Latest news confirms PHE’s priorities for action to reduce unintentional injuries among the under-fives

In 2014, Public Health England (PHE) produced guidance to local authorities and their partners on Reducing unintentional injuries in and around the home among children under five years.

The guide, developed with CAPT, identified five injury priorities – ‘five for the under-fives’ – choking, suffocation and strangulation; falls; poisoning; burns and scalds; and drowning.

Focusing on these injury types will help have the biggest impact on young children – reducing the injuries that cause the most harm.

Recent events have confirmed the need for action.

Suffocation - nappy sacks

‘Nappy sack suffocation warnings increase following baby deaths’ – ITV News 28 August 2015

For the second time this year, a baby in Derbyshire was suffocated to death by a nappy sack.

“These two local deaths of very young babies were tragic accidents which have had a devastating impact on the families involved.” – Councillor Dave Allen, Derbyshire County Council

There have been at least 16 confirmed cases of baby deaths due to nappy sacks. Nappy sacks are plastic bags and can cause suffocation. A small baby can pull the bag over their nose and mouth but is then unable to pull it away.


Suzie Dyball’s seven-month-old daughter nearly drowned last month after the bath seat she was sitting in tipped over.

After the accident, she took to Facebook to raise awareness of the dangers of bath seats, and her post has had over 170k shares.

RoSPA report that one in three accidental drowning deaths in children aged two and under involve bath seats.

In Suzie’s case, it happened while she had turned away for a matter of seconds. She told the Mirror: "I had been kneeling by the bath and had stood up to get the toothbrush on the windowsill. I hate to think what might have happened had I turned to grab some loo roll or taken a step away.”

Suzie’s daughter made a full recovery, but as her post shows, the accident could very easily have been a fatal one:

“Yesterday evening Felicity (7 months) was in the bath in this seat when it tipped over and trapped her face down in the water. I was right there by the bath. A couple of the suction pads were still stuck to the bath and it was hard to free her. The few seconds it took felt like a lifetime.”

Bath seats are not safety devices. They can give parents a false sense of security. In February this year, Public Health England issued a patient alert about the use of bath seats.

Burns and scalds

National Burn Awareness Day is 21 October

Burns and scalds are the fourth highest cause of hospital admissions for under-fives. 12% of hospital admissions are for more than three days compared with an average of 5% for all unintentional injuries. These injuries are expensive to treat and serious burns and scalds are disfiguring and disabling for young children.

“I may look and sound like a normal happy teenager but I am not. I can’t be the same, and I never will. Some people can just take in the fact they’re burnt and the scars will never go away. But my mind won’t let me accept them, I hate them." Lizzie, who suffered a bathwater scald as a toddler

Unfortunately, many parents are unaware of the risks. The five main causes are:

  • Hot drinks – especially for babies around one year of age.
  • Contact with hot household appliances – burns from hair straighteners have doubled in recent years and they now account for 10% of burns injuries to children.
  • Hot water including water heated on a cooker.
  • Hot heating appliances, including radiators and pipes.
  • Bath water scalds. The injuries peak at about a year old and the injuries can be very severe. 21% of hospital admissions are for over three days.


The two main poisoning risks for the under-fives are medicines and household chemicals.

The concentrated detergent in a liquid detergent capsule is up to five times stronger than in traditional laundry products. So, if a curious baby bites into one, the chemicals cause breathing problems as the airway rapidly swells.

This is why the European Union is requiring liquitab manufacturers to adapt their product and packaging to help protect small children from harm. AISE (the International Association for Soaps, Detergents and Maintenance Products) is spearheading a European-wide awareness campaign on liquitabs, Keep Caps from Kids

Although household chemicals present a significant hazard, the majority of hospital admissions (70%) for poisoning result from children swallowing adults’ medicines. Storing medicines safely out of reach and preventing toddlers finding them in handbags are effective ways of preventing these accidents.


Falls lead to the most injury-related hospital admissions for under-fives. They are also the third most common cause of death for this age group. A fall from a relatively low height such as from a high chair can have serious consequences including brain damage. The main hazards are:

  • Furniture – the cause of the bulk of the admissions but few deaths
  • Stairs and steps – another leading cause of admissions
  • While being carried – sometimes result in death and primarily affect babies
  • Windows and balconies – also result in deaths

Effective approaches to prevention vary depending on the child’s age/stage of development. Parents and carers sometimes underestimate how soon their baby is able to wriggle off raised surfaces such as a bed or changing mat. Safety gates can make stairs safer for children up to the age of 24 months. Locks and catches can help prevent access to balconies and windows, coupled with age-appropriate explanations to the child about the risks.

Suffocation and strangulation

Choking, suffocation and strangulation – key messages from PHE

Safety advice on preventing suffocation

Safety advice on preventing strangulation

Preventing deaths from nappy sacks

Nappy sacks campaigns

CAPT resources to prevent suffocation and strangulation


Drowning – key messages from PHE

Safety advice on protecting children from drowning

PHE’s patient alert about the use of bath seats

CAPT resources to prevent drowning

Burns and scalds

Burns and scalds – key messages from PHE

Safety advice on protecting children from burns and scalds

Lizzie’s story of her burns

Health visiting and raising awareness of burns and scalds

A clinician explains the impact of burns and scalds

CAPT resources to prevent burns and scalds

CAPT has a special offer to support National Burn Awareness Day on 21 October 2015 – over 50% off the burns prevention DVD resource pack and posters. Closing date for orders Monday 19 October.


Poisoning – key messages from PHE

Safety advice on preventing poisoning

EU regulations on liquitabs

A clinician explains the impact of poisoning

CAPT resources to prevent poisoning


Falls – key messages from PHE

In focus: serious falls

A clinician explains the impact of head injuries

CAPT resources to prevent falls

Training and consultancy support from CAPT

CAPT worked closely with PHE to develop the guidance Reducing unintentional injuries in and around the home among children under five years and offers local authorities and their partners evidence-based support for effective action. This includes an opportunity to talk through the PHE guidance and explore local prevention opportunities including programmes to help develop key groups in the workforce including health visiting and children’s centres.

To find out more, contact Kevin Lowe on 020 7608 7363.

Updated September 2015