Housing and the home environment

November 2012

Topic briefing

Young children are most at risk of being seriously injured in an accident at home. This briefing explains the key issues relating to housing and the home environment for senior practitioners and policymakers working in child accident prevention.

Key issues

  • Children aged 0-4 years are most at risk of being seriously injured in an accident at home.1 Factors that increase the risk of a young child suffering a serious accident in the home include poverty and overcrowding.
  • 9 out of 10 parents of under 5s feel that their home is a very safe place for their child, but there is often low awareness of very serious risks such as those posed by burns from hair straighteners, falls from windows and smoke from house fires.2
  • People who work with parents and carers of young children can play an important role in educating them about the real injury risks for children in the home and simple steps they can take to reduce them.
  • Guidance from NICE3 confirms the importance of partnership working to address home safety issues, particularly when it comes to promoting the use of home safety equipment.

Accidents in the home statistics: injuries

Each year around 35,000 children under the age of 5 – equivalent to 4 every hour – are admitted to hospital due to accidents. This excludes transport accidents.4

Where place of occurrence is known, accidents at home are responsible for over 80% of emergency hospital admissions for unintentional injuries among under 5s (again excluding transport accidents). For under 18s, the figure is 50%.1

Table 1: Some of the main causes of serious childhood accidents in the home and the costs of treatment

Causes of serious accidental injury for 0-4s in the home
Number of annual emergency admissions for 0-4s4Indicative cost of treatment (where known)

Falls

  • Falls from windows can cause severe brain injuries and even death.
  • Falls down stairs, from high chairs and changing tables can all have serious consequences for young children.
Around 16,000 a year, or 45 every day.
  • £6,981 for a 3 day stay in paediatric intensive care for a severe traumatic brain injury, plus £43,100 for 100 days of specialist inpatient rehabilitation.5

Scalds and burns

  • A hot drink can still scald a young child 15 minutes after the water has boiled.
  • Hair straighteners can still burn up to 8 minutes after being unplugged.
  • It can take just 5 seconds for a toddler to suffer third degree burns from scalding bath water.
Around 2,200 a year, or 6 every day.
  • £1,850 to treat a minor hot drink scald (covering less than 10% of the body).6
  • £63,157 to treat a major burn (covering 30-40% of the body).6
  • Up to £172,821 to treat a very serious bath water scald.7

Poisoning

  • The most common cause of accidental poisoning is everyday painkillers, followed by household cleaning products.
  • Detergent capsules and concentrated detergents pose new risks to young children.
Around 4,200 a year, or 11 a day.
 

Fire

  • Breathing poisonous smoke can kill a child in under a minute.
Around 100 admissions a year for inhaling poisonous smoke from a fire at home. 

Accidents in the home statistics: deaths

In 2009 there were 193 accidental deaths among under 15s. 42% of these were transport-related and 58% non-transport related. Under 5s accounted for 94 of the accidental deaths, which is just under half. 79% of the deaths among under 5s were non-transport related.8

Many of these accidental deaths will have taken place in a home setting, particularly for children under 5. Among the 74 non-transport related deaths for under 5s there were:

  • 29 deaths from accidental threats to breathing which includes:
    • 10 deaths of under 1s from accidental suffocation and strangulation in bed
    • 4 deaths of 1-4 year olds from accidental hanging and strangulation eg from blind cords
  • 17 deaths from accidental drowning and submersion eg in baths and garden ponds
  • 9 deaths from falls eg from windows
  • 4 deaths from exposure to smoke, fire and flames, primarily house fires.8

Causes of accidents in the home

A number of factors are known to increase the likelihood of accidents in the home:

  • poor housing and overcrowded conditions – children from overcrowded homes are three times more likely to be injured9
  • lack of home safety equipment
  • distraction and poor supervision
  • stress, a death in the family, chronic illness, homelessness or moving home
  • smoking – poorer parents are more likely to smoke and having a smoker in the household reduces the likelihood of there being a working smoke alarm10
  • changes to the child's usual routine, being in a hurry
  • being unfamiliar with surroundings, such as when on holiday or visiting friends or relatives.

