2011;128(3): Zilinski Ashly E, Lynn Rochtt, Gary A. Smith. Stair-rlatd injuris to young childrn tratd in US mrgncy dpartmnts, Pdiatrics. 2012; 129(4): Mutlu M, Cansu A, Karakas T, Kalyoncu M, Erduran E. Pattrn of pdiatric poisoning in th ast Karadniz rgion btwn 2002 and 2006: Incrasd suicid poisoning. Human Exprimnt Toxicology. 2010; 29(2): Wrnck GL, Hasslmann MH. Profil of hospital admissions du to acut poisoning among childrn undr 6 yars of ag in th mtropolitan rgion of Rio d Janiro, Brazil. Rvista Da Associacao Mdica Brasilira. 2009;55(3): Kndrick D, Marsh P. Babywalkrs: Prvalnc of us and rlationship with othr safty practics. Inju Prv. 1998;4: Smith GA, Bowman MJ, Luria JW, Shilds BJ. Baby walkr-rlatd injuris continu dspit warning labls and public ducation. Pdiatrics. 1997;100(2):E Rutkoski JD, Sippy M, Gains BA. Traumatic tlvision tip-ovrs in th pdiatric patint population. J Surg Rs. 2011;166: Pdn M, Oygbit K, Ozann-Smith J, t al, ditors. World rport on child injury prvntion. Gnva: World Halth Organization; Rhmani R, LBlanc JC. Hom visits rduc th numbr of hazards for childhood hom injuris in Karachi, Pakistan: A randomizd controlld trial. Intrnational Journal of Emrgncy Mdicin. 2010;3(4): Al Mutairi t al.; This is an Opn Accss articl distributd undr th trms of th Crativ Commons Attribution Licns ( which prmits unrstrictd us, distribution, and rproduction in any mdium, providd th original work is proprly citd. Pr-rviw history: Th pr rviw history for this papr can b accssd hr: 10