The role of parents and temperament on children's estimation of physical ability: links to unintentional injury prevention

The impact of children's temperament on recurrent unintentional injuries: the role of paternal parenting styles as a mediator

Background

Unintentional injuries (UIs) pose a threat to the health of children all over the world and are a major global health problem. The recurrence of UIs are influenced by the host itself or environmental factors. Children's temperament and paternal parenting styles (PPS) are important potential factors for poor health outcomes, including recurrent unintentional injuries (recurrent UIs). Therefore, exploring the relationship among these variables may help reduce the likelihood of recurrent UIs in children.

Purpose

To elucidate the mediating effect of PPS in the relationship of children's temperament characteristics and recurrent UIs among children.

Methods

By multistage random cluster sampling method, a total of 2,850 pupils in grades four and five from 10 different schools were included. The survey included the characteristics of UIs in the past year, parenting styles, and children's temperament. Structural equation modeling (SEM) was used to examine the possible mediating effect of PPS between children's temperament and recurrent UIs.

Results

In this study, the incidence rate of recurrent UIs was 3.8%. In temperament, children with recurrent UIs had higher mean scores than the non-recurrent UIs group (t = -3.40, -3.52, -3.45, respectively; p < 0.001) in the activity, predictability, persistence. Meanwhile, the scores of negative PPS (punishing, over-interference, rejection, and overprotection) were higher in the recurrent UIs group than in the non-recurrent UIs group (t = -5.78, -5.05, -5.56, and -3.29; p < 0.001, < 0.001, < 0.001, < 0.001, respectively). Using a stepwise binary logistic regression model, grade (OR = 0.23, 95% CI [0.12-0.41], p < 0.001), activity (OR = 1.61, 95% CI [1.14-2.26], p = 0.007) and over-interference (OR = 2.28, 95% CI [1.37-3.80], p = 0.002) had a significant independent relationship with recurrent UIs. The SEM results indicated that children's temperament was significantly related to negative PPS (β = 0.26, p < 0.001) and recurrent UIs (β = 0.11, p = 0.029). The results of the bootstrap test confirmed the significance of the mediating effect of PPS (β = 0.06, p < 0.001) between children's temperament and recurrent UIs.

Conclusions

These results suggest that negative PPS plays an important role in mediating children's temperament and recurrent UIs. It is essential to consider PPS when creating tailored intervention programs to reduce children's recurrent UIs.

Effect of parental supervision of infants at age 4 to 6 months on injuries at age 4 to 12 months

This study analyzed the effect of parental supervision of infants at age 4 to 6 months on injuries at age 4 to 12 months. Among all Korean children born during 2008-2009, 464,326 (50.6%) infant had parents who responded to a questionnaire that surveyed their safety and supervision when infant were 4 to 6 months-old. Based on questionnaire score, infant were divided into "safe" or "unsafe" group. 1:1 propensity score matching was used to balance the groups, and injury diagnosis and treatments were analyzed. After matching, we examined the records of 405,862 infant. The unsafe group had significantly increased risk ratios (RRs) for injury of head/neck (RR: 1.06), trunk/abdominopelvic region (RR: 1.12), upper extremities (RR: 1.04), and from burn and frostbite (RR: 1.10). The risks of a wound and fracture and foreign body injury were significantly greater in infant whose parents sometimes left them alone (RR: 1.15 and 1.06, respectively), and whose parents did not always keep their eyes on them (RR: 1.04 and 1.13, respectively). Infant whose parents had a hot drink when carrying them had an increased risk of burn injuries (RR: 1.21). Injuries were less common in infant whose parents provided more supervision.

Pediatric trauma in the California-Mexico border region: Injury disparities by Area Deprivation Index

BACKGROUND

The California-Mexico border region is a high-volume trauma area with populations of widely disparate socioeconomic status. This work analyzed differences in demographics and mechanism of injury in children using the Area Deprivation Index (ADI), a composite measure of 17 markers of neighborhood socioeconomic disadvantage.

METHODS

A retrospective review was performed of pediatric patients evaluated at the regional Level I Pediatric Trauma Center between 2008 and 2018. Collected data included patient demographics and injury characteristics. Patient addresses were correlated to neighborhood disadvantage level using ADI quintiles, with a higher quintile representing greater socioeconomic disadvantage.

RESULTS

A total of 9,715 children were identified, of which 4,307 (44%) were Hispanic. Hispanic children were more likely to live in more disadvantaged neighborhoods than non-Hispanic children (p < 0.001). There were markedly different injury mechanisms in neighborhoods with greater socioeconomic disadvantage (higher ADI) compared with those with less socioeconomic disadvantage. Sports-related and nonmotorized vehicular trauma predominated in less disadvantaged neighborhoods, while higher ADI quintiles were strongly associated with pedestrian versus automobile, motorized vehicle accidents/collisions, and nonaccidental injuries (p < 0.001).

CONCLUSION

This analysis represents the first study to characterize pediatric traumatic injury patterns based upon the neighborhood ADI metric. Area Deprivation Index can be a useful resource in identifying disparities in pediatric trauma and children at increased risk for vehicular and abusive injury who may benefit from increased resource allocation, social support, and prevention programs.

LEVEL OF EVIDENCE

Prognostic and epidemiological, Level III.

