Journal of Pediatric Psychology 29(6) pp. 433-446, 2004
Journal of Pediatric Psychology vol. 29 no. 6 © Society of Pediatric Psychology 2004; all rights reserved
Understanding Toddlers’ In-Home Injuries: II. Examining Parental Strategies, and Their Efficacy, for Managing Child Injury Risk
University of Guelph
All correspondence should be addressed to Barbara Morrongiello, University of Guelph, Psychology Department, Guelph, Ontario, N1G 2W1, Canada. E-mail: bmorrong{at}uoguelph.ca.
 |
Abstract |
|---|
 Top Abstract Controlling Access to HazardsSupervisionTeachingPresent StudyMethodResultsDiscussionAcknowledgmentsReferences |
|---|
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.
Unintentional injury constitutes a serious health threat to children (Baker, O’Neill, & Ginsburg, 1992
; Canadian Institute of Child Health, 1994), and young children are especially vulnerable to injuries that occur in the home (Baker et al., 1992; Glik, Kronenfeld, & Jackson, 1993; Shannon, Brashaw, Lewis, & Feldman, 1992). Although a number of studies have asked parents to comment on child injury risk and the child safety practices they employ, we have a limited understanding of what parents actually do in their home to manage injury risk to young children and how efficacious their strategies are. These issues are considered in the present report.
Because parental safety behavior plays a critical role in the prevention of injuries to young children, it is essential that we fully understand the nature and efficacy of such behaviors. Protecting young children from in-home injuries requires the participation of parents to (1) control access to hazards, by eliminating them or using barriers to prevent access to them when possible; (2) provide supervision as necessary; and (3) teach children about safety in developmentally appropriate ways. Prior research has revealed that supervision and control of access to hazards are the predominant strategies reported by parents for children 1 to 2 years of age; however, use of these strategies declines after 2 years of age as parents shift their emphasis to the use of teaching (Garling & Garling, 1995). Hence, toddlers in the 2-to-3-year range may be at elevated risk of injury if they are incapable of or unwilling to follow safety rules being taught by their parents.
|
Controlling Access to Hazards |
|---|
|
TopAbstractControlling Access to HazardsSupervisionTeachingPresent StudyMethodResultsDiscussionAcknowledgmentsReferences |
|---|
Parents of young children 1 and 2 years of age report using primarily barrier methods to prevent toddlers’ access to hazards at home (e.g., Garling & Garling, 1995
; Thuen, 1992). However, many studies have documented the surprising finding that parents do not utilize many safety devices to manage injury risk at home, despite their awareness of such devices (Colver, Hutchinson, & Judson, 1982; Greensher, 1984). A poor use rate is evident even when devices are provided for free (Dershewitz & Williamson, 1977; Gallagher, Hunter, & Guyer, 1985). Hence, availability is not the key to use.
Previous research reveals that parents’ decisions to implement barrier measures are influenced by a variety of factors, including beliefs about the appropriateness of the measure for their child’s developmental level, the success of taking the measure, the extent of inconvenience of taking the measure, social influence and the partner’s opinion of the measure, their child’s vulnerability for injury, and the potential severity of injury (e.g., Glik, Kronenfeld, & Jackson, 1991; Greaves, Glik, Kronenfeld, & Jackson, 1994; Peterson, Farmer, & Kashani, 1990; Wortel, de Geus, & Kok, 1995). In addition, prior injury experience can motivate parents to implement environment-based prevention initiatives (e.g., Russell & Champion, 1996); and income, parent education, and housing quality have also been shown to relate to the in-home prevention practices of parents (e.g., Gielen, Wilson, Faden, Wissow, & Harvilchuck, 1995; Ueland & Kraft, 1996).
Obviously, considerable research has sought to identify factors that influence parents’ use of such environment-based strategies to reduce injury risk for young children. Surprisingly, however, the efficacy of this approach in child injury prevention has not been clearly established. Nor has anyone compared the efficacy of this approach with other popular strategies, such as parent supervision and teaching children, to establish that environment-based prevention initiatives are uniquely efficacious, as is generally assumed. This is one goal in the present study.
|
Supervision |
|---|
|
TopAbstractControlling Access to HazardsSupervisionTeachingPresent StudyMethodResultsDiscussionAcknowledgmentsReferences |
|---|
There has been considerable speculation that inadequate supervision is a leading contributor to child injuries (e.g., Garbarino, 1988
). Epidemiological data provide indirect support for this notion: Children in single-parent homes (Rivara & Mueller, 1987), those living with substance-abusing parents (Westfelt, 1982), and those having a very young parent (McCormick, Shapiro, & Starfield, 1981) all show elevated rates of injury. Despite these indirect links, however, there is very limited evidence directly relating supervision to child injury and confirming supervision as a protective factor (reducing the risk of injury) or a risk factor (elevating the risk of injury).
It is generally assumed that it is a parent’s primary role in injury prevention to protect the child from accessing hazards, such as by supervision (Stratton, 1985). Lab studies indicate that parents expect supervision to prevent injuries and recognize the need to vary their supervision depending on the child’s age and extent of environmental risk (Fagot, Kronsberg, & MacGregor, 1985; Garling & Garling, 1991, 1993; Peterson, Ewigman, & Kivlahan, 1993). However, other studies reveal that parents do not, in fact, vary supervision for high-risk, frequently injured children (e.g., Glik et al., 1991, 1993; Rosen & Peterson, 1990). Hence, what parents report in the lab may bear little relation to how they typically behave during the course of their day-to-day interactions with their children. In addition, findings revealing limited agreement among parents, nurses/physicians, and child protection service workers about what constitutes "adequate supervision" for children (e.g., Peterson et al., 1993) further highlight the need for research that directly examines the relation between supervision and child injury risk. This is one goal in the present study. In addition, because supervision is most likely to be successful if parents anticipate potential injury-causing events and thus have time for preventive actions (e.g., Holden, 1983), another issue addressed herein is the extent to which parents proactively plan for using a supervisory strategy to reduce child injury risk at home, and whether perceived injury risk influences parental supervision of children.
