Introduction to Preventive Pediatrics

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Introduction

to Preventive

Pediatrics

958 PEDIATRIC PATIENT EDUCATION

Frederick H. Lovejoy, Jr, MD

From the Harvard Medical School and The Children’s Hospital, Boston

The following papers all discuss preventive

pe-diatrics: what the pediatric patient, and his or her

parents, should know and do to prevent accidents

and disease. The responsibility for teaching these

concepts and techiques is no longer solely within

the purview of the pediatrician. Parents are

bom-barded daily, through the print and broadcast

me-dia, with information concerning disease and its

prevention. Schools, civic organizations, and even

museums have taken up the challenge of not only

exciting but educating their audiences in the

pre-vention of disease. In this fertile environment of

health education, pediatricians must define a mean-ingful role.

To prepare themselves adequately for this

re-sponsibility, pediatricians must become knowledge-able about epidemiologic data, gain familiarity with

models for accident prevention, and become aware

of the expanded role they play in accident preven-tion.

EPIDEMIOLOGY OF ACCIDENTS

Mortality and morbidity data will help

pediatri-cians become aware of the need for preventive

efforts. The leading causes of accidental death in

children for the years 1964, 1968, 1974, and 1978

are shown in the Figure.’ Statistics for four age

groups (less than 1 year, 1 to 4 years, 5 to 14 years,

and 15 to 24 years) are compared. The frequency

rates of various injury-related events, based on data

from the Massachusetts Health Data Consortium

for the period October 1977 to September 1978, are

shown in the Table.’ Such data can help pediatri-cians focus on the areas in greatest need of preven-tive efforts.

Read before the Symposium on Pediatric Patient Education:

Challenge for the SOs, Dallas, Nov 29-30, 1983.

Reprint requests to (F.H.L.) The Children’s Hospital, 300

Long-wood Aye, Boston, MA 02115.

American Academy of Pediatrics.

MODELS FOR ACCIDENT PREVENTiON

Pediatricians should also know about models for

disease and accidental injury. Thirty years ago,

Gordon introduced a major concept when he

equated injury with disease and suggested

ap-proaching accidents in terms of an agent, host, and environment.

A more recent model focuses on active and

pas-sive preventive initiatives. Active prevention

in-volves actions that can be performed by the

indi-vidual, such as educating parents to turn down the

water-heater thermostat or to purchase and use

infant car seats. Passive prevention is defined as

the use of technology or laws to protect the individ-ual without requiring his or her personal

involve-ment. Examples of passive prevention include the

safe packaging of drugs and household products,

fluoridation of public waters, speed limits of 55

miles per hour, and the installation of air bags in automobiles.

A third model defmes prevention in terms of

engineering, enforcement, and education. For

ex-ample, engineering has created safe car-seat

re-straints for children, legislation has required the

use of these restraints, and education has been

necessary to ensure that seat restraints are not only purchased but also used.

A fourth model considers prevention as part of a

continuum of illness or the accident event. Primary, secondary, and tertiary levels of medical care

illus-trate this point. Primary prevention focuses on

preventing the accident, secondary prevention

fo-cuses on preventing clinical illness, and tertiary

prevention focuses on preventing serious morbidity or mortality.

A fifth model of prevention addresses the

acci-dent in the following terms: pre-event, event, and

postevent. The elimination of floor heaters and use

of matches that burn with less heat are examples

of “pre-event” prevention. The installation of

smoke detectors and fire-retardant clothing

con-tribute to prevention of mortality and morbidity at

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80- 70- 60-C V S 0 U, .c40 U, 0 30 All Accidents Mechanical AccidentsAll Motor Vehicle All Accidents 20- Ingestion FoodlObject 10-Motor Vehicle Fires! Bums Falls I 1964 I 1968 I 1974 I 1978 I 1964 I 1968 I 1974 I 1978 I 1964 I 1968 I 1974 I 1978

Figure. Leading causes of accidental death in children, United States, 1964 to 178 (Reproduced with permission from Lovejoy and Bahamon’).