Self-Control, Parental Monitoring, and Adolescent Problematic Mobile Phone Use: Testing the Interactive Effect and Its Gender Differences

Previous studies have revealed that self-control was one of the critical factors of adolescent problematic mobile phone use. Few studies, however, have explored the interaction of internal control force (i.e., self-control) and external control force such as parental monitoring. The present study tested the interactive effect of self-control and parental monitoring on adolescent problematic mobile phone use and its gender differences. A sample of 926 adolescents completed our anonymous self-report survey. Results showed that self-control and parental monitoring negatively predicted problematic mobile phone use, while gender positively predicted problematic mobile phone use. Self-control and parental monitoring had an interactive effect on problematic mobile phone use, with the effect of self-control on problematic mobile phone use being stronger for adolescents with low levels of parental monitoring than for those with high levels of parental monitoring. Self-control and gender had an interactive effect on problematic mobile phone use, with the effect of self-control on adolescent problematic mobile phone use being stronger in girls than in boys. Moreover, there were significant gender differences in the interaction of self-control and parental monitoring, in that the interactive effect of self-control and parental monitoring on problematic mobile phone use was more potent in girls than in boys. The findings reveal how the internal control force (i.e., self-control) and external control force (i.e., parental monitoring) work together in explaining adolescent problematic mobile phone use and uncover the potential gender differences in exploring adolescent problematic mobile phone use from the individual-environment perspective. Limitations and implications are discussed.

Child-Pedestrian Traffic Safety at Crosswalks—Literature Review

Child pedestrians make up 30% of the total number of children injured in road traffic in the EU. They are a particularly vulnerable subgroup because they exhibit specific traffic behavior related to cognitive and physical development, sociodemographic characteristics, and environmental conditions. This paper provides an overview of research of parameters that affect the safety of children in the conflict zones of the intersection—crosswalks. The overview was undertaken targeting available research mostly conducted in the last 10 years all over the world, related to the identification of parameters that affect the safety of child-pedestrians, and models developed for the prediction of pedestrian and child-pedestrian behavior. Research conducted on various urban networks provides insight into locally and more widely applicable impact parameters connected to child characteristics and infrastructural and traffic elements, but also distractors (e.g., electronic devices) as new phenomena influencing children’s road safety. A review of pedestrian behavior-prediction models suggests that models are being developed for the general population, and models for children’s behavior, with specific parameters, are missing. For further research, more detailed analysis of the impact of distractors and of COVID–19 pandemic non-mobility, as well as an analysis of possible infrastructural solutions to increase children’s road traffic safety, is suggested.

Children's Play and Independent Mobility in 2020: Results from the British Children's Play Survey

The British Children’s Play Survey was conducted in April 2020 with a nationally representative sample of 1919 parents/caregivers with a child aged 5–11 years. Respondents completed a range of measures focused on children’s play, independent mobility and adult tolerance of and attitudes towards risk in play. The results show that, averaged across the year, children play for around 3 h per day, with around half of children’s play happening outdoors. Away from home, the most common places for children to play are playgrounds and green spaces. The most adventurous places for play were green spaces and indoor play centres. A significant difference was found between the age that children were reported to be allowed out alone (10.74 years; SD = 2.20 years) and the age that their parents/caregivers reported they had been allowed out alone (8.91 years; SD = 2.31 years). A range of socio-demographic factors were associated with children’s play. There was little evidence that geographical location predicted children’s play, but it was more important for independent mobility. Further, when parents/caregivers had more positive attitudes around children’s risk-taking in play, children spent more time playing and were allowed to be out of the house independently at a younger age.

Injuries on the Youth Soccer (Football) Field: Do Additional Referees Reduce Risk? Randomized Crossover Trial

OBJECTIVE

Youth soccer injury can be prevented through various means, but few studies consider the role of referees. Following previous research suggesting children take fewer risks when supervised intensely, this randomized crossover trial evaluated whether risky play and injuries decrease under supervision from three referees instead of one referee.

METHODS

Youth soccer clubs serving a metropolitan U.S. area participated. Boys' and girls' clubs at under age 10 (U10) and under age 11 (U11) levels were randomly assigned such that when the same clubs played each other twice in the same season, they played once with one referee and once with three referees. A total of 98 games were videotaped and subsequently coded to obtain four outcomes: collisions between players, aggressive fouls (involving physical player-to-player contact) called by the referee(s) on the field, aggressive fouls judged by trained coders, and injuries requiring adult attention or play stoppage.

RESULTS

Poisson mixed model results suggest players in the 98 games committed fewer aggressive fouls, as identified independently by referees (rate ratio [RR] 0.58; 95% confidence interval [CI] 0.35-0.96) and by researchers (RR 0.67; 95% CI 0.50-0.90), when there were three referees versus one referee. Collisions (RR 0.98; 95% CI 0.86-1.12) and injury rates (RR 1.15; 95% CI 0.60-2.19) were similar across conditions.

CONCLUSION

When the same youth soccer clubs played with three referees rather than one, they committed fewer aggressive fouls. More intense supervision created better rule adherence. Injury rates were unchanged with increased supervision. Results raise questions concerning whether financial investment in additional referees on youth soccer fields yields safety benefits.

