Welcome to the training on Preventing Unintentional Injury: Birth through 20 Years provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
The goal of this module is to equip Texas Health Steps providers and others to identify risk factors for unintentional injury for ages birth through 20 years, provide age-appropriate anticipatory guidance and apply state law and best practices to prevent unintentional injury and death.
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Summarize the leading causes of unintentional injury and death in infancy, early childhood, middle childhood and adolescence.
- Specify risk factors for unintentional injuries and effective risk-reduction strategies at various ages and stages of development.
- Integrate into routine clinical practice age-appropriate anticipatory guidance to prevent unintentional injury.
- Interpret Texas safety laws that prevent childhood injury and death.
Note: The term “parents” in this module also refers to caregivers and guardians. The term “childhood” refers to children ages birth through 18 years. For the purposes of this module, the emphasis is on the leading causes of unintentional injury death for specified age groups. Resources mentioned throughout the module can be accessed from the Appendix tab on this page.
Please note this module expires on 6/17/2024.
This module was released on 6/17/2021.
Continuing Medical Education
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 contact hour(s) of Continuing Nursing Education.
Certified Health Education Specialists
Sponsored by The Texas Department of State Health Services, Continuing Education Service, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES®) and/or Master Certified Health Education Specialists (MCHES®) to receive up to 1.25 total Category I contact education contact hours. Maximum advanced-level continuing education contact hours available are 1.25.
The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 hours of credit.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.25 hour(s) for attendance.
Certified Community Health Worker
The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.25 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support.
- Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
- Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
- Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
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- American Academy of Pediatrics. (2016). Are you prepared for disasters?
- American Academy of Pediatrics, Bright Futures Guidelines and Pocket Guide.
- American Academy of Pediatrics. Bright Futures Tool and Resource Kit.
- American Academy of Pediatrics, Bright Futures: Developmental, Behavioral, Psychosocial, Screening, and Assessment Forms for children and adolescents.
- American Academy of Pediatrics. The Injury Prevention Program (TIPP). Patient education handouts.
- American Academy of Pediatrics. (2019). All-Terrain Vehicle Injury Prevention: Two-, Three-, and Four-Wheeled Unlicensed Motor Vehicles. Pediatrics, 105(6), 1352-1354.
- American Academy of Pediatrics. (2019). Policy Statement: Prevention of Drowning.
- American Academy of Pediatrics. (2019). Policy Statement: Transporting Children With Special Health Care Needs. Pediatrics, 143(5) e20190724.
- American Academy of Pediatrics. (2018). Policy Statement: Child Passenger Safety.
- American Red Cross. (2020). The 7 Ways to Prepare for a Home Fire.
- Center for Adolescent Substance Abuse Research (CeASAR), Children’s Hospital Boston. (2016). CRAFFT 2.0 screening interview.
- Centers for Disease Control and Prevention. Protect the Ones You Love: Child Injuries are Preventable. (2019). A national action plan for child injury prevention.
- Centers for Disease Control and Prevention. (2013). Health and Safety of Young Workers: Proceedings of a U.S. and Canadian Series of Symposia.
- Centers for Disease Control and Prevention. (2012). National Action Plan for Child Injury Prevention.
- Centers for Disease Control and Prevention. Tips to Prevent Poisonings.
- Centers for Disease Control and Prevention, WISQARS (Web-based Injury Statistics Query and Reporting System).
- Consumer Product Safety Commission. Search page for recalls and repairs of products.
- National Highway Traffic Safety Administration. Resources for Parents and Caregivers.
- Safe Kids Worldwide. List of Safe Kids Coalitions in Texas.
- Safe Kids Worldwide, National Child Passenger Safety Certification. Find a Tech.
- Texas Health Steps, Anticipatory Guidance Provider Guide.
- Texas Health Steps Child Health Clinical Record Forms.
- Texas Health Steps Periodicity Schedule.
- Texas Health Steps, Developmental and Mental Health Screening Tools.
- Texas Medicaid Provider Procedures Manual (TMPPM).
- Substance Abuse and Mental Health Services Administration. Resources for Screening, Brief Intervention and Referral to Treatment (SBIRT).
- Texas Safety Laws
- National Resources with Texas Representation
- Injury Prevention Resources in Texas
- Patients and Families
- Firearms, Child Access Protection and Safe Storage Laws (Texas Penal Code 46.13).