I I I I

1964 1968 1974 1978

<1 Year lto4Years 5tol4Years 15 to 24 Years

SUPPLEMENT 959 All Accidents Motor Motor FIres! Vehicle

Bums

:::::::::<

Drownings #{149}

Drowning Ingestion

#{149}-.----.#{149}-.--.---#{149}----#{149}Firearms

Poison Bums

Fires!

FIIs

TABLE. Injury-Related Hospitalizations for All Massachusetts Children and Youth by Primary Diagnosis According

to ICDA-8 N code*

Code Description No. of

Hospitalizations % of Total Rate/10,000 Child-Years 800-804 805-829 830-839 840-848 850-854 860-869 870-907 910-918 920-929 930-939 940-949 950-959 960-979 980-989 990-995 919 Skull fractures Other fractures Dislocations Sprains and strains

Intracranial injuries

Internal injuries (abdomen, chest, pelvis) Lacerations and open wounds

Superficialinjuries

Contusions and crush injuries Effects of foreign bodies Burns

Spinal cord and nerve injuries Adverse effects of medicinals

Toxic effects of nonmedicinals

Other adverse effects (drownings,

electro-cutions) Unspecified 1,464 4,982 1,011 791 4,253 560 2,043 215 1,040 309 591 146 1,238 656 164 31 7.5 25.6 5.2 4.0 21.8 2.9 10.5 1.1 5.3 1.6 3.0 0.7 6.4 3.4 0.8 0.2 7.8 26.7 5.4 42 22.8 3.0 10.9 1.2 5.6 1.7 3.2 0.8 6.6 35 0.9 0.2

Totals 19,496 1000 104.5

* From Lovejoy and Chafee-Bahamon.’ Data based on figures obtained from the Massachusetts Health Data

Consor-tium data base for the period October 1977 to September 1978.

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960 PEDIATRIC PATIENT EDUCATION

the time of the event. Burn centers minimize

ad-verse outcomes after the event.

Pediatricians can use these various models to

interpret new data and incorporate them into

pre-ventive efforts.

PEDIATRICIAN’S ROLE

Pediatricians are in a unique position to prevent

disease and accidents. The main difficulty lies in

finding effective means to bridge the gap between

the physician’s expertise and the needs and

con-cerns of the lay public. One avenue for implement-ing prevention is the focus of attention on patient

education as discussed in the following paper by

Fulginiti. A second avenue is the teaching of med-ical students, house officers, office nurses, social

workers, and other professionals to carry out

pre-ventive efforts. Third, pediatricians may become

involved in the regulatory process. They may

en-courage the passage of sound laws, work with the

Consumer Product Safety Commission, or

promul-gate awareness of regulatory actions among their

patients. Fourth, pediatricians may interact with

manufacturers, builders, designers, and planners to promote preventive efforts. Fifth, through monitor-ing and reporting, pediatricians can draw attention

to hazards in the environment. They can

recom-mend adjustments in preventive efforts to improve

public acceptance and compliance with laws and

programs directed at specific prevention goals.

Sixth, pediatricians can participate in professional

committees, such as the American Academy of

Pe-diatrics’ Committee on Accident and Poison

Pre-vention or the AAP Committee on Infectious

Dis-ease. Finally, pediatricians can stimulate public

concern by communicating useful information to

large audiences through cooperation with the mass

media.

Thus, pediatricians can use a variety of avenues for implementing prevention. Seven potential areas have been determined. patient education, teaching,

regulation, engineering and manufacturing of

prod-ucts, reporting and monitoring, participation in

committee activities, and cooperation with the

me-dia.

SUMMARY

Pediatricians can do much to ensure an active, forceful, and rational approach to the prevention of childhood injury and disease. The extent of progress

over the next decade will, in large measure, be

determined by the ability of pediatricians to work

with the nonmedical community in implementing

meaningful accident prevention efforts.

REFERENCE

1. Lovejoy FH Jr, Chafee-Bahamon C: The physician’s role in accident prevention. Pediatr Rev 1982;4:53-60

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1984;74;958

Pediatrics

Frederick H. Lovejoy, Jr