The Risk and Protective Factors for Pediatric Eye Injuries: A Case-Crossover Study

Purpose: To investigate state- and trait-like risk factors leading to childhood eye injuries controlling for the between-subject difference. This study measured socioeconomic, environmental, behavioral, and injury event characteristics to identify eye injury protective and risk factors.Methods: A retrospective case-crossover study including patients aged 0-18 years old (y.o.) with severe eye trauma treated at the Canton Hospital Zenica between 2011 and 2017 was conducted. One case time point was at the time of injury, and two control time points 1 month before the injury and a month before the survey.Results: Of 36 patients meeting the criteria, four were excluded, resulting in 32 cases and 64 controls. The mean age was 10.79 in males (77.8%) and 11 y.o. in females (22.2%). In univariate GEE logistic regression unusual activity had odds of 17.25 (95%CI = 6.97, 42.70), working/chores vs.running activity odds of 6.60 (95%CI = 1.71, 25.46), very active level vs.an intermediate child activity level odds of 5.26 (1/0.19, 95%CI = 1.75, 16.67) no supervision odds of 2.63 (1/0.38, 95%CI = 1.45, 4.76) and less than 7 hours of sleep odds of 4.69 (95%CI = 1.06, 20.77) of sustaining an eye injury. Using the quasi-likelihood approach and QICu as an indicator, the best model yielded odds of getting eye injured = 0.59 + 19.35*engaging in unusual activity+0.21*supervised by an adult person+0.84*playing+3.04*working within the households+0.22*other activity.Conclusions: Giving the best model to predict injuries, the combined strategies of teaching, modifying the environment, and the watchful supervision present a preventive triad that needs to be further explored and encouraged in practice.

Physical Literacy and Resilience in Children and Youth

Background: There is growing interest in the relationship between physical and psychosocial factors related to resilience to better understand the antecedents of health and successful adaptation to challenges in and out of school, and across the lifespan. To further this understanding, a trans-disciplinary approach was used to investigate the association between the multidimensional constructs of physical literacy and resilience in children at a key stage in their development.

Methods: Cross-sectional data were collected from 227 school children aged 9-12 years old from five schools in Winnipeg, Manitoba, Canada. Resilience was measured using the Child and Youth Resilience Measure, and physical literacy through the Physical Literacy Assessment for Youth tools. Data were provided by self-report, surrogate assessors of the child (physical education teachers and parents), and trained assessors for movement skills. These data were analyzed using correlation and logistic regression.

Results: Resilience was significantly correlated with numerous indicators of physical literacy, including movement capacity, confidence, and competence, environmental engagement, and overall perceptions of physical literacy. Regressions indicated that resilience could be predicted by movement confidence and competence, environmental engagement, and overall physical literacy.

Conclusions: The findings of this study, using a constellation of sources, provide foundational evidence for the link between resilience and physical literacy among children, encouraging the importance of physical literacy development in schools. Longitudinal studies are required to further examine this relationship and how these previously unrelated fields may work together for a richer understanding of the interplay between the physical and psychological determinants of well-being.

Social Cognition, Child Neglect, and Child Injury Risk: The Contribution of Maternal Social Information Processing to Maladaptive Injury Prevention Beliefs Within a High-Risk Sample

Objective

Inadequate supervision has been linked to children's injuries. Parental injury prevention beliefs may play a role in supervision, yet little theory has examined the origins of such beliefs. This study examined whether mothers who perpetrated child neglect, who as a group provide inadequate supervision, have more maladaptive beliefs. Then, it tested a social information processing (SIP) model for explaining these beliefs.

Methods

SIP and injury prevention beliefs were assessed in disadvantaged mothers of preschoolers (N  =  145), half with child neglect histories.

Results

The neglect group exhibited significantly more maladaptive injury prevention beliefs than comparisons. As predicted, SIP was linked to beliefs that may increase injury risk, even after accounting for relevant sociodemographic variables.

Conclusions

Findings support the link of beliefs to injury risk and suggest that specific cognitive problems may underlie these beliefs. Future work should further validate this model, which may inform enhancements to prevention efforts.

Child abuse and neglect experts' determination of when a child being left home alone constitutes child neglect

Background

Only 14 states have laws or guidelines regarding the minimum age a child may be left home alone. These ages range from 6 to 14 years. Our objective was to identify factors that influence child neglect determination by experts with regards to parents leaving children home alone.

Methods

American Academy of Pediatrics Section on Child Abuse and Neglect members (N = 523) were surveyed from July–August, 2015. Respondents were asked whether scenarios involving a child of varying age knowingly left home alone for 4 h were neglect in the presence or absence of injury to the child and the legality of the situation. Comparisons were performed using the chi-square test.

Results

One hundred ninety-three members responded (36.9%). In the scenario where there were no relevant laws and the child was uninjured, nearly 100% of the child experts determined this as being child neglect when the child was 6 years old. For 8, 10, 12, and 14 year olds, this was 88, 48, 4, and 1%, respectively. However, a significantly higher percentage of experts considered it child neglect for most ages when there was a law making the scenario illegal as compared when there was no law, and when the child was injured versus when they were not. The only demographic variable that showed a difference in child neglect determination was that females were more likely to consider higher aged children as having been neglected when there were no laws but the child was injured. The vast majority of experts (85%) stated that leaving a child home alone for 4 h should be illegal if the child is < 9 years old, and nearly one-half (44%) said it should be illegal for children < 11 years old.

Conclusions

A number of factors affect how experts view children being left home alone as potential child neglect. Our data suggests that such cases may be evaluated differently due to variations in state laws, even though the risk to the child is the same. These results call for child safety law reform to provide greater uniformity in the evaluation of potential child neglect cases and better protect the safety of children.

Independent Development of Imagination and Perception of Fitts' Law in Late Childhood and Adolescence

Recent neurophysiological and behavioral research suggests perception-action systems are tightly coupled. Accordingly, Fitts' law has been observed when individuals execute, perceive, and imagine actions. Developmental research has found that (a) children demonstrate Fitts' law in imagined actions and (b) imagined movement time (MT) becomes closer to actual MT as age increases. However, action execution, imagination, and perception have yet to be assessed together in children. The authors investigated how imagined and perceived MTs related to actual MTs in children and adolescents. It was found that imagined MTs were longer than execution MTs were. Perception MTs were lower than execution MTs for children and more consistent with execution MTs for adolescents. These results suggest potential mechanistic differences in action imagination and perception.

