Older siblings as potential supervisors of younger siblings: sibling supervisors' recognition of injury-risk behaviours and beliefs about supervisee risk taking and potential injury outcomes.

BACKGROUND: Past research has shown that increased injury risk for supervisees during sibling supervision is in part due to the supervision practices of older siblings. METHODS: The current study used a photo sorting task to examine older siblings' recognition of injury-risk behaviours, their perceived likelihood of supervisees engaging in, or being injured while engaging in, these behaviours, and awareness of past risk-taking behaviours of supervisees. Mothers completed the same measures and an interview about sibling supervision in the home. RESULTS: Mothers reported that sibling supervision occurred most frequently in the kitchen, living room, and children's bedrooms, for approximately 39 min/day, and that the more time the children spent together in a room, the more frequently the older sibling supervised the younger one. The most common reasons mothers gave for why sibling supervision was allowed included beliefs that the older child knows about hazards and unsafe behaviours and that the child could provide adequate supervision. Photo sort results revealed that older siblings were able to correctly identify about 98% of risk behaviours, with these scores significantly higher than what mothers expected (79%). However, compared with mothers, older siblings were less aware of risk behaviours that their younger siblings had engaged in previously. In addition, mothers rated supervisees as 'fairly likely' both to engage in risk behaviours and to experience an injury if they tried these behaviours, whereas sibling supervisors rated both supervisee risk behaviour and injury outcomes as 'not likely' to occur. CONCLUSION: Older siblings showed good knowledge of hazards but failed to realize that younger children often engage in injury-risk behaviours. Efforts to improve the supervision practices of sibling supervisors need to include changing their perception of supervisees' injury vulnerability and potential injury severity, rather than targeting to increase knowledge of injury-risk behaviours per se.

Identifying predictors of medically-attended injuries to young children: do child or parent behavioural attributes matter?

OBJECTIVE: To investigate whether one can differentiate injured and uninjured young children based on child behavioural attributes or indices of caregiver supervision. METHOD: A matched case-control design was used in which case participants were children presenting to an emergency department for treatment for an injury and age/sex matched control participants presented for illness-related reasons. During structured phone interviews about supervision parents reported on general supervisory practices (standardised questionnaire) and specific practices corresponding to time of injury (cases) or the last time their child engaged in the activity that incited their match's injury (controls). Parents also reported on child behavioural attributes that have been linked to child risk taking in prior research (inhibitory control, sensation seeking). RESULTS: Results revealed no group differences in child behavioural attributes; however, the control group received more supervision both in general (OR = 4.82, 95% CI 1.89 to 12.33) and during the specified activity that led to injury in cases (OR = 5.38, 95% CI 2.13 to 13.58). CONCLUSION: These findings confirm past speculation that caregiver supervision influences children's risk of medically-attended injury and highlight the importance of targeting supervision in child-injury prevention interventions.

Once bitten, twice shy? Medically-attended injuries can sensitise parents to children's risk of injuries on playgrounds.

OBJECTIVE: To compare risk perceptions of parents whose child sustained a medically attended playground injury (cases) with those of parents whose child had not (controls) to address two questions. Does having a child experience a medically attended injury: (1) sensitise parents to children's injury vulnerability and severity; (2) influence parents' appraisal of the injury mechanism (child's behaviour), attributions for injuries or beliefs about strategies for prevention? METHOD: Each case-control parent dyad was assigned to one of two conditions: (1) being presented with 10 common injury-risk playground behaviours specific to the equipment on which their child had been hurt, and asked to appraise injury vulnerability and severity; or (2) being presented with scenarios about playground injuries that varied in severity but were all based on the same child behaviour, and asked questions about this behaviour, attributions for injury and strategies for prevention. RESULTS: The results support the occurrence of a sensitisation process. Compared with control parents, case parents showed higher ratings of injury severity and children's vulnerability to injury, made fewer attributions for injuries to bad luck, and endorsed a greater diversity of prevention strategies, including parent (closer supervision), child (teaching rules about safe play on playgrounds) and environmental (modifications to playgrounds). CONCLUSIONS: A child's medically attended injury can create a "teachable moment" for the parent. Linking injury-prevention programming to this teachable moment may increase the likelihood of evoking changes in parental supervisory behaviour and their setting of rules limiting their child's risk behaviours to reduce the occurrence of childhood injury.

