Early-Life Temperamental Differences as Longitudinal Predictors of Unintentional Injuries

OBJECTIVE

Unintentional injuries are the leading cause of hospitalization and death among children. Compared to environmental factors, less attention in injury preventive efforts has been paid to how individual characteristics relate to the risk of injury. Using a large prospective cohort, the current study assessed the longitudinal impact of early-life temperament on the cumulative number of injuries until mid-adolescence.

METHODS

The data came from the European Longitudinal Study of Pregnancy and Childhood (ELSPAC-CZ). Temperament was evaluated by mothers when children were 3 years old (N = 3,545). The main outcome was the pediatrician-reported sum of child's injuries from age 3 to 15 (seven timepoints). Latent profile analysis (LPA) was used to determine classes based on temperamental dimensions and then extended to a mixture model with a distal count outcome. The covariates included maternal conflict and attachment, sex, family structure, and maternal education.

RESULTS

The LPA determined the existence of three classes: shy children (8.1% of the sample; lowest activity/highest shyness), outgoing children (50.8%; highest activity/lowest shyness), and average: children (41.1%; middle values). Results from a mixture model showed that the outgoing temperament was associated with the highest longitudinal risk for injuries, as both average children (IRR = 0.89 [0.80, 0.99]), and the shy children (IRR = 0.80 [0.68, 0.95]) had lower risk.

CONCLUSIONS

Early childhood temperamental differences can have long-term effects on injury risk. Highly active children showed the highest risk for future injuries, suggesting that these characteristics make them more likely to be involved in novel and potentially dangerous situations.

Is parental propensity to risk associated with their child's medically-attended injuries? A cross-sectional study

BACKGROUND

Societal expectations about safety influence parents' risk perceptions and children's risky play opportunities. This study examined parents' propensity to take risks themselves and their propensity to accept risks for their child, sex-related differences in parents' propensity to accept risks for their child, and the association between parents' propensity to accept risks for their child and that child's medically-attended injury history.

METHODS

A total of 467 parents attending a pediatric hospital with their 6-12-year-old child completed a questionnaire about their risk propensity for themselves and for their child and reported their child's injury history.

RESULTS

Parents' risk propensity for themselves was significantly higher than for their child, and fathers' risk propensity for themselves was higher than mothers'. Linear regressions showed that fathers reported significantly more propensity to accept risks for their child than mothers, but parents did not differentiate between their sons and daughters. A binary logistic regression showed that parents' propensity to accept risks for their child was a significant predictor of pediatric medically-attended injury.

CONCLUSIONS

Parents were more comfortable in taking risks for themselves than for their child. While fathers were more comfortable with their children engaging in risks than mothers, child's sex was not related to parents' propensity to accept risks for their child. Pediatric injury was predicted by parents' propensity to accept risks for their child. Further research investigating injury type and severity related parent risk propensity is needed to determine how parents' attitudes toward risk might relate to severe injury.

Interventions to change parental parenting behaviour to reduce unintentional childhood injury: a randomised controlled trial

OBJECTIVE

The previous study has shown the impact of paternal involvement in childcare on unintentional childhood injury; yet the causality is unknown. The purpose of this study is to investigate whether the intervention of an educational video on paternal involvement in childcare can prevent unintentional injury among young children.

METHODS

A randomised controlled trial of parents of children born at two obstetrics wards in Japan (n=451, intervention group: 223, control group: 228) was conducted. Parents in the intervention group watched an educational video that promote paternal involvement in childcare, while parents in the control group watched an educational video on the prevention of shaken baby syndrome. The participants were followed for up to 18 months after the birth of their child. The primary outcome of this study was unintentional injury at 3, 6, 12 and 18 months. The secondary outcome was paternal involvement in childcare based on maternal observation. Unintentional injury-free rates over time were assessed using the Cox proportional hazard model.

RESULTS

Children in the intervention group were less likely to have unintentional injury, such as burn (HR: 0.29 (95% CI: 0.09 to 0.87)) and caught by a door (HR: 0.66 (95% CI: 0.48 to 0.91)) compared with the control group. Fathers in the intervention group showed higher frequency of taking their children for a walk (coefficient: 0.19 (95% CI: 0.05 to 0.32)).

CONCLUSIONS

Educational videos promoting paternal involvement in childcare is effective to prevent unintentional childhood injury.

Maternal depression and childhood injury risk: A population-based cohort study in Denmark

AIMS

To assess the association between different stages of maternal depression and injury risk in offspring aged 0-10 years.