|
Teaching |
|---|
|
TopAbstractControlling Access to HazardsSupervisionTeachingPresent StudyMethodResultsDiscussionAcknowledgmentsReferences |
|---|
Research on parenting indicates that verbalizations to children about safety peaks at about 2 years of age and declines thereafter as parents shift to focus on teaching about social norms for behavior (Gralinski & Kopp, 1993
). Although parents make the transition to using predominantly teaching strategies during the toddler years (e.g., Garling & Garling, 1995), little is known about the efficacy of this approach for moderating child injury risk. Research with preschoolers (Morrongiello, Midgett, & Shields, 2001) and school-age children (Peterson, Mori, & Scissors, 1986) indicates that parents routinely overestimate children’s knowledge of safety and the ability of children to manage injury risk on their own. These findings suggest that use of teaching as a prevention strategy may elevate children’s risk of injury during the toddler years as well, particularly if parents inadequately judge the appropriateness of this strategy (e.g., Garling & Garling, 1988; Valsinger, 1985) and utilize it in place of, instead of in addition to, environmental/barrier methods and/or supervision/parent-based strategies to deal with child injury risk. Evaluating parents’ use of child-based strategies, and the relation of these to injury risk among toddlers, is addressed in the present study. |
Present Study |
|---|
|
TopAbstractControlling Access to HazardsSupervisionTeachingPresent StudyMethodResultsDiscussionAcknowledgmentsReferences |
|---|
We addressed four questions relevant to parents’ strategies to manage injury risk for toddlers at home. First, to what extent do parents report using environmental/barrier strategies (modification of the physical space to control access to hazards), parent-based strategies (supervision or parental behavioral modification), and child-based strategies (teaching the child safety rules), and how does strategy use vary with room location in the home (e.g., installing a safety device to prevent the child reaching the top of the stove, using the back burners or turning the pot handles around when cooking, instructing the child to not reach for anything on the stove)? Second, based on toddlers’ in-home injuries during the course of the study, what is the relative efficacy of these prevention strategies, and does efficacy vary on a room-by-room basis? Third, to what extent do parents react to child injury with implementation of a prevention strategy to decrease the chance of recurrence? Finally, based on an examination of the type of parental supervision at the time of injury, are there any supervision strategies that relate to injury risk? We also sought to utilize parents’ reports of supervision to develop a taxonomy of supervision strategy for use in subsequent research on child injury.
To address these questions, we conducted in-depth home interviews in which, on a room-by-room basis, parents reported on the strategies they used to manage risk of injury for their toddler in that location. Subsequently, for a period of 12 weeks mothers tracked actual injuries to their child and completed a diary entry form for each event (e.g., what the child was doing at the time, what the mother was doing and her location, level of supervision at the time of injury). Within 2–3 days of the event, mothers completed a telephone interview in which further information about the injury was obtained (e.g., preventive action, if any, taken in reaction to the injury). Considerable additional information was gathered to elaborate the nature and extent of toddlers’ injuries and identify key determinants of them; however, these data are considered under a separate publication (Morrongiello, Ondejko, & Littlejohn, in press).
|
Method |
|---|
|
TopAbstractControlling Access to HazardsSupervisionTeachingPresent StudyMethodResultsDiscussionAcknowledgmentsReferences |
|---|
Participants
A final sample of 62 mothers participated, including 31 mothers having a firstborn son in the target age range of 2 to 2.5 years (M = 2.3, SD = 3 months) and 31 mothers having a firstborn daughter (M = 2.3 years, SD = 3 months); an additional 8 mothers discontinued participation and their data were therefore excluded. All mothers were married and living with their spouse. An equal number of participants with sons and daughters were surveyed in the spring, summer, fall, and winter to control for any seasonal variation in injury rates at home. Participants were randomly selected from an existing database of families interested in research on child development. In general, the sample comprised families in the low- to moderate-income range, with the majority of participants having completed only high school. Specifically, maternal education for the sample showed the following distribution: 91% of mothers had some high school or had obtained a high school diploma and 9% had some university or had obtained a university degree. Annual family income distribution for the sample was as follows: 25% earned less than $25,000; 48% earned $25,000–$49,999; 19% earned $50,000–$74,999; and the remaining 8% earned over $75,000. On average, participants had lived at their current residence for 52 months. None of the immediate family members had ever been hospitalized for an injury. There was little ethnic diversity in the sample; nearly all families were caucasian.
Measures
During the initial 2.5-hour home visit, mothers completed a demographic sheet to assess family income and the extent of maternal education; a variety of other measures were taken and reported elsewhere (Morrongiello et al., 2004). Mothers then accompanied the examiner throughout their home and, on a room-by-room basis, discussed safety issues and injury-prevention strategies they used to manage risk of injury for their toddler in that location of the home. These discussions were lengthy and rich with examples of specific injury-prevention approaches used by mothers. At the conclusion of the discussion, the examiner would explain to the mother that one can categorize prevention initiatives into three types (environment-based, parent-based, and child-based) and would use examples given by the mother to illustrate these broad categories. Subsequently, the mother was asked to give a rating (on a 6-point Likert scale: 1 = not at all to 6 = very much) to indicate the extent to which each strategy was used to manage child injury risk in that location of the home. Hence, mothers provided ratings of the extent to which they used the three prevention initiatives of interest in each room in the home.
During the 12 weeks of the study, mothers completed a diary entry form each time the target child experienced an injury at home, with injury defined (cf. Morrongiello et al., 2001) as tissue damage (e.g., cut, burn, bump, redness) lasting longer than 30 minutes, including evidence suggesting internal (nonvisible) tissue damage, such as symptoms indicating a negative reaction (e.g., vomiting) in response to the ingestion of a hazardous substance (e.g., poison); the definition did not include any requirement about intervention or pain because our pilot data revealed that young children were especially prone to carry on (e.g., cry and whine, suggesting pain) in response to very minor tissue damage that lasted only a few minutes, and we did not want to include such very minor injuries. They also recorded this event on an injury-recording calendar that was placed on the refrigerator. The calendar allowed the participants to track study phone calls and injury events, thereby making it easy for them to indicate to the telephone interviewer how many, if any, injuries had occurred since the last study phone call. Within 2–3 days of each injury, the mothers completed a telephone interview about the event.
Taken together, the diary and interview provided a wealth of information about the injury process. The only information of relevance to this report is that on the nature and extent of supervision at the time of injury and parental reaction to the injury (i.e., prevention initiative implemented, if any, to prevent recurrence). With regard to supervision at the time of injury, mothers indicated whether they’d (1) had the child in view (i.e., had been constantly watching), (2) had been listening in although the child had not been not in view, and whether this auditory monitoring had been constant or intermittent, or (3) had been neither watching nor listening in but checking on the child intermittently. Parents had no difficulty describing their level of supervision in these terms. With regard to preventive initiatives in reaction to their child’s injury, mothers indicated whether they had done anything special, or had planned to do so, using a 3-point scale: 1 = no intervention taken or planned, 2 = intervention planned but not yet implemented, and 3 = intervention implemented.