School-age children's safety attitudes, cognitions, knowledge, and injury experiences: how do these relate to their safety practices?

BACKGROUND: A variety of factors affect the safety and risk practices of school-age children, but rarely have multiple factors been considered simultaneously. OBJECTIVE: To examine children's safety attitudes and cognitions more thoroughly and assess how these factors, along with children's safety knowledge and injury experiences, relate to children's safety practices. METHODS: Over several classroom sessions, boys and girls in two age groups (7-9, 10-12 years) completed a psychometrically sound questionnaire that indexes their behaviors, attitudes, cognitions, knowledge, and injury experiences. RESULTS: Fewer safety practices were reported by older than younger children and boys than girls. Children's attitudes, cognitions, knowledge, and injury experiences each correlated with safety practices, but only safety attitudes and injury experiences predicted practices in a multivariate model. CONCLUSION: Exploring the relative influence of numerous factors on safety practices highlights the important role that attitudes play in predicting children's safety practices. Implications of these results for injury prevention programming are discussed.

Risk factors for unintentional injuries due to falls in children aged 0-6 years: a systematic review.

OBJECTIVE: To identify risk factors for unintentional injuries due to falls in children aged 0-6 years. DESIGN: A systematic review of the literature. METHODS: Electronic databases from 1966 to March 2005 were comprehensively searched to identify empirical research that evaluated risk factors for unintentional injuries due to falls in children aged 0-6 years and included a comparison group. RESULTS: 14 studies met the inclusion criteria. Studies varied by the type of fall injury that was considered (ie, bunk bed, stairway, playground or infant walker) and with respect to the quality of evidence. In general, major risk factors for the incidence or severity of injuries due to falls in children included age of the child, sex, height of the fall, type of surface, mechanism (dropped, stairway or using a walker), setting (day care v home care) and socioeconomic status. CONCLUSION: Despite a high burden, few controlled studies have examined the risk and protective factors for injuries due to falls in children aged 0-6 years. The only study to examine falls from a population health perspective suggests that age, sex and poverty are independent risk factors for injuries due to falls in children.

The Parent Supervision Attributes Profile Questionnaire: a measure of supervision relevant to children's risk of unintentional injury.

OBJECTIVE: To further establish the psychometric properties of the Parent Supervision Attributes Profile Questionnaire (PSAPQ), a questionnaire measure of parent supervision that is relevant to understanding risk of unintentional injury among children 2 through 5 years of age. METHODS: To assess test-retest reliability, parents completed the PSAPQ twice, with a one month interval. Internal consistency estimates for the PSAPQ were also computed. Confirmatory factor analyses were applied to the data to assess the four factor structure of the instrument by assessing the convergent and divergent validity of the subscales and their respective items. RESULTS: Test-retest reliability and internal consistency scores were good, exceeding 0.70 for all subscales. Factor analyses confirmed the hypothesized model--namely that the 29 item questionnaire comprised four unique factors: protectiveness, supervision beliefs, risk tolerance, and fate influences on child safety. CONCLUSIONS: Previous tests comparing the PSAPQ with indices of actual supervision and children's injury history scores revealed good criterion validity. The present assessment of the PSAPQ revealed good reliability (test-retest reliability, internal consistency) and established the convergent and divergent validity of the four factors. Thus, the PSAPQ has proven to have strong psychometric properties, making it a unique and useful measure for researchers interested in studying links between supervision and young children's risks of unintentional injury.

Measuring parent attributes and supervision behaviors relevant to child injury risk: examining the usefulness of questionnaire measures.