METHODS

Population-based cohort study of all live-born children in Denmark from 1 January 1997 until 31 December 2013 (n = 1,064,387). Main outcome measure was emergency department contacts with a main diagnosis of injury coded as DS00-DT98 (chapter XIX) according to the ICD-10. All information was obtained from Danish national registries.

RESULTS

Maternal depression was associated with higher injury hazard in the offspring throughout childhood compared to offspring of mothers with no history of depression. The strongest association was seen for the first year of life. First-time maternal depression was most strongly associated with injury in the child, especially in the first year of life (aHR = 1.70, 95% CI: 1.48-1.96). Children of mothers with relapse depression had 1.57 higher hazard of injury in the first year of life (aHR: 1.57, 95% CI: 1.44-1.70). Children of mothers with previously treated depression (postdepression) had 1.13 higher hazard of injury in the first year of life (aHR: 1.13, 95% CI: 1.09-1.17). Continuous treatment for depression was associated with a nonsignificant higher hazard of injuries in the first year of life (aHR: 1.06, 95% CI: 0.91-1.23).

CONCLUSIONS

Maternal depression was associated with higher injury risk in the offspring, particularly in early childhood. The association persisted in children of mothers with relapse depression. Our results suggest that children of mothers with depression are vulnerable several years after depression onset and treatment cessation.

Effects of parental mental illness on children's physical health: systematic review and meta-analysis

BACKGROUND

Children of parents with mental disorder face multiple challenges.

AIMS

To summarise evidence about parental mental disorder and child physical health.

METHOD

We searched seven databases for cohort or case-control studies quantifying associations between parental mental disorders (substance use, psychotic, mood, anxiety, obsessive-compulsive, post-traumatic stress and eating) and offspring physical health. Studies were excluded if: they reported perinatal outcomes only (<28 days) or outcomes after age 18; they measured outcome prior to exposure; or the sample was drawn from diseased children. A meta-analysis was conducted. The protocol was registered on the PROSPERO database (CRD42017072620).

RESULTS

Searches revealed 15 945 non-duplicated studies. Forty-one studies met our inclusion criteria: ten investigated accidents/injuries; eight asthma; three other atopic diseases; ten overweight/obesity; ten studied other illnesses (eight from low-and middle-income countries (LMICs)). Half of the studies investigated maternal perinatal mental health, 17% investigated paternal mental disorder and 87% examined maternal depression. Meta-analysis revealed significantly higher rates of injuries (OR = 1.15, 95% CI 1.04-1.26), asthma (OR = 1.26, 95% CI 1.12-1.41) and outcomes recorded in LMICs (malnutrition: OR = 2.55, 95% CI 1.74-3.73; diarrhoea: OR = 2.16, 95% CI 1.65-2.84). Evidence was inconclusive for obesity and other atopic disorders.

CONCLUSIONS

Children of parents with mental disorder have health disadvantages; however, the evidence base is limited to risks for offspring following postnatal depression in mothers and there is little focus on fathers in the literature. Understanding the physical health risks of these vulnerable children is vital to improving lives. Future work should focus on discovering mechanisms linking physical and mental health across generations.

DECLARATION OF INTEREST

None.

Association between maternal and paternal mental illness and risk of injuries in children and adolescents: nationwide register based cohort study in Sweden

OBJECTIVE

To determine the association between parental mental illness and the risk of injuries among offspring.

DESIGN

Retrospective cohort study.

SETTING

Swedish population based registers.

PARTICIPANTS

1 542 000 children born in 1996-2011 linked to 893 334 mothers and 873 935 fathers.

EXPOSURES

Maternal or paternal mental illness (non-affective psychosis, affective psychosis, alcohol or drug misuse, mood disorders, anxiety and stress related disorders, eating disorders, personality disorders) identified through linkage to inpatient or outpatient healthcare registers.

MAIN OUTCOME MEASURES

Risk of injuries (transport injury, fall, burn, drowning and suffocation, poisoning, violence) at ages 0-1, 2-5, 6-9, 10-12, and 13-17 years, comparing children of parents with mental illness and children of parents without mental illness, calculated as the rate difference and rate ratio adjusted for confounders.

