An Evidence Based An Evidence Based Overview of Overview of

Parental Parental Supervision and Supervision and Childhood Injury Childhood Injury

RiskRiskPresented Feb 16, 2010Presented Feb 16, 2010

At the ICPHSO Annual MeetingAt the ICPHSO Annual Meetingbyby

Michael Corbett, M.A. Michael Corbett, M.A.

OverviewOverview

How serious is the childhood injury How serious is the childhood injury problem?problem?

How do we define supervision and How do we define supervision and does it help reduce child injuries?does it help reduce child injuries?

What is the nature and scope of What is the nature and scope of supervision?supervision?

What other factors are important What other factors are important predictors of injury and how do these predictors of injury and how do these relate to supervision?relate to supervision?

The Burden of Childhood The Burden of Childhood InjuryInjury

Unintentional childhood injury #1 cause of death Unintentional childhood injury #1 cause of death and a leading cause of hospitalizationand a leading cause of hospitalization

In the US, 73,000 children (0-19) died of In the US, 73,000 children (0-19) died of unintentional injury between 2000 and 2005unintentional injury between 2000 and 2005

23,000 under the age of 1023,000 under the age of 10 92,000 children a year permanently disabled92,000 children a year permanently disabled 39,000 children a day require medical treatment39,000 children a day require medical treatment Large majority of pre-school aged injuries occur in Large majority of pre-school aged injuries occur in

the home the home 40% related to consumer products40% related to consumer products 90% may be preventable 90% may be preventable

What is Caregiver What is Caregiver Supervision?Supervision?

Not as simple as it may seemNot as simple as it may seem Generally measured as:Generally measured as: Attention to child Attention to child Proximity to child Proximity to child Continuity of supervisionContinuity of supervision Relevance to injury risk is keyRelevance to injury risk is key

Does Supervision Reduce Does Supervision Reduce Childhood Injuries?Childhood Injuries?

Current finds suggest supervision Current finds suggest supervision does protect children does protect children

Observational, self-report Observational, self-report (questionnaire, interview, diary (questionnaire, interview, diary recording, ER data) coroners reports recording, ER data) coroners reports all show links between caregiver all show links between caregiver supervision and child injurysupervision and child injury

The Home Supervision The Home Supervision StudyStudy

Parents tracked supervision for 10 Parents tracked supervision for 10 daysdays

Recorded both “in-view” and “out-of-Recorded both “in-view” and “out-of-view” supervisionview” supervision

Supervision rating scales assessed Supervision rating scales assessed watching, listening and checking inwatching, listening and checking in

ResultsResultsWho is Supervising and to What Degree?Who is Supervising and to What Degree? Mothers primary supervisor most (78%) of the time and dads less so Mothers primary supervisor most (78%) of the time and dads less so

(16%)(16%) On average children were supervised 96% of the timeOn average children were supervised 96% of the time Younger children left unsupervised less often than older (1% vs 8%)Younger children left unsupervised less often than older (1% vs 8%)

Level of Supervision Under Different CircumstancesLevel of Supervision Under Different Circumstances Children in-view more than out of view (80% vs 20%)Children in-view more than out of view (80% vs 20%) Higher level of supervision when children were in view than out of Higher level of supervision when children were in view than out of

viewview Older children more likely to be out of view than youngerOlder children more likely to be out of view than younger Higher level of supervision for young than older children when out Higher level of supervision for young than older children when out

of viewof view Telephone interviews - younger children had been seen by a parent Telephone interviews - younger children had been seen by a parent

within a shorter period of time (2.2.mins) than older children (4.4 within a shorter period of time (2.2.mins) than older children (4.4 mins)mins)

When Left AloneWhen Left Alone Alone without supervision more often in the living room/family Alone without supervision more often in the living room/family

room than kitchen/dining or bathroom: Boys (76%) more than girls room than kitchen/dining or bathroom: Boys (76%) more than girls (28%) (28%)

SignificanceSignificance Results suggest that children are left Results suggest that children are left

completely unsupervised some portion of completely unsupervised some portion of the timethe time

Children are often supervised from a Children are often supervised from a distance and out of viewdistance and out of view

Children are routinely supervised in ways Children are routinely supervised in ways that could lead to injurythat could lead to injury

Child attributes, parental Child attributes, parental beliefs/personality traits are important beliefs/personality traits are important contributing factorscontributing factors

Child CharacteristicsChild Characteristics

Gender has important implications for Gender has important implications for supervision and injurysupervision and injury

Boys experience more injuries than girlsBoys experience more injuries than girls Boys act in way that elevate injury risk Boys act in way that elevate injury risk

so require greater levels of supervisionso require greater levels of supervision Parents do not supervise boys more Parents do not supervise boys more

closelyclosely Parents socialize boys differentlyParents socialize boys differently

Child CharacteristicsChild Characteristics Impulsivity, risk taking, highly active and/or Impulsivity, risk taking, highly active and/or

sensation seeking, lack behavioral control or are sensation seeking, lack behavioral control or are high on behavioral intensity = more injurieshigh on behavioral intensity = more injuries

Parents supervised these children moreParents supervised these children more Behaviorally intense children: more injuries at Behaviorally intense children: more injuries at

low supervision than at highlow supervision than at high Behaviorally controlled children: low levels of Behaviorally controlled children: low levels of

injury even at reduced levels of supervisioninjury even at reduced levels of supervision Sensation seekers: supervision is not enoughSensation seekers: supervision is not enough Parents must be Parents must be in tune in tune with their child’s with their child’s

behavior and developmentbehavior and development Highest risk at developmental milestonesHighest risk at developmental milestones

Parental CharacteristicsParental Characteristics Personality and beliefs influence supervision and Personality and beliefs influence supervision and

injuryinjury Neuroticism associated with more injuriesNeuroticism associated with more injuries Conscientiousness with fewer injuriesConscientiousness with fewer injuries Mothers high on protectiveness, vigilance , Mothers high on protectiveness, vigilance ,

confidence and worry have children with fewer confidence and worry have children with fewer injuries injuries

Mothers high in vigilance show closer supervisionMothers high in vigilance show closer supervision Beliefs about leaving children unattended for Beliefs about leaving children unattended for

longer periods are associated with more injurieslonger periods are associated with more injuries

SummarySummary Supervision is a key parental strategy for reducing Supervision is a key parental strategy for reducing

childhood injuries related to consumer productschildhood injuries related to consumer products Product developers should be aware that Product developers should be aware that

supervision does not always offer adequate supervision does not always offer adequate protectionprotection

Products specifically for boys are more likely to Products specifically for boys are more likely to pose a threat than products for girls because of pose a threat than products for girls because of riskier behaviour and inadequate supervisionriskier behaviour and inadequate supervision

Parental beliefs about supervision can be important Parental beliefs about supervision can be important to influence in safety awareness messagingto influence in safety awareness messaging

Full understanding of supervision and injury risk Full understanding of supervision and injury risk must consider child, parent and environmental must consider child, parent and environmental characteristics and their interactionscharacteristics and their interactions