Understanding toddlers' in-home injuries: I. Context, correlates, and determinants

Multimethod strategies (i.e., questionnaires, parents' observations, injury-event recording diaries, telephone and home interviews) were used to study in-home injuries experienced by toddlers over a 3-month period. Cuts, scrapes, and puncture wounds were the most common injuries. The majority of injuries affected children's limbs, and injuries most often occurred in the morning. Boys were injured most often in rooms designated for play, and a majority of their injuries followed from misbehavior. Girls were most often injured in nonplay areas of the home, with the majority of injuries occurring during play activities. Boys experienced more frequent and severe injuries than girls, although girls reacted more than boys to their injuries. Child factors relevant to injury included: risk taking, sensation seeking, and ease of behavior management. Temperament factors did not relate to child injury. Parent factors relevant to child injury included parents' beliefs about control over their child's health, protectiveness, and beliefs about child supervision. Regression analyses revealed that both child (i.e., risk taking) and parent (i.e., protectiveness) factors were significant determinants of child injury.     

The analysis of parental ratings of children's behavior using LISREL

A common procedure for assessing children's behavior is to obtain parental ratings of the child. Since the ratings obtained are a function of both parent and child, disentangling the child's phenotype from that of the rater becomes an important methodological problem. For the analysis of genetic and environmental contributions to children's behavior, solutions to this are available when multiple raters, e.g., two parents, rate multiple children, e.g., twins. This paper describes and illustrates simple LISREL models for the analysis of parental ratings of children's behavior. We show how the assumption that mothers and fathers are rating the same behavior in children can be contrasted with the weaker alternative that parents are rating correlated behaviors. Given the stronger assumption, which appears adequate for ratings of children's internalizing behavior problems, the contribution of rater bias and unreliability may be separated from the shared and nonshared environmental components of variation in a behavior genetic analysis.The work reported in this paper was supported in part by Grants MH45268, AA08672, and MH19392 and the Carman Trust for Scientific Research.     

Understanding unintentional injury risk in young children II. The contribution of caregiver supervision, child attributes, and parent attributes

OBJECTIVE: To identify child and parent attributes that relate to caregiver supervision and examine how these factors influence child-injury risk. METHODS: Mothers completed diary records about supervision of their young child (2-5 years) when at home. Standardized questionnaires provided information about child attributes, maternal attributes, and children's history of injuries. RESULTS: Correlations revealed that child attributes and parent attributes related both to actual maternal supervision and child-injury scores. Regression analyses to predict injury scores revealed child-temperament factors alone predicted all levels of severity (minor, moderately severe, and medically attended), but parent supervision also contributed to predict medically attended injuries. CONCLUSIONS: Both child and parent factors influenced caregiver's supervision of young children at home and related to child-injury risk. For medically attended injuries, child attributes and parent supervision both predicted risk, whereas for less serious injuries, child factors alone determined risk.     

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

OBJECTIVE: Unintentional injuries, the leading cause of pediatric mortality, are caused by a complex set of intrapersonal and environmental factors. The role of three critical variables--parental supervision, children's temperament, and estimation of children's physical abilities--was examined. METHODS: Sixty-four 6- and 8-year-old children completed a laboratory experiment with a parent. Both children and parents judged the child's ability to complete reaching, stepping, and crouching tasks. Parents also completed a parent-report measure of children's temperament. RESULTS: Both children and parents overestimated children's ability, although children did so more than parents. Parents of temperamentally impulsive and undercontrolled children judged that their children could complete tasks that were actually beyond the child's ability. Temperament also affected children's judgments while parents were known to be present or absent: Temperamentally impulsive and undercontrolled children were more accurate in their judgments when parents were standing next to them than when parents were hidden from view behind a one-way mirror. CONCLUSIONS: The mechanism by which parental supervision might protect children from injury appears to be at least twofold: (a) Parents overestimate children's ability less frequently than children themselves, suggesting supervising parents could intervene to prevent children from attempting dangerous activities; and (b) children judge their physical abilities more cautiously when parents are present. Implications for temperament theory and for injury prevention are discussed.     