RESULTS

Children with parental mental illness contributed to 201 670.5 person years of follow-up, while children without parental mental illness contributed to 2 434 161.5 person years. Children of parents with mental illness had higher rates of injuries than children of parents without mental illness (for any injury at age 0-1, these children had an additional 2088 injuries per 100 000 person years; number of injuries for children with and without parental mental illness was 10 235 and 72 723, respectively). At age 0-1, the rate differences ranged from 18 additional transport injuries to 1716 additional fall injuries per 100 000 person years among children with parental mental illness compared with children without parental mental illness. A higher adjusted rate ratio for injuries was observed from birth through adolescence and the risk was highest during the first year of life (adjusted rate ratio at age 0-1 for the overall association between any parental mental illness that has been recorded in the registers and injuries 1.30, 95% confidence interval 1.26 to 1.33). Adjusted rate ratios at age 0-1 ranged from 1.28 (1.24 to 1.32) for fall injuries to 3.54 (2.28 to 5.48) for violence related injuries. Common and serious maternal and paternal mental illness was associated with increased risk of injuries in children, and estimates were slightly higher for common mental disorders.

CONCLUSIONS

Parental mental illness is associated with increased risk of injuries among offspring, particularly during the first years of the child's life. Efforts to increase access to parental support for parents with mental illness, and to recognise and treat perinatal mental morbidity in parents in secondary care might prevent child injury.

Ocular injuries, attention deficit and hyperactivity disorder, and maternal anxiety/depression levels: Is there a link?

PURPOSE

Given the increased risk of accidents in patients with attention deficit and hyperactivity disorder (ADHD) or maternal anxiety/depression, we aimed to investigate the frequency of the two diseases in children with penetrating eye injury (PEI).

METHODS

Altogether 79 children, 39 with PEIs and 40 healthy individuals (control group), aged 5-15 years, underwent a complete ophthalmologic examination. Afterwards, schedule for affective disorders and schizophrenia for school-aged children was conducted to assess the psychiatric diagnosis of all children. Turgay diagnostic and statistical manual of mental disorders (DSM-IV)-based child and adolescent behavior disorders screening and rating scale (T-DSM-IV-S) was filled by parents to evaluate the severity of ADHD symptoms. The depression and anxiety levels of mothers of each group were evaluated by two self-report measures: the Beck depression scale and the state-trait anxiety inventory (STAI), respectively. Data were analyzed by IBM SPSS version 22.0. The Chi-square and Fisher's exact test were used to determine whether there is a significant difference between qualitative variables while independent sample t and Mann-Whitney U tests to compare quantitative variables.

RESULTS

The only diagnostic difference was a significantly higher frequency of ADHD among patients with PEIs (48.7% in PEI vs. 17.5% in control group, χ² = 7.359, p = 0.007). The total scores of the T-DSM-IV-S (attention subscale U = 418.000, p = 0.006; hyperactivity subscale U = 472.000, p = 0.022) and maternal state-trait anxiety inventory (maternal STAI-state U = 243.000, p = 0.003; maternal STAI-trait U = 298.000, p = 0.021) were significantly higher in the PEI group than in control group. In logistic regression, children with PEI had a tendency to have a 3.5-fold increased risk for ADHD (OR = 3.538, CI = 0.960-13.039, p = 0.058).

CONCLUSION

ADHD was detected almost 1 in 2 children with PEIs. Besides, the maternal anxiety level was significantly higher in the PEI group than in the control group. This association should be further explored via a future prospective longitudinal study. Since a proper treatment of ADHD in children and anxiety treatment in mothers may prevent vision loss following PEIs in children.

Statistical models for longitudinal zero-inflated count data: application to seizure attacks

Background

Chronic non-communicable diseases:- such as epilepsy, are increasingly recognized as public health problems in developing and African countries. This study aimed at finding determinants of the number of epileptic seizure attacks using different count data modeling techniques.

Methods

Four common fixed-effects Poisson family models were reviewed to analyze the count data with a high proportion of zeros in longitudinal outcome, i.e., the number of seizure attacks in epilepsy patients. This is because, in addition to the problem of extra zeros, the correlation between measurements upon the same patient at different occasions needs to be taken into consideration.

Results

The investigation remarkably identified some important factors associated with epileptic seizure attacks. As people grow old, the number of seizure attacks increased and male patients had more seizures than their female counterparts. In general, a patient's age, sex, monthly income, family history of epilepsy andservice satisfaction were some of the significant factors responsible for the frequency of seizure attacks (P value<0.05).

Conclusion

This study suggests that zero-inflated negative binomial is the best model for predicting and describing the number of seizure attacks as well as identifying the potential risk factors. Addressing these risk factors will definitely contain the progression of seizure attack.

