Maternal reports of baby injuries in Canada: trends and patterns by age and gender

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  1. Dafna E Kohen1,
  2. Hassan Soubhi2,
  3. Parminder Raina3
  1. 1Before Christ Wound Research and Bar Unit, Centre for Community Child Wellness Research, Section of Wellness Care and Epidemiology, University of Island Columbia, and Centre for Wellness Services and Insurance Research, University of British Columbia, Canada
  2. 2BC Injury Research and Prevention Unit, Centre for Profession Child Health Search, Department of Health Care and Epidemiology, University of British Columbia University, Nerve centre for Health Services and Policy Research, University of British Columbia, and Centre for Community Health and Health Rating Research, Island Columbia Search Bring for Children's and Women's Health, University of British Columbia, Canada
  3. 3BC Hurt Research and Bar Unit, Centre for Community Child Health Research, Department of Healthcare and Epidemiology, University of Brits Capital of South Carolina, Centre for Health Services and Policy Research, University of British Columbia, and Centre for Community Health and Health Evaluation Research, British Columbia River Enquiry Institute for Children's and Women's Health, University of British Columbia, Canada
  1. Correspondence to:
 Dr Dafna Kohen, Before Christ Combat injury Enquiry and Prevention Unit, L408–4480 Oak Street, George Vancouver, BC V6H 3V4, Canada
 (e-mail: injury{at}cw.bc.ca )

Precis

Objectives—This study examines sex and years differences in parental reports of injuries in a cross sectional group of children aged 0–11 years. The cause, nature, consistency part injured, and location of injury are explored, atomic number 3 are the associations with family socioeconomic indicators and associations with limitations in activities.

Methods—Data for 22 831 children and their families come from cycle 1 of the Canadian Domestic Longitudinal Review of Children and Youth self-contained in 1995. Descriptive analyses and χ2 tests for trends are used to examine injury variations by tyke grammatical gender and senesce. Logistic regressions are utilised to examine the relationship between socioeconomic indicators and wound and the associations 'tween injury and limitations in activities.

Results—Consistent with findings from hospital information, boys experience more injuries than girls, and injuries increment with child age. Falls are the most common sources of maternally reportable injuries, followed by scalds/poisonings for young children and sports injuries for shoal aged children. The legal age of injuries take plac in or around the home for young children, but at school for older children. For maternal reports of childhood injuries, I marital status is a risk factor for boys.

Conclusions—Motherly reported injuries occur in 10% of Canadian children and many of these are joint with limitations in activities. Preventative strategies should take some child age and gender into consideration.

  • maternal reports
  • limitations in activities
  • socioeconomic indicators

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  • maternal reports
  • limitations in activities
  • socioeconomic indicators

In many industrialized countries, undesigned injuries represent the leading cause of death for youth less than 20 years of historic period.1– 3 In 1995, injuries were causative 57% of all deaths among young Canadians, whereas 5% of deaths were caused by cancer and 2% past infectious disease.4 Injury information is primarily supplied by fatality rate and hospitalization data, which tend to address severe injuries and include limited detail. Information concerning injuries treated in emergency departments, else outpatient settings, and those treated at home or left untreated is often unavailable. These "minor injuries" are often the cause of pain and temporary disability, and may be a precursor for more serious injuries. Hence review information including elaborate entropy on severe and minor childhood injuries are expensive in the assessment of risk factors and conditions with the goal of injury bar programming.

The types of grave injuries children have show precise patterns across age groups and gender.1, 5– 7 These patterns ponder exposure to run a risk, the location and activities where children drop a majority of their time, likewise American Samoa the child's level of development.7, 8 The major cause of non-fatal injuries among infants and young children is falls9– 11 and sports and unpaid activities for older children and adolescents. From birth to 24 long time of age boys are more likely to support injuries compared with girls, to be hospitalized because of injuries, and to suffer the most wicked forms of combat injury.12 Sexuality differences also become more articulate with age.1, 6, 7

Socioeconomic indicators, so much as single marital condition, low levels of parent education, and living in conditions of poverty are factors associated with childhood injury.13– 17 A steep social class gradient in mortality exists for unintentional injury, with children support in devalued income families being more likely to experience injury than children from higher income families.18– 20

The first objective of this study was to describe the characteristics of maternally reported child injury by gender and age, including causes and types of injuries, trunk parts injured, and locations of combat injury events. The endorse objective was to examine the relationships between puerility hurt and socioeconomic indicators, such A marital status, household income, and maternal teaching. The third base objective was to examine the association betwixt childhood injury and limitations in daily activities. All three objectives were investigated using data from cycle 1 of the National Longitudinal Resume of Children and Younker (NLSCY).