Risk factors of bicycle traffic injury among middle school students in chaoshan rural areas of china

BACKGROUND

Bicycle injuries are a leading cause of accidental death among children in the world, and bicycle-related injuries are also very common in China, thus to find out bicycle injury risk factors is imperative. This study aims to identify the cyclist-, bicycle- and road-related risk factors of bicycle injury, to develop health education programs as an intervention and to provide a scientific basis for establishing policies against bicycle injury.

METHODS

We selected two middle schools randomly among seven schools in Chaoshan rural areas,where the main means of transportation for students from home to school was bicycle. The subjects were middle school students from 7th to 9th grades from Gucuo Middle School and Hefeng Middle School. Cyclists were surveyed through questionnaires about bicycle injury in the past 12 months.

RESULTS

Multivariable logistic analysis showed that compared with a combination-type road、 motor lane and a non-intact road were both risk factors of bicycle injuries. This was followed by riding with fatigue, non-motor lane and inattentive riding.

CONCLUSION

Bicycle injuries are frequent in China. Three risk factors on bicycle traffic injury among middle school students in Chaoshan rural areas of China were identified. This study provides important data to develop intervention strategies for China and other developing countries.

Approaches used by parents to keep their children safe at home: a qualitative study to explore the perspectives of parents with children aged under five years

Background

Childhood unintentional injury represents an important global health problem. Many unintentional injuries experienced by children aged under 5 years occur within the home and are preventable. The aim of this study was to explore the approaches used by parents of children under five in order to help prevent unintentional injuries in the home and the factors which influence their use. Understanding how parents approach risk-management in the home has important implications for injury practitioners.

Methods

A multi-centre qualitative study using semi-structured interviews. A thematic approach was used to analyse the data. Sixty five parents of children aged under 5 years, from four study areas were interviewed: Bristol, Newcastle, Norwich and Nottingham.

Results

Three main injury prevention strategies used by parents were: a) Environmental such as removal of hazards, and use of safety equipment; b) parental supervision; and c) teaching, for example, teaching children about safety and use of rules and routine. Strategies were often used in combination due to their individual limitations. Parental assessment of injury risk, use of strategy and perceived effectiveness were fluid processes dependent on a child’s character, developmental age and the prior experiences of both parent and child. Some parents were more proactive in their approach to home safety while others only reacted if their child demonstrated an interest in a particular object or activity perceived as being an injury risk.

Conclusion

Parents’ injury prevention practices encompass a range of strategies that are fluid in line with the child’s age and stage of development; however, parents report that they still find it challenging to decide which strategy to use and when.

Using a Virtual Environment to Examine How Children Cross Streets: Advancing Our Understanding of How Injury Risk Arises

PURPOSE

To examine how risk of injury can arise for child pedestrians.

METHODS

Using a highly immersive virtual reality system interfaced with a 3-D movement measurement system, younger (M = 8 years) and older (M = 10 years) children's crossing behaviors were measured under conditions that introduced variation in vehicle speed, distance, and intervehicle gaps.

RESULTS

Children used distance cues in deciding when to cross; there were no age or sex differences. This increased risk of injury in larger intervehicle gaps because they started late and did not monitor traffic or adjust walking speed as they crossed. In contrast, injury risk in smaller intervehicle gaps of equal risk (i.e., same time to contact) occurred because crossing behavioral adjustments (starting early, increasing walking speed while crossing) were not sufficient.

CONCLUSIONS

Dependence on distance cues increases children's risk of injury as pedestrians when crossing in a variety of traffic situations.

The health consequences of child mental health problems and parenting styles: unintentional injuries among European schoolchildren

OBJECTIVE

Unintentional injury is the leading cause of death for schoolchildren. We assessed the association between externalizing psychopathology, parenting style, and unintentional injury in European children in the community.

METHODS

Data were drawn from the School Children Mental Health in Europe project and included 4517 schoolchildren across seven diverse European regions. Past-year injuries serious enough to seek medical attention were reported by mothers. Child mental health problems were assessed using validated measures and reported by the mothers, teachers, and children. Parenting styles were based on The Parenting Scale and the Parent Behaviors and Attitudes Questionnaire.

RESULTS

Children with attention-deficit/hyperactivity symptoms and oppositional defiant symptoms had a higher risk of injury compared to other children whether based on parent report (OR=1.47, 95% C.I. 1.2-1.9), teacher report (OR=1.36, 95% C.I. 1.1-1.7), or parent and teacher report combined (OR=1.53, 95% C.I. 1.1-2.1). Children who self-reported oppositional symptoms also had higher risk of injury (OR=1.6, 95% C.I. 1.1-2.4). Low-caring behavior of parents increased the risk of injury (OR=1.4, 95% C.I. 1.1-1.9).

CONCLUSION

Unintentional injury is a potential adverse health consequence of child externalizing problems. Interventions to improve parent-child relationships and prevention as well as focused treatment for externalizing problems may reduce the burden of injury.

Maternal perceptions of supervision in pre-school-aged children: a qualitative approach to understanding differences between families living in affluent and disadvantaged areas

AIM

To explore maternal perceptions of supervision and childhood unintentional injury in order to develop understanding and explanation for differences in unintentional injury rates between an advantaged and disadvantaged area.

BACKGROUND

Unintentional injury is the second cause of mortality and a significant cause of morbidity in the zero to four year age group. Children living in socio-economic disadvantage are at a greater risk of unintentional injury than their more affluent counter-parts.

