Review: parenting interventions can reduce unintentional injuries in children and increase use of safety practices
Dr D Kendrick, University of Nottingham, Nottingham, UK;
Do parenting interventions reduce unintentional injuries in children and increase use of safety equipment and practices?
Studies selected compared individual-based or group-based parenting interventions with no intervention (control) in parents of children ⩽18 years of age and reported ⩾1 of the outcomes listed below. Interventions had to have a specified protocol, manual, or curriculum to change parenting knowledge, attitudes, or skills. Outcomes were self-reported or medically attended unintentional injury or injury of unspecified intent, Home Observation for Measurement of the Environment (HOME) scores (higher score = safer home environment), possession and use of home safety equipment, and safety practices (eg, unsafe hot water temperature). Meta-analysis could not be done for home safety outcomes because of heterogeneity in the measurements.
Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, 11 other databases, conference abstracts, reference lists, and websites were searched for randomised controlled trials (RCTs), quasi-RCTs, or controlled before–after studies. The metaRegister of clinical trials, National Research Register, and register of Medical Editors Trial Amnesty were searched for unpublished studies. 15 studies (n = 7269) met the selection criteria: 11 RCTs (n = 5966) (5 had adequate allocation concealment, 4 had blinded outcome assessment, and 8 had >80% follow-up) and 4 non-RCTs (n = 1303) (Reisch score range 0.60–0.84, higher score = better quality; based on criteria that included study design, blinding, and attrition).
Meta-analysis of RCTs showed that parenting interventions led to fewer injuries than no intervention (table). 2 studies showed that the intervention group had higher overall HOME scores than the control group, (mean score range 29–41 v 27–39, p<0.04). Single studies showed that the intervention group had better child-care skills (88% v 61%, p<0.001) and greater use of electrical socket covers (odds ratio 1.9, 95% CI 1.2 to 3.2) than the control group but groups did not differ for keeping poisonous substances out of reach, use of safe sleep practices, and lowering temperature on water heaters. 1 RCT showed that the intervention group had fewer observed hazards in the home than the control group at 34 months (0.22 v 0.38, p = 0.04) and 46 months (0.21 v 0.46, p = 0.003).
Parenting interventions can reduce unintentional injuries in children and increase use of safety practices.
Kendrick D, Barlow J, Hampshire A, et al. Parenting interventions for the prevention of unintentional injuries in childhood. Cochrane Database Syst Rev 2007;(4):CD006020.
Clinical impact ratings: Family/general practice 5/7; Health promotion 6/7; Paediatrics 6/7; Public/community health 5/7
The review by Kendrick et al showed the power of preventive intervention: across 9 studies, injury risk was reduced by 18%, and 1 unintentional injury was prevented for an average of 25 treated children. The findings are a call to action as accidental injury is the major cause of death and disability among children.1 The findings are consistent with reports of improved outcomes (eg, child injuries, neglect, parenting attitudes, and home environment quality) after home visitation by nurses2 3 and other health professionals.4 Future research could address methodological issues such as self-report bias, definitions of unintentional injury, dose of intervention, and whether other aspects of parenting must be addressed to reduce injuries. Furthermore, studies of the multiple, inter-related social determinants of unintentional injury are also needed. Unintentional injury may be influenced by various child (age, gender, developmental level, and temperament), family (social support, parenting quality, violence, socioeconomic status, and literacy), and community (sport, school, and playground environments) factors. However, it is time for nurses, other healthcare professionals, and policy makers to take action given that promotion of positive parental knowledge and behaviour effectively lowers rates of unintentional child injuries.