- Texas Occupant Restraints Laws.
- Open truck beds (Texas Transportation Code 545.414)
- Bicycle Laws (Texas Code 551)
- Carbon Monoxide Detector Laws (Texas Human Resources Code 42.060) and (Texas Health and Safety Code 766.003)
- Child Personal Flotation Device Law (Texas Water Safety Act)
- Texas Tobacco Laws (Cigarette, E-Cigarette and Tobacco Laws)
- Fire Safe Cigarettes (Cigarette Fire Safety Standards)
- Fire Safety in Residential Dwellings (Texas Health and Safety Code 766)
- Graduated Driver Licensing Laws (Texas GDL Program)
- Pool Safety Law (Pool and Spa Safety Act Information)
- Child Protective Services (CPS), Texas Department of Family and Protective Services.
- Hazardous Products, Texas Department of State Health Services.
- Safe Riders Traffic Safety Program, Texas Department of State Health Services.
- Texas Youth Connection, Texas Department of Family and Protective Services.
- The Health Assessment and Toxicology (HAT) Program, Texas Department of State Health Services.
- Child Safety Campaigns, Texas Department of Family and Protective Services.
- HealthyChildren.org. Information about sports safety for children from the American Academy of Pediatrics
- Protect the Ones You Love: Child Injuries are Preventable. A national action plan for child injury prevention from the Centers for Disease Control and Prevention.
- Safe Kids Worldwide. Information and tips about child safety.
- Safe Kids Worldwide. Car and Road Safety for Big Kids.
- Safe Kids Worldwide. The Ultimate Car Seat Guide.
- Safe Riders Traffic Safety Program. Information about child passenger safety from the Texas Department of State Health Services.
- Texas Health Steps information about finding a health-care provider and getting a ride to a checkup.
- Watch Kids Around Water. From HelpandHope.org, information on children’s water safety from the Texas Department of Family and Protective Services. In English and Spanish.
- American Academy of Pediatricians, AAP News. (2020). Keep hand sanitizers out of children’s reach.
- American Academy of Pediatricians, healthychildren.org. (2020). Guns in the home.
- American Academy of Pediatrics. (2019). Policy Statement: Prevention of Drowning. Pediatrics, 143 (5) e20190850
- American Academy of Pediatrics. (2018). Policy Statement: Child Passenger Safety. Pediatrics, 142 (5): e20182460
- American Academy of Pediatrics. (2019). Policy Statement: Transporting Children With Special Health Care Needs. Pediatrics, 143(5) e20190724.
- American Academy of Pediatrics, healthychildren.org. (2018). ATVs are Not for Children: AAP Urges These Safety Rules.
- American Academy of Pediatrics, Task Force on Sudden Infant Death Syndrome. (2016). Policy Statement: SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics, 138(5): e20162938.
- American Association of Poison Control Centers. (2021). Hand Sanitizer.
- Ablewhite, J., Peel, I., McDaid, L., Hawkins, A., Goodenough, T., Deave, T., Stewart, J., & Kendrick, D. (2015). Parental perceptions of barriers and facilitators to preventing child unintentional injuries within the home: a qualitative study. BMC Public Health, 15, 280.
- Bell, J., & Condren, M. (2016). Communication Strategies for Empowering and Protecting Children.
- Journal of Pediatric Pharmacology and Therapeutics, 21(2), 176–184.
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury. (2020). Trends in emergency department visits for contact sports–related traumatic brain injuries among children — United States, 2001–2018. Morbidity and Mortality Weekly Report (MMWR), 69(27), 870–874.
- Centers for Disease Control and Prevention. (2020). Transportation Safety: Risk Reduction for Every Age.
- Centers for Disease Control and Prevention. 2019. Texas High School Youth Risk Behavior Survey, 2019.
- Centers for Disease Control and Prevention. National Center for Injury Prevention and Control, WISQARS. (2019). Leading causes of deaths.
- Centers for Disease Control and Prevention. National Center for Injury Prevention and Control, WISQARS. (2018). Leading causes of unintentional injury deaths.
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury. (2012). National Action Plan for Child Injury Prevention.
- Consumer Product Safety Commission. (2020). Pool or Spa Submersion: Estimated Nonfatal Drowning Injuries and Reported Drownings, 2020 Report.
- Consumer Product Safety Commission. (2018). How to plan for the unexpected: Preventing child drownings. Publication No. 359.