Maternal mental health and childhood injury: evidence from the UK Millennium Cohort Study

OBJECTIVE

We assessed whether maternal mental health problems increased rates for child injury during the preschool years and mid-childhood, and the extent to which associations could be accounted for by a range of potential explanatory factors.

DESIGN

We analysed the UK Millennium Cohort Study, a nationally representative sample with data collected throughout childhood. Multinomial regression was used to investigate whether two measures of maternal mental health (diagnosed depression/anxiety and psychological distress) were associated with subsequent childhood injury. Models adjusted for sociodemographics, parenting and child externalising behaviours.

MAIN OUTCOME MEASURE

Maternal report of unintentional injuries (none, 1, 2+) recorded at three data collection periods (3-5 years; 5-7 years; 7-11 years).

RESULTS

The analytic sample comprised n=9240 families who participated 3-11 years with complete data on exposures and outcomes (multiply imputing missing covariates). Exposure to maternal mental health problems was associated with increased rates of subsequent childhood injuries. Associations attenuated after adjustment for potential explanatory factors, although they remained elevated. For example, high maternal distress was associated with injuries 3-5 years (adjusted relative risk ratio (aRRR): 1 injury=1.18, 95% CI 0.86 to 1.61; 2+ injuries=2.22, 95% CI 1.22 to 4.02); injuries 5-7 years (aRRR: 1 injury=1.31, 95% CI 0.97 to 1.76; 2+ injuries=1.84, 95% CI 1.09 to 3.09); and injuries 7-11 years (aRRR: 1 injury=1.03, 95% CI 0.81 to 1.31; 2+ injuries=1.33, 95% CI 0.97 to 1.81).

CONCLUSIONS

Children exposed to mothers with mental health problems had higher rates of childhood injury than those not exposed. If further investigation of this association suggests causality then it will be important to test measures that address mothers' mental health issues with a view to reducing injuries among their children.

Risk Engagement and Protection Survey (REPS): developing and validating a survey tool on fathers' attitudes towards child injury protection and risk engagement

INTRODUCTION

Fathers play a unique role in keeping children safe from injury yet understanding of their views and attitudes towards protecting children from injury and allowing them to engage in risks is limited. The purpose of this study was to develop and validate an instrument to measure fathers' attitudes towards these two constructs.

METHODS AND FINDINGS

An instrument was developed that used prior qualitative research to inform item generation. The questions were assessed for content validity with experts, then pilot-tested with fathers. The survey was completed by 302 fathers attending hospital with their child for an injury or non-injury reason. Results of confirmatory factor analysis identified eight items relating to the protection from injury factor and six items relating to the risk engagement factor. Correlation between the two factors was low, suggesting these are two independent constructs.

CONCLUSIONS

The Risk Engagement and Protection Survey offers a tool for measuring attitudes and assisting with intervention strategy development in ways that reflect fathers' views and promotes a balanced view of children's needs for safety with their needs for engaging in active, healthy risk-taking.

Community-Based Study on Family-Related Contributory Factors for Childhood Unintentional Injuries in an Urban Setting of Sri Lanka

A community-based descriptive cross-sectional study was carried out among children aged 1 to 4 years residing in an urban setting of Sri Lanka to assess the incidence and associated family-related factors of unintentional injuries. A total of 458 children were recruited using simple random sampling technique, giving a response rate of 91.6%. The incidence of unintentional injuries that needed medical attention during the study period of 3 months was 28.1 per 100 children (95% CI = 19.46-36.74). The factors that were significantly associated with the occurrence of unintentional injuries among children are low monthly income of the family (P = .045), low social support to the mother of index child (P = .022), nonauthoritative type of parenting of the mother of index child (P = .039), cared by person other than mother during day time (P = .002), frequent arguments between parents (P = .004), and frequent alcohol consumption of father (P = .001).

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.

The influence of parenting on early childhood health and health care utilization

OBJECTIVE

This study examined whether parenting, specifically parental support, structure, and behavioral control, predicted early childhood health care use and moderated the negative effects of socioeconomic disadvantage.

METHODS

A sample of 250 parent-child dyads from a longitudinal intergenerational research program participated.

RESULTS

Greater parental support was associated with increased rates of nonemergency care and a higher ratio of outpatient to emergency room (ER) services, a pattern reflecting better health and service use. Support also moderated the negative effects of disadvantaged family background. Greater behavioral control by parents predicted lower rates of both nonemergency care and ER visits. Structured parenting and behavioral control were associated with lower rates of respiratory illness.

