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Table 1.  Body Part and Injury Mechanism for 123 Injuries in 104 Children Injured in Their Homes
Body Part and Injury Mechanism for 123 Injuries in 104 Children Injured in Their Homes
Table 2.  Items and Prevention Suggestions for 120 Injuries in 104 Children Injured in Their Homes
Items and Prevention Suggestions for 120 Injuries in 104 Children Injured in Their Homes
1.
Morrongiello  BA, Howard  AW, Rothman  L, Sandomierski  M.  Once bitten, twice shy? medically-attended injuries can sensitise parents to children’s risk of injuries on playgrounds.  Inj Prev. 2009;15(1):50-54. doi:10.1136/ip.2008.019398PubMedGoogle ScholarCrossref
2.
Gielen  AC, McDonald  EM, Shields  W.  Unintentional home injuries across the life span: problems and solutions.  Annu Rev Public Health. 2015;36:231-253. doi:10.1146/annurev-publhealth-031914-122722PubMedGoogle ScholarCrossref
3.
Schnitzer  PG, Dowd  MD, Kruse  RL, Morrongiello  BA.  Supervision and risk of unintentional injury in young children.  Inj Prev. 2015;21(e1):e63-e70. doi:10.1136/injuryprev-2013-041128PubMedGoogle ScholarCrossref
4.
Morrongiello  BA, Ondejko  L, Littlejohn  A.  Understanding toddlers’ in-home injuries, II: examining parental strategies, and their efficacy, for managing child injury risk.  J Pediatr Psychol. 2004;29(6):433-446. doi:10.1093/jpepsy/jsh047PubMedGoogle ScholarCrossref
Research Letter
December 2018

Association Between Unintentional Child Injury in the Home and Parental Implementation of Modifications for Safety

Author Affiliations
  • 1Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 2Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 3Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 4Johns Hopkins Krieger School of Arts & Sciences, The Johns Hopkins University, Baltimore, Maryland
JAMA Pediatr. 2018;172(12):1189-1190. doi:10.1001/jamapediatrics.2018.2781

Medical attention for an injury can increase parents’ perception of their child’s susceptibility to injury.1 Understanding subsequent parental actions to avert future injuries can inform prevention efforts. In this study, we describe the injured body part and parents’ reports of (1) the cause of the injury, (2) what could have prevented it, and (3) changes made afterward.

Methods

We reviewed medical records of pediatric emergency department patients who sought care for an unintentional home injury between January 1 and December 31, 2012, and contacted the parents for a home interview. The medical record review provided details about the injury and the child’s age and sex. The parental interview, which was audiorecorded and transcribed, provided parents’ responses to the following: (1) Please describe how your child got injured. (2) Do you think there is anything that could have prevented the injury? If so, what? (3) Have you done anything to change the area of the home where the child was injured? If so, what?

Home interviews were conducted on average 27 days (range, 5-57 days) after the pediatric emergency department visit. A codebook of parental responses was generated and analyzed to yield the following groups of codes: (1) body part injured (head/neck/face, leg, arm/hand, or other), (2) injury mechanism (fall, cut/pierce, burn, struck by/against, or carbon monoxide poisoning), (3) item(s) involved (toys, furnishings, house features, food/beverage, or other), (4) parents’ perception of preventability (child behavior, adult supervision, or safer environment), and (5) changes made (increased supervision, got rid of/replaced item, or safer environment (restricted access to dangerous item).

We tallied the code groups and arranged cross-tabulations of injury mechanisms and body parts. At recruitment, we obtained written parental informed consent per approval by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board.

Results

One hundred four children (42 female and 62 male) aged 6 months to 7 years (mean [SD] age, 2.9 [1.8] years) who were predominantly of black race/ethnicity (84 [80.8%]) experienced 123 injuries. One injury mechanism was associated with 109 of 123 injuries (88.6%), while 2 injury mechanisms were associated with 14 of 123 injuries (11.3%). The most common injury mechanism was a fall (57 of 123 [46.3%]), and the most common body part injured was the head/neck/face (76 of 123 [61.8%]) (Table 1). Most children (99 of 104 [95.2%]) had 1 injured body part, whereas 5 of 104 children (4.8%) had 2 injured body parts.

