Mothers' Supervision and Perception of Young Children's Risk of Unintentional Injury in the Home

Investigated whether control exerted through supervision isbelieved by mothers to reduce risk of unintentional injury totheir children. 150 mothers of 1-, 2-, and 3-year-old childrenrated the risk of their child having an injury and indicatedwhat injuries they anticipated in different rooms of the homeunder four conditions of supervision. A clear effect of supervisionwas observed in that rated risk and the number of anticipatedinjuries decreased depending on whether the mother was in thesame room or not. Furthermore, a decrease was found when themother was in the same room engaged in the same activity asthe child (either playing with or being assisted by the child).The observed effects of supervision were less strong for olderchildren and for rooms perceived as less dangerous.     

Risk for minor childhood injury: an investigation of maternal and child factors

OBJECTIVE: To examine how maternal and child characteristics interact to moderate injury rate and injury severity for young children. METHODS: In this study, 149 mothers reported their toddlers' injuries over a 6-month period during biweekly interviews. Mothers completed questionnaires assessing parenting behaviors, psychological characteristics, and their children's injury-relevant behaviors. RESULTS: Maternal locus of control was found to moderate the association between children's risky behavior and child injury rate. Specifically, an external locus of control was associated with increased child injury rate for high-risk but not for low-risk children. CONCLUSION: These findings illuminate the potential importance of parental locus of control in moderating high-risk injury-relevant behavior.     

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.     

Childhood unintentional injuries: factors predicting injury risk among preschoolers

OBJECTIVE: To examine the relationships between maternal perceptions of risk, stress, social support, safety-proofing behaviors, supervision practices and unintentional injuries to children under 5 years old. METHODS: Household interviews were conducted with 159 mothers who had a preschool-age child. The secondary data were part of a population-based study that collected self-report data and home observational data. Diaries were used for collecting prospective injury data. RESULTS: White children whose mothers were unemployed and whose homes needed repair were reported to be at higher injury risk than other children. Predicting a higher injury risk were children's behavioral characteristics as well as their being older than 2.5 years. Maternal social support, stress, and coping variables were not related to injury risk. Maternal perceptions of risk variables interacted with maternal safety behavior variables when predicting injury risk. CONCLUSIONS: Childhood injuries are predicted by a set of interrelated sociodemographic, cognitive, behavioral, and child-related factors.     

The child as a projectile

Unintentional injury is the leading cause of death in children under the age of fourteen. The majority of these injuries/deaths occur when the child becomes airborne during an accident. The most common mechanisms by which children become airborne are motor vehicle collisions, bicycling accidents, and falls. A head injury is seen in a significant number of children in this setting. This includes injury to the scalp, skull, coverings of the brain, or the brain itself. These injuries are the most common cause of death in children resulting from unintentional injury. Other typical injuries include external bruises and abrasions, extremity fractures, and bruising or bleeding of internal organs. We propose to name this constellation of injuries the projectile child syndrome. This refers to those injuries occurring in infants and children as a result of becoming airborne during the events of an accident. The pattern of injuries seen as related to the anatomy of the child is stressed. A review of the impact to society and guidelines for prevention are presented. Anat. Rec. (New Anat.) 253:167–175, 1998. © 1998 Wiley-Liss, Inc.     

Mothers' home-safety practices for preventing six types of childhood injuries: what do they do, and why?

OBJECTIVE: To identify determinants of mothers' home-safety practices for preventing six types of common injuries to children (burns, poisoning, drowning, cuts, strangulation/suffocation/choking, and falls). METHODS: Home interviews were conducted with mothers of children 19-24 and 25-30 months old about home-safety practices. For each of 30 safety precautions to prevent these six types of injuries, mothers indicated whether or not they engaged in the practice, and explained why. RESULTS: Regression analyses revealed both common and unique determinants of mothers' home-safety practices to prevent these six types of home injuries. For burns, cuts, and falls, beliefs that child characteristics and parent characteristics elevated the child's risk of injury were the key determinants of the mother's engaging in precautionary measures. For drowning, poisoning, and suffocation/strangulation/choking, health beliefs also contributed to predict mothers' practices, including beliefs about potential injury severity and extent of effort required to implement precautionary measures. CONCLUSIONS: The factors that motivated mothers to engage in precautionary measures at home varied depending on the type of injury. Intervention programs to enhance maternal home-safety practices will need to target different factors depending on the type of injury to be addressed.     