METHODS

Qualitative study using semi-structured interviews; content data analysis was undertaken. Participants included 37 mothers with a child aged less than five years; 16 living in an area of disadvantage (and high rate of childhood unintentional injury) and 21 living in an advantaged area (and low rate of childhood unintentional injury).

FINDINGS

Parents in both areas described the importance of parental supervision in reducing child unintentional injury risks. Parents in both areas used listening as a supervision strategy. Parents in both areas described how 'when the child goes quiet' that is a cue for them to make a visual check on the child. Listening was used more for boys than girls in both areas, but parents in the advantaged area used listening as a supervision strategy more frequently than those in the disadvantaged area. Parents described supervision strategies as being shaped by child character and age rather than child gender. Parents in both areas described similar strategies for managing distractions. An important difference was found with regard to older siblings; parents living in the advantaged area described older siblings as an injury risk to younger children. Parents in the disadvantaged area described older siblings as providing some supervision for younger children. Parents living in disadvantaged circumstances may face greater challenges with regard to supervision than parents living in advantaged circumstances and this may partly explain differences in injury risk.

Examining parents' behaviors and supervision of their children in the presence of an unfamiliar dog: does The Blue Dog intervention improve parent practices?

OBJECTIVES

Young children are at particular risk for dog bite injuries. This study examined parents' supervision of and reactions to their children in the vicinity of an unfamiliar dog.

METHODS

A pre/post intervention/control group randomized design assessed whether exposure to The Blue Dog, a dog bite prevention and education program, positively impacted parent behaviors.

RESULTS

No group differences in pre or post-intervention measures emerged, indicating that The Blue Dog did not evoke improvements in parents' behaviors. Generally, parents showed risky reactions and encouraged children to interact with the dog, even though they knew very little about the dog's safety or disposition. Supervision measures (proximity, watching) remained unchanged (watching) or more lax (proximity) across sessions.

CONCLUSIONS

The results highlight the importance of targeting parent behavior, not just child behavior, in programs that aim to reduce risk of childhood dog bites. The Blue Dog did not effectively change parent behavior.

"You have to listen to me because I'm in charge": explicit instruction improves the supervision practices of older siblings

OBJECTIVES

Sibling supervision increases young children's risk of unintentional injury. Both noncompliance by the supervisee and insufficient supervision contribute to this risk. The current study examined whether explicitly instructing older siblings to supervise their younger siblings and prevent specific risky behaviors improves their supervision practices.

METHODS

Supervisees and older siblings were placed together in a playroom. One group of older siblings were given explicit instructions not to allow the supervisee to engage in specific risk behaviors, whereas a second group was not.

RESULTS

Informing older siblings that they were "in charge" resulted in a higher frequency of proactive supervision strategies, more forceful reactions to stop supervisee risk taking, and a trend toward improved watchfulness. Supervisees in the no instruction condition also engaged in more hazard interactions compared with those in the instruction condition.

CONCLUSIONS

Explicitly informing older children to supervise younger siblings may reduce younger children's risk of injury when siblings are supervising.

Marital conflict and fifth-graders' risk for injury

BACKGROUND

Injuries are the leading cause of morbidity and mortality for American children. Marital conflict has been associated with a range of negative health outcomes, but little is known about how marital conflict may influence risk of injury among children. We hypothesized marital conflict would be related to increased youth injury risk after controlling for relevant demographic and parenting covariates.

METHODS

A community sample of 3218 fifth-graders recruited from three US locales was utilized. Ordinal logistic regression models were used to predict the frequency of unintentional injuries from marital conflict while adjusting for demographics, parenting factors (nurturance, communication, involvement with youth), and family cohesion.

RESULTS

Higher levels of marital conflict were associated with higher rates of injury that required professional medical attention (OR=1.20, 95% CI 1.06, 1.35 per standard deviation). The same association held after inclusion of all covariates in a multivariate ordinal logistic regression model.

CONCLUSIONS

Parental marital conflict is associated with higher rates of injuries requiring professional medical attention in preadolescent children.

Supervision to prevent childhood unintentional injury: developmental knowledge and self-efficacy count

Caregiver developmental knowledge was tested as a moderator of the association between caregiver-perceived self-efficacy and perceived supervision to prevent childhood unintentional injury. Caregivers (N = 123; 95 mothers and 28 fathers) of children (M = 3.5 ± 1.2 years, 49.6% female, 80.8% Caucasian) were recruited from pediatric primary care offices and local message boards. All caregivers completed self-report questionnaires on perceived self-efficacy, developmental knowledge, and perceived supervision to prevent injury. Separate hierarchical linear regression models were conducted to test moderation for mothers and fathers. The interaction effect of perceived self-efficacy and developmental knowledge significantly predicted maternal-perceived supervision, R (2) change = .06, F(1, 86) = 6.76, p < .01. No significant findings were detected for fathers. Models of studying injury prevention that consider complex cognitive-behavioral interactions and their potential modifiable role in the development of injury-prevention practices may elucidate upon the attitude-practice gap currently identified in the literature.

The roles of child, parent and environmental factors in pedestrian supervision

Pedestrian injuries are a significant health risk to children, particularly those 5-9 years of age. Surprisingly, few studies have explored parent-related factors that may moderate this risk. We examined parental supervision choices in the context of child pedestrian experience, parent perceptual factors and varying levels of environmental risk. A series of street crossing scenarios were used to examine the roles of child, parent and environmental factors in determining parents' supervision choices. Parents recognised differing levels of risk across environmental conditions and altered their supervision choices accordingly. Child age and parental risk perception were significantly predictive of supervision choices. Our results demonstrate that parents assess multiple factors when determining the intensity of supervision necessary for their children. Notably, parents adjust their supervision in direct relation to changes in the physical environment. Implications of these findings for injury prevention and future research are discussed.

