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.     

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.     

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.     

Effective treatment for postpartum depression is not sufficient to improve the developing mother-child relationship

Maternal depression is prevalent, and puts children at risk. Little evidence addresses whether treatment for maternal depression is sufficient to improve child outcomes. An experiment was conducted testing whether psychotherapeutic treatment for mothers, suffering from major depression in the postpartum period, would result in improved parenting and child outcomes. Participants included depressed women randomly assigned to interpersonal psychotherapy (n = 60) or to a waitlist (n = 60), and a nondepressed comparison group (n = 56). At 6 months, depressed mothers were less responsive to their infants, experienced more parenting stress, and viewed their infants more negatively than did nondepressed mothers. Treatment affected only parenting stress, which improved significantly but was still higher than that for nondepressed mothers. Eighteen months later, treated depressed mothers still rated their children lower in attachment security, higher in behavior problems, and more negative in temperament than nondepressed mothers. Initial response to treatment did not predict reduced risk for poor child outcomes. Early maternal negative perceptions of the child predicted negative temperament and behavior problems 18 months after treatment. Treatment for depression in the postpartum period should target the mother-infant relationship in addition to the mothers' depressive symptoms.     

Impact on maternal parenting stress of receipt of genetic information regarding risk of diabetes in newborn infants.

Our objective was to investigate whether notification of high-risk status for type 1 diabetes in newborn infants results in an increased maternal-parenting stress level when compared with notification of low-risk status for type 1 diabetes. Maternal parenting stress level was assessed at 5-7 weeks postpartum (baseline) and was reassessed 4-5 months after parents were informed of their newborn infants' genetic screening results (follow-up). Parenting stress level was measured using the total stress score (TSS) of the Parenting Stress Index/Short Form. The outcome variable, change in TSS, was calculated by subtracting the baseline TSS from the follow-up TSS. Demographic variables such as maternal race, maternal age, maternal education level, maternal marital status, child's birth order, and total family income were assessed through a structured phone interview at the time of baseline assessment. The risk factor of interest was the child's human leukocyte antigen (HLA) status for type 1 diabetes, i.e., whether child was at a high or moderate (combined into "high") genetic risk or at a low genetic risk for type 1 diabetes. A sample of 88 mothers (23 with a high-risk child and 65 with a low-risk child) was evaluated. Baseline median TSSs were 65 and 74 for mothers of low-risk infants and mothers of high-risk infants, respectively. Both groups' median TSS decreased between baseline and follow-up. No significant differences were found between change in TSS and maternal age, race, education level, marital status, total family income, or child's birth order. Although the median decrease in TSS was smaller in mothers with a high-risk child when compared with mothers of a low-risk child, this difference was not statistically significant. We did not find an association between newborn's HLA status and change in maternal TSS. The results of this study suggest that notification of high-risk status for type 1 diabetes in newborn infants may not result in an increased level of parenting stress among mothers.     

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.     

Insatiable insecurity: maternal obesity as a risk factor for mother–child attachment and child weight

Childhood obesity has become a rising health problem, and because parental obesity is a basic risk factor for childhood obesity, biological factors have been especially considered in the complex etiology. Aspects of the family interaction, e.g., mother–child attachment, have not been the main focus. Our study tried to fill this gap by investigating whether there is a difference between children of obese and normal weight mothers in terms of mother–child attachment, and whether mother–child attachment predicts child’s weight, in a sample of 31 obese and 31 normal weight mothers with children aged 19 to 58 months. Mother–child attachment was measured with the Attachment Q-Set. We found that (1) children of obese mothers showed a lower quality of mother–child attachment than children of normal weight mothers, which indicates that they are less likely to use their mothers as a secure base; (2) the attachment quality predicted child`s BMI percentile; and (3) the mother–child attachment adds incremental validity to the prediction of child’s BMI beyond biological parameters (child’s BMI birth percentile, BMI of the parents) and mother’s relationship status. Implications of our findings are discussed.     

Understanding toddlers' in-home injuries: II. Examining parental strategies, and their efficacy, for managing child injury risk

Multimethod strategies (i.e., questionnaires, injury-event recording diaries, and telephone and home interviews) were used to study in-home injuries experienced by toddlers over a 3-month period and to identify anticipatory prevention strategies implemented by parents, on a room-by-room basis, that effectively reduced child injury risk. Three types of prevention strategies were used by parents: environmental (e.g., hazard removal, safety devices to prevent access), parental (e.g., increased supervision, parent modification of their own behavior to decrease injury risk for their child), and child based (e.g., teaching rules or prohibitions to promote safety), with parents often using a combination of these. Use of these strategies, and their efficacy to reduce injury risk, varied on a room-by-room basis. Nonetheless, two general conclusions are supported: (1) An emphasis on child-based strategies never decreases, and often elevates, risk of injury to toddlers; and (2) parental and environmental strategies, either singularly or in combination, serve protective functions that significantly reduce children's risk of in-home injury. Although it is commonplace for parents of children between 2 and 3 years of age to transition from environmental and supervision strategies to the use of teaching and rule-based ones to manage injury risk, doing so too early clearly elevates children's risk of injury in the home.     

