Injury in Children (Child Development)


An “accident” implies that an injury is a random, unpredictable event, an act of God or fate. We use the term “injury control” instead of “accident” to imply that harm can be minimized if controls are in place. Most “accidents” to young children are preventable.Worldwide, unintended and avoidable injuries cause millions of premature deaths, especially to preschool age children. Immaturity of the prefontal cortex makes young children unlikely to think things through, so they get themselves into dangerous places and activities. Unlike infants, preschoolers growing motor skills allow them to run, leap, jump and grab in a flash. Their curiosity is boundless and their impulses are uninhibited. As parents and caregivers we often have to find a balance between giving our children freedom to explore and experience the world fully and protecting them from harm.Describe an injury you (or your child/relative) sustained as a child, including injuries that resulted in stitches, broken bones, or scars. Could any of these injuries have been prevented? How? (remember, prevention happens on three levels) Did any of the developmental characteristics of a preschool child that were discussed above contribute to the injury?Things to refer to for this post:Gross motor skills (large body movements) improve dramatically between 2 and 6. These abilities require practice, and a certain level of brain maturation, plus motivation. Children learn these skills by teaching themselves, by learning them from other children and their families, and when they are given plenty of time and opportunities to practice.Fine motor skills (small body movements, especially of the hands and fingers) are much harder for preschoolers to master.Children’s artwork provides a way of practicing fine motor skills, and it involves coordination of action and thought as well as a sense of accomplishment.Look at how art can show the developmental progress a child is making in their perception of human beings and their ability to use symbols to illustrate it. Pages 236 and 237 show how dramatic the change in ability is.Age related trends are apparent in particular kinds of injuries, which should alert us to the particular dangers of various periods. For preschoolers, death is more often caused by accidentally swallowing poison, being burned, choking, or drowning. They are less likely to be killed in car crashes, especially when adults obey laws that require children to ride in car seats.For the very young, under 24 months, falls are likely to be fatal. Teenagers and young adults are most often killed as passengers of drivers in car accidents.The immaturity of the prefrontal cortex makes young children less likely to think things through, so they plunge into dangerous places and activities.Injury prevention is no accident. It is a choice made by parents, by manufacturers, by legislators, and by society. Safety surfaces rather than concrete under climbing equipment, car seats, and bicycle helmets are examples of some social controls. In practice, this means anticipating, controlling, and preventing dangerous activities.Three levels of prevention are needed. Laws and practices should be put in place to protect everyone (primary), appropriate supervision can guard against accidents (secondary), and medical treatment that is quick and effective when injury occurs (tertiary).

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Do children eat too much, too little, or just the
right amount?
Does brain maturation make children laugh or
cry too quickly?
If children never climb up trees or wade in
water, do they suffer?
Are accidents accidental?
Which is worst, neglect or abuse?
Growth Patterns
•Children become slimmer as
the lower body lengthens.
•Each year from age 2 through
6, well-nourished children add
almost 3 inches in height and
gain about 4 1⁄2 pounds in
•Center of gravity moves from
the breastbone down to the
belly button.
Body Changes
Size and Balance
These cousins are only four years
apart, but note the doubling in leg
length and marked improvement in
Body Changes
• Children need far fewer calories per pound of
body weight than infants do.
• Children in low-income families are especially
vulnerable to obesity because their cultures still
guard against undernutrition and their parents
may rely on fast foods.
Body Changes
Nutritional deficiencies
• Most children in developed nations consume more
than enough calories, they do not always obtain
adequate iron, zinc, and calcium.
• Many customs entice children to eat sweets which
are a poor substitute for balanced, varied diet.
• Gender, ethnicity, and income correlate with body
• Estimated 3 to 8 percent of all young children are
allergic to a specific food—almost always a
common, healthy one.
Healthy Eating
Healthy preschoolers
Consume less fried foods
Gain bone mass, but not fat
Eat more dark green and
orange vegetables
Body Changes
Oral health
• Too much sugar, too little fiber, diet, and health
cause tooth decay.
• Parental childhood experiences and habits and
income may create barriers to good dental care.
• USPS urges addition of fluoride coat to teeth of
preschoolers who have no other source of
Obsessions and Allergies
• Some children exhibit normal, age-dependent
obsessive-compulsive behavior related to food
choices and bedtime routine—these typically
disappear by middle childhood
• 3 to 8 percent of preschool children have specific
• Cow’ milk; eggs; peanuts or tree nuts; soy; wheat; fish
and shellfish
• Diagnostic standards for allergies vary.
Brain Development
By age 2, a child’s brain weighs 75 percent of what
it will in adulthood.
