Injuries among children in home and out-of-home care.

As the number of children receiving care in out-of-home settings increases in the United States, the risk of injury in such settings has become the subject of intense research. OBJECTIVES: This study examined the relative safety of out-of-home care compared with care in a child's own home. METHODS: This community based prospective cohort study of 656 families in three adjacent counties in the Piedmont region of North Carolina characterizes the patterns and rates of injuries among children less than 5 years of age in three child care settings, home care (HC), center based care (CBC), and other out-of-home care (OOHC). Information about minor and severe injuries was obtained from parents using monthly telephone interviews over a one year period. Statistical modeling designed to handle unbalanced data with correlated observations was used as the primary tool for analysis. RESULTS: Rate of minor injuries was highest in CBC, followed by HC, and then OOHC. However, these differences for OOHC may have been due to reporting biases and errors in rate estimates. There were no significant differences in severe injury rates among the three settings. CONCLUSIONS: The risk of serious injury among children under 5 in CBC is not different from that of children in HC or OOHC despite the fact that the risk of minor injury is higher.     

Injuries in child care centers: gender-environment interactions

OBJECTIVES: To examine child characteristics (age, gender) and child care center environments (socioemotional quality, physical safety) that jointly predict injuries for preschool children. METHODS: A two year prospective study of 360 preschool children, ages 2-6 years, was conducted in four urban child care centers. Composite scores for center quality and physical safety were derived from on-site observations, and injury rates were based on teacher reports. Poisson regression analyses examined age, gender, center quality, center safety, and the interactions of gender with quality and safety as predictors of injury incidence over one child year. RESULTS: Age was significantly associated with injury rates, with younger children sustaining higher rates. An interaction between gender and center quality also significantly predicted injury incidence: girls in low quality centers experienced more injuries, while girls in high quality centers sustained fewer injuries than their male peers. Finally, an interaction between gender and center safety showed that girls in high safety centers sustained more injuries than boys, while girls in low safety centers sustained fewer injuries. CONCLUSIONS: Injuries occur even in relatively safe environments, suggesting that in child care settings, the socioemotional context may contribute, along with physical safety, to the incidence of injury events. Further, gender specific differences in susceptibility to environmental influences may also affect children's vulnerability and risks of injuries. The prevention of injuries among preschool children may thus require attention to and modifications of both the physical and socioemotional environments of child care.     

Risk factors for out-of-home custody child care among families with alcohol and substance abuse problems

AIM: To study the risk of children to mothers with alcohol and/or substance abuse related problems for early childhood out-of-home care in Finland. METHODS: A population-based cross-sectional retrospective analysis of 526 pregnant women attending special outpatient clinics during 1992-2001 and their 626 offspring, with out-of-home care data until 2003 provided by the National Child Welfare Register. RESULTS: Fifty percent (95% confidence interval 46-54%) were at some point and 38% (34-42%) by the age of two years, in out-of-home care. Out-of-home care was associated with maternal care for substance abuse after delivery, nonemployment, housing, daily smoking during pregnancy, increasing number of previous births, mother in custody in her childhood, maternal education, previous child in custody, drug in urine during pregnancy, unplanned pregnancy, partner with significant abuse, regular health-care contact for abuse, daily alcohol consumption before and/or during pregnancy, newborn not discharged with mother, neonatal abstinence symptoms (NAS), intensified perinatal surveillance or NICU, and delayed discharge from hospital. CONCLUSIONS: There is a substantial risk of children born to mothers with significant alcohol and/or substance abuse related problems for out-of-home care during early childhood. Factors identified during the pre- and perinatal period are associated with this risk.     

Injuries and their relation to potential hazards in child day care.

OBJECTIVES: To prospectively determine the incidence rate of injuries that required medical attention among children in day care and to identify possible hazards related to these injuries. SETTING: King County, Washington. METHODS: Prospective cohort study of children in a sample of licensed day care facilities. RESULTS: From 1 July 1992 to 30 June 1993, 53 medically attended injuries were reported by 133 day care sites; incidence rate 1.9 per 100,000 hours of day care attendance. The rate of injury in 91 small family day care homes was essentially the same as that in 42 larger day care centers; relative rate 1.0 (95% confidence interval 0.6 to 1.9). Injuries that required sutures accounted for 39% of the cases, while 17% required a cast, splint, or sling. No child was hospitalized. Sixty nine sites were inspected and all had potentially correctable physical hazards, with a median of 15 hazards per site (range 7 to 26). These potential hazards had little relationship to the risk of injury and a case-by-case review identified only two injuries that might have been prevented by a more energy absorbent playground surface. CONCLUSIONS: The incidence of medically attended injuries found in this study is consistent with other studies from the United States. Most injuries were minor and had little relation to physical hazards at day care locations.     

