Recently published articles
Injury and Health Among Children in Vulnerable Families
Many social factors increase the risk of childhood injury, including family income, domestic and neighborhood violence, young maternal age, and drug or alcohol use by the child’s caregiver. A study of 2,397 families found that five-year-old children with these risk factors have a 12.3 percent incidence rate of injuries that required medical care, compared to the CDC national average of 9.3 percent. The effect of these risk factors changes with age, as children interact with their environment differently as they grow. Additionally, 5-year-old males were 12 times more likely to be injured than females, and this difference increases with age. This is possibly due to parenting strategies, since mothers are more likely to teach injury prevention strategies to their daughters. Finally, disparities in available safe recreational activities and the use of child safety seats by low-income families also contributes to the risk of injury.
Full Reference: Sridharan L, Crandall M. Injury and health among children in vulnerable families Journal of Trauma 2011;70(6):1539-45.
Depression and Thoughts of Death Among Disadvantaged Mothers
Suicide is the second leading cause of death in adults ages 25-34 and is on the rise in women. A study of 4,898 families investigated whether maternal depression or suicidal thoughts affect the health of both children and their mothers. These families were targeted because they had many social risk factors for poor health (such as low income), and the mothers were screened for depression and thoughts of death. Eighteen percent of mothers were determined to be clinically depressed, and of this group, 33 percent also reported having thoughts of death. The study compared mothers with both depression AND thoughts of death to mothers who met criteria for depression only. After 1 year, mothers with depression and thoughts of death were twice as likely to have been hospitalized, and their infants were significantly more likely to be hospitalized as well. Infant hospitalization also occurred much more frequently when depression was paired with either domestic violence or maternal alcohol use. After 3 years, there were no significant differences found in the developmental health of their children.
Full Reference: Crandall M, Sridharan L, Schermer CS. Depression and thoughts of death among disadvantaged mothers: risk factors and impact on maternal and child health Archives of Suicide Research 2010;14(3):248-60
Injury and Health Among Toddlers in Vulnerable Families
Children in vulnerable families are thought to be at a higher risk for injury and poor health, especially in the first year of life. ‘Vulnerable families’ are those with social risk factors, such as low income, unwed parents, violence in the home or neighborhood, and substance abuse by the caregiver. A study of nearly 5,000 vulnerable families found that 13.7 percent of infants were injured within their first year of life. This is much higher than the national average of 5.9 percent. Additionally, injury in the first year was the most accurate predictor of injury in the third year of life. African American race was also a strong predictor of injury in the third year, likely because African American children are much more likely to live in a neighborhood that is unsafe. Despite this, childhood injury did not seem to be significantly related to overall health problems of 3-year-old children, although many of the individual risk factors for injury were related to lower performance on a measure of developmental progress.
Full Reference: Crandall M, Sridharan L, Schermer CS. Injury and health among toddlers in vulnerable families Journal of Trauma 2010;68(5):1128-33.
Attitudes and Beliefs of Adolescents and Parents Regarding Adolescent Suicide
Suicide is the third leading cause of death among adolescents, yet only 2 percent of suicide attempts are addressed by a doctor. To investigate beliefs about suicide, focus groups of 66 students and 30 parents participated in guided discussions about suicide risk, predictability, and preventability. It was found that although many participants thought that suicide was a problem, they did not think it greatly affected their own community. While many adolescents believed that they could recognize behavioral changes that could predict suicide, they acknowledged this could be difficult if the person hides their symptoms. Additionally, many parents misidentified drug and alcohol use as normal teenage activities, rather than risk factors for suicide. These results indicate that children and parents need education on how suicide is underidentified in their communities, and pediatricians should address this issue and screen their patients during regular visits.
Full Reference: Schwartz K, Pyle S, Dowd D, Sheehan K. Attitudes and beliefs of adolescents and parents about adolescent suicide. Pediatrics 2010;125:221-227.
The Stamp-in-Safety program, an intervention to promote better supervision
The Stamp-in-Safety program is a behavioral intervention aimed at reducing childhood injuries on the playground. The program educates teachers on proper playground supervision and rewards children for safe play with a fun stamp. Teacher supervision is addressed because low levels of supervision increase the likelihood of incorrect equipment usage by children, which increases the risk of injury. When tested against a control group, teachers were more likely to supervise children closely and use effective explanations about playground safety, rather than just warnings such as “Stop doing that!” Additionally, there was an observed but not statistically significant decrease in risk taking behaviors from children using the Stamp-in-Safety program. These behaviors include going down the slide in a way other than feet first, standing to close to the swings, and more than three children on a climbing structure at the same time.
Full Reference: Chelvakumar G, Sheehan K, Hill AL, Lowe D, Mandich N, Schwebel DC. The Stamp-in-Safety Program, an intervention to promote better supervision of children on childcare center playgrounds: An evaluation in an urban setting. Inj Prev, 2010, Published Online First; 29 June 2010 doi: 10.1136/ip.2009.025056.