Interactions between child behavior patterns and parenting: implications for children's unintentional injury risk

OBJECTIVES: Two factors were considered as predictors of children's risk for unintentional injury: (a) children's temperamentally difficult behavior patterns and (b) parenting. Along with hypotheses to replicate previous univariate effects, it was hypothesized that active, involved parents with sufficient time resources might reduce injury risk among temperamentally at-risk children. METHODS: Study 1 used a retrospective design with a diverse sample of over 10,000 5-year-olds. Study 2 replicated Study 1 using a prospective design and behavioral data from a sample of over 1,000 children followed from 6 to 36 months of age. RESULTS: In Study 1, male gender, child hyperactivity, and family poverty predicted injury in a univariate manner. In Study 2, male gender and lack of positive parenting predicted injury in a univariate manner. Interaction effects also emerged: in Study 1 the interaction between child hyperactivity and parental time resources protected children from injury, and in Study 2 the interaction between child's difficult temperament and positive parenting protected children from injury. CONCLUSIONS: Children at increased risk for injury, i.e., those with hyperactive and difficult behavior patterns, might be protected in the environment of positive parenting. Theoretically, results suggest that researchers should consider Temperament x Environment interactions along with univariate predictors of outcome behavior. From an applied perspective, results have implications for the design of injury prevention campaigns: Parents who spend positive time with temperamentally difficult children might protect them from injury.     

Injuries Among Toddlers: Contributions from Child, Mother, and Family

Mothers' reports of injuries among 116 toddlers followed longitudinallyfrom 1 to 3 years were used to designate one group (n=32) ashaving higher injury liability and one group (n=84) as havinglower injury liability. The self-reported temperament of themothers, directly appraised aspects of the toddlers' homes,and directly observed characteristics of the toddlers were correlatedwith injury liability. Higher injury liability was signifiedby features from all three sources. The mothers tended to beless educated and depicted themselves as more emotionally overwhelmedand less energetic; the homes tended to be less optimal forchild development, of lower socioeconomic status, and markedby higher levels of noise and disorder; and the toddlers, whowere likely to be male, were observed to be less tractable andmanageable. Regression analyses indicated that a combinationof characteristics of the mother and home provided a moderatelystrong multiple R with toddler's injury liability, and the toddler'scharacteristics made no additional significant contributions.The results are interpreted as indicating that the injury liabilityof toddlers can be better established by considering foremostthose social and environmental conditions extrinsic to the child.However, that same emphasis may not apply to older childrenand adolescents. It is suggested that pediatric psychologiststake a developmental perspective when evaluating factors pertainingto children's injuries.     

The role of fathers in toddlers' unintentional injury risk

OBJECTIVES: Previous work suggests that maternal parenting and supervision reduces risk for children's unintentional injuries, but very little research has examined the role of fathers in children's unintentional injury risk. The role of fathers in protecting children from unintentional injury was considered. METHODS: A prospective longitudinal design predicted injury risk in 181 toddlers from the ages of 6 to 36 months. Predictor variables included child gender and temperament, individual difference factors of the mother and father, and parenting factors of the mother and father. RESULTS: Hierarchical regression models suggested that fathers' report of gains to the family from their employment was the strongest predictor of risk of children's unintentional injury. Several other paternal and maternal factors were also modestly related to injury risk. CONCLUSIONS: Data indicate the need to consider the role of fathers in protecting children from unintentional injuries.     

Externalizing behaviors and minor unintentional injuries in toddlers: common risk factors?

