Unintentional Injuries in Preschool Age Children

Unintentional injuries are the leading cause of death among children. Previous research has shown that most of the injuries occur in and around the home. Therefore, parents have a key role in the occurrence and prevention of injuries. In this study, we examined the relationship among home injuries to children and parental attention deficit hyperactivity disorder (ADHD) symptoms, parental attitudes, and children’s behavioral problems. Forty children who were admitted to the emergency department because of home injuries constitute the study group. The control group also consisted of 40 children, who were admitted for mild throat infections. The parents filled out questionnaires assessing parental ADHD, child behavioral problems, and parenting attitudes. Scores were significantly higher for both internalizing disorders and externalizing disorders in study groups. We also found that ADHD symptoms were significantly higher among fathers of injured children compared with fathers of control groups. Democratic parenting was also found to correlate with higher numbers of injuries. Parenting style, as well as the psychopathology of both the parents and children, is important factors in children’s injuries. A child psychiatrist visit following an emergency procedure may help to prevent further unintentional injuries to the child. (Medicine 94(32):e1378) Abbreviations: ADHD = attention deficit hyperactivity disorder, AIS = Abbreviated Injury Scale, ASRS = Adult ADHD Self-Report Scale, CBCL 1.5/5 = Child Behavior Checklist, ED = emergency department, PARI = Parent Attitude Research Instrument. INTRODUCTION im Selcuk Esin, Ha D, urat Mutlu, MD around 1 million children die every year because of these injuries. Although death is the most dramatic result of injuries, it is not the most common one. Gallagher has shown that for each death, 45 children are hospitalized and 1300 children are admitted to emergency department (ED) because of injuries. Household environment has particular importance in unintentional injuries. The home is the leading location of injury for young children, accounting for nearly half of all childhood injuries. Preschoolers, who spend most of their time at home, are more prone to be exposed to home injuries compared with school age children. Caregivers have a key role in the occurrence and prevention of childhood injuries in the home. Research has shown that most injuries occur when children are in the care of a parent. It is also well known that parenting style which refers to the standard strategies parents use in raising their children has an impact on physical health of children. Although these studies suggest the possible role of quality and style of parenting, very little is known about the relationship between parenting style and unintentional injuries. Mental health status and psychiatric problems of both parents and children are also among the well-known risk factors for home injury. Attention deficit hyperactivity disorder (ADHD), characterized by overactivity, inattention, and impulsivity, is one of the most common childhood disorders. With respect to these characteristics, ADHD has the strongest relationship to injury risk among all childhood psychiatric disorders. Studies have shown that having ADHD nearly doubles the risk for injuries in childhood. ADHD is not only a childhood disorder, but over half of children with ADHD continue to have difficulties in adult life also. Childrearing is one of the areas in which individuals with ADHD have the most difficulty. They can be forgetful about important childrearing tasks, insensitive to the child’s needs, and ineffective with respect to parental monitoring. Combining this data with genetic findings, which show that approximately 25% to 50% of children with ADHD have a parent with the disorder, it is highly expected that the presence of ADHD in the parents may also be a risk factor for home injuries in childhood. But the data on the role of parental ADHD in unintentional childhood injuries are lacking. We hypothesized that parents of children who admit to ED for unintentional injuries may have significant ADHD symptoms or/and have a particular parenting style that might increase the risk of injuries. We also hypothesized that these children would have more psychiatric problems compared with their peers. Therefore, the aim of this study is to examine the nintentional home injuries and parental enting style, and children’s behavioral www.md-journal.com | 1 MATERIALS AND METHODS The study was conducted in the Erzurum Regional Training and Education Hospital in Turkey. Ethical clearance was obtained from the ethics committee of Ataturk University. All the parents were informed about the study, and the patients whose parents agreed to participate were also included in the study. The parents whose children were accepted into the study provided written informed consent. Patients, aged 1 to 5 years old, who were admitted to the ED because of unintentional home injury (March–June 2013) constitute the sample of the study group. We used the World Health Organization’s (WHO) unintentional injury definition, and included children who were admitted with an injury which was accidentally occurred such as poisoning, burns and scalds, drowning, incision, falls, and transport-related injuries. Injuries that occurred because of interpersonal violence and self-harm were categorized as intentional injuries, and children who were referred for such injuries were excluded. Children who had a physical and sensory disability or a significant developmental delay that would make them more prone to injuries, which would therefore affect the interpretation of results, were not included in the study. Abbreviated Injury Scale (AIS) is coded on a scale of 1 to 6, where 1 being a minor injury and 6 being maximal. And we also excluded children whose AIS was 4 because asking parents to fill out questionnaires in such a situation would be ethically inappropriate and would decrease the reliability of the data. We used individual matching method; therefore, the control group was recruited after the study groups were completed. The control group consisted of children admitted to the ED because of mild throat infections. In Turkey, EDs accept all kinds of admissions, and throat infections are among the most common reasons for admissions. One control case that was age and sex matched with a study group and did not have a history of unintentional home injury that required a hospital admission was included in the study. Parents were requested to fill out the questionnaires before the child’s discharge from the ED, after all the medical procedures were finished and the child was stabilized. In the case of only one form filled out in home by his/her parent, the others fill out in hospital, and then returned to our unit.