Children from the poorest families are 3 times more likely to be admitted to hospital with accidental injuries11 and 13 times more likely to die as a result of accidents.12

Policy arena

NICE guidance

The NICE guidance on preventing unintentional injuries among under-15s in the home3 focuses on home safety assessments and the supply and installation of home safety equipment. It also covers education and advice when delivered as part of these interventions. The recommendations in the guidance include:

  • prioritising households at greatest risk of unintentional injuries
  • establishing partnerships to ensure coordinated delivery
  • following up on home safety assessments and equipment interventions.

The guidance makes it clear that all practitioners visiting the homes of families with young children should give consideration to home safety issues.

Building regulations

Building regulations apply to most new buildings in England and Wales. A series of ‘approved documents’ deal with issues such as fire safety, electrical safety and the use of safety glass. As a result of changes made in 2009, new homes must be fitted with thermostatic mixing valves to reduce the risk of bath water scalding.

Housing Health and Safety Rating System (HHSRS)

The Housing Act 2004 requires local authorities and other landlords to conduct health and safety risk assessments for residential properties, using the HHSRS. The tool covers the major home hazards including those which contribute to accidental injury.

Product safety regulations

Product safety regulations and the work of local trading standards officers help to reduce risks from faulty or dangerous consumer goods. There are specific regulations covering various aspects of children’s clothing, toys and equipment, as well as requirements for the fire resistance of household furniture and furnishings, the safety of glass used in furniture and the packaging of medicines and chemicals.

Prevention programmes

Preventing childhood accidents in the home requires a combination of approaches based around education, home safety assessments and home safety equipment. The NICE guidance3 recommends the following criteria for prioritising home safety interventions according to greatest risk:

  • households with children under 5
  • families living in rented or overcrowded conditions
  • families living on a low income
  • families who lack properly installed safety equipment
  • households identified through the HHSRS as living in non-decent properties with known hazards.

Education and awareness

Everyone who works with parents and carers of under 5s can play a role in raising awareness of home safety issues, in particular educating people about the hazards that can cause serious injuries to children. Research conducted by CAPT in 2010 shows that:2

  • 87% of parents of under 5s feel that their home is very safe for their child
  • 71% worry about their child having a bad accident
  • 44% believe there is nothing they can do to stop accidents from happening
  • 19% think that making sure their home is a safe haven for their child takes too much time and energy.

The research also revealed that while many parents are aware of common but serious risks, such as scalds from hot drinks and falls down the stairs, they are much less aware of the risk of injuries from hot hair straighteners, falls from windows and smoke from house fires.

One of the reasons that under 5s have accidents at home is because they develop so fast that parents and carers find it difficult to keep up with what they are able to do. Practitioners can help parents and carers understand the real home safety risks at different ages and stages of development, support changes to household routines and encourage the use of safety equipment.

Child Safety Week

Child Safety Week is CAPT’s community education campaign which takes place in June each year. The campaign promotes the small steps that families can take to make a big difference to children’s safety in the home and other settings. Simple steps for making the home environment safer for under 5s include:

  • always placing hot drinks far out of reach of small children
  • making sure cleaning products, tablets and matches are stored safely
  • placing hair straighteners into a heat protective pouch and putting them away immediately after use
  • using home safety equipment such as stair gates, smoke alarms, cupboard locks and window restrictors.

Issue-led campaigns

Education and awareness-raising campaigns can also focus on particular home safety risks that are responsible for high numbers of hospital admissions. There is little regional variation in the numbers of emergency admissions resulting from different types of home accidents, so you can use national data to help plan your programmes and then fine-tune it with local data. Talking to frontline hospital workers and liaising with Child Death Overview Panels can help you to find out about new and emerging safety issues.

One of the aims of the Making the Link website is to share resources and good practice from successful campaigns. Sharing good practice is especially helpful when it comes to new and emerging safety risks, such as:

Home safety assessment

NICE guidance on reducing unintentional injuries among under 15s in the home3 emphasises the importance of statutory and voluntary sector partners working together to conduct home safety assessments.

From 2009-11, RoSPA ran Safe at Home – the national home safety equipment scheme. Safe At Home addressed known barriers to the installation of home safety equipment by providing free equipment and professional installation. The scheme focused on the most disadvantaged families with children aged up to 5 years, in areas with the highest accident rates.