Procedure
An initial home visit was made during which mothers were administered all questionnaires, were given an injury-recording calendar to place on the refrigerator, and were familiarized with how to complete the injury-recording forms, which were organized in a binder. Sample forms were reviewed to ensure that all mothers fully understood what was to be done following an injury to their child.
Participants were contacted by telephone every 2–3 days so that information about injury events would still be fresh in their memory; prior research suggests that minor injuries (Peterson et al., 1993) are not recalled as well as more severe ones (Pless & Pless, 1995). Participants were contacted in this way for 12 weeks, with a minimum of two injuries required for inclusion in the study; all participants met this inclusion criterion. If there were more than three injuries to report on during a phone call, then only three were randomly selected by the interviewer for discussion (i.e., about 10 minutes per injury event), so as to keep the phone calls to a reasonable length of no longer than 30 minutes. At the end of each phone call, a time for the next was scheduled.
At the conclusion of the study, an interviewer returned to the home to pick up the binder containing the injury-relevant forms and give the mother a bouquet of flowers, pamphlets about child safety, and a Safe Seasons calendar as thank-you gifts.
|
Results |
|---|
|
TopAbstractControlling Access to HazardsSupervisionTeachingPresent StudyMethodResultsDiscussionAcknowledgmentsReferences |
|---|
Anticipatory Prevention Strategies and Their Relation to Child Injuries
At the beginning of the study, for each room in the home, mothers rated (range, 1–6) the extent to which they used environment-, parent-, and child-based strategies to manage injury risk for their toddlers, with higher numbers indicating greater use of the strategy. An analysis of variance (ANOVA) with sex (2) as a between-subject factor and room (6) and strategy (3) as within-subject factors revealed that strategy use varied with room, F(10, 1051) = 38.06, p < .001 (throughout the Results section, we report the multivariate test results for all analyses involving within-subject factors).
Follow-up ANOVAs, on data from each room separately, revealed that use of the three strategies varied for the bathroom, F(2, 180) = 8.73, p < .05; living room, F(2, 180) = 9.74, p < .001; playroom, F(2, 180) = 17.95, p < .05; bedroom, F(2, 180) = 63.51, p < .001; and stairs, F(2, 180) = 115.51, p < .001, as shown in Figure 1. For the kitchen, mothers reported comparably high rates of use for all three strategies. Bonferroni t-tests confirmed a number of significant effects (p < .05) for other rooms: (1) For the bathroom, mothers used significantly more environment- and parent-based strategies than child-based ones; (2) for the living room, comparably high levels of parent- and child-based strategies were used, significantly exceeding mothers’ use of environment-based strategies; (3) for the playroom, comparably high levels of environment- and child-based strategies were used, significantly exceeding the use of parent-based strategies; (4) for the bedroom, the most common type of prevention strategy was child-based and the least common was parent-based, with the use of environment-based strategies falling at an intermediate level and differing significantly from the other two; and (5) for the stairs, the most common type of strategy was parent based, the least common was environment based, and child-based strategies fell intermediately, differing significantly from the other two (see Figure 1).
|
Of course, the prevention strategies that mothers report using are relevant to child injury only if they serve a protective function and are actually associated with fewer injuries to their child. To address this issue, correlations were conducted comparing mothers’ reports of their use of each of the three strategies with the actual incidence of injuries their child experienced during the study, for each room separately. For the bathroom and kitchen, mothers reported using all three strategies a great deal (Figure 1); however, fewer child injuries were associated with environment-based strategy use, r(62) = –.55 and –.50, respectively, p < .05, and parent-based strategy use, r(62) = –.63 and –.36, p < .05. The use of child-based strategies, in which children were assumed to manage injury risk for themselves, did not protect children from injury in the bathroom or kitchen.
For the living room, parent- and child-based strategies were used more than environmental ones (see Figure 1); however, only parental strategies were associated with fewer injuries, r(62) = –.48, p < .05. In fact, leaving the child to independently manage the injury risk when no environmental changes had been implemented to promote safety was actually a risk factor for injury, as indicated by a significant positive association between use of child-based strategy and child injury rates in the living room, r(62) = .36, p < .05.
For the playroom, mothers utilized primarily environment- and child-based strategies, using parent-based strategies significantly less often (see Figure 1). However, both environmental strategies, r(62) = –.24, p < .05, and parent-based strategies, r(62) = –.23, p < .05, were associated with fewer injuries in the playroom. Hence, although mothers did not, as a group, report heavy use of parent-based strategies for children in the playroom, those mothers who used this strategy had children who experienced fewer injuries.
For the child’s bedroom, mothers again depended on their child to manage injury risk independently, and they also used environment-based strategies to a comparably high degree (see Figure 1). In this case, environmental strategies were associated with fewer injuries, r(62) = –.28, p < .05; however, child-based strategies were associated with increased injury risk, r(62) = .22, p < .05. These findings suggest that environmental strategy use in the absence of a parent-based strategy is not sufficient to maintain a child’s safety in the bedroom.
For the stairs, mothers depended on their own and their child’s behavior to manage injury risk (see Figure 1). However, neither of these served to effectively protect against injury risk, as indicated by the lack of any significant associations between parent-based and child-based strategies and child injury rates on the stairs (p > .05).
Overall, the pattern of these findings suggests that environmental and parental strategies both play essential roles to curtail child injury risk in the home. Child-based strategies serve no protective function and, depending on what other prevention strategy is in place, may actually elevate children’s risk of injury in a room.
Prevention Initiatives in Reaction to Child Injuries
For each injury the child experienced during the study, mothers indicated whether or not any prevention interventions had been implemented or planned to prevent injury recurrence (e.g., application of a safety device, increase in supervision or change in supervision approach, implementation of and teaching the child a new rule) using a 3-point scale: 1 = no intervention taken or planned, 2 = intervention planned but not yet implemented, 3 = intervention implemented. Analysis of these proportion scores, with sex (2) as a between-subject factor and prevention action (3) as a within-subject factor, revealed significant variation in preventive action taken, F(2, 180) = 101.62, p < .01, but no differences related to the child’s sex. Follow-up tests, with a Bonferroni correction applied, indicated that significantly fewer injuries resulted in a prevention initiative by the mothers (12%) than were followed by no intervention (66%) or a planned intervention that was not yet implemented (22%) (p < .05); owing to the low incidence, the type of intervention implemented was not examined.
Thus, the majority of the time (66% of injuries) there was no initiative taken by mothers to prevent injury recurrence to their toddler. Moreover, there were no significant correlations between a parent’s preventive action score (i.e., proportion of injuries that resulted in the mother actually implementing a prevention initiative) and the severity of the child’s injury (i.e., proportion of injuries that were coded as severe, or the total proportion of injuries coded as somewhat serious plus very severe). Thus, mothers were no more likely to implement a prevention initiative in response to severe than more minor injuries, and in general, they did not respond to child injury with a preventive initiative.
