Behavioral Aspects of Pediatric Home Injury Prevention

David C. Schwebel, Ph.D.Department of Psychology,University of Alabama at Birmingham

Pediatric Injuries in the Home

Injuries: leading cause of child death in most countries, causing more deaths in USA than next 10 leading causes of death combined

At least half of pediatric injuries occur in the home

Young children are particularly vulnerable Exposure (spend more time in home) Risks related to child development – falls,

poisoning, burns, drowning, etc.

Injuries in the Home

But even adolescents and adults are vulnerable

Adolescent Injuries in the HomeDescriptive Data on Safety of Homes with Adolescents (N = 42)

Safety Measure % at risk

Fire/BurnsExposed electrical wires 20No smoke detector functioning in home 15No fire extinguisher present in home 54

Carbon Monoxide PoisoningNo carbon monoxide detector present 88

AlcoholAlcohol present in home 56Alcohol present in unlocked location 31

FirearmsFirearm present in home 38Firearm unlocked in home 29

FireworksFireworks present and unlocked 6

TrippingElectrical cords exposed 21Rug or other floor covering peeling up 14

Outdoor Stairways/Rails/PorchesItems littering outdoor stairways 14Broken or absent handrails 22Porch rail unstable or missing 11

From Schwebel, D. C., Gilliland, M. J., & Moore, J. G. (2009). Physical environment of the home and adolescent injury risk. International Emergency Nursing, 17, 47-51.

Behavioral Strategies for Home Injury Prevention

Many strategies can and do work Most strategies overlap and should

be used concurrently

Targeting children Targeting parents Targeting the home environment

Targeting Children

Must consider development – cognitive, perceptual, motor, inhibition, and more

Prevention can take many forms Developing safe decision-making skills Learning and obeying safety-related rules Developing inhibition Having safe home environment to engage

within Interacting with safe objects (e.g., toys)

Examples from my Laboratory

Teaching children safe behaviors Training 7-8 year old children safe

street-crossing behavior Training 3-6 year old children how to

safely interact with their pet dogs

Targeting Parents

Changing adult habits is not easy! Prevention can take many forms

Improved supervision – intervene when danger emerges

Model safe behaviors Simply be present, and children will act

more cautiously

Example from my Laboratory

Parent presence causes children to act more cautiously

Children (ages 6-8) complete 4 physical tasks, sometimes set within their ability and sometimes beyond their ability

Parents stand silently in the room half the time, either for first sets of trials or last sets of trials

Results: Influence of Parents on Child Decision-Making

0

10

20

30

40

50

60

70

80

90

100

Percent Judged Correctly w ithParents Present

Percent Judged Correctly w ithParents Absent

Per

cen

t E

stim

ated

Co

rrec

tly

Parents Present First

Parents Absent First

From Schwebel, D. C., & Bounds, M. L. (2003). The role of parents and temperament on children’s estimation of physical ability: Links to unintentional injury prevention. Journal of Pediatric Psychology, 28, 505-516.

Conclusions: Influence of Parents

The mere presence of parents seems to cause children to make more cautious decisions

That influence seems to persist after parents leave the room

Results replicated at pedestrian setting, in street-crossing task

Results form theoretical basis for playground intervention, Stamp-in-Safety program

Targeting the Home Environment

Industry must produce safe toys, cribs, and other items children interact with

Dangerous items for young children must be kept away from those young children

Parents must safeguard the environment They must recognize what is dangerous so

they know what to safeguard They must know how to safeguard what is

dangerous They must actually do the work of

safeguarding

Example from my Laboratory

Simulated rooms arranged: living room, toddler’s bedroom, bathroom

70 hazards to young children placed in the rooms

First-time parents of 1-2 year old children asked to identify hazards to toddlers

QUESTION: Do parents recognize what is dangerous to their children?

Hazards by the Sink

Results

Setting Hazards Recognized Bedroom (of 20) 8.18 (3.56)Bathroom (of 15) 8.31 (2.20)Living Room (of 35) 16.69 (4.36)Full “House” (of 70) 33.18 (8.47)

ANSWER: No…at least not as much as we’d hope

From: Gaines, J., & Schwebel, D. C. (2009). Recognition of home injury risks by novice parents of toddlers. Accident Analysis and Prevention, 41, 1070-1074.

Conclusions: Home Environment

Parents may not even recognize the risks to children present in the homes

Interventions will need to either: Educate parents about the risks present

OR Create environments that are safe

without parent intervention (OR both)

Summary

Behavioral strategies to prevent child injury in the home can take many forms Target children Target parents Target the home environment

Multidisciplinary, multifaceted, international efforts are needed

Acknowledgments

ICPHSO for inviting me to speak today Adolescent risks: Janice Gilliland, Jeffrey Moore (co-authors); Macie Brown,

Mary Cotton, Danielle DeLuna, Christal Montgomery, Brandi Robinson (data collection & processing)

Pedestrian Safety Training: Award Number R01HD058573 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (Funding). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health & Human Development or the National Institutes of Health. Staff: Katie Byington, Ivory Dale, Aaron Davis, Kane Jones, Rosalyn King, Megan Knauss, Jordan Mizzell, Elizabeth O’Neal, Meredith Renfroe, Katie Sack, Ksenia Shingareva, Jasmine Stanford, Bryanna Tate; IT: Aeron Gault, Joan Severson, Matt Schikore, Digital Artefacts

Dog Safety Training: Blue Dog Trust (funding); Staff: Ivory Dale, Aaron Davis, Kane Jones, Rosalyn King, Megan Knauss, Jordan Mizzell, Elizabeth O’Neal, Meredith Renfroe, Katie Sack, Jasmine Stanford, Bryanna Tate; Collaborators: Barbara Morrongiello, Melissa Bell, Julia Stewart

Parent presence and child risk-taking: Marjorie Bounds (co-author); Oni Hasan-McDade, Natasha Holloway, Sheryl Roque, Julie Sherrod, Adam Summerlin (data collection & processing)

Parent recognition of hazards: Joanna Gaines (co-author); Songul Abay, Danielle Dulion Pitts, Jessica Meservy, Nina Reynolds (data collection & processing)