OBJECTIVE: This study aimed to identify self report questionnaire measures of parent attributes and behaviors that have relevance for understanding injury risk among children 2-5 years of age, and test a new Parent Supervision Attributes Profile Questionnaire (PSAPQ) that was developed to measure aspects of protectiveness and parent supervision. METHODS: Naturalistic observations were conducted of parents' supervision of children on playgrounds, with questionnaires subsequently completed by the parent to measure parent education, family income, parent personality attributes, attributes relevant to parent supervision, and beliefs about parents' control over the child's health status. These measures were then related to children's risk taking and injury history. RESULTS: Visual supervision, auditory supervision, and physical proximity were highly intercorrelated, indicating that parents employed all types of behaviors in service of supervision, rather than relying predominantly on one type of supervisory behavior. Physical proximity was the only aspect of supervision behavior that served a protective function and related to children's risk taking behaviors: parents who remained close to their children had children who engaged in less risk taking. On questionnaires, parents who reported more conscientiousness, protectiveness, worry about safety, vigilance in supervision, confidence in their ability to keep their child safe, and belief in control over their child's health had children who showed less risk taking and/or experienced fewer injuries. The new PSAPQ measure was associated with specific aspects of supervision as well as children's risk taking and injury history. CONCLUSIONS: This study reveals several parent attributes and behaviors with relevance for child injury risk that can be measured via self report questionnaires, including the new PSAPQ.

Do children's intentions to risk take relate to actual risk taking?

OBJECTIVES: Concerns about safety and rigorous ethic standards can make it very difficult to study children's risk taking. The goal of this study was to determine how closely intentions to risk take relate to actual risk taking among boys and girls 6-11 years of age. METHODS: Children initially completed an "intentions to risk take" task. Following administration of several questionnaires they later participated in an actual risk taking task. RESULTS: At all ages, for both boys and girls, intentions to risk take was highly positively correlated with actual risk taking. When discrepancies occurred these were usually of minimal magnitude. CONCLUSIONS: Tasks that tap children's intentions to risk take can serve as proxy indicators of children's actual risk taking.

Influence of safety gear on parental perceptions of injury risk and tolerance or children's risk taking.

OBJECTIVES: Risk compensation theory has been shown to relate to how individuals behave in areas such as traffic safety and consumer product safety. The present study examines whether risk compensation theory applies to parents' judgments about school age children's permissible risk taking under non-safety gear and safety gear conditions for seven common play situations. The extent of the child's experience with the activity and parental beliefs about safety gear efficacy were examined as possible moderators of extent of children's risk taking allowed by parents. METHOD: A telephone interview was used to obtain each parent's ratings of permissible risk taking by their child (for example, speed at which child is allowed to cycle, height allowed to climb to on a climber) under safety gear and no gear conditions, and ratings of child experience and gear efficacy. RESULTS: Results confirmed risk compensation operated under all seven play situations, resulting in parents reporting they would allow significantly greater risk taking by their children under safety gear than non-safety gear conditions. Children with more experience with the activities were to be allowed greater risk taking, even when not wearing safety gear. Parents who believed more strongly in the efficacy of the safety gear to prevent injuries showed greater risk compensation. No sex differences emerged in any analyses. CONCLUSION: Results highlight the need to communicate to parents that safety gear moderates injury risk but does not necessarily guarantee the prevention of injury, particularly if children are allowed greater risk taking when wearing safety gear.

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

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

Gender biases in children's appraisals of injury risk and other children's risk-taking behaviors.

Children ages 6, 8, and 10 years were given tasks designed to assess their beliefs about risk of injury from activities. Children were asked to appraise the risk of injury for boys and girls engaging in various play behaviors and to judge the sex of the character in stories about children engaging in activities that result in injuries. Results revealed gender biases in children's appraisals of injury risk: Both boys and girls rated boys as having a lower likelihood of injury than girls even though the boys and girls were engaging in the exact same activities. Children also showed higher accuracy in identifying the sex of the character in stories of boys' injuries than girls' injuries, and accuracy improved with the participant's age. Overall, the results indicate that by the age of 6 years children already have differential beliefs about injury vulnerability for boys and girls. Although boys routinely experience more injuries than girls, children rate girls as having a greater risk of injury than boys. With increasing age, school-age children develop a greater awareness of the ways in which boys and girls differ in risk-taking activities that lead to injury outcomes.

Mothers' responses to sons and daughters engaging in injury-risk behaviors on a playground: implications for sex differences in injury rates.