Maternal Supervision and Child Injuries
An essential element of a parent-based strategy to manage injury risk is supervision. Because of the paucity of data on supervision, we were especially interested to determine whether certain types of supervision were more likely than others to accompany an incident of a child’s being injured. Toward this aim, mothers indicated whether or not they were in the same room as the child at the time of injury. Results revealed that mothers were not in the same room as their child in approximately 67% of injuries, with no difference as a function of child’s sex. Hence, direct supervision by being in the same room with the child occurred infrequently at the time a child was injured.
The parent’s being in the same room, of course, does not guarantee that the child is being properly supervised, just as the parent’s not being in the same room does not necessarily indicate a complete lack of supervision. Hence, mothers also reported information from which we developed a taxonomy of level of supervision of the child at the time of injury. Maternal reports were assigned scores from the following scale (higher scores indicating greater supervision): 1 = not supervising (e.g., had not checked on the child in > 5 minutes); 2 = listening in intermittently but at least once every 5 minutes (e.g., mother is on the phone in another room and stops to listen for child at least once within a 5-minute interval); 3 = checking on child at least once every 5 minutes (e.g., mother is in a different room than the child and goes to visibly check on the child); 4 = listening in constantly (e.g., mother is in another room but is listening for the child constantly); 5 = listening to and watching the child constantly. Subsequently, the scores were converted to determine the proportion of injuries that occurred under each level of supervision.
To examine the level of maternal supervision provided at the time of injury, an ANOVA was applied to these data with sex (2) as a between-subject factor and level of supervision (5) as a within-subject factor. These data appear in Figure 2. A significant interaction effect, F(4, 400) = 3.82, p < .01, indicated that type of supervision at the time of injury varied for boys and girls. To determine the nature of these differences, follow-up Bonferroni t-tests were conducted comparing the data for boys and girls at each level of supervision. Results revealed comparably high rates of injuries for boys and girls when mothers left children unsupervised or used the strategy of intermittently listening in on the child. Similarly, there were comparably low rates of injuries to boys and girls when mothers provided constant and direct supervision, such as by consistently listening in or watching the child. However, injury rates for boys and girls differed significantly when mothers used the strategy of intermittently going to check on the child, with boys experiencing more injuries than girls (p < .05). In fact, injury rates for boys when mothers intermittently listened in were as high as when mothers left their sons unsupervised, and rates for girls were as low as when mothers provided direct and close supervision (see Figure 2). Hence, anything less than constant supervision was associated with high injury rates among boys. In contrast, injury risk was lower for girls even when an intermittent monitoring strategy was used, as long as this strategy involved actually going to check on the child and not just listening in intermittently.
|
Relation of Perceived Injury Risk to Child Supervision and to Actual Injury Risk
Early on during the first home visit, mothers rated the extent of risk of injury for their child in each room in the house (1 = no real risk of injury to 6 = very high risk of injury). At the end of the visit and in the context of other room-by-room questions, they indicated an actual maximum length of time (in minutes) that they left their child alone in each room. We were interested to determine whether perceived injury risk related to how long a child would be left alone in a room, and whether length of time alone related to number of injuries on a room-by-room basis.
An ANOVA applied to the perceived injury risk ratings, with sex (2) as a between-subject factor and room (5) as a within-subject factor, revealed no difference in mothers’ ratings of injury risk in their home for sons and daughters but significant variation in injury risk ratings for different rooms, F(4, 269) = 21.20, p < .001. Follow-up paired comparisons, with a Bonferroni correction applied, revealed that the greatest risk was judged to be in the bathroom, followed by the kitchen (i.e., significantly lower than the bathroom and higher than the bedroom, playroom, and living room areas), and the least in the bedroom, playroom, and living room (no significant differences among these three) (see Figure 3).
|
Analysis of the data for the time that the child was left alone also revealed significant variation by room, F(4, 284) = 17.06, p < .001, with the pattern of differences mirroring that obtained for injury risk. As can be seen in Figure 4, and confirmed by follow-up tests with a Bonferroni correction applied, children were allowed significantly more time in the bedroom, playroom, and living room areas (no significant differences among these) than in the bathroom or kitchen areas (no significant difference). In addition, a significant effect of sex emerged, F(1, 284) = 3.86, p = .05, indicating that boys were generally allowed greater time alone at home (i.e., received less supervision) than girls.
|
Consistent with the notion that mothers strategically use supervision as a way of moderating perceived injury risk, correlational analyses revealed that mothers’ ratings of risk of injury were related to the length of time they left their child alone in areas perceived to pose high risk of injury, specifically the kitchen, r(62) = –.31, p < .05, and bathroom, r(62) = –.41, p < .05. Hence, for rooms that mothers perceived to pose a high injury risk, they allowed their child less time alone there.
With the goal of managing injury risk for children in high-risk areas of the home, did this strategic supervision allocation approach (i.e., allowing the child limited time alone) serve to actually reduce injuries? Correlating time-left-alone scores with injuries on a room-by-room basis revealed a positive relation for the bathroom, r(62) = .41, p < .05, and the kitchen, r(62) = .35, p < .05. Hence, when mothers’ perception of injury risk was high, they provided closer supervision and left their child alone less of the time, and this strategic supervision allocation approach served a protective function, resulting in fewer injuries to the child.
|
Discussion |
|---|
|
TopAbstractControlling Access to HazardsSupervisionTeachingPresent StudyMethodResultsDiscussionAcknowledgmentsReferences |
|---|
By examining mothers’ reports of strategies they utilized to manage injury risk for toddlers at home and relating these to child injury on a room-by-room basis, the present study provides a number of insights into what mothers do to manage injury risk throughout the home, and the relative efficacy of these efforts. This is the first study, to our knowledge, to document that prevention strategies, and their efficacy, vary with location in the home.* Surprisingly, mothers seldom took action to prevent recurrence following an injury to their child, even for more severe injuries. The findings also indicate that mothers use supervision strategically, most likely in areas perceived to pose a high risk of injury for their child, and that supervision effectively reduced child injury risk in these high-risk areas. In addition, a taxonomy of supervision strategies was developed and related to child injury occurrence, providing important information on those strategies that seem to most elevate injury risk. These and other findings are further elaborated below.