Baby Safety Showers: Effective, But Not Sufficient
A baby safety shower is a short educational program that informs young mothers on the risks and prevention methods for childhood injury in the home. Participants in these showers receive information, as well as safety products to use in their homes, such as smoke detectors and cabinet safety latches. The effectiveness of these showers was tested in a group of teenage mothers in Chicago, using a pre- and post- program survey, and by asking the mothers to photograph the ways they implemented the safety devices. The results showed that the mothers did increase their usage of many of the safety products provided. However, a much greater insight that was gained from the photos is that because of poor housing conditions, these safety products may actually do little to prevent child injury. For example, a photo showing the proper usage of an outlet cover also depicted a hole in the wall that exposed electrical wires, a much larger danger. Pediatricians should consider asking mothers about the quality of their housing conditions when discussing home safety with their patients.
Full Reference: Sanguino S, Wiltsek D, Sheehan K. Baby safety showers: effective, but not sufficient. Journal of Trauma, Injury, Infection, and Critical Care, 2010; 69 (4): S237-S238.
Supervision of Young Children with Fall Injuries
In order to identify risk factors for childhood fall injuries, the relationship between these injuries and the type of caregiver supervision was investigated. Of the 108 child falls studied, 61 percent occurred when the caregiver was supervising more than one child at the time. Seventy percent of these falls that occurred from heights, and caregivers in these cases were much more likely to report that they had been supervising only by listening or not supervising at all. Interestingly, in one-third of the total cases, the caregiver reported that they were within reach of the child. This leads to the question of how effective supervision is in preventing childhood injury from falls. Many falls also occurred when the child had been placed at a height by the caregiver or placed in a piece of child furniture (such as a high chair) without using restraints. This indicates that caregiver education may prevent these types of falls.
Full Reference: Powell EC, Castro Y, Sheehan KM. Supervision of Young Children with Fall Injuries. Journal of Trauma, Injury, Infection, and Critical Care, 2010; 69(4): S214-S217.
Randomized Trial of Home Safety Education Intervention Using a Safe Home Model
To counsel families about child safety in the home, many physicians use The Injury Prevention Program (TIPP), developed by the American Academy of Pediatrics. This program uses information sheets divided by age in order to address the safety issues relevant to each developmental stage in children. A different approach, the Safe Home Model, was found to be equally effective when tested against TIPP. The Safe Home Model uses a 4 feet x 8 feet physical model of a house with four bedrooms. Each room has safety tips related to that area in the house. Both methods were used to educate parents in a dermatology clinic waiting room, and a research assistant used the same script to discuss the safety information with parents while they learned from either method. Pre-test scores show that most parents already had a high level of knowledge about home safety, indicating that they gather this type of information in various ways. Parents in both the Safe Home Model group and the control group (TIPP) showed a similar increase in knowledge about injury prevention in the home, indicating that either safety education model contributes positively to the retention of this knowledge.
Full Reference: Powell EC, Malanchinski J, Sheehan KM. A Randomized Trial of a Home Safety Education Intervention using a Safe Home Model. Journal of Trauma, Injury, Infection, and Critical Care, 2010; 69(4):S233-S236.
Multiple Imputation in Trauma Disparity Research
As disparity research increases in the field of trauma, it has become more necessary to address missing data in the National Trauma Data Bank. Although the NTDB remains the most comprehensive database for cases of trauma, the missing data hinders the quality of the entire dataset, thus limiting the research opportunities. This experiment utilizes multiple imputations to correct for missing data. This project supports the multiple imputation is a useful tool to handle the missing race and insurance data.
Full Reference: Oyetunji T, Crompton J, Ehanire I, Stevens K, Efron D, Haut E, Chang D, Cornwell E, Crandall M, Haider A. Multiple imputation in trauma disparity research. Journal of Surgical Research 2011;165(1):e37-42
When Products Fail: Injuries Related to Children’s Products and Activities
Today, injuries kill more children than any disease, while also contributing to child morbidity. Injuries can be caused by product malfunction, failure to heed product restrictions, or an accident despite proper use. With few infant products regulated by mandatory standards and agencies, the majority of child equipment and toys safety requirements are voluntary. Parental supervision, protective equipment for physical activities, and safety education are simple actions that should be paired with more thoughtfully designed products, effective and extensive pre-market testing, and a comprehensive recall process in order to hopefully reduce the number of severe pediatric injuries.
Full Reference: Powell, Elizabeth C. “When Products Fail: Injuries Related to Children’s Products and Activities.” Pediatric Annals, September 2008; 37(9):598-604.
A Statewide Model Program to Improve Emergency Department Readiness for Pediatric Care
The national Emergency Medical Services for Children program has worked for over 20 years to improve the response to pediatric emergencies; unfortunately, the quality of care lags far behind that for adults, with higher mortality rates in pediatric cases that correspond to adult emergency situations. Working to advance pediatric emergency preparedness, Illinois’ facility recognition process aims to achieve national pediatric health care objectives, as well as the Health Resources and Services Administration performance measures. The state’s plan begins with a thorough needs assessment, followed by multifaceted task force and criteria development, and then implementation region-by-region. The Illinois model for a statewide facility recognition process can serve as a template for anyone working to bridge the gap between pediatric and adult emergency patient care.
Full Reference: Cichon ME, Fuchs S, Lyons E, Leonard D. “A Statewide Model Program to Improve Emergency Department Readiness for Pediatric Care.” Annals of Emergency Medicine, August 2009; Volume 54, Number 2: 198-204.