Window safety mechanisms to prevent falls in children (educational programs to increase use)

Conclusion: No indications for effectiveness

There is lack of evidence that home-safety interventions increase the possession of window locks, screens, or windows with limited opening (OR=1.16; 95%CI=0.84, 1.59). The small number of studies and the small sample sizes in many of the studies will have meant that these analyses had limited power to detect anything other than very large intervention effects for some outcomes. These nonsignificant findings should therefore be viewed as an absence of evidence rather than as evidence of the absence of intervention effect.

Recommendations (for research & practice)

There is a paucity of studies that have evaluated whether safety education, with or without increased access to safety equipment, increases fall-prevention practices or reduces fall-injury rates in children. Ideally, what is required is either very large trials of good methodologic quality or multiple smaller trials that are sufficiently clinically homogenous to combine in future meta-analyses and that measure and record injury outcomes. Unfortunately, the sample size requirements for trials to assess the effectiveness of window locks may well be prohibitive. An alternative, used to assess the effectiveness of smoke alarms and cycle helmets, is to design methodologically rigorous observational studies that measure and adquately adjust for a wide range of confouding factors.

While future evidence is awaited, child health and social care providers should continue to provide fall-safety interventions as part of their strategies to improve child health. However, providers must ensure that the interventions are based on the latest evidence, are planned using sound public health principles, and are rigorously evaluated.

Review Date: 10/02/2011
Version: 1.0
Status: Publish

Procedure
Articles (reviews) and reports were included that were published between 1980 and 2010, in English and Dutch. The outcomes of the study were reviewed by the Dutch Consumer Safety Institute.

Strategy: An online literature search was performed by a researcher of the Consumer Safety Institute and after this a more thorough search was performed by the documentation centre of CSI (Catalog CenV, Pubmed, Injury lit, Google, Websites, 'Grey' literature). Results of each search were compared on differences and potential missed studies were added. First the titles and then abstracts were scanned in order to include relevant studies. In the case of insufficient information obtained from abstracts the full text articles were obtained. Relevant articles were scrutinized and background documents were created. In addition, relevant references of included articles were checked on new and relevant articles (i.e., snowball search).

The outcomes of the study were reviewed by an expert in the field of child safety in the spring of 2011.

Background documents

Home safety education and provision of safety equipment for injury prevention (version 1.0)
D. Kendrick, C. Coupland, C. Mulvaney ... [et al.] (2007)

Preventing childhood falls at home: meta-analysis and meta-regression (version 1.3)
Denise Kendrick, Michael C. Watson, Caroline A. Mulvaney ... [et al.] (2008)