Injury Prevention Strategies and Their Efficacy
Consistent with previous findings (Garling & Garling, 1993, 1995), mothers reported using a variety of strategies. These included (1) environmental modifications to prevent access to hazards, (2) parent-based strategies involving the monitoring of children and changes to parents’ behaviors that served to decrease child injury risk, and (3) child-based strategies that focused on teaching about safety and the transfer of risk management to the child. However, mothers’ use of these approaches varied differentially throughout the home, as did the approaches’ relative efficacy.
Examining the use of these strategies on a room-by-room basis revealed interesting variations, and the interviews with mothers provided further insights into the bases for these variations. For example, mothers did not report heavy use of parent-based strategies for playrooms. Consistent with this, mothers would often comment on their need to have the playroom be a place that the child could go to that specifically did not require close supervision. They therefore used predominantly environment- and child-based approaches, striving to make the configuration of the playroom physically safe and teaching the child to manage any remaining risk independently. Similarly, for the living room, mothers often were adamant in refusing to use environment-based strategies that stripped the room of interesting decor or other adult-valued items (e.g., vases), believing, instead, that their child needed to learn not to touch such things. To balance this value against their desire to keep their child safe, they therefore used predominantly child- and parent-based prevention approaches for the living room.
Thus the picture that emerges from the present findings is that mothers do not simply adopt a prevention strategy and apply it uniformly throughout the home. Rather, they consider socialization goals they have for their child (e.g., the child’s need to learn self-control) and quality-of-life values important to themselves (e.g., a desire to have the living room decorative and attractive, suitable for entertaining adult company). Not surprisingly, therefore, parents act on their safety concerns in different ways throughout the home as they strive to balance child safety with socialization goals and personal values. The present findings go beyond those obtained in prior research by revealing that parents’ decisions about managing injury risk at home are multiply determined ones, and a thorough understanding of such decision making requires an appreciation of the broader socialization and life context in which such decisions occur.
The present study extends prior research on parents’ injury prevention strategies in another important way, namely, by examining the actual efficacy of these strategies. Overall, the pattern of these findings suggests that both environmental and parental strategies play essential roles in moderating child injury risk in the home. In the absence of environment-based strategies (e.g., in the living room), heavy use of parent-based strategies can effectively reduce children’s risk of injury. Similarly, in the absence of parent-based strategies (e.g., in the playroom), the application of environment-based strategies can effectively reduce injury risk for toddlers. There were no locations in the home, however, for which child-based strategies proved effective for moderating injury risk, even though mothers reported using this strategy quite a lot in most locations of the home. In fact, for areas in which mothers reported using mostly either an environment- or a parent-based strategy (i.e., in the child’s bedroom and the living room), an emphasis on allowing children to manage risk for themselves actually emerged as a risk factor and was associated with higher rates of injuries in those locations. Hence, present findings highlight that during the toddler years, when parents are beginning to emphasize teaching and the implementation of child-based strategies so that management of injury risk can be passed on to the child, the necessity remains to continue using environment- and parent-based strategies to prevent in-home injuries.
Research with preschoolers (Morrongiello et al., 2001) and school-age children (Peterson et al., 1986) indicates that parents routinely overestimate children’s knowledge of safety and their ability to manage injury risk on their own. The present findings suggest that use of teaching as a prevention strategy may elevate children’s risk of injury during the toddler years as well, particularly if parents inadequately judge the appropriateness of this strategy (e.g., Garling & Garling, 1988; Valsinger, 1985) and utilize it in place of, instead of in addition to, environmental methods and/or parent-based strategies to manage injury risk. For example, Peterson, DiLillo, Lewis, and Sher (2002) found that when mothers intervened to prevent reinjury to toddlers, about 50% of the time they focused on teaching, rather than implementing a parent-focused strategy or an environmental change (which each represented 25% of interventions). Moreover, research examining children’s knowledge, as opposed to compliance with rules, as a predictor of child injury reveals that although children can be very knowledgeable about rules and safety, it is extent of compliance, not knowledge per se, that relates to injury (Morrongiello et al., 2001). Thus, parents of toddlers should not be fooled into thinking that their child is capable of managing injury risk on his or her own based on the child’s ability to recite safety rules. Put simply, child-based teaching strategies need to occur concurrently with other more efficacious strategies, such as environment- and parent-based initiatives, in order to effectively manage injury risk to toddlers at home.
Finally, one surprising result in the present study is that mothers did not often respond to child injury by making a change to their prevention approach, not even when more severe injuries occurred. These results are consistent with those reported by Peterson, Bartelstone, Kern, and Gillies (1995), who found that for 80% of injuries to children 8 and 9 years old during a 1-year interval, mothers reported that no remedial action was taken to prevent recurrence. Similarly, in a recent study of toddlers’ home injuries, Peterson et al. (2002) found that mothers intervened to prevent reinjury in only 6% of cases. Thus, despite the popular belief that it is the role of parents to prevent injury to children (Stratton, 1985), the results from several studies indicate that parents are unlikely to be motivated to preemptive action following an injury to their child. Examination of interviews when mothers were queried about this in the present study revealed that the predominant response given was that they felt they were doing all they could already, therefore no further action seemed warranted. Interestingly, Peterson et al. (2002) found a small but positive association between proactive interventions and child injuries. These findings may indicate that some children are at risk of injury despite a parent’s best efforts to keep them safe (see Morrongiello & Dawber, 1998, 2000, for further discussion) and/or that parents are implementing many ineffective prevention strategies, such as too heavy an emphasis on teaching (see above).
Supervision
In studies of childhood injury, "lack of supervision" is often cited as a significant risk factor. However, few studies offer any operational definition of supervision or provide a taxonomy of ways of supervising that relate to child injury risk. In the present study, supervision was defined as the parent both knowing the child’s whereabouts and monitoring the child’s behaviors and activities, either intermittently or constantly. Using mothers’ reports about ways they supervised their toddler, a supervision taxonomy was developed, ranging from no supervision (i.e., had not checked on the child for > 5 minutes) to direct supervision (i.e., child within sight and reach), with indirect supervision (e.g., intermittently checking, listening in) or monitoring strategies falling at intermediate levels. It should be noted that some have argued that monitoring strategies should not be considered as constituting supervision because the supervisor is not likely to be in a position to intervene in a corrective or protective manner (cf. Wills et al., 1997a, b). However, we felt it important to incorporate these strategies in our taxonomy of supervision because parents utilize them often, and a monitoring strategy that involves intermittently checking on the child could certainly deter risk behavior by the child based on application of learning principles and what is known about how an intermittent reinforcement schedule typically impacts on behavior. In addition, monitoring strategies such as listening in could certainly allow parents sufficient time to intervene and prevent injury if auditory information (e.g., child talking aloud about what he/she plans to do or is doing) precedes behaviors that elevate injury risk. For a variety of reasons, therefore, we concluded that monitoring strategies have the potential to positively impact on child injury risk in much the same way as can direct supervision.