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.     

Informational needs in families after their child's mild head injury

OBJECTIVE: When a child is hospitalized due to an illness or injury, the entire family may experience stress and/or anxiety. According to parents who have been in such a situation, providing adequate information is one of the most valuable ways to help the family deal with such feelings. Most mild head injuries suffered by children do not require hospitalisation and in such cases, their families should be provided with appropriate information in connection with their visit to the emergency ward. In the present study, family informational needs are characterized. METHODS: The families of 57 children who had suffered a mild head injury at 0-15 years of age answered one open-ended question. The analysis was carried out using content analysis. RESULTS: This analysis revealed two types of needs, i.e., a need for information concerning the head injury itself and how to provide care, as well as a need for reassurance and support in sharing and coping with the emotional burden. CONCLUSION: Despite differences in the severity of the child's head injury and requirement for hospitalisation, all the families expressed the same informational needs but also the need for emotional support. PRACTICE IMPLICATIONS: In connection with the treatment of children with head injuries, health-care personnel should provide the parents both with information concerning the injury and its treatment and with emotional support.     

'And Then It Started Bleeding': Children's and Mothers' Perceptions and Recollections of Daily Injury Events

Explored children's and mothers' recollections of minor injury within the frameworks of both folk wisdom and the current literature on children's memory for real-world events. Recall opportunities given every 2 weeks for 6 months revealed that 8- to 11-year-old children and their mothers were more likely to recall events that involved unusual circumstances or novel behavior, events accompanied by higher negative affect, and events receiving medical treatment. Mothers and children similarly tended to recall physical features of the event such as the location of child and of caregiver, time of day, clothing worn by the child, weather, and type of treatment received. They tended to disagree on more judgmental aspects such as perceptions of one another's emotions and attributions of causality. The results failed to confirm predictions derived from folk wisdom that suggest that early minor injury may prevent injury later in life; in this study, even remembered injuries were not followed by preventive behavior and potentially serious events were not better recalled than less serious events. Our findings were thus consistent with current models of children's memory for real-world events.     

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.     

Socialization of children's emotion regulation in mother-child dyads: a developmental psychopathology perspective

This study investigated the socialization of children's emotion regulation in 25 physically maltreating and 25 nonmaltreating mother-child dyads. Maltreating mothers and their 6- to 12-year-old children were recruited from two parenting programs affiliated with Children's Protective Services with a control group matched on race, SES, child gender, and child age. Children and their mothers were interviewed individually about their (a) management of emotional expression. (b) strategies for coping with emotional arousal, and (c) anticipated consequences following emotional displays. Compared to controls, maltreated children expected less maternal support in response to their emotional displays, reported being less likely to display emotions to their mothers, and generated fewer effective coping strategies for anger. Maltreating mothers indicated less understanding of children's emotional displays and fewer effective strategies for helping children to cope with emotionally arousing situations than nonmaltreating mothers. Further, findings indicated that maternal socialization practices (e.g., providing support in response to children's emotional display, generating effective coping strategies for their child) mediate the relation between child maltreatment and children's regulation of emotional expression and emotional arousal. These findings suggest that children's emotion regulation strategies are influenced by their relationship with their social environment (e.g.. physically maltreating, nonmaltreating) and that the experience of a physically maltreating relationship may interfere with children's emotional development.     

Predictors of unintentional injuries to school-age children seen in pediatric primary care.

OBJECTIVE: To identify predictors of unintentional injury to school-age children seen in pediatric primary care. METHODS: Members of a managed health care system (295 children ages 5-11 years and their mothers) participated. We used Time 1 measures of child, maternal, and family functioning and health care utilization to predict rates of unintentional child injury for the following year. Multiple regression analyses were performed to identify variables contributing to prospective injury rates. RESULTS: The final regression model included eight Time 1 variables and accounted for 21% of the variance in Time 2 injury rates. Significant predictors of increased injury liability were younger child age, more children at home, child behavior problems, child social competence, three indices of reduced child health, and maternal anxiety. CONCLUSIONS: We discuss the utility of these predictors for pediatric psychologists in targeting primary care preventive interventions to families at risk for unintentional child injury.     