The association of activity level, parent mental distress, and parental involvement and monitoring with unintentional injury risk in fifth graders

OBJECTIVE

Extend findings with young children by examining the strength of association of activity level, parent mental distress, and parental involvement and monitoring with fifth graders' unintentional injuries.

METHODS

Ordinal logistic regression models were used to predict unintentional injury frequency among 4745 fifth-graders. Examined predictors included demographics, parent reports of mental distress, temperamental activity level (tendency to be fidgety, restless, and constantly in motion), and parental involvement and monitoring in adolescents' lives.

RESULTS

Higher levels of both activity level and parent mental distress predicted more frequent injuries.

CONCLUSIONS

As has been found with younger children, unintentional injuries in fifth graders are associated with both parent and child characteristics. The result is discussed in the context of adolescent development. Implications include those for injury prevention (multi-dimensional prevention strategies that incorporate environmental modifications as well as training of youth and parents) and future research (study of potential mechanisms behind injury risk behavior via longitudinal and experimental research; study of injury risk during this phase of child development).

Supervision of young children with fall injuries

BACKGROUND

Specific information about the supervision of young children with injuries related to falls is limited. In this study, we describe the supervision and physical environment of falls resulting in medical care in the emergency department.

METHODS

We enrolled a convenience sample of 108 children younger than 7 years with fall injuries.

RESULTS

The average age was 3 years, and 56% were male. Seventy-six (70%) were a fall from a height including 16 that involved stairs. Among caretakers in a nongroup setting (n = 95), most (61%) were supervising more than one child. The attention to the child was holding or playing with the child (13%), observing (45%), usually constantly, or listening for the child (19%); 9% reported no supervision at the time of the fall. Thirty-two percent stated they were touching or within reach of the child. Of falls indoors (n = 56), the supervisor was in the same room as the child for more than half of cases. There was no association between the number of children supervised and fall type (height vs. same level). When compared with those with same level falls, children with falls from a height were more often supervised with listening or no supervision (vs. observation, holding, or playing with the child) χ², p = 0.004.

CONCLUSIONS

Many children were supervised at the time of their fall. Most caretakers had visual contact, and up to a third were touching or within reach of the child. The strategies used in these apparently low-risk situations were insufficient to prevent the falls we report.

"I think he is in his room playing a video game": parental supervision of young elementary-school children at home

OBJECTIVES

Using a prospective design, this research examined supervision of young elementary-school children at home and how this relates to child injury, parent permissiveness, and children's risk-taking propensity.

METHODS

Mothers reported children's history of injuries and recorded home supervision over a 2-month interval on a weekly basis. Children independently completed diaries about daily events, including injuries.

RESULTS

Children spent 24% of time alone, mostly supervised intermittently or not at all. Parent permissiveness was associated with increased time unsupervised, while children's risk-taking propensity was associated with decreased time unsupervised. Greater direct supervision was associated with fewer injuries, while more indirect and non-supervision time emerged as risk factors and were associated with more frequent injury.

CONCLUSIONS

These results extend those from preschool-aged children and suggest that caregiver supervision influences risk of injury across a broad age range throughout childhood. Implications for children's safety are discussed.

Sibling supervision and young children's risk of injury: a comparison of mothers' and older siblings' reactions to risk taking by a younger child in the family

Although parental supervision is associated with reduced risk of injury to young children, supervision by older siblings has been shown to increase this risk. The current study, conducted in Guelph, Canada, explored how this differential risk of injury may arise. It compares the supervision behaviors of mothers to those of their older children when each was the designated supervisor of a young child, shown on a videotape to engage in no risk, risk, and rule violation behaviors in a home situation. The mothers and older child supervisors were told to imagine the toddler on the videotape was the young child in their own family, and to stop the tape and speak to the child whenever they would in real life. Results indicated that supervisees were allowed to engage in more risk behaviors when supervised by older siblings than by mothers. Sibling supervisors reacted to risk behaviors with more prohibitions, whereas mothers adopted a teaching orientation and gave more explanations and directions in response to risk behaviors by the supervisee. Implications for injury prevention and directions for future research are discussed.

Child home injury prevention: understanding the context of unintentional injuries to preschool children

Injury to young children at home is a public health problem. In New Zealand, over half the injury deaths and hospitalisations among 0-4 year olds occur at home. Causes and risk factors for child injury have been identified, but their circumstances are not well described. Understanding the context, however, is important for developing and implementing effective prevention. To obtain the descriptions of injury events, semi-structured interviews were conducted with a convenience sample of 100 caregivers of 0-4 year olds attending an emergency department for a home injury. Analysis from this exploratory study indicated that most events occurred within usual family activity, but had multiple factors interacting. Injury was rarely the expected outcome. Findings concurred with findings from others' research that reported home injury to be complex and multifaceted. Factors related to the environment, the child, the parent, their behaviours and activity interacted, with common patterns preceding injury being evident such as times of day and disrupted routines. Factors were often found to occur regardless of the cause of injury. Complex parental factors were identified, such as not anticipating risk, having unrealistic expectations of children, lacking knowledge of child development and accepting injury as a norm. Directions for further research are identified.