Applying the taxonomy developed to assess level of supervision at the time of injury supported several conclusions about the relation between supervision and toddlers’ risk of in-home injuries. First, not surprisingly, children experienced a predominance of injuries when left unsupervised (i.e., alone for > 5 minutes). Second, surprisingly, supervision per se did not guarantee safety (see also Wills et al., 1997a, b), and there were differences in how supervision related to child injury for boys and girls. Specifically, boys experienced as many injuries when their mother was using intermittent monitoring strategies as when mothers left their son unsupervised. Hence, the only supervision strategies that seemed to reduce injury risk for boys were effort-intensive ones involving constant monitoring and/or direct supervision (see also Morrongiello & Dawber, 1998).
Examining the relations between supervision level and injury risk for girls revealed both similarities and differences in comparison with what was found for boys. As was true for boys, a parental strategy of listening in was associated with many injuries when mothers did this only intermittently. Occasionally listening in from a distance is not likely to deter a child from risk taking, because the child’s experience of this is that he/she is not being supervised (i.e., the child is unaware that the parent is listening in from a distance). Nor is intermittently listening in from a distance likely to allow sufficient time for the parent to intervene in a protective or corrective fashion. However, when the mothers in our study constantly listened in, children experienced relatively few injuries. Constantly listening in allows parents to immediately detect changes in a child’s behavior that could elevate injury risk, resulting in timely intervention. And the fact that parents are close enough to listen in on the child constantly ensures relatively close proximity for quickly reaching the child. Hence, listening in was an effective supervision strategy for moderating injury risk for boys and girls but only when parents used it as a means of constantly monitoring their child.
Boys and girls differed, however, in the incidence of injuries experienced when mothers used an intermittent supervision strategy of going to check on the child. Specifically, mothers’ actually appearing in order to check on the daughter intermittently was associated with as few injuries as when mothers supervised directly or used constant monitoring strategies. In contrast, for boys, this strategy was associated with as many injuries as when the child was unsupervised. Apparently, the expectation that the mother might show up at any moment was sufficient to curtail risk behavior among girls, but not boys. Alternatively, the process by which girls engage in risk behavior may allow mothers more time to intervene to prevent injury than is true for boys; in at least one study, boys have been shown to more quickly approach and interact with hazards, thereby requiring faster intervention by the mother to ensure their safety (Morrongiello & Dawber, 1998). Whatever the explanation, the present findings suggest that boys require more effortful supervision strategies than do girls to manage their risk of home injuries.
The need for mothers to use frequent and effortful prevention strategies to keep boys safe has also been noted in observational, naturalistic studies of children’s risk taking and mothers’ efforts to manage injury risk in toddlers 2 to 3.5 years of age. Specifically, when toddlers and their mothers were left in a contrived-hazards situation with many injury risk hazards of interest to toddlers nearby, mothers needed to physically remove boys from the vicinity of hazards, whereas verbal statements by mothers were sufficient for redirecting girls away (Morrongiello & Dawber, 1998). Taken together, the findings from these studies suggest that boys behave in ways that make it more difficult for parents to ensure their safety compared with daughters. Consequently, parents’ maintaining proximity so that they can reach their child quickly and providing some type of constant supervision both seem essential to promoting toddlers’ safety, especially that of sons.
Finally, the present results reveal a relation between supervision and perceived injury risk, with mothers strategically using supervision as a way of moderating injury risk, at least under certain circumstances. Specifically, when mothers’ perception of injury risk was high, they provided closer supervision, leaving their child alone less of the time. Although lab-based studies (e.g., Garling & Garling, 1993) have found that mothers report they would supervise more closely in high-risk areas, the present study provides actual evidence of this and establishes that this supervision strategy reduces injury risk for toddlers and is associated with fewer injuries to children. Extending these findings, it may be that the most effective way to promote closer supervision of toddlers by parents is to provide persuasive communications that promote beliefs about the potential risks that exist throughout the home.
Limitations and Directions for Future Research
Although this study substantially advances our understanding of approaches that parents take to manage injury risk for toddlers at home, it has limitations, and several additional questions merit attention in future research. First, the data provide information on the relation between supervision and injury but do not speak to the broader issue of how supervision actually plays a role as a risk factor or protective factor in child injury. For example, without knowing about "near-misses," where injury happened to be narrowly avoided, we cannot ascertain whether certain strategies of supervision are more effective than others for actually preventing injury. Similarly, without data on the frequency with which parents use these different supervision strategies, it is difficult to evaluate relative risk, that is, risk based on rate of exposure to the different types of supervision. It might be, for example, that parents seldom use a strategy of intermittently listening in, but when they do, injuries nearly always occur. Research allowing for conditional-probability types of analysis (e.g., given the rate of use of x type of supervision, what is the rate of injury?) is sorely needed for definitive conclusions about how different supervision strategies influence injury risk for toddlers at home. It is also apparent that further study is needed to illuminate sex differences in the ways that boys and girls get hurt and identify supervision strategies that would best reduce injury risk in these cases. The fact that mothers in our study used different strategies in different risk environments also demands that attention be paid to risk context in future research on this topic. Finally, although we focused on firstborn children in this study, it is probably commonplace for parents to use older siblings as proxy parents to supervise younger siblings. There is virtually nothing known about how this impacts on child injury risk (e.g., the relation of injury risk to characteristics of older and younger children and how they interact) and what factors motivate parents to utilize this approach to supervision. Similarly, because changes in developmental status yield different requirements for supervision, it would be useful in future research to extend this study to older ages in order to identify how supervision changes with developmental status of the child and influences injury risk accordingly.
While it is apparent that parents providing constant and direct supervision, coupled with close proximity to children, best ensures a child’s safety, it is also evident from the present and past research (e.g., Morrongiello & Dayler, 1996) that parents are sometimes unable or unwilling to do so. Hence, further research is needed to identify less effortful supervision strategies that effectively curtail child injury risk for boys and girls in different settings, to identify factors that influence parents’ decisions about their child’s supervision needs in different settings, and to promote parents’ appreciation of the relation between child injury risk and supervision.
|
Acknowledgments |
|---|
|
TopAbstractControlling Access to HazardsSupervisionTeachingPresent StudyMethodResultsDiscussionAcknowledgmentsReferences |
|---|
This research was generously supported by grants to the first author from the Social Sciences and Humanities Research Council of Canada and the University of Guelph. The authors extend their appreciation to the parents for their interest in our research, to Dr. Serge Desmarais for statistical advice, and to Shawn Matheis for assistance with data analysis. This article is dedicated to the memory of Lizette Peterson, who encouraged us in this work and challenged us to study the complexity of parents’ home safety practices.
|
Footnotes |
|---|
* While the present manuscript was being processed, a similar study of home injuries among children 15 to 18 and 33 to 36 months of age was published (Peterson, DiLillo, Lewis, & Sher, 2002
). Despite some important methodological differences, aspects of their findings are relevant to those reported herein and are mentioned where appropriate. 