In all but 2 cases, an item was identified as contributing to the injury: 42 of 120 (35.0%) involved house features, 40 of 120 (33.3%) involved furnishings, 13 of 120 (10.8%) involved food/beverage, and 10 of 120 (8.3%) involved toys (Table 2). Parents, who were mostly female (96 of 104 [92.3%]) and high school graduates (78 of 104 [78.8%]), identified at least 1 prevention strategy (86 of 104 [82.7%]). Of the 110 suggestions, 44 (40.0%) were to create a safer environment (eg, store hazardous products), 34 (3.9%) were to modify child behavior (eg, implement new rules), and 32 (29.1%) were to provide increased adult supervision. Fifty-nine of 104 parents (56.7%) reported making changes: 53 of 104 (50.9%) modified the environment, 22 of 104 (21.2%) got rid of/replaced items, and 8 of 104 (7.7%) increased supervision.

Discussion

This study explored how parents changed their homes after a medically attended unintentional injury to prevent reoccurrence. Most parents identified a prevention strategy, commonly an environmental one (eg, store hazardous products); however, only 59 of 104 (56.7%) made modifications. Parents’ endorsement of environmental modification (eg, passive strategies) is encouraging because this approach is a preferred injury prevention strategy.2 Increasing supervision (eg, active strategies) represented a smaller proportion (32 of 104 [29.1%]) of parents’ suggestions. Evidence suggests that supervision can reduce injuries to young children; however, research is required to address the many challenges parents face in these efforts.3,4

Limitations and Conclusions

Limitations of these findings include that parental self-report about the injury could have been influenced by the time that elapsed from the injury event to the home interview and by social desirability bias. Parents’ ideas regarding safety changes were generally consistent with best practices for injury prevention, although the low rate of actually implementing changes represents a gap that future prevention efforts should address.

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Article Information

Accepted for Publication: June 26, 2018.

Corresponding Author: Vanya C. Jones, PhD, MPH, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Ste 544, Baltimore, MD 21205 (vjones@jhu.edu).

Published Online: October 8, 2018. doi:10.1001/jamapediatrics.2018.2781

Author Contributions: Dr Jones had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Jones, Shields, McDonald, Gielen.

Acquisition, analysis, or interpretation of data: Jones, Shields, Ayyagari, Frattaroli, Gielen.

Drafting of the manuscript: Jones, Ayyagari, Gielen.

Critical revision of the manuscript for important intellectual content: Jones, Shields, Frattaroli, McDonald, Gielen.

Statistical analysis: Jones, Ayyagari, Gielen.

Obtained funding: McDonald, Gielen.

Administrative, technical, or material support: Jones, Shields, Frattaroli, McDonald.

Supervision: McDonald, Gielen.

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was supported by grant CE001507 from the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (Dr Gielen).

Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Morrongiello  BA, Howard  AW, Rothman  L, Sandomierski  M.  Once bitten, twice shy? medically-attended injuries can sensitise parents to children’s risk of injuries on playgrounds.  Inj Prev. 2009;15(1):50-54. doi:10.1136/ip.2008.019398PubMedGoogle ScholarCrossref
2.
Gielen  AC, McDonald  EM, Shields  W.  Unintentional home injuries across the life span: problems and solutions.  Annu Rev Public Health. 2015;36:231-253. doi:10.1146/annurev-publhealth-031914-122722PubMedGoogle ScholarCrossref
3.
Schnitzer  PG, Dowd  MD, Kruse  RL, Morrongiello  BA.  Supervision and risk of unintentional injury in young children.  Inj Prev. 2015;21(e1):e63-e70. doi:10.1136/injuryprev-2013-041128PubMedGoogle ScholarCrossref
4.
Morrongiello  BA, Ondejko  L, Littlejohn  A.  Understanding toddlers’ in-home injuries, II: examining parental strategies, and their efficacy, for managing child injury risk.  J Pediatr Psychol. 2004;29(6):433-446. doi:10.1093/jpepsy/jsh047PubMedGoogle ScholarCrossref
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