Interview with Elsa Rocha

27/06/2006

Pediatricians are the health care providers with the most access to parents and children.

Elsa Rocha is a pediatrician in Faro, Portugal and works as a volunteer for APSI (Portuguese Association for Child Safety Promotion) a member of the European Child Safety Alliance of EuroSafe.

1. Historically how have pediatricians been involved in child injury prevention?

Pediatric injury prevention is now one of the most important and challenging aspects of child health care. The principle that runs through the history of pediatrics has always been the need to advocate on behalf of children's health. For the last 30 years the rising proportion of child health problems rooted in emotional, social, economic and environmental conditions requires a new approach to training pediatricians to enable them to work not only as clinicians at the bedside, but to also serve as advocates in the community. Child injury and chronic illnesses have replaced infectious pathologies as the leading causes of childhood morbidity and mortality as a result of improved nutrition, sanitation and medical science.

Historically in many countries injury prevention was lead and undertaken primarily by pediatricians. Nowadays, advocating on behalf of children means advocating first for child safety as injuries are currently a major cause of death and disability throughout the developed world. In their daily practices pediatricians deal with the real world of mortality and morbidity caused by injuries placing them in a leading position to recognise the need for safer environments for children and to advocate closing the gap between the scientific-established good practices, community awareness and current legislation.

2. Why do pediatricians play an important role in child injury prevention?

Pediatricians have a critical role to speak out to improve the health and well-being of children and are uniquely positioned to take an active role in injury control and prevention and to reduce the burden of injuries. Due to their collective position in society as respected authorities on health and their individual interaction with patients, pediatricians can be facilitators in helping families adopt healthier ways of living. Because pediatricians spend more then 60% of their consultation time with well-child care they have an excellent opportunity to motivate parents and patients to adopt healthier ways of living.

There are several areas where pediatricians can have a major impact either directly or through implementing effective injury control strategies: education, screening, hazard identification, research, advocacy and policy-making, treatment, closing the gap between the epidemiological/scientific knowledge of injury prevention and what is happening in the real world.

In addition, pediatricians are optimally suited to bring together and facilitate diverse groups to focus on a comprehensive approach to injury prevention. Pediatricians can lead such groups because of their unique ability to manage, coordinate and supervise the entire spectrum of pediatric care. Finally, pediatricians are also needed to speak out for continued and improved funding of injury prevention activities.

3. How can pediatricians be involved in educating parents and caregivers on child safety?

Pediatricians are the health care providers with the most access to parents and children. During the first 3 years of life, approximately 11 "well-child" visits are recommended in Portugal for example and 6 more until 18 years old, making well-child care the most common type of pediatric consultation. In regard to education and counselling, a pediatrician is key to influencing parental behaviour to reduce risk of injury. Effective counselling is developmentally focused, prioritising injuries for the particular age group receiving counselling. Research has indicated that patients are influenced by medical advice to take appropriate action.

Parents must be convinced that active injury prevention is worthwhile and the most appropriate times for offering prevention advice are during child health surveillance clinics and during treatment of an accident, which become key "teachable moments" If parents trust their child's pediatrician they are more likely to follow the doctor's advice and change their behaviour. Examples of efforts being made in pediatricians' practices and community health centers include the following:

  • Provision of anticipatory guidance
  • Brochures and fact sheets in the waiting areas
  • Posters and information on the walls
  • Staff trained to provide counselling on proper child safety seat and booster seat use and installation

In addition to the important role of pediatricians to promote injury prevention to individual patients and families, clinics, emergency departments and hospitals they can also join injury prevention coalitions in their communities.

4. What role can pediatricians play in achieving laws and standards to increase children's safety (i.e. bike helmet legislation, installation of smoke alarms, seat belt enforcement, use of pool fencing, etc.)?

As I mentioned before, the principle that runs through the history of pediatrics is the need to advocate on behalf of children. As children have little or no political voice of their own, they rely on the proxy voice of others, including pediatricians to speak out on their behalf. Pediatricians can collaborate with their unique knowledge on child development and can provide accurate data for research including information on how the injury occurred and what happened to the child. By describing the accident and showing the link between a product or situation and the severity of such an injury pediatricians can advocate for effective interventions.

There is a connection between pediatric clinical work and advocacy. Pediatricians see the pain and problems created by injuries. They become effective advocates for injury prevention because the strongest advocacy is created by those closest to the problem and most aware of what is needed. Pediatricians can be very effective and convincing speakers with the media, politicians and industry since they are recognised as respected medical professionals protecting the interests of children.

5. How can child injury prevention specialists support or assist pediatricians to be stronger advocates for child safety?

Although most pediatricians may believe that injury prevention is part of their role, they often recognise they are not active enough in this area. This is often attributed to lack of time, lack of knowledge, lack of resources (such as printed materials designed for parent education, a regular publication of data on childhood injury mortality) and sometimes fear of parental reactions.

Injury epidemiology and prevention are under emphasised in medical education. Child injury prevention specialists should have a place on residency programmes to help improve the knowledge and skills of pediatricians so this knowledge can be applied in practice. Child advocacy training should also be included in pediatric curricula. Pediatricians have an awareness of issues confronting children in particular on local level, so they need to gain an understanding of the political framework of the issue, how change can occur and how they can contribute to bring about the necessary change. This is the role of the child injury prevention specialist.

More awareness of injury prevention good practices could be promoted to pediatricians through the existing pediatric associations and introduce opportunities for involvement in injury prevention advocacy issues through national injury organisations.

As a pediatrician, I have to say that I've done all my training on child injury prevention, not in medical school or during my residency training but working as a volunteer for an NGO, APSI (Portuguese Association for Child Safety Promotion) for the last 6 years, receiving training on community work and putting it into practice.

Working with APSI has helped me develop an arsenal of tools that together with my clinical skills have facilitated my advocacy activity on child injury prevention. It has been a challenge but very rewarding both for my professional and personal life.

For more information please contact Elsa Rocha at: elsarocha@hdfaro.min-saude.pt.

Share this page