Contributions of multiple risk factors to child injury

OBJECTIVE: Most previous research on etiological factors that predict children's unintentional injuries has focused on single independent risk factors that predict injury, but psychological methods and theory lend themselves to simultaneous consideration of multiple risk factors that might together create an increased or decreased risk for injury. METHOD: One approach to considering multiple risk factors of child injury, inspired by Lizette Peterson's notion of process analysis, is to consider how risk factors serve in moderated, mediated, and mediated moderation roles to each other. We present two lines of research that exemplify such models.In each, multiple risk factors for child injury are considered within a single theoretical model. CONCLUSIONS: Implications for understanding the etiology of children's unintentional injuries and developing empirically derived injury prevention techniques are discussed.     

Maternal Intervention Strategies in Enforcing Children's Bicycle Helmet Use

We investigated maternal methods of enforcing helmet usage in children. Although the American Academy of Pediatrics recently called for stronger parenting strategies to increase bicycle-helmet use, there has been virtually no study of typical parenting strategies to influence children to wear their helmets. In the present study, mothers of second- and eighth-grade children responded to 12 vignettes portraying typical excuses children give for not wearing a helmet. Even after continued child refusal, mothers reported they would try to persuade, discuss or command their child to wear the helmet, more often than they would use consequences. Initially, there were no age or gender effects, but as the vignettes portrayed the child protesting, mothers of second-grade girls suggested the use of consequences more often than mothers of eighth-graders. The reverse was true for mothers of second-grade boys, although these differences typically did not reach statistical significance. Overall, the data support the American Academy of Pediatrics' suggestion for more effective parenting strategies, especially for children at highest risk for bicycle injury.     

Brief report: the impact of maternal posttraumatic stress disorder symptoms and child gender on risk for persistent posttraumatic stress disorder symptoms in child trauma victims

OBJECTIVE: To longitudinally examine the impact of maternal posttraumatic stress disorder symptoms (PTSS) on child adjustment following a child's traumatic injury, focusing on child gender differences. METHODS: Forty-one child traumatic injury victims aged 8-18 years and their biological mothers were interviewed over two follow-ups (6 weeks and 7 months). Children were administered the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale for Children and Adolescents (CAPS-CA), whereas mothers completed the CAPS. RESULTS: Six weeks post trauma, maternal PTSS were significantly related to PTSS in boys but not in girls. However, at 7 months, maternal PTSS were strongly related to child PTSS in both boys and girls. Significant 6-week maternal distress-child gender interactions suggested that maternal PTSS, especially avoidance, predicted greater 7-month PTSS but that this was primarily because of a significant relationship in females. CONCLUSIONS: Maternal distress was found to negatively impact subsequent child adjustment, particularly in females. These results underscore the importance of considering family-centered interventions for child PTSD, especially in girls.     

Unintentional injuries in a twin study of preschool children: environmental, not genetic, risk factors

OBJECTIVE: To analyze the relative contribution of latent genetic and environmental factors to differences in the injury liability of children, and to examine the association between measured socio-economic, family, and child-behavior variables and unintentional injury risk. METHODS: Unintentional injuries from birth to age 5, together with information regarding measured risk variables, were reported by mothers in a sample of 1027 same-sex twin pairs from a nationally representative 1994-1995 birth cohort. RESULTS: Child-specific environmental factors accounted for most of the variance (86.4%) in the likelihood of ever having an injury. When considering the risk of two or more injuries child-specific environmental factors explained 60.2% of the variance and family-wide environmental influence 39.8%. Measured socio-economic, family, and child-behavior factors predicted frequent injury. CONCLUSIONS: Results give little support to the concept of a heritable injury-prone trait in preschool children; environmental influences accounted for most of the injury variance in this sample. However, behavioral variables, especially the child's externalizing problem behaviors, are also important in explaining unintentional injuries.     

Relation among marital conflict,child coping,and child adjustment

The goal of this study was to simultaneously examine maternal attributions, affect, and parenting in mothers of children with and without attention deficit hyperactivity disorder (ADHD) using a multimethod approach (vignettes, confederate child video clips, and video clips of mother's own child). Of the participants, 23 were 7- to 12-year-old children (19 boys, 4 girls) with ADHD and their mothers, and 29 were 7- to 12-year-old comparison children (21 boys, 8 girls) and their mothers. Results indicated that mothers of children with ADHD attributed inattentive-impulsive behavior to less controllable and intentional factors and reported more negative affect and power assertive parenting in response to it than comparison mothers. They also attributed this behavior to more internal factors than comparison mothers but only when viewing their own children and to more global/stable factors but only when viewing their own children or a confederate child. Interestingly, mothers of children with ADHD reported more positive parenting in response to prosocial behavior while attributing this behavior to less controllable and global/stable factors than comparison mothers; compliance also was seen as less controllable, global/stable, and intentional by mothers of children with ADHD.     