OBJECTIVE: To investigate predictors for externalizing behaviors and minor unintentional injuries in toddlers and to examine whether common risk factors can be identified. METHODS: Linear regression models were used to investigate the contributions of predictors belonging to the domains of child characteristics and parental characteristics. Participants were 117 boys (M = 16.9 months) and their parents. RESULTS: Two common risk factors for externalizing behaviors and minor injuries were identified: maternal low conscientiousness and paternal low self-control. In addition, children's inhibitory control and dispositional frustration as well as maternal externalizing symptoms contributed independently to children's externalizing behaviors. CONCLUSIONS: Results supply some evidence for the interrelatedness of negative outcomes and on the existence of common risk factors. Interventions could aim to address these common risk factors in order to pursue a number of goals at the same time, instead of focusing on only one type of negative outcome.     

Don't run with scissors: young children's knowledge of home safety rules

OBJECTIVE: To examine 4- to 6-year-old children's knowledge of their parents' home safety rules and to identify predictors of children's home injuries. METHODS: Within the context of an interview, parents completed a home safety questionnaire in which they specified home safety rules, rated their child's compliance with each rule, explained not having rules, reported on maternal supervision, and reported on the frequency of their child's injuries. We evaluated children's knowledge of home safety rules by having them play a home safety game designed for this study. RESULTS: Children spontaneously recalled only about half of their parents' home safety rules. Prompting resulted in their recognition of about 40% more rules. However, children's knowledge scores did not predict the frequency of their injuries. The best predictors of children's injuries were children's compliance with home safety rules and extent of parental supervision. CONCLUSIONS: These findings suggest that interventions to promote young children's safety knowledge will not likely reduce childhood injuries unless children consistently comply with these rules or parents supervise children to ensure compliance.     

Effects of parental viewing of children's risk behavior on home safety practices

OBJECTIVE: To examine the effects of parent viewing of their child's actual risk behavior on home safety practices. METHODS: Sixty-one 4-to 7-year-old children and their caregivers participated in a three session project. Parents were exposed to one of three videos: (a) their own child with simulated home hazards, (b) a pilot child with hazards, or (c) a control child development video. Observations of home hazards as well as parent measures of supervision and vulnerability were completed pre and post-intervention. RESULTS: Exposure to a video of a parent's own child playing with simulated hazards resulted in improved home safety practices. Exposure to a pilot child interacting with home hazards did not increase parent safety behaviors. No group differences in levels of vulnerability were found. CONCLUSIONS: Parental attitudes are an important consideration in designing successful injury interventions. Increasing parental awareness of their child's risk to injury may be a valuable tool to change safety behaviors.     

Children's coping strategies and coping efficacy: relations to parent socialization, child adjustment, and familial alcoholism

The relations of children's coping strategies and coping efficacy to parent socialization and child adjustment were examined in a sample of school-age children that included families in which some of the grandparents and/or parents had an alcoholism diagnosis. Parents and older children reported on the children's coping strategies; parents reported on their parenting behavior; and teachers reported on children's externalizing and internalizing problems. Measures of parent socialization were associated with parents' and children's reports of active coping strategies and parents' reports of both support-seeking coping and coping efficacy. Some of these relations were moderated by familial alcohol status. Children higher in parent-reported active/support-seeking coping and coping efficacy were rated lower in teacher-reported externalizing and internalizing adjustment problems. The findings were consistent with the view that active/support-seeking coping and coping efficacy mediated the association of parent socialization to children's psychological adjustment and that this relation was sometimes moderated by parental alcohol status.     

Impact of Parental Health Problems on Children: Concepts, Methods, and Unanswered Questions

Described conceptual and methodological issues that arise inthe design and analysis of data from studies of the impact ofparental health problems on children. Researchers should considerhow the functional effects, duration, and type of exposure ofparental health problems affect children's psychological experience.Multiple pathways (e.g., parental modeling, family socializationpractices, and genetic factors) that affect the transmissionof psychological and/or health risk to children need to be considered.Important methodological issues in this area of research includesample selection and bias, confounding factors, and limitedassessment of family influences. Future work should identifyfactors that enhance child and family resilience to the effectsof parental health problems. Studies are also needed to developand test interventions to reduce the psychological morbidityassociated with parental health problems.     