- DeGeorge, K. C., Neltner, C. E., & Neltner, B. T. (2020). Prevention of Unintentional Childhood Injury. American Family Physician, 102(7), 411-417.
- Farley, K. X., Aizpuru, M., Wilson, J. M., Daly, C. A., Xerogeanes, J., Gottschalk, M. B., & Wagner, E. R. (2020). Estimated Incidence of Electric Scooter Injuries in the US From 2014 to 2019. JAMA network open, 3(8), e2014500.
- Gaw, C. E., Berthet, E., Curry, A. E., Zonfrillo, M. R., Arbogast, K. B., & Corwin, D. J. (2020). Pediatric Health Care Provider Perspectives on Injury Prevention Counseling in Acute and Primary Care Settings. Clinical Pediatrics, 59(13), 1150–1160.
- Klein, D. A., Paradise, S. L., & Landis, C. A. (2020). Screening and Counseling Adolescents and Young Adults: A Framework for Comprehensive Care. American Family Physician, 101(3), 147–158.
- Mayo Clinic. (2020). Mayo Clinic Q and A: What is ‘dry drowning?’
- McDonald, E. M., Mack, K., Shields, W. C., Lee, R. P., & Gielen, A. C. (2016). Primary Care Opportunities to Prevent Unintentional Home Injuries: A Focus on Children and Older Adults. American Journal of Lifestyle Medicine, 12(2), 96–106.
- National Highway Traffic Safety Administration. (2012). Reducing the potential for heat stroke to children in parked motor vehicles: evaluation of reminder technology.
- National Institute for Occupational Safety and Health. (2019). Young worker safety and health.
- Null, J., (2020). Heatstroke Deaths of Children in Vehicles.
- Rix, K., Demchur, N. J., Zane, D. F., & Brown, L. H. (2020). Injury rates per mile of travel for electric scooters versus motor vehicles. The American Journal of Emergency Medicine. Published online: Oct. 27, 2020.
- American Academy of Pediatrics. (2019). Technical Report: Alcohol Use by Youth. Pediatrics, 144(1), e20191357.
- Safe Kids Worldwide. (n.d.). Choking and Strangulation.
- Schwebel, D. C., Tillman, M. A., Crew, M., Muller, M., & Johnston, A. (2017). Using interactive virtual presence to support accurate installation of child restraints: Efficacy and parental perceptions. Journal of Safety Research, 62, 235–243.
- Schwebel, D. C., MacKay J. M., & Redden, D. (2020). Study protocol: a randomized non-inferiority trial using interactive virtual presence to remotely assist parents with child restraint installations. Injury Prevention, 26, 289-294.
- Schnitzer, P. G., Dowd, M. D., Kruse, R. L., & Morrongiello, B. A. (2015). Supervision and risk of unintentional injury in young children. Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention, 21(e1), e63–e70.
- Sylvestre, M-P., Wellman, R. J., Ahun, M., Datta, G., Jutras-Aswad, D., & Loughlin, J. O. (2020). Discrete time measures versus trajectories of drinking frequency across adolescence as predictors of binge drinking in young adulthood: a longitudinal investigation. BMJ open, 10(9), e035939.
- Willcox-Pidgeon, S. M., Franklin, R. C., Leggat, P. A., & Devine, S. (2020). Identifying a gap in drowning prevention: high-risk populations. Injury Prevention, 26, 279-288.
- Zonfrillo, M. R., Gittelman, M. A., Quinlan, K. P., & Pomerantz, W. J. (2018). Outcomes after injury prevention counselling in a paediatric office setting: a 25-year review. BMJ Paediatrics Open, 2(1), e000300.
- Zonfrillo, M. R., Melzer-Lange, M., & Gittelman, M. A. (2014). A comprehensive approach to pediatric injury prevention in the emergency department. Pediatric emergency care, 30(1), 56–62. [Abstract.]
Developmental Surveillance and Screening: Birth through 6 Years
Integrate validated developmental screenings and ongoing surveillance to meet Texas Health Steps requirements for preventive medical checkups.
Implement best clinical practices to identify and treat exercise-induced dyspnea, apply an algorithm to clear athletes to return to play, and determine when specialty care is necessary.
Management of Overweight and Obesity in Children and Adolescents
Adopt best practices that can be used in primary care to assess, treat and prevent overweight and obesity in children and adolescents.