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.     

Effect of maternal panic disorder on mother–child interaction and relation to child anxiety and child self-efficacy

To determine whether mothers with panic disorder with or without agoraphobia interacted differently with their children than normal control mothers, 86 mothers and their adolescents (aged between 13 and 23 years) were observed during a structured play situation. Maternal as well as adolescent anxiety status was assessed according to a structured diagnostic interview. Results showed that mothers with panic disorder/agoraphobia showed more verbal control, were more criticizing and less sensitive during mother–child interaction than mothers without current mental disorders. Moreover, more conflicts were observed between mother and child dyadic interactions when the mother suffered from panic disorder. The comparison of parenting behaviors among anxious and non-anxious children did not reveal any significant differences. These findings support an association between parental over-control and rejection and maternal but not child anxiety and suggest that particularly mother anxiety status is an important determinant of parenting behavior. Finally, an association was found between children’s perceived self-efficacy, parental control and child anxiety symptoms.     

Impact on maternal parenting stress of receipt of genetic information regarding risk of diabetes in newborn infants

Our objective was to investigate whether notification of high-risk status for type 1 diabetes in newborn infants results in an increased maternal-parenting stress level when compared with notification of low-risk status for type 1 diabetes. Maternal parenting stress level was assessed at 5–7 weeks postpartum (baseline) and was reassessed 4–5 months after parents were informed of their newborn infants' genetic screening results (follow-up). Parenting stress level was measured using the total stress score (TSS) of the Parenting Stress Index/Short Form. The outcome variable, change in TSS, was calculated by subtracting the baseline TSS from the follow-up TSS. Demographic variables such as maternal race, maternal age, maternal education level, maternal marital status, child's birth order, and total family income were assessed through a structured phone interview at the time of baseline assessment. The risk factor of interest was the child's human leukocyte antigen (HLA) status for type 1 diabetes, i.e., whether child was at a high or moderate (combined into “high”) genetic risk or at a low genetic risk for type 1 diabetes. A sample of 88 mothers (23 with a high-risk child and 65 with a low-risk child) was evaluated. Baseline median TSSs were 65 and 74 for mothers of low-risk infants and mothers of high-risk infants, respectively. Both groups' median TSS decreased between baseline and follow-up. No significant differences were found between change in TSS and maternal age, race, education level, marital status, total family income, or child's birth order. Although the median decrease in TSS was smaller in mothers with a high-risk child when compared with mothers of a low-risk child, this difference was not statistically significant. We did not find an association between newborn's HLA status and change in maternal TSS. The results of this study suggest that notification of high-risk status for type 1 diabetes in newborn infants may not result in an increased level of parenting stress among mothers. Am. J. Med. Genet. 86:219–226, 1999. © 1999 Wiley-Liss, Inc.     

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.     

Single nucleotide polymorphisms in the transcobalamin gene: relationship with transcobalamin concentrations and risk for neural tube defects

Homocysteine levels are elevated in mothers of neural tube defect (NTD) children, which may be due to a disturbed folate or vitamin B12 metabolism. Vitamin B12 is transported to the tissues by transcobalamin (TC). We previously showed that a low holo-TC/total-TC ratio is a risk factor for NTD, possibly due to an impaired binding of vitamin B12 to TC. The coding region of the TC gene of 12 individuals was analysed for genetic variations responsible for a disturbed vitamin B12 binding. The influence of the genetic variations observed on total-TC, holo-TC, holo-TC/total-TC, erythrocyte vitamin B12, plasma homocysteine concentrations and risk for NTD was explored in 42 mothers of a child with NTD and in 73 female controls. Direct sequencing analyses revealed five single nucleotide polymorphisms (SNPs). Three SNPs affected total-TC concentrations, whereas two SNPs seem to affect the binding of vitamin B12. None of the genotypes defined by the SNPs had a significant effect on homocysteine levels, or was associated with an increased NTD risk. Among the five SNPs observed only P259R could partly explain the reduced proportion of vitamin B12 bound to TC, which has been associated with an increased risk for having a child with NTD. Some of the variants studied affected total-TC and holo-TC/total-TC ratio but a larger study population is required to elucidate whether these SNPs influence delivery of vitamin B12 to the tissue, influence homocysteine levels and whether they are associated with an increased NTD risk.     

Maternal support in the delivery room and birthweight among African-American women

OBJECTIVES: We performed a hospital-based case control study of African-American mothers to explore the relationship between maternal support by a significant other in the delivery room and very low birthweight (VLBW). METHODS: We administered a structured questionnaire to mothers of VLBW (less than 1,500 g; N=104) and normal birthweight (greater or equal to 2,500 g; N=208) infants. RESULTS: The odds ratio for VLBW comparing women without social support in the delivery room to those with a companion was 3.5 (2.1-5.8). Several traditional risk factors were not associated with VLBW, but older maternal age and perceived racial discrimination were. CONCLUSIONS: Maternal support in the delivery room or factors closely associated with it significantly decreases the odds of delivering a VLBW infant for African-American women.     