Disparities in risk communication: a pilot study of asthmatic children, their parents, and home environments

Parents' knowledge and control of asthma triggers in home environments can help reduce risks associated with asthmatic children's respiratory health. This pilot study used both qualitative and quantitative methods to determine parental knowledge of their children's asthma triggers in home environments, control of those triggers, and information received and trusted. Twelve parents of asthmatic children in the greater Pittsburgh area--8 white and 4 African American--participated in one-on-one interviews about home exposures to asthma triggers. All parents described the link between asthma symptoms and both environmental tobacco smoke (ETS) and pet dander exposures. House dust mites and mold were also commonly identified asthma triggers. All 8 white parents reported receiving information from physicians about controlling home environmental triggers of asthma, but the 4 African American parents reported having received no such information. However, all 12 parents reported having greater trust in information received from physicians than from other sources. White parents were significantly more aware of potential asthma triggers and performed significantly more actions to control the triggers in their homes. African American parents noted stressful experiences with primary and secondary care, less recall of information sharing about asthma triggers, and a focus on symptom management vs trigger avoidance.     

Foster Family-based Treatment

Pressley Ridge Youth Development Extension (PRYDE) is a foster family-based treatment program for troubled and troubling children and adolescents. PRYDE represents a movement away from treating youths in groups within institutions to treating them individually within the context of a normal family. Highly qualified parents attend 25 hours of preservice training, successful completion of which results in placement of a troubled child in their home. These "treatment parents" are required to document their use of a variety of treatment and relationship-building behaviors and evaluate the youth's performance each day. In each PRYDE home, the youngster earns or loses points for engaging in specifically targeted appropriate or inappropriate behaviors, respectively. The accumulated points for each day result in a certain level of privileges for the next day. Frequent in-home training and supervision and 24 hour on-call services are provided to each PRYDE family. Since its inception in 1981, PRYDE has served over 100 youngsters. During 1984 (as of September), 82 % of the youth discharged from PRYDE successfully returned to a less restrictive setting within their communities (e.g., their families, regular foster care, independent living). Of the 28 youth successfully discharged from PRYDE since 1982, only one had returned to a more restrictive placement within 6 months of discharge. Thus, PRYDE represents a viable treatment alternative to institutionalization for extremely difficult to treat youths.     

Mothers' Anticipation and Prevention of Unintentional Injury to Young Children in the Home

Investigated anticipation and prevention of children's unintentionalinjuries in the home. 150 mothers of 1-, 2-, and 3-year-oldchildren kept weekly diaries of anticipated injuries and unanticipatedinjuries/near injuries to their child. Mothers anticipated between57 and 67% of all injury events, a majority when the child wasin the same room as the injury-causing agent prior to interactingwith it. Few anticipated injuries led to injury. In these casesno significant differences were found depending on child's ageand sex. In contrast, mothers of younger children most frequentlyreported preventing injury by physically restricting or movingthe child away and by changing the environment, whereas mothersof older children more frequently engaged in teaching.     

Measures of Children's Injuries: Self-Reported Versus Maternal-Reported Events with Temporally Proximal Versus Delayed Reporting

Although attention has recently been focused on understandingand preventing children's injuries, much controversy existsover the best data collection methods for examining child injuries.This study examined three methodological issues relevant tochildhood injury data collection including the length of timechildren and parents can be expected to meaningfully recallinjuries, whether the parent or child is a preferred informantabout the injury, and the potential use of near injuries asa proxy measure for actual child injuries. Both children andtheir mothers were individually interviewed every 2 weeks fora total of 6 months about both injuries and near injuries. Inaddition, at the end of the 6-month period, they were askedto recall all injuries that occurred during those 6 months.Overall, children reported more injuries than mothers. Childrenrecalled far fewer and mothers recalled slightly fewer eventsthan had been reported in the biweekly interviews. There werefewer near injury than actual injury events reported, althoughthis varied across categories, with some categories (e.g., carpassenger injuries) having more near than actual injuries, andother categories (e.g., cuts, bumps, and bruises) having manymore actual than near injuries reported. Limitations of theproject are discussed and implications for future research advanced.     