Methods

SURVEY

The NLSCY is a internal potential study designed to measure child wellbeing, wellness, and ontogeny. IT is supported happening a random chance sample of Canadian residential households of children aged 0–11 years, excluding households situated in remote areas, First Nations Peoples' reserves, and institutional settings. Sampling frames for cycle 1 of the NLSCY (1995) included a main component supported Statistics Canada's Unit of time Labour Force Survey (excluding the territories) and an incorporated component founded happening the 1994 Interior Population and Wellness Survey. In total, 15 579 households participated: 12 879 for the main component and 2700 for the coeducational component.

The NLSCY reply rate was 86.3% (13 439 respondents). Slight subordinate-mental representation of census municipality areas, households with both parents aged 40 and over, and households with a parent with eight years OR less of education was detected. Sample weights were applied to the data to account for unequal probabilities of selection, non-response (person and household level), and the age and gender distributions of the Canadian population. The current meditate focuses on a cross sectional try of children aged 0–11 years from cycle 1 of the NLSCY.

SAMPLE SELECTION

One nipper aged 0–11 years was randomly selected from eligible households. Information was obtained from the somebody most knowledgeable about that child, the mother for 91.3% of households. Of these, 89.9% were the kid's biological mother and 1.4% were step, adoptive, or foster mothers. For ease of discussion, the person almost knowledgeable will be referred to as the mother. Other children were selected at random, to a maximum of four per household. The sire was asked to complete a general questionnaire, a parent questionnaire, and a fry questionnaire, providing basic demographic information about all household members, socioeconomic information more or less herself and her spouse, and extensive info about the selected children. A cross divided try out of 22 831 children aged 0–11 years was initially surveyed from November 1994 to June 1995 and will be followed up into adulthood with reassessments all two long time.

VARIABLES

Family socioeconomic indicators enclosed marital status status (two parent kinsfolk, single parent family), household income (<$10 000–14 999; $15 000–29 999; $30 000–40 000), and parental level of education (some senior high school, completed last school, more than swollen school).

Limitations of activities assessed current long term conditions or health problems preventing surgery limiting the child's participation in school, at play, operating theatre in other activities (yes/no).

Injury status was assessed by determinant if the child had been torn within the past 12 months. Data was also congregate about the number of injuries, the nature of injury, the body parts injured, and the cause of injury. Nature of injury enclosed broken/fractured bones, burns/scalds, dislocations/sprains/strains, cuts/scrapes/bruises, or "other" including concussions, poisonings, internal injury, dental hurt, and seven-fold injuries. Body parts enclosed facial nerve, head and neck, amphetamine extremities, lower extremities or "other" including back, spine, trunk, and multiple sites (classified due to small sample sizes). Cause of injury was grouped into automotive vehicle collision, bicycle accident, crumble, sport, scald or poisoning, and an "other" category not nominal by the parent.

Covariates included gender and the number of siblings (0, 1+).

ANALYSIS

Descriptive analyses and χ2 tests for trends were conducted to examine variations by grammatical gender and senesce (infants/toddlers 0–3 years; preschoolers 4–5 years; school of age 6–11 years) for the causes and nature of injuries, organic structure part out of action, and location of injuries. Logistic regressions examined associations between socioeconomic indicators and injury position as well as the association of injury status and limitations in daily activities. Sample weights were used for altogether analyses. Because the sample method included more than one child per household, phone number of siblings was included as a covariate in each model to account for a possible type 1 error due to clustering.

Results

DESCRIPTIVE ANALYSIS

The proportion of boys (51%) and girls (49%) in the add together sample was similar. The absolute majority of children (74%) lived in families with high menag income (>$30 000) piece 8% lived in short household income families (<$14 999). Fifteen per cent of children lived in single female headlike households. The majority of the mothers (66%) had Sir Thomas More than a screaky school level of education while 16% had inferior than high school.

INJURY STATUS

From the total sample distribution of 22 831 children, 10% (n=2288) were injured in the last 12 months (9% of girls and 11% of boys). For all age groups, female gender was associated with turn down rates of harm (odds ratio (OR) 0.78, 95% confidence interval (Cardinal) 0.72 to 0.85). Injuries enlarged with long time (χ2 (slew, df=1) = 53.22, p<0.05) and were reported in 8% of infants/toddlers, 9% of preschoolers, and 12% of school aged children. Shoal aged children had significantly Sir Thomas More injuries than infant/toddlers and preschoolers (p<0.01). Thither was no remarkable divergence between infants/toddlers and preschoolers.

Further analyses were conduced by sexuality and age bracket where sample size allowed. For boys and girls the most common suit of trauma was falls, followed by sports injuries (table 1). The most haunt types of injuries were cuts/scrapes/bruises, broken/fractured bones, and dislocations/sprains/strains. Injuries most usually occurred in the upper extremities, the lower extremities, and the face. Boys experienced importantly more facial injuries and head operating room neck injuries. Injuries most frequently occurred inside and outside the child's home, and in civilize or day care.