Anxiety and depression in parents 4-9 years after the loss of a child owing to a malignancy: a population-based follow-up

BACKGROUND: Some consider the loss of a child as the most stressful life event. When the death is caused by a malignancy, the parents are commonly exposed not only to their own loss, but also to the protracted physical and emotional suffering of the child. We investigated parental risk of anxiety and depression 4-9 years after the loss of a child owing to a malignancy. METHOD: In 2001, we attempted to contact all parents in Sweden who had lost a child due to a malignancy during 1992--1997. We used an anonymous postal questionnaire and utilized a control group of non-bereaved parents with a living child. RESULTS: Participation among bereaved parents was 449/561 (80 %); among non-bereaved 457/659 (69%). We found an increased risk of anxiety (relative risk 1.5, 95 % confidence interval 1.1-1.9) and depression (relative risk 1.4, 95 % confidence interval 1.1-1.7) among bereaved parents compared with non-bereaved. The risk of anxiety and depression was higher in the period 4-6 years after bereavement than in the 7-9 years period, during which the average excess risks approached zero. Psychological distress was overall higher among bereaved mothers and loss of a child aged 9 years or older implied an increased risk, particularly for fathers. CONCLUSIONS: Psychological morbidity in bereaved parents decreases to levels similar to those among non-bereaved parents 7-9 years after the loss. Bereaved mothers and parents who lose a child 9 years or older have on average an excess risk for long-term psychological distress.     

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.     

The relationship of prenatal alcohol exposure and the postnatal environment to child depressive symptoms

OBJECTIVE: This study examined the association between prenatal alcohol exposure and child depressive symptoms, and the mediating effects of maternal and child characteristics. METHODS: Participants were 42 children aged 4-5 years and their biological mothers. Prenatal alcohol consumption was assessed by self-report of maximum drinks per drinking occasion. The Pictorial Depression Scale (PDS) measured child depressive symptoms. Mother-child interactions were assessed using the family interaction puzzle task. RESULTS: Structural equation modeling indicated that prenatal alcohol exposure was associated with more negative child affect. In turn, mothers of more negative children were less emotionally connected to their children, and those children had higher levels of depressive symptomatology. Results could not be explained by current maternal drinking patterns or maternal depression. CONCLUSIONS: Study findings highlight the importance of examining prenatal alcohol exposure as a risk factor in the prediction of childhood-onset depression and the environmental mechanisms that may mediate that relationship.     

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.     

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.     

Exposure to high doses of birch pollen during pregnancy,and risk of sensitization and atopic disease in the child

BACKGROUND: The role of maternal allergen exposure during pregnancy in sensitization and development of atopic disease in the child remains controversial. In the spring of 1993, extremely high levels of birch pollen were recorded in Stockholm, Sweden. In 1994, the corresponding pollen levels were low. The aim of this study was to assess the influence of exposure during pregnancy to high/low doses of birch pollen on the risk of sensitization and development of atopic disease in children. In addition, a comparison was made with children exposed to birch pollen in early infancy. METHODS: Three hundred and eighty-seven children with atopic heredity, born in Stockholm in July-October 1993 or 1994 (mothers exposed during pregnancy), were investigated at age 4.5 years. The children were clinically examined and were skin prick tested (SPT) with inhalant and food allergens. IgE antibodies (RAST) against birch pollen and recombinant birch pollen allergen (rBet v 1) were analysed in serum. A comparison was made with a similar group of children exposed during the same incident, but in the first 3 months of life, in 1993. RESULTS: The children of mothers high-dose exposed during pregnancy in 1993 tended to be more sensitized (SPT > or = 3 mm) to birch pollen than the children with low-dose exposure during the corresponding period in 1994 (7.6 and 4.6%, respectively, OR: 1.7; 95% CI: 0.7-4.1). A similar but weak tendency was seen for positive RAST analyses (> or =0.35 kU/l) against birch pollen and rBet v 1. Children of mothers high-dose exposed during pregnancy were significantly less sensitized to birch pollen than the children high-dose exposed in early infancy (17.9%, OR: 0.4; 95% CI: 0.2-0.7). There was an overall trend towards a slightly increased prevalence of bronchial asthma, allergic rhinoconjunctivitis and atopic dermatitis in the group with mothers high-dose exposed during pregnancy, compared to those with low exposure. CONCLUSION: Exposure of the mother during pregnancy to high levels of birch pollen resulted in a tendency towards increased risk of sensitization to the same allergen and symptoms of atopic disease in children with atopic heredity. Furthermore, our data indicate that exposure of the mother during pregnancy to inhalant allergens is less likely to result in sensitization in the child than exposure of the child in early infancy.