Terminal care of the child with cancer at home

One hundred paediatric patients with either leukaemia (36%), solid tumours (34%) or brain tumours (30%), treated at the Children's Hospital, University of Helsinki, Finland, died during 1987–92; 70 of them died while in organized terminal care. They were treated at home (60%), in hospital (29%), and partly at both (11%). One or both parents stayed at home to take care of their child. Personnel of the oncologic ward coordinated home care. The purpose of this study was to evaluate the advantages and disadvantages of a terminal care program, with special reference to terminal care at home. Evaluation included retrospective analysis of patients' records, as well as a structured interview with the two parents separately. The quality of life of the children during the terminal period was greatly influenced by their happiness at being at home. Relief of symptoms, particularly pain, was in most instances adequate. Most parents had no complaints to make afterwards. Only some of them complained of having received too little information, too little supervision and support, and insufficient preparation for the death of the child. Thus, the system of terminal care at home proved satisfactory for the child and the whole family in many different respects. For successful home care, the parents need continuous supervision, help and support by well-trained personnel.     

The development of home visiting by child care nurses

Child care nurses play a crucial role in the care of children and their families at home. In addition to carrying out prescribed technical care, they also have a role to play in health promotion and education. An important part of the healthcare provision, the independent child care nurses' work is part of a multidisciplinary approach.     

Health needs of Australian children living in out-of-home care

BACKGROUND: Children living in out-of-home care have high and frequently unidentified health needs. The Child Protection Unit at Sydney Children's Hospital offers comprehensive health screening to children in care. AIMS: To report the experience of the health screening clinic and the rates of identified health problems of children in care in this sample, and to compare these rates with the general child population and children in care overseas. METHODS: Comprehensive multidisciplinary health screens were offered to children in out-of-home care. RESULTS: High rates of physical, developmental and emotional health problems were identified. The rates of poor health were greater than the average child population of New South Wales, but similar to the rates of poor health reported in children in care overseas. CONCLUSIONS: Children in care are a vulnerable group of the child population who experience unacceptable levels of poor health. Comprehensive health screens can help identify previously undetected health problems.     

Intercountry adoptees in out-of-home care: a national cohort study

AIM: To investigate risks of placements in out-of-home care for non-European adoptees. METHODS: Intercountry adoptees born outside Europe 1973-1984 (n = 16,522) were compared with same age peers from the majority population (n = 1,026,523) using national demographic and child welfare registers. Multivariate analyses were performed using logistic regression models, and odds ratios (OR) for different forms of out-of-home care placements were calculated. RESULTS: After adjustments for socio-demographic background variables, the OR:s for placements of intercountry adoptees in residential care from age 10 were 5.1 (95% CI 4.6-5.8) and 3.0 (95% CI 2.6-3.6) for placements in foster care from age 10. For placements in all forms of out-of home care up to age 10, the odds were on par with the majority population. Higher child age at adoption, origin from Latin America, single parent adoption and maternal age above 35 at birth of the child were identified as significant predictors of out-of-home care from age 10. CONCLUSION: Intercountry adoptees emerge as a risk group for placements in out-of home care during adolescence, especially for entries into residential care (in Sweden usually triggered by persistent behaviour problems).     

Acute child poisonings in Oslo: a 2-year prospective study

AIM: To study the current epidemiology, clinical course and outcome of poisonings among children in Oslo and compare findings to a similar study from 1980. METHODS: Observational study with prospective inclusion of all children (<15 years of age) with a main diagnosis of acute poisoning treated in hospital or outpatient clinic in Oslo for 2 years. RESULTS: One hundred seventy-five episodes of acute poisoning were included at the outpatient clinic only (n = 65), the paediatric department only (n = 82) or both (n = 28 referrals). Annual incidence was 97 per 100 000, significantly lower than in 1980 (230 per 100 000). Highest incidence was in 1-year-old males (576 per 100 000). In children <8 years of age, the most common toxic agents were pharmaceuticals (39%) and household products (32%); children > or = 8 years ingested mainly ethanol (46%) or pharmaceuticals (36%). Five percent of all children were comatose, and complications were seen in 13%. All children survived without sequelae. Half of the admissions needed treatment; most commonly used treatments were activated charcoal (33%), gastric lavage (9%) and emetics (9%). CONCLUSION: The incidence of child poisonings in Oslo has significantly reduced since 1980. Only half of the poisonings needed treatment, most of the poisonings were mild and the clinical outcome was good.     

Injuries in primary care practices

A study of injuries among 0-15 year old children attending primary care clinics in a low social class and a middle class neighbourhood was carried out during a period of one year. Data were collected in a structured form by the physicians while the patient was in the clinic. The rate of injuries was 121.3/1000 children per year in the clinic from the lower social class neighbourhood and 70.7/1000 children per year in the clinic from the middle class neighbourhood. Injuries in playgrounds, and on pavements and streets occurred in higher proportions in the low social class than in the middle class neighbourhood clinics. The most frequent causes of injuries were falls and being struck and injured by cutting/piercing instruments; these caused mostly contusions and lacerations. The clinic was the first place of treatment in 65% of the cases in the middle class area and in 45% in the lower social class area; 28% and 10% respectively were referred to the hospital for additional treatment. Data from primary care clinics should be considered when estimating the incidence of injuries in the community, in planning intervention programmes, and future research.