Received November 19, 2002; revision received February 19, 2003; accepted March 18, 2003
|
References |
|---|
|
TopAbstractControlling Access to HazardsSupervisionTeachingPresent StudyMethodResultsDiscussionAcknowledgmentsReferences |
|---|
Baker, S. P., O’Neill, B., & Ginsburg, M. (1992). The injury fact book. New York: Oxford University Press.
Canadian Institute of Child Health. (1994). The health of Canada’s children: A profile (2nd ed.). Ottawa: Author.
Colver, A., Hutchinson, P., & Judson, E. (1982). Promotion of children’s home safety. British Medical Journal, 385, 1177–1180.
Dershewitz, R. A., & Williamson, J. (1977). Prevention of childhood household injuries: A controlled clinical trial. American Journal of Public Health, 12, 1148–1153.
Fagot, B. I., Kronsberg, S., & MacGregor, D. (1985). Adult responses to young children in risky situations. Merrill-Palmer Quarterly, 31, 385–395.
Gallagher, S., Hunter, P., & Guyer, B. (1985). A home injury prevention program for children. Pediatric Clinics of North America, 1, 95–112.
Garbarino, J. (1988). Preventing childhood injury: Developmental and mental health issues. American Journal of Orthopsychiatry, 58, 25–45.[Web of Science][Medline]
Garling, T., & Garling, A. (1988). Parents’ protection of children from dangers. In J. Valsinger (Ed.), Children’s development within socioculturally structured environments (Vol. 1, pp. 60–83). Norwood, NJ: Ablex.
Garling, A., & Garling, T. (1991). The ability of mothers of young children to anticipate potential home accidents. Children’s Environment Quarterly, 8, 24–30.
Garling, A., & Garling, T. (1993). Mothers’ supervision and perception of young children’s risk of injury in the home. Journal of Pediatric Psychology, 18, 105–114.
Garling, A., & Garling, T. (1995). Mothers’ anticipation and prevention of unintentional injury to young children in the home. Journal of Pediatric Psychology, 20, 23–36.
Gielen, A., Wilson, M., Faden, R., Wissow, L., & Harvilchuck, J. (1995). In-home injury prevention practices. Health Education Quarterly, 22, 85–95.[Web of Science][Medline]
Glik, D. C., Kronenfeld, J., & Jackson, K. (1991). Predictors of risk perceptions of childhood injury among parents of preschoolers. Health Education Quarterly, 18, 285–301.[Web of Science][Medline]
Glik, D., Kronenfeld, J., & Jackson, K. (1993). Safety behaviors among parents of preschoolers. Health Values, 17, 18–27.
Gralinski, J. H., & Kopp, C. B. (1993). Everyday rules for behavior: Mothers’ requests to young children. Developmental Psychology, 29, 573–584.[CrossRef][Web of Science]
Greaves, P., Glik, D. C., Kronenfeld, J. J., & Jackson, K. (1994). Determinants of controllable in-home child safety hazards. Health Education Research, 9, 307–315.
Greensher, J. (1984). How anticipatory guidance can improve control of childhood "accidents." Pediatric Counselling, 3, 1–8.
Holden, G. (1983). Anticipating misbehavior: Mothers as tacticians in the supermarket. Child Development, 54, 233–240.[CrossRef]
McCormick, M., Shapiro, S., & Starfield, B. (1981). Injury and its correlates among 1-year-old children. American Journal of Diseases of Children, 135, 159–163.
Morrongiello, B. A., & Dawber, T. (1998). Toddlers’ and mothers’ behaviors in an injury-risk situation: Implications for sex differences in childhood injuries. Journal of Applied Developmental Psychology, 19, 625–639.[CrossRef][Web of Science]
Morrongiello, B. A., & Dawber, T. (2000). Mothers’ responses to sons and daughters engaging in injury-risk behaviors on a playground: Implications for sex differences in injury rates. Journal of Experimental Child Psychology, 76, 89–103.[CrossRef][Web of Science][Medline]
Morrongiello, B. A., & Dayler, L. (1996). A community-based study of parents’ knowledge, attitudes, and beliefs related to childhood injuries. Canadian Journal of Public Health, 87, 383–388.[Web of Science][Medline]
Morrongiello, B. A., Midgett, C., & Shields, R. (2001). Don’t run with scissors: Young children’s knowledge of home safety rules. Journal of Pediatric Psychology, 26, 105–115.
Morrongiello, B. A., Ondejko, L., & Littlejohn, A. (2004). Understanding toddlers’ in-home injuries: I. Context, correlates, and determinants. Journal of Pediatric Psychology, 29, 415–431.
Peterson, L., Bartelstone, J., Kern, T., & Gillies, R. (1995). Parents’ socialization of children’s injury prevention: Description and some initial parameters. Child Development, 66, 224–235.[CrossRef][Web of Science][Medline]
Peterson, L., DiLillo, D., Lewis, T., & Sher, K. (2002). Improvement in quality and quantity of prevention measurement of toddler injuries and parental interventions. Behavior Therapy, 33, 271–297.[CrossRef][Web of Science]
Peterson, L., Ewigman, B., & Kivlahan, C. (1993). Judgments regarding appropriate child supervision to prevent injury: The role of environmental risk and child age. Child Development, 64, 934–950.[CrossRef][Web of Science][Medline]
Peterson, L., Farmer, J., & Kashani, J. (1990). Parental injury prevention endeavors: A function of health beliefs? Health Psychology, 9, 177–191.[CrossRef][Web of Science][Medline]
Peterson, L., Mori, L., & Scissors, C. (1986). Mom or dad says I shouldn’t: Supervised and unsupervised children’s knowledge of their parents’ rules for home safety. Journal of Pediatric Psychology, 11, 177–188.
Pless, C., & Pless, B. (1995). How well they remember: The accuracy of parent reports. Archives of Pediatric and Adolescent Medicine, 149, 533–558.
Rivara, F., & Mueller, B. (1987). The epidemiology and causes of childhood injuries. Journal of Social Issues, 43, 13–31.
Rosen, B., & Peterson, L. (1990). Gender differences in children’s outdoor play. Clinical Psychology Review, 10, 187–205.