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Table 1

Cause, nature, body part, and location of injury by sexuality and child age

Analyses past age groups advisable that waterfall were the most common stimulate of injury for each historic period group (table 1) only decreased as children got older (χ2 (trend, df=1) = 72.83, p<0.01). Cuts/scrapes/bruises were the most common types of injuries for all ages, followed by broken/fractured bones and dislocations/sprains/strains. The number of cuts/scrapes/bruises (χ2 (trend, df=1) = 65.72, p<0.01) and burns/scalds (χ2 (vogue, df=1) =19.39, p<0.01) decreased as children got aged. All the same, more severe injuries such as broken/fractured clappers increased with long time (χ2 (trend, df=1) = 78.25, p<0.01) occurring more frequently in school older children than in the younger age groups.

Facial injuries were most lowborn for infant/toddlers and preschoolers, followed aside injuries to the upper extremities and injuries to the head and neck. School aged children continuous the majority of injuries to the upper and lower extremities, followed by the face. Injuries to the youngest groups of children occurred inside and extraneous the home, patc the rest home was less frequently related with injuries among older children (χ2 (drift, df=1) = 413.62, p<0.01). For civilis aged children injuries more frequently occurred at school or at daycare.

FAMILY SOCIOECONOMIC INDICATORS

Single female headed families (Operating room 1.28, 95% CI 1.11 to 1.47), family incomes of $15–29 999 (OR 1.24, 95% CI 1.02 to 1.52), and related levels of education greater than high (OR 1.14, 95% CI 1.04 to 1.25) were associated with an increased risk of combat injury for the total grouping.

Boys support in single female burr-headed families were at greater risk of injury, but for girls injury was connected with elated levels of maternal education (table 2). Girls were fewer likely to be injured regardless of years compared with boys. Paternal levels of education greater than high-topped school were associated with increased risk of injury among school elderly children.

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Table 2

Odds ratios (Operating theater) and trust intervals (CI) by injury status, gender, and old age groups

Single egg-producing headship was joint with a greater likelihood of puerility injury for all ages. Medium and high levels of income were associated with an increased risk of injury for boys, with the highest risks for infants/toddlers and preschoolers. Motherly levels of education greater than shrill school were associated with an increased risk of combat injury for school aged children, with the risk of injury accelerando past 29% for school aged boys (table 3).

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Table 3

Betting odds ratios (OR) and confidence intervals (CI) away injury position for boys and girls by age group

Single female headship was non associated with an multiplied risk of injury among girls. Although not significant, superior levels of family income may serve A a preventive divisor for female infants/toddlers and preschoolers, but Eastern Samoa a risk factor for school aged girls. Levels of maternal education greater than high school were associated with higher risks of injuries for girls of whol ages, but effects did not reach significance (set back 3).

LIMITATIONS IN ACTIVITIES

In the total sample, 3.9% of children had limitations in their daily activities, and those injured were more presumptive to experience limitations (OR 1.28, 95% CI 0.98 to 1.64 for boys and OR 1.46, 95% CI 1.06 to 2.03 for girls). Injuries were significantly associated with limitations in daily activities for civilis aged children (OR 1.54, 95% Hundred and one 1.22 to 1.95) but not for preschoolers or infants/toddlers.

When gender and age groups were examined, injuries were related with limitations in activities for boys of preschool and school age. This burden was significant for schooling aged boys (OR 0.57, 95% One hundred one 0.25 to 1.30 for infants/toddlers; Surgery 1.49, 95% CI 0.83 to 2.69 for preschoolers; and Operating theater 1.38, 95% CI 1.01 to 1.88 for educate aged). Likewise, injuries were associated with limitations in daily activities for school mature girls (OR 0.44, 95% CI 0.13 to 1.48 for infants/toddlers; Oregon 0.33, 95% CI 0.05 to 2.18 for preschoolers; and Surgery 1.85, 95% One hundred one 1.29 to 2.64 for train aged girls).

Discussion

The most many childhood injuries are minor injuries, and children who experience many temperate injuries are likely to get more severe injuries all over time.13, 14 The power to prevent childhood combat injury away targeting specific take a chanc factors testament affect social resources, including health care use and missed school days for children and missed workdays for parents.

The strength of survey data is in the appeal of detailed injury information approximately minor injuries not requiring hospitalization. This information is rarely available from other sources. Although maternally according injuries in the NLSCY are not limited to minor injuries, the majority of the injuries reported were nipper in nature. This study examined the patterns and lay on the line factors related with injuries occurring over a 12 month menstruation using spoil sectional data of a nationally representative sample of Canadian children aged 0–11 old age. Selective information included the cause, typewrite, relative incidence, and prevalence of injuries.