Videotapes of children engaging in injury-risk activities on a playground were shown to mothers, who were asked to intervene by stopping the tape and saying whatever they would to their child in the situation shown. Results revealed that mothers of daughters were more likely to judge behaviors as posing some degree of injury risk, and they intervened more frequently and quickly than mothers of sons. Mothers' speed to intervene positively correlated with both children's injury history and their risk-taking tendencies, indicating that mothers of children who were previously injured and who often engaged in injury-risk behaviors had a higher degree of tolerance for children's risk taking than mothers of children who experienced fewer injuries and less frequently engaged in injury-risk behaviors. Mothers' verbalizations to children's risk taking revealed that daughters received more cautions and statements communicating vulnerability for injury, whereas sons received more statements encouraging risk-taking behavior.

Age and gender differences in school-age children's appraisals of injury risk.

OBJECTIVE: To examine age and gender differences in children's perception of injury risk and to evaluate cognitive factors that relate to their appraisal of risk. METHODS: The participants were 120 children (6 to 10 years of age), who used a series of photographs, which depicted play activities that varied from no to high risk, to appraise injury risk. RESULTS: Children were able to distinguish varying degrees of injury risk. Boys rated risk as lower than girls, and 6-year-old children identified fewer risk factors and did so more slowly than 10-year-old children. For girls, perceived vulnerability to injury was the best predictor of injury risk ratings, whereas for boys it was judged severity of potential injury. CONCLUSIONS: Children's appraisal of risk and age and gender differences in related factors highlight important components for injury prevention programs.

Why do boys engage in more risk taking than girls? The role of attributions, beliefs, and risk appraisals.

OBJECTIVE: Assessed for age and sex differences in school-age children's reporting of injury-risk behaviors, ratings of injury-risk in various play situations, attributions for injuries (self, other, bad luck), and beliefs about their vulnerability to injury in comparison to their peers (more, less, comparable vulnerability). METHODS: We used a structured interview and drawings that depicted children showing wary or confident facial expressions when engaged in injury-risk play activities. RESULTS: Children's reported risk taking could be predicted from their risk appraisals, beliefs about the likelihood of injury, and attributions of injuries to bad luck, and these factors resulted 80% correct assignment of cases by sex in a discriminant analysis. The wary affect display resulted in higher injury-risk ratings than the confident display, with this effect being greater for girls than boys. CONCLUSIONS: Cognitive-based factors differentiate boys from girls and contribute to sex differences in children's injury-risk behaviors.

Prevention of paediatric acquired brain injury: an interactive, elementary-school program.

Responding to a gap in existing programs that aim to prevent spinal cord and brain injuries among children, an interactive activity-based program was developed and implemented through local elementary schools, focusing on children 8 to 10 years of age. Evaluation involved a pretest/post-test design with a comparison group who had not experienced the program. Children who participated in the program showed increases in knowledge, self-reported changes in behaviour, and favourable shifts in attitudes about vulnerability to injury four months after exposure to the program. Control group children responded similarly to how children in the intervention group responded on the pretest measure.

Children's perspectives on injury and close-call experiences: sex differences in injury-outcome processes.

Compared boy's and girls' self-reports of injuries and close calls, using a structured telephone interview that was conducted each of 14 days to obtain reports of antecedent events (past memories of similar injuries, immediate injury context), attributions of blame (own behavior, other's behavior, bad luck), ratings of injury severity, telling parents about injuries, and the factors that influence children's learning to avoid injury-risk behaviors. In comparison to girls, boys reported more injuries and close calls, were more likely to be with peers when injured, were more likely to repeat behaviors that had resulted in prior injuries, were more likely to erroneously attribute injuries to bad luck, were more likely to rate injuries as low in severity, and were less likely to tell their parents about these events.

Sibling power: influence of older siblings' persuasive appeals on younger siblings' judgements about risk taking behaviours.