Extensive sprouting and then pruning of dendrites
has already taken place.
The brain reaches 90 percent of adult weight by
age 6.
Brain Development
Brain Development
Speed of thought
Primary reason for faster thinking is new and
extensive myelination.
A gradual increase in myelination makes 6-yearolds much quicker than 3-year-olds, who are
quicker than toddlers.
Faster and Faster
Myelination is a lifelong
process. Shown here is a
cross section of an axon
(dark middle) coated with
many layers of Schwann
cells, as more and more
myelin wraps around the
axon throughout childhood.
Age-related slowdowns in
adulthood are caused by
gradual disappearance of
myelin layers
Brain Development
Brain Development: Connecting the
Corpus callosum
Long, thick band of nerve fibers that connects the
left and right hemispheres of the brain and allows
communication between them
Specialization in certain functions by each side of
the brain, with one side dominant for each activity
Left side of the brain controls the right side of the
body, and vice versa.
Handedness is partly
1 in 10 children prefers
left hand.
Many cultures support
on right-handedness
(difference-equalsdeficit error).
Brain Development
Contemporary views on left-right
Distinction exaggerated
No exclusive sidedness in healthy people
Both sides of brain involved in almost every skill
Brain is flexible, especially in early life
Brain Development: Planning and Analyzing
Maturation of prefrontal cortex
Prefrontal cortex is very limited in infancy and
continues to develop at least until early adulthood.
Between ages 2 and 6, neurological increases are
especially notable in the areas of the cortex, where
planning, thinking, social awareness, and
language occur.
Neurological immaturity is another reason adults
need to prevent childhood injury.
Brain Development: Planning and Analyzing
Impulsiveness and preservation
Maturation of the prefrontal cortex gradually
facilitates focused attention and curbed
Before such maturation, many young children jump
from task to task; they cannot stay quiet.
Others act in the opposite way: In a phenomenon
called perseveration, some children persevere in,
or stick to, one thought or action, unable to quit.
Brain Development: Planning and Analyzing
From ages 2 to 6, maturation of the
prefrontal cortex has several notable
Sleep becomes more regular.
Emotions become more nuanced and responsive.
Temper tantrums decrease or subside.
Uncontrollable laughter and tears are less
Brain Development:
Planning and
Many religious rituals have sustained
humans of all ages for centuries,
including listening quietly in church on
Ash Wednesday—as Nailah Pierre
tries to do.
Can Nailah Pierre sit still?
This is developmentally
difficult, but for three
reasons she probably will
– (1) gender (girls mature
earlier than boys)
– (2) experience (she has been
in church many times), and
– (3) social context (she is one
of 750 students in her school
attending a special service at
Nativity Catholic church).
Emotions and the Brain:
Three Main Parts
• Tiny brain
structure that
fear and
• Brain structure
that is a central
processor of
memory for
• Brain area that
responds to
the amygdala
and the
to produce
hormones that
activate other
parts of the
brain and body
A Hormonal Feedback Loop
Emotions and the Brain
Early traumatic or stressful events
Increased risk
• Permanent learning and memory deficits related to
toxic stress
• Later major depression, PTSD, and ADHD
• Cognitive and memory growth with reassuring
• Context, duration, parental support, and child
temperament are important
Improved Motor
Improved motor skills
• Children develop all their
motor skills spontaneously
and diligently as they play.
• By age 6, most North
Americans ride tricycles;
climb ladders; pump their legs
on swings; and throw, catch,
and kick balls.
Each age has special
sources of pleasure.
Improved Motor Skills
Improved motor skills
Muscle growth, brain maturation, and guided
practice advance every gross motor skill.
Practice improves dexterity and advances fine
motor skills, which involve small body movements.
Motor Skills Development
2 years
• Run without falling; climb out of crib; walk up stairs; feed
self with spoon; draw spirals
3 years
• Kick and throw ball; jump with both feet; pedal a tricycle;
copy simple shapes; walk down stairs; climb ladders
4 years
• Catch a beach ball; use scissors; hop on either foot; feed;
feed self with fork; dress self; copy most letters; pour
liquid without spilling; brush teeth
Motor Skills Development
5 years
• Skip and gallop in rhythm; clap, bang, sing in
rhythm; copy difficult shapes and letters; climb
trees, jump over things; use a knife to cut;
wash face and comb hair
6 years
• Draw and paint recognizable images; write
simple words; read a page of print; tie shoes;
catch a small ball
Specific skills
Brain maturation,
motivation, and guided
practice make gross motor
skills possible.
Practice with
big kids
Gross Motor Skills
Influence of culture and
locale is important.