Child Injury: The Role of Supervision in Prevention

As the leading cause of death and major contributor to hospitalization for children, unintentional injury is a significant health problem in the United States. How supervision influences children’s risk of injury has been of interest for some time, and much progress has been made recently to address definitional and measurement issues pertaining to supervision. Increasing evidence supports the notion of a general relationship between increased supervision and decreased injury risk, but also reveals that child behavioral attributes and environmental characteristics can interact with level of supervision to affect injury risk, making it challenging to develop guidelines regarding what constitutes “adequate” supervision. Further research is needed to explore if and how children’s risk of injury varies with different supervisors (eg, mothers vs fathers vs older siblings) and how these relations change as a function of children’s developmental level. Recent research has identified messaging approaches that are effective to invoke a commitment to more closely supervising young children at home. Examining how these messages affect actual supervisory practices is an essential next step in this research and can support the development of evidence-based programs to improve supervision and reduce children’s risk of injuries.

Does health-related quality of life predict injury event?

Background:

Unintentional injury is a leading threat to children's health. Some human factors have been determined as predictor of unintentional injury. Association between Health-Related Quality of Life (HRQOL) as a human factor and unintentional injuries is unclear. The objective of study is to examine the association between HRQOL and unintentional injuries among primary school children.

Methods:

This study was a cross-sectional conducted in Ahwaz, a city in Iran. Overall, 3375 children aged 6-10 years were randomly selected from primary school. HRQOL was measured by 56 items taken from seven domains of Netherlands Organization for Applied Scientific Research Academic Medical Center (TNO AZL) child quality of life (TACQOL) parent form. Parents were interviewed to collect information about incidence, cause and a brief description of injury within the past 12 months prior to the study.

Results:

The response rate was 3375 of 3792 (89%). There was a significant trend for increasing occurrence of injury with decreasing of HRQOL score (p was less than 0.001). Adjusted OR for injury was significantly higher in very low (2.38, 95% CI: 1.45-3.86), low (2.18, 95% CI: 1.34-3.56), and medium (1.73, 95%CI: 1.06-2.83) HRQOL groups compared to reference group (very high HRQOL). The median of total HRQOL (P less than 0.001) and all its domains (P=0.017) (except autonomous functioning) was lower in injured group compared to uninjured one.

Conclusions:

This study found an association between HRQOL and unintentional injury among primary school children. This is a preliminary finding and further investigations with a well-defined analytical design are needed.

Relation of caregiver alcohol use to unintentional childhood injury

OBJECTIVE

The present study used a case-crossover design to investigate the association of caregiver alcohol consumption and supervision to children's injury occurrence and severity.

METHOD

A community sample of 170 mothers of toddlers was interviewed biweekly about their children's daily injuries for a period of 6 months.

RESULTS

Proximal caregiver-reported alcohol use predicted higher likelihood of injury occurrence and higher injury severity, whereas caregiver-reported supervision predicted lower likelihood of injury occurrence and lower injury severity.

CONCLUSION

Even at low levels, proximal caregiver alcohol use may contribute to higher risk for childhood injuries and more severe injuries. The combined effect of supervision and drinking on injury likelihood warrants further exploration.

Do visually salient stimuli reduce children's risky decisions?

Children tend to overestimate their physical abilities, and that tendency is related to risk for unintentional injury. This study tested whether or not children estimate their physical ability differently when exposed to stimuli that were highly visually salient due to fluorescent coloring. Sixty-nine 6-year-olds judged physical ability to complete laboratory-based physical tasks. Half judged ability using tasks that were painted black; the other half judged the same tasks, but the stimuli were striped black and fluorescent lime-green. Results suggest the two groups judged similarly, but children took longer to judge perceptually ambiguous tasks when those tasks were visually salient. In other words, visual salience increased decision-making time but not accuracy of judgment. These findings held true after controlling for demographic and temperament characteristics.

`What, Me Worry?'

Little is known about the bases of parental worry about adolescents' risk for acquiring a sexually transmitted infection (STI). Parents ( N = 247) of adolescents 12—17 years endorsed reasons that explained their worry or nonworry. Parents' past experience of an STI, perception of the child's sexual activity, and racial self-identification were predictors of worry. Cluster analyses identified five groups of worriers and four groups of nonworriers. Worriers tended to select reasons reflecting an external parental locus of control or child-specific reasons. Nonworriers endorsed reasons consistent with internal parental locus of control. Findings suggest that preventive health communication should be tailored to parents' perceptions of risk and protective factors.

Interactions between child behavior patterns and parent supervision: implications for children's risk of unintentional injury

Unintentional injuries are the leading cause of death for children. Prior research has implicated both child behavioral attributes and parent supervisory patterns as risk factors. The present study assessed interactions between these two risk factors and determined whether supervision moderates the relation between child attributes and injury. Mothers completed questionnaire measures of child attributes and supervisory patterns and also recorded how they supervised their young child (2-5 years) at home on each of 10 randomly selected days within a 3-week period. Results provide support for the moderating effect of supervision: Supervision interacted with some child attributes to elevate children's risk of medically attended injury and with other attributes to decrease injury risk. Implications for preventing childhood injuries are discussed.