CONCLUSIONS

This study highlights the importance of considering parenting practices when examining variations in early childhood health and health care, and the relevance of parental behavior in designing interventions for high-risk populations.

Fathers' views on their financial situations, father-child activities, and preventing child injuries

Unintentional injuries are a leading public health problem for children, particularly among those living at lower socioeconomic levels. Parents play an important preventive role, and the aim of this study was to examine fathers' views on the role of their family financial situation in preventing children's injuries. In-depth interviews were conducted with 15 fathers of children 2 to 7 years living in western Canada. Questions solicited fathers' views about their financial situation and their child injury prevention efforts. Data analysis was underpinned by masculinity theory and guided by constant comparative grounded theory methods. Findings included that fathers living with fewer financial limitations emphasized use of safety equipment and aligned themselves with provider and protector masculine ideals. Fathers with moderate financial constraint described more child-centered safety efforts and efforts to manage finances. Those facing greatest constraint demonstrated aspects of marginalized masculinities, whereby they acknowledged their economic provider limitations while strongly aligning with the protector role. These findings hold relevance for development of interventions aimed at reducing child injury risk inequities. Taking into account how masculinities may shape their beliefs and practices can inform design of father-centered interventions for men living at different points on the socioeconomic spectrum.

Toddlers' unintentional injuries: the role of maternal-reported paternal and maternal supervision

Research indicates that mothers' supervision protects children from injuries. However, little research has examined the role of fathers' supervision in children's injuries.

OBJECTIVES

This study compared the role of maternal and paternal supervision in children's injury risk and severity using maternal reports.

METHODS

Mothers (n = 170) of toddlers were interviewed for 6 months about their children's unintentional injuries.

RESULTS

Children were more likely to engage in high activity levels and were at higher risk for injury when being cared for by their fathers. Although higher supervision predicted lower injury risk for both mothers and fathers, fathers' close supervision (as reported by mothers) was a stronger predictor of injury risk than mothers' supervision.

CONCLUSION

Children's higher levels of activities may have accounted for their higher risk of injury when in their fathers' care. These findings indicate the need to include fathers in injury prevention efforts.

Men on Fathering in the Context of Children’s Unintentional Injury Prevention

Injuries are a leading cause of death for children, and parental safety behaviors are fundamental to child injury prevention. Fathers’ perspectives are largely absent. Our novel research connects masculinities, fathering, and childhood injury. Sixteen fathers of children aged 2 to 7 years in two Canadian urban settings participated in photo-elicitation interviews detailing activities they enjoyed with their children and concerns regarding child safety. Participants described how elements of risk, protection, and emotional connection influenced their approach to fathering as it related to injury prevention. Most men considered engaging children in risk as key to facilitating development and described strategies for protecting their children while engaging in risk. Many men identified how the presence of an emotional connection to their children allowed them to gauge optimal levels of risk and protection. There exists a tremendous opportunity to work with fathers to assist in their efforts to keep their children safe.

Striking a balance between risk and protection: fathers' attitudes and practices toward child injury prevention

OBJECTIVES

To gain understanding of fathers' attitudes, decisions, and practices regarding the level of risk they are willing to expose their children to and the level of protection they feel is necessary.

METHODS

Interviews were conducted with a diverse sample of 32 fathers of children aged 2 to 7 years in British Columbia. Questions addressed fathers' roles and typical activities with their children, child safety concerns and practices. Grounded theory methods guided data analysis.

RESULTS

Fathers believed a central aspect of their role involved actively exploring the world with their children through physical and play-based activities. Fathers made decisions about the appropriateness of activities, striking a balance between protecting their child and exposing them to risk and new experiences. Most fathers placed high value on providing their children with risk-taking opportunities and discussed many positive aspects of risk and experiencing minor injuries. The potential for serious injury was considered in weighing decisions regarding risk engagement. A theoretical model outlining 4 decision-making characteristics for striking a balance is proposed.

CONCLUSION

Injury prevention interventions can benefit from understanding the meanings and priorities fathers hold about their children's safety, creating programs that resonate with fathers to increase relevance. To maximize success, messaging should consider fathers' decision-making characteristics, incorporate the importance of healthy risk taking for child development, and teach fathers how to minimize likelihood of injury in the context of being active and taking risks with their child.