Environmental Hazards
Harm young, growing brains and bodies more
than older, developed ones
Are particular concerns for urban, low SES
Impact asthma and other respiratory problems
Heavily contaminated air and environment
A composite of 157 brains of
adults—who, as children, had
high lead levels in their blood—
shows reduced volume.
The red and yellow hot spots are
all areas that are smaller than
areas in a normal brain.
EXPOSURE. PLOS MEDICINE, 5 (5), 741–750. DOI: 10.1371/JOURNAL.PMED.0050112
Toxic Shrinkage
Eliminating Lead
Lead was recognized as a poison a
century ago.
• U.S. finally banned lead in paint in 1978 and in
automobile fuel in (1996).
• Children who are young, low SES, and/or living
in old housing tend to have higher levels.
• Teenage involvement in impulsive, violent
crimes is linked to lead poisoning of the brain.
Fine Motor Skills
Fine motor skills
Are more difficult to master
Involve small hand and finger movements
Often involve both sides of brain
Influenced by practice and maturation
On average, mature 6 months earlier in females
Children learn whatever motor skills their culture teaches.
Some master chopsticks, with fingers to spare; others cut
sausage with a knife and fork..
Same Situation, Far Apart: Finger Skills
Artistic Expression
All forms of artistic
In every artistic
• Blossom during early
• Skill gradually comes with
practice and maturation
Correlated with later
creative drawing
Cultural context
• Adult encouragement,
child practice, and
developing technical skill
• Influence expression
Artistic Expression
All forms of artistic
In every artistic
• Blossom during early
• Skill gradually comes with
practice and maturation
Correlated with later
creative drawing
Cultural context
• Adult encouragement,
child practice, and
developing technical skill
• Influence expression
Injuries and Abuse
In almost all families of every income, ethnicity,
and nation, parents want to protect their children
while fostering their growth.
In every nation, more young children die from
accidents than from any other specific cause.
Avoidable Injury
Age-related dangers
Motor-vehicle deaths
Injury control (harm reduction)
Safety surfaces
Car seats
Bike helmets
Safety containers for medications
Pool monitoring
Levels of Injury Prevention
Primary prevention
• Actions that
change overall
conditions to
prevent some
unwanted event or
circumstance, such
as injury, disease,
or abuse.
• Actions that avert
harm in a high-risk
situation, such as
stopping a car
before it hits a
pedestrian or
installing traffic
lights at dangerous
Tertiary prevention
• Actions, such as
immediate and
effective medical
treatment, that are
taken after an
adverse event
(such as illness,
injury, or abuse)
occurs and that are
aimed at reducing
the harm or
Child Maltreatment
Child maltreatment
• Intentional harm to or avoidable endangerment of anyone under 18
years of age
Child abuse
• Deliberate action that is harmful to a child’s physical, emotional, or
sexual well-being
Child neglect
• Failure to meet a child’s basic physical, educational, or emotional
Child Maltreatment
Substantiated maltreatment
• Harm or endangerment that has been reported,
investigated, and verified
Reported maltreatment
• Harm or endangerment about which someone has
notified the authorities
Why is there a difference between
reported versus substantiated cases of
Rates of Substantiated Child Maltreatment
Still Far Too Many
Frequency of Maltreatment
Reports have increased since 1950, but
substantiated rates have decreased every year
since 1990.
Fewer homes with many small children.
Variation in level of professional scrutiny related to
Maltreatment may be under-reported.
Substantiated Child Maltreatment
Getting Better?
As you can see, the number of victims of child maltreatment in the United
States has declined in the past decade.
Warning Signs
In general: Delayed development (slow
growth, immature communication, lack of
curiosity, unusual social interactions)
By early childhood: Fearful, startled by
noise, defensive, quick to attack, confused
between fantasy and reality
• These are the symptoms of post-traumatic
stress disorder
Consequences of Maltreatment
Effects of maltreatment are devastating and
long-lasting—the child and the community
are affected.
Mistreated and neglected children
• Regard people as hostile and exploitative
• Are less friendly, more aggressive, and more
isolated than other children
• Experience greater social deficits
• May experience large and enduring economic
Child Maltreatment
Three levels of prevention
• Primary prevention: Focus on macrosystem and
exosystem; stable neighborhood, family cohesion,
decreasing financial instability, family isolation, and
teenage parenthood
• Secondary prevention: Focus on identifying and
intervening ; insecure attachment
• Tertiary prevention: Focus on limiting harm after
Tertiary Prevention and Placement
Permanency planning
Foster care
Kinship care
Do you know the difference?

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