A new approach to understanding pediatric farm injuries

The objective of this study was to apply a new conceptual approach to the study of pediatric farm injuries. A large case series of pediatric farm injuries in North America was evaluated to assess interactions between risk factors for injury. Information about pediatric farm injuries to children in three age groups (<6 years, 6-12 years, 13+ years) was coded with respect to children's behavior (did unexpected child behavior contribute to injury?), predictability of injury risk (based on what the child had been doing, was the nature or occurrence of injury unexpected?), environmental events (did unexpected environmental events contribute to injury?), and level of environmental risk (low, high). The reliability of coding between independent raters was excellent (kappa=.83) for the 330 cases providing complete data. Results revealed that, in high-risk environments, unexpected child behavior was coded more frequently when children under 6 years were injured than for older children, whereas in low-risk environments unexpected child behavior had less impact on injury risk and showed no such age variation. With increasing age, the predictability of injury increased in a high-risk context, suggesting that youth engage in increasingly hazardous activities as they develop. Consistent with this interpretation, unexpected environmental events increasingly contributed to injury in a high-risk context in the oldest age groups. The observed variations in risk factors suggest that interactions between behavioral and environmental factors are important to consider in studies of the etiology of pediatric farm injuries.

The cost of foreign body injuries in the upper aero-digestive tract: need for a change from a clinical to a public health perspective?

OBJECTIVE

This paper addressed the impact in terms of direct costs of the injuries in children due to foreign bodies in the upper aero-digestive tract.

METHODS

Two thousand one hundred and three consecutive cases were collected from 2000 to 2002 in 16 European hospitals, 1 hospital for each participating country, and referred to children aged until 14 who had FB injuries. Costs were based on the extraction of the FB procedures and on hospitalization length, based on DRGs. Determinants of costs and of length of stay (LOS) were analyzed using a multilevel model.

RESULTS

The major cost of the treatment of FB injuries is covered by the ENT Departments, which are usually the first choice of referral, directly from the patients. Children had a mean LOS of 2.13 days (95% C.I. 1.99-2.29). Treatment of the FB was associated with a mean cost of euro 1017.37 (95% C.I. 963.27-1073.51). In the multivariable analysis higher costs are related to the modality of arrival to the hospital by walk, to the site of the injury (ICD-933, ICD-934, ICD-935 in particular) and to the use of surgery in removing the FB.

DISCUSSION

Foreign bodies injuries are posing a great threat not only with regards to the clinical aspects but also from the public health perspective, their treatment being associated with high costs, in particular when surgery is needed.

Pediatric unintentional injury: behavioral risk factors and implications for prevention

Unintentional injury is the leading cause of death for children and adolescents between the ages of 1 and 18 in the United States, accounting for more deaths than the next 20 causes of mortality combined. It is estimated that pediatric injury accounts for more than $50 billion in annual losses from medical care costs, future wages, and quality of life. Despite these numbers, much remains to be learned about the behavioral risks for pediatric unintentional injury. This article reviews behavioral risk factors for pediatric unintentional injury risk, with a particular focus on four broad areas. First, we discuss the effects of demographic risk factors, including gender, socioeconomic status, and ethnicity. Second, we present information about child-specific risk factors, including temperament, personality, psychopathology, and cognitive development. Third, we discuss the influence of parents and other primary caregivers on childhood injury risk, with a particular focus on the effects of supervision and parenting quality and style. Finally, we discuss the role of peers on child injury risk. We conclude with a discussion of the ways in which the material reviewed has been translated into injury prevention techniques, with a focus on how pediatricians might use knowledge about etiological risk to prioritize safety counseling topics. We also present thoughts on four priorities for future research: injury risk in diverse nations and cultures; developmental effects of injury; the influence of multiple risk factors together on injury risk; and translation of knowledge about risk for injury into intervention and prevention techniques.

Older siblings as supervisors: does this influence young children's risk of unintentional injury?

Unintentional injury is a leading cause of death and hospitalization of young children. Many of these injuries occur in the home when children presumably are being supervised. This study focused on the under-explored issue of sibling supervision in the home, drawing on data collected from a sample of Canadian mothers. Mothers in this sample completed a structured telephone interview and mailed back questionnaires to provide information about the nature and extent of sibling supervision that occurs in the home, as well as the younger child's injury history. Results indicated that older siblings supervise younger ones about 11% of their mutual wake time, with children typically playing and parents usually doing other chores during this time. Time spent with siblings as supervisors was positively related to the supervisee's history of injuries suggesting that sibling supervision may elevate younger children's risk of injury. However, the behavior of the supervisee contributed to risk more so than that of the supervisor. Specifically, sibling supervisors were reported to utilize the same types of strategies as their mother and father in their efforts to supervise and persuade younger children to stop things that could lead to injury. However, poor compliance by the younger child when the older sibling was supervising predicted injury. Implications for childhood injury and directions for future research are discussed.

Finding the daredevils: development of a Sensation Seeking Scale for children that is relevant to physical risk taking

OBJECTIVE

There were two objectives in this research. First, to develop and evaluate the criterion validity of a questionnaire measure of sensation seeking in children, by examining how scores on this instrument relate to various indices of physical risk taking in children 7-12 years of age. Second, to develop both a parent-report and child-report version of the instrument.

METHODS

Drawing on the literature, items tapping five potential aspects of sensation seeking were developed, with parents and children responding to comparable items. For each of these five subscales, internal reliability estimates were computed separately for the parent-report and child-report versions. To establish criterion validity, subscale scores were related to three indices of children's risk taking commonly used in research: actual risk taking, intentions-to-risk take, self-reports about risk taking on a standardized questionnaire.

RESULTS

On both the child-report and parent-report versions, the same three of the five subscales yielded acceptable internal reliability scores and significantly related to the various indices of risk taking.

CONCLUSIONS

This new measure adequately assesses aspects of sensation seeking relevant to children's risk taking. Because individuals high in sensation seeking engage in greater risk taking and are at increased risk of injury, this instrument may prove particularly useful to aid in identifying those children most likely to engage in injury-risk behaviors so that targeted interventions can be applied to this group.