Parenting practices as mediators of child physical activity and weight status

Understanding the environmental factors that influence children's physical activity is an important prerequisite before effective physical activity interventions can be developed and implemented. Parenting is one environmental factor that has been empirically shown to positively influence children's physical activity. However, in order to promote physical activity in children, a better understanding of how parents influence children's physical activity behavior is required. Previously, Birch and Davison developed a model depicting parental factors hypothesized to influence child dietary behaviors. We extended this model by identifying parental factors hypothesized to promote physical activity in children. This review focuses on the mediational role that parenting practices and behaviors play in influencing child mediators of physical activity behavior, and, ultimately, weight status. Priorities for future research are discussed.     

Factors associated with retaliatory attitudes among African American adolescents who have been assaulted

OBJECTIVES: (a) To describe attitudes regarding retaliation among adolescents who have been assaulted. (b) To examine assault/event characteristics, personal, parental, and environmental factors associated with the retaliatory attitudes of adolescents who have been assaulted. METHODS: African American youth aged 10-15 years presenting to two large urban hospitals with peer assault injury and a parent/caregiver completed interviews in their home after their emergency department visit. RESULTS: Multivariate analyses revealed that lower SES, older age, and adolescents' perceptions that their parents support fighting were related to endorsing retaliatory attitudes. Girls who were aggressive were more likely to endorse retaliatory attitudes. However, level of aggression did not impact boys' retaliatory attitudes. Affiliating with aggressive peers influenced the retaliatory attitudes of boys, but did not influence girls' retaliatory attitudes. Overall, youths' perceptions of their parents' attitudes toward fighting had the greatest impact on retaliatory attitudes. CONCLUSIONS: Adolescents' perceptions of their parents' attitudes toward fighting may be a factor in subsequent re-injury among youth. Violence prevention and intervention efforts need to involve components that assess parental attitudes and incorporate strategies to engage parents in violence prevention efforts. In addition, interventions for youth who have been assaulted may need to incorporate some gender-specific components in order to address the unique needs of girls and boys.     

Adolescent Illegal Drug Use: The Impact of Personality, Family, and Environmental Factors

This study examined the relationship between the domains of environmental factors, family illegal drug use, parental child-rearing practices, maternal and adolescent personality attributes, and adolescent illegal drug use. A nonclinical sample of 2,837 Colombian youths and their mothers were interviewed about intrapersonal, interpersonal, and environmental factors in their lives. Results indicated that certain environmental factors (e.g., violence, drug availability, and machismo), family drug use, a distant parent–child relationship, and unconventional behavior are risk factors for adolescent illegal drug use. As hypothesized, results showed that the adverse effects of family illegal drug use on adolescent drug use can be buffered by protective parental child-rearing practices and environmental factors, leading to less adolescent illegal drug use. Prevention and treatment efforts should incorporate protective environmental, familial, and intrapersonal components in order to reduce adolescent illegal drug use     

Observation of family functioning at mealtime: a comparison between families of children with and without overweight

OBJECTIVE: To examine differences between families of children with and without overweight on parental control and support. METHODS: Twenty-eight families with an overweight child and a control group of 28 families with a normal weight child (age range 7-13 years) participated in the study. Observations and self-reports of mealtime family functioning were administered and analyzed. RESULTS: Parents of children with overweight reported to exert more control on their children's feeding behavior and an equal amount of parental support in comparison with parents of children without overweight. However, observations at mealtime indicated that in families with an overweight child, maladaptive control strategies were twice as prevalent, and less parental support was displayed. CONCLUSIONS: Self-reports and observations provide complementary information on how parents interact with their overweight children. Family-based treatment programs should include discussions on the adequate amount of parental control and support.