Russell, K., & Champion, V. (1996). Health beliefs and social influence in home safety practices of mothers with preschool children. IMAGE: Journal of Nursing Scholarship, 28, 59–64.
Shannon, A., Brashaw, B., Lewis, J., & Feldman, W. (1992). Nonfatal childhood injuries: A survey at the Children’s Hospital of Eastern Ontario. Canadian Medical Association Journal, 146, 361–365.[Abstract]
Stratton, P. (1985). The role of the family in childhood risk: The origins of competence. In T. Garling & J. Valsinger (Eds.), Children within environments: Toward a psychology of accident prevention (pp. 129–142). New York: Plenum.
Thuen, F. (1992). Preventing childhood accidents in the home: Parental behavior to reduce household hazards. Scandinavian Journal of Psychology, 33, 370–377.[Web of Science][Medline]
Ueland, O., & Kraft, P. (1996). Safety measures taken by Norwegian mothers. Injury Prevention, 2, 197–201.
Valsinger, J. (1985). Theoretical issues of child development and the problem of accident prevention. In T. Garling & J. Valsinger (Eds.), Children within environments: Toward a psychology of accident prevention (pp. 13–36). New York: Plenum.
Westfelt, J. (1982). Environmental factors in childhood accidents. Acta Paediatrica Scandinavica Supplement, 291.
Wills, K., Christoffel, K., Lavigne, J., Tanz, R., Schofer, J., Donovan, M., et al., for the Kids N Cars Research Team. (1997a). Patterns and correlates of supervision in child pedestrian injury. Journal of Pediatric Psychology, 22, 89–104.
Wills, K., Christoffel, K., Lavigne, J., Tanz, R., Schofer, J., Donovan, M., et al. (1997b). Supervision in childhood injury cases: A reliable taxonomy. Accident Analysis and Prevention, 29, 133–137.
Wortel, E., de Geus, G. H., & Kok, G. (1995). Behavioral determinants of mothers’ safety measures to prevent injuries of pre-school children. Scandinavian Journal of Psychology, 36, 306–322.[Web of Science][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  B. A. Morrongiello and S. L. Schell Child Injury: The Role of Supervision in Prevention American Journal of Lifestyle Medicine, January 1, 2010; 4(1): 65 - 74. [Abstract] [PDF]
|
|
|
|
 |
|
 B. A. Morrongiello, B. Walpole, and B. A. McArthur Brief Report: Young Children's Risk of Unintentional Injury: A Comparison of Mothers' and Fathers' Supervision Beliefs and Reported Practices J. Pediatr. Psychol., November 1, 2009; 34(10): 1063 - 1068. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K J Phelan, J Khoury, Y Xu, and B Lanphear Validation of a HOME Injury Survey Inj. Prev., October 1, 2009; 15(5): 300 - 306. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. C Schwebel and D. Kendrick Caregiver supervision and injury risk for young children: time to re-examine the issue Inj. Prev., August 1, 2009; 15(4): 217 - 219. [Full Text] [PDF]
|
|
|
|
|
|
B A Morrongiello, M Corbett, and R J Brison Identifying predictors of medically-attended injuries to young children: do child or parent behavioural attributes matter? Inj. Prev., August 1, 2009; 15(4): 220 - 225. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Shen, S Yang, J Han, J Shi, R Yang, Y Du, and L Stallones Non-fatal injury rates among the "left-behind children" of rural China Inj. Prev., August 1, 2009; 15(4): 244 - 247. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Damashek, N. A. Williams, K. Sher, and L. Peterson Relation of Caregiver Alcohol Use to Unintentional Childhood Injury J. Pediatr. Psychol., May 1, 2009; 34(4): 344 - 353. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L A Petrass, C F Finch, and J D Blitvich Methodological approaches used to assess the relationship between parental supervision and child injury risk Inj. Prev., April 1, 2009; 15(2): 132 - 138. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. E. Boles and M. C. Roberts Supervising Children During Parental Distractions J. Pediatr. Psychol., September 1, 2008; 33(8): 833 - 841. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. R. Porter, L. A. Crane, L. M. Dickinson, J. Gannon, J. Drisko, and C. DiGuiseppi Parent Opinions About the Appropriate Ages at Which Adult Supervision Is Unnecessary for Bathing, Street Crossing, and Bicycling Arch Pediatr Adolesc Med, July 1, 2007; 161(7): 656 - 662. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. P. Hymel and Committee on Child Abuse and Neglect When Is Lack of Supervision Neglect? Pediatrics, September 1, 2006; 118(3): 1296 - 1298. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. A. Morrongiello, M. Corbett, M. McCourt, and N. Johnston Understanding Unintentional Injury-Risk in Young Children I. The Nature and Scope of Caregiver Supervision of Children at Home J. Pediatr. Psychol., July 1, 2006; 31(6): 529 - 539. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. A. Morrongiello, M. Corbett, M. McCourt, and N. Johnston Understanding Unintentional Injury Risk in Young Children II. The Contribution of Caregiver Supervision, Child Attributes, and Parent Attributes J. Pediatr. Psychol., July 1, 2006; 31(6): 540 - 551. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B A Morrongiello and M Corbett The Parent Supervision Attributes Profile Questionnaire: a measure of supervision relevant to children's risk of unintentional injury Inj. Prev., February 1, 2006; 12(1): 19 - 23. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Kendrick, M. Watson, C. Mulvaney, and P. Burton How useful are home safety behaviours for predicting childhood injury? A cohort study Health Educ. Res., December 1, 2005; 20(6): 709 - 718. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D Fiissel, G Pattison, and A Howard Severity of playground fractures: play equipment versus standing height falls Inj. Prev., December 1, 2005; 11(6): 337 - 339. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. A. Morrongiello Caregiver Supervision and Child-Injury Risk: I. Issues in Defining and Measuring Supervision; II. Findings and Directions for Future Research J. Pediatr. Psychol., October 1, 2005; 30(7): 536 - 552. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. C. Schwebel and B. K. Barton Contributions of Multiple Risk Factors to Child Injury J. Pediatr. Psychol., October 1, 2005; 30(7): 553 - 561. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Nagaraja, J. Menkedick, K. J. Phelan, P. Ashley, X. Zhang, and B. P. Lanphear Deaths From Residential Injuries in US Children and Adolescents, 1985-1997 Pediatrics, August 1, 2005; 116(2): 454 - 461. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. A. Morrongiello, L. Ondejko, and A. Littlejohn Understanding Toddlers' In-Home Injuries: I. Context, Correlates, and Determinants J. Pediatr. Psychol., September 1, 2004; 29(6): 415 - 431. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||