Long-term behavior problems following pediatric traumatic brain injury: prevalence,predictors, and correlates

OBJECTIVE: To study identified rates of long-term behavior problems in children with traumatic brain injury (TBI) compared to children with only orthopedic injuries and risk factors and correlates for new behavior problems following TBI. METHODS: Sample included children with severe TBI (n = 42), moderate TBI (n = 41), and orthopedic injuries only (ORTHO;n = 50). The baseline assessment measured child behavior, adaptation, and neuropsychological, academic, and family functioning. Follow-ups were conducted at 6 and 12 months and at an extended follow-up a mean of 4 years after injury. RESULTS: The prevalence of caseness, defined as elevated behavior problem ratings, was higher in one or both TBI groups than in the ORTHO group at each follow-up (e.g., 36% of severe TBI group, 22% of moderate TBI group, and 10% of ORTHO group at extended follow-up). Most instances of postinjury-onset caseness at the extended follow-up were evident within the first year after TBI. Predictors were severe TBI, socioeconomic disadvantage, and preinjury behavioral concerns. Concurrent correlates included weakness in working memory and adaptive behavior skills, poorer behavior and school competence, and adverse family outcomes. CONCLUSIONS: Postinjury-onset caseness is persistent, risks are multifactorial, and correlates include child dysfunction and family sequelae.     

A Qualitative Study of How Preschoolers’ Problematic Sleep Impacts Mothers

Background: Sleep disturbances are common among preschool-aged children. As children’s problematic sleep is commonly defined by subjective reports from parents as to how the issue affects them, we took a qualitative approach to explore the perceptions and experiences of mothers and main caregivers of preschoolers with problematic sleep. The aim was to understand their firsthand experiences. Methods: Purposive sampling was used to identify mothers of 3- to 4-year-olds whose sleep was a problem for them. Semistructured interviews were conducted with 16 mothers. The interviews were analyzed for anticipated and emergent themes, the latter generated from exploring the impact of the child’s sleep problems on the mother herself. Results: Mothers described difficulties mainly with bedtime resistance and night waking and the adverse consequences affecting siblings and partners. Predominant themes falling under the umbrella of emotional responses (e.g., resignation, guilt or shame, confusion or frustration, and defeat) and daytime functioning (e.g., exhaustion, moodiness, poorer concentration, less socializing) emerged from mothers describing the impact the child’s sleep problem had on her personally. Conclusions: This study highlights the overwhelming impact a child’s sleep problems can have on a mother both emotionally and physically, and expressions of shame and guilt suggest some mothers assume much of the responsibility for their child’s sleep problem. The findings provide insight into understanding mothers’ personal responses in dealing with their preschoolers’ sleep that could be useful to assist health professionals in history taking and establishing a treatment plan.     

Intentional injuries among children and adolescents in Massachusetts

We estimated age-specific and sex-specific incidence rates of intentional injuries (assaults or suicide attempts) occurring between 1979 and 1982 in a population of 87,022 Massachusetts children and adolescents under 20 years of age in 14 communities with populations of 100,000 or less. The average annual incidence of intentional injuries treated at a hospital was estimated to be 76.2 per 10,000 person-years. Overall, 1 in 130 children was treated each year for an intentional injury. More than 85 percent of the injuries resulted from assaults, such as fights, rape, and child battering; 11.4 percent were self-inflicted. Intentional injuries were most common among adolescents. Each year, 1 in 42 teenage boys was treated for an assault-related injury, and 1 in 303 teenage girls was seen for a suicide attempt. Repeated episodes of intentional injury were identified in 4.3 percent of the children. In this population, intentional injuries accounted for 3.4 percent of all injuries but 9.8 percent of hospital admissions and 15.7 percent of deaths from injury. The rate of intentional injury was directly correlated with both the degree of urbanization and the poverty level of the community of residence. We conclude that intentional injuries are relatively common in this population and that attempts to prevent them must be directed to the children who are at greatest risk.