OBJECTIVES: Although many injuries happen when school age children are away from home and in the company of other children, we know surprisingly little about interpersonal influences on children's risk taking decisions. The aim of the present study was to examine the influence of older siblings' persuasive appeals on young children's decisions about engaging in behaviours that could threaten their physical safety. METHODS: Forty same sex sibling pairs participated. Children were shown drawings of play scenes (bicycling, river crossing, and sledding), with each depicting lower and higher risk paths of travel. Children of 8 years made initial decisions as to which paths they would take. Subsequently, their older sibling acted as a confederate and tried to persuade them to change their decisions. RESULTS: After the appeals of older siblings, younger children significantly shifted their decisions: choices of less risky paths replaced the initial selection of more risky paths, and vice versa. A positive sibling relationship was predictive of younger siblings' decision changes. Boys and girls were equally effective in persuasion but they did so using different types of arguments, with boys communicating primarily appeals to fun and girls emphasizing appeals to safety. CONCLUSIONS: These findings highlight the effect that older siblings can have on risk taking decisions of younger siblings. Accordingly, they document the importance of considering the interpersonal context of risk taking when designing interventions to reduce injuries among elementary schoolchildren.

A community-based study of parents' knowledge, attitudes and beliefs related to childhood injuries.

This study assessed parents' knowledge of injury risks for children, attitudes within children's injury-risk behaviours, and beliefs related to a number of aspects of childhood injuries. Parents completed questionnaires and participated in discussions using scenarios depicting child-injury situations that involved a parent and child. Results indicated that parents view injuries largely as a natural consequence of childhood and they believe children learn about risk avoidance from injury experiences. Parents' responses did not indicate a strong belief that injuries to children are preventable or that they should assume primary responsibility for preventing injuries to children. Parents readily identified potential injury consequences and alternative behaviours but provided a number of rationales for making choices that place their child at injury risk: explanations related to convenience, minimizing stress, placing their own goals as a priority, and believing they can keep the child safe in a hazardous situation. Injury prevention programming that targets parents needs to focus on increasing awareness of the scope of the problem and altering attitudes and beliefs related to prevention.

'What I said' versus 'what you heard': a comparison of physicians' and parents' reporting of anticipatory guidance on child safety issues.

OBJECTIVE: Unintentional injuries are the number one cause of death for infants. Many of these injuries could be prevented if parents took additional safety precautions. In this study physicians' and parents' perspectives regarding the part that physicians play in educating first time parents about child safety issues were compared. METHODS: All pediatricians and family physicians in London, Ontario were surveyed by mail (68% return rate) regarding their practices, attitudes, and beliefs related to parent education about child safety issues. A sample of 114 first time mothers, including 38 each with 6, 12, and 18 month old infants, completed a telephone interview. All parents had physicians who had returned questionnaires. RESULTS: There was good correspondence between parents' and physicians' judgments about the safety issues most often covered, and what role physicians should adopt regarding parent education about child safety issues. In addition, they both agreed that parents seldom seek out safety information by asking questions. Relative to parent reports, however, physicians significantly overestimated the time they spent on safety issues and the degree of their direct involvement in communicating this information. The best predictor of time spent by physicians on safety issues was their rating of the importance of assuming the role of parent educator. The best predictor of parents asking questions about child safety was their rating of the adequacy of physicians' responses to previously asked questions. CONCLUSIONS: The results suggest that both physicians and parents contribute to undermine communication about child safety during well-baby visits.

Spatial knowledge in blind and sighted children.

Spatial knowledge was evaluated in sighted and congenitally blind children using a large-scale four-location navigation task adapted from the work of Landau, Spelke, and Gleitman (1984). From video records we coded the exact path taken and determined accuracy of initial turn, closest position, and final position, relative to target location. We then computed a score to index the efficiency of the path taken. For the sighted sample, after the navigation task, children constructed a tactile map of the test space without the aid of vision and, following removal of the blindfold, drew from memory the spatial layout of the test space. Performance on the navigation and mapping tasks consistently indicated increasing cognitive mapping skills with age in sighted children. Blind children performed comparably to the sighted on all measures except accuracy at final position, for which their performance was worse than that of the sighted. Analysis of the directness of novel paths and other measures taken suggest caution in ascribing well developed Euclidean coding skills to very young children. Results are discussed in light of Landau et al.'s (1984) conclusions.