Preventing Injury in Children

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.

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.

Understanding Unintentional Injury-Risk in Young Children I. The Nature and Scope of Caregiver Supervision of Children at Home

OBJECTIVE

To examine the supervision that young children routinely receive when awake and at home with a parent.

METHODS

Mothers were trained to complete continuous recordings about supervision of their young child (2-5 years) when at home on each of 10 randomly selected days within a 3-week period.

RESULTS

Children were supervised more often than unsupervised but were completely out of view of supervisors about 20% of their awake time, and supervision was poorer when out of view of supervisors. Older children (4-5 years) were unsupervised (8% of awake time) more often than younger children (2-3 years; 1%), were more often out of view of supervisors than younger children, and received poorer supervision than younger children when out of view of supervisors. Few sex differences were found.

CONCLUSIONS

These data provide insights into the nature and scope of supervision that young children routinely experience when at home. Implications of these findings for identifying patterns of supervision that elevate children's risk of injury are discussed.

Caregiver Supervision and Child-Injury Risk: I. Issues in Defining and Measuring Supervision; II. Findings and Directions for Future Research

OBJECTIVE

To discuss the role of caregiver supervision in child-injury risk, with attention given to definitional and methodological issues and outlining important questions to be addressed in future research.

METHODS

Analysis, synthesis, and critique of existing literature.

RESULTS

Comparisons across studies are difficult because of insufficient specificity regarding what constitutes supervision. Hence, a multi-dimensional definition of supervision is developed based on the literature. Numerous issues arise when attempting to measure supervision and these are extensively discussed, along with reporting on the recent development of two questionnaire measures of supervision (Beliefs About Supervision Questionnaire and Parent Supervision Attributes Profile Questionnaire) that have shown good validity and hold promise for addressing the problem of measuring caregiver supervision in reliable and valid ways. A review of the findings on relations between supervision and child-injury risk reveals that many substantive questions remain unanswered. A number of recommendations for future research are given and a conceptual model is presented that focuses attention on the need for research that examines how factors interact to influence child-injury risk. This model has relevance not only for research but also for prevention and serves to emphasize the complementary nature of environment-oriented and person-oriented approaches to child-injury prevention.

CONCLUSION

Direct evidence linking supervision to child-injury risk is scarce and many important questions remain unanswered. Based on the conceptual model presented, in future research it is important to examine how supervision interacts with other key factors to influence children's risk of injury.

Parental correlates of unintentional burn injuries in infancy and early childhood

The main purpose of this paper is to review parental factors associated with unintentional burns in early childhood. The problem and characteristics of early childhood burns are discussed. Child injury prevention strategies and models are presented. Parental correlates of pediatric injuries in general and specific to burns are reviewed. In conclusion, the authors recommend greater examination of parental variables potentially amenable to treatment, such as psychological functioning, and improved methodology including the use of prospective analyses, multiple methods and informants, and comparison groups. These efforts should enable greater understanding of parental factors related and causal to early childhood burns and, in turn, guide prevention initiatives.