More than 66,000 families received free safety equipment through Safe at Home and over 5 times as many families received information and support. The cost of the equipment provided for each child was £95.99.13

Although Safe at Home concluded in 2011, some areas secured alternative funding to allow them to continue their home safety equipment scheme. Other areas continue to operate their own schemes which pre-dated Safe at Home. Free home fire risk checks are carried out by the fire and rescue service in many areas, while in others a partnership approach enables fire safety to be incorporated into a wider home safety assessment.

Partnership working

Key organisations that can play a role in promoting home safety for young children include:

  • health visiting teams
  • Family Nurse Partnership programmes
  • children’s centres
  • early years and children’s services
  • community and voluntary organisations including organisations such as Home Start, whose volunteers support families in their own homes
  • housing associations and local authority housing departments
  • fire and rescue services
  • nurseries
  • NHS stop smoking teams.

The independent evaluation of the Safe at Home programme says that: “At local level, partnership working featured strongly as one of the most important factors required for establishing and sustaining a scheme.”14

The NICE guidance on preventing unintentional injuries among under-15s in the home explains that statutory and voluntary sector partners should form partnerships to:

  • collect information on households where children and young people aged under 15 may be at greatest risk of an unintentional injury
  • identify and address barriers to creating a safe home environment
  • get the community involved
  • conduct home safety assessments and supply and install home safety equipment.3

How Making the Link can help you

Making the Link is here to support people with a role to play in child accident prevention throughout England. We recognise that effective child accident prevention programmes and strategies happen through successful partnership working.

We’d like to hear about the work you’re doing in your area and what’s worked well, so that we can share the information with other professionals on the Making the Link site.

Email us at info@makingthelink.net to:

  • submit case studies about your child accident prevention work
  • suggest ideas for Making the Link resources that you would find helpful
  • find out more about the project or any of the information on our website. 

Explore the Making the Link website to:

Stay up to date with Making the Link

Useful links

Making the Link site links

CAPT links

  • Practioner support: Explore the home safety resources in our practitioner support finder, including information on burns and scalds, falls and safety equipment.
  • Accidents and child development guide and One step ahead wallchart: these resources highlight key injuries at different stages of development, along with advice for practitioners to pass on to parents and carers.
  • Look who's falling and Too hot to handle DVD resource packs: these resources on preventing falls and burns and scalds help practitioners to extend parents' knowledge of the links between child development and accidents.

External links

Download this topic briefing as a PDF

Notes for this feature

  1. Hospital Episode Statistics (HES) data on emergency hospital admissions resulting from unintentional and deliberate injury in England, for 2007-08. The data excludes transport accidents. Place of occurrence is not recorded for all injuries.
  2. CAPT survey for Child Safety Week 2010. The survey was of 2,636 respondents who had children under the age of 5. The survey was conducted by Mum Poll and ran from 7-9 June 2010.
  3. NICE guidance PH30 – Preventing unintentional injuries among under-15s in the home.
  4. HES data on emergency hospital admissions among children aged 0-4 years in England due to accidental causes, for 2008-09. The data excludes transport accidents.
  5. See our article on the costs of head injuries for more information.
  6. See our article on the costs of burns for more information.
  7. See our article on the costs of bath water scalds for more information.
  8. Mortality statistics for England and Wales for 2009, Office for National Statistics.
  9. R Alwash and M McCarthy, Accidents in the home among children under 5: ethnic differences or social disadvantage? BMJ, 1988.
  10. D Rowland et al, Prevalence of working smoke alarms in local authority inner city housing: randomised controlled trial, BMJ, 2002.
  11. Hippisley-Cox et al, Unintentional injury increases with deprivation, BMJ, 2002.
  12. P Edwards et al, Deaths from injury in children and employment status in family: analysis of trends in class specific death rates, BMJ, 2006.
  13. Safe at Home – the National Home Safety Equipment Scheme, RoSPA.
  14. Evaluation of the National Safe at Home Scheme – Final report (PDF), The University of Nottingham, 2011.
Updated December 2013