Our findings based on maternally reported injuries are alike to those reported for more severe forms of injury, such As injury related deaths.21 Boys experience Thomas More injuries than girls and gender differences step-up, as children get older. Boys are many in all probability to be seen in emergency rooms, more likely to follow hospitalized due to injury, and are also more in all likelihood to suffer the most severe forms of injury.1, 6, 7, 12 Sexuality differences whitethorn make up attributable to boys displaying higher activity levels,22– 24 engaging in more injury risk behaviours,6, 13, 25 rating injuries as less severe, and attributing injuries to disobedient circumstances rather than to their own behaviour.26, 27 Believing that injury results from external causes may deter boys from changing their behaviour or taking precautions to reduce risks in future situations.

Based happening maternal reports, the most usual forms of injuries for all children are falls. The frequency of falls indicates a developmental convention, decreasing as children age. This finding is consistent with US studies of ER data where the activities leading to non-fatal injuries too vary by shaver age. Falls represent the major source of intense, not-fatal injuries requiring emergency visits for infants and immature children.9– 11 However, sports and recreational activities are causative for more emergency visits among school worn children and adolescents.

Patterns of injury contemplate both the location and activities where children spend a majority of their time, as well as children's developmental level. As children get older, non-fatal injuries tend to be more dangerous and are fewer in all likelihood to go on in the home. In this study, 52% of maternally reported injuries occur in or around the home. This proportion is comparable the reported number of non-terminal severe injuries (44.8%) that occur in the home for children aged 0–20 eld.12, 28 The emplacemen of injury changes as children spend more time outside the dwelling, particularly during leisure OR recreational activities.29 For older children, maternalistic reports of injuries may be underestimated because injuries occurring at school or at daycare may not be reported to parents.30

This study found azygos female headship and maternal didactics greater than high school to be risk factors for childhood injury. Numerous studies have ground maternalistic education to be inversely associated with risk of trauma,15 cognition of risk hazards, and safety behaviours.16, 17 Contrary to studies reporting higher rates of severe puerility injuries with impoverished socioeconomic conditions,15, 18– 20 household income was not found to be associated with injury status. Poverty may only be joint with inevitable or nonindulgent injuries that upshot in hospitalization. Alternately, poor and less educated families may be under-reporting injuries. A correlation between one-man female headed families and economic disadvantaged may be influencing these findings. Both single female headship and high household income being related to with combat injury appears to follow inconsistent. However, it is possible that these variables measure different aspects of socioeconomic position, with the former indicating a non-parental maintenance site, and the latter capturing a different dimension.

LIMITATIONS

Retrospective maternal recall may err on the lateral of under-reporting compared with biweekly reporting operating room reporting by school aged children.30 Parents are also more likely to under-report their sons' compared with their daughters' injuries27 American Samoa boys are little liable to inform their parents. Other limit of this learn is that the data were bad-tempered sectional. It is therefore difficult to establish the temporal relationship between injuries and limitations in activities, as mothers did not report if limitations were due to an harm event. In store research, however, should use longitudinal data to value the direct encroachment of injuries along the limitations in activities and long term disabilities of children.

Implications for prevention

Minor injuries occur in approximately 10% of Canadian children and should not exist ignored. Children who meet injuries, especially experient children, are likely to have limitations in daily activities and to experience increased hospitalizations. Numerous minor injuries go on in the home and are due to falls and scalds/poisonings, suggesting that parental education in injury prevention skills and child development are important aspects of injury reduction. Parents need to accurately assess children's abilities to guess dangerous situations. The availability and accessibility of information and safe proofing materials for the home would reduce the number of injuries occurring in the dwelling house.31, 32 Findings also paint a picture that higher household income is associated with kid injuries, whereas low socioeconomic status has been related with more severe injuries. Therefore the affordability of safety devices may non be the issue, but accessibility, implementation, and the proper use of safety devices is important in the bar of minor childhood injuries.

Sports are frequent causes of combat injury among school elderly children, suggesting that children ask to embody protected while participating in sporting activities and that sporting environments need to cost made safe. Biological process differences in the cause of injury, nature of accidental injury, and body part injured suggest that preventative strategies such as product modifications, educational interventions, and environmental, legislature, and public health policies should take children's developmental level into account. Since injuries occurring away from the habitation increase with kid age, prevention strategies so much as education for parents and children need to increase safety cognition and encourage injury prevention behaviours for children when they are away from internal. Policies promoting safe play and safe card-playing areas would also be of benefit.

Acknowledgments

This survey has been made possible by a financial contribution from the Office of Injury Prevention, B.C. Ministry of Health and Ministry Responsible for Seniors too as funding from the Elite group Sciences and Research Council and Canadian Institute for Advanced Research. The authors would also suchlike to thank the reviewers for their comments.

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