Utskrift från Malmö högskolas webbplats www.mah.se

CHILD INJURIES AT HOME – Prevention, Precautions and Intervention with focus on scalds

Contact person: Anna Carlsson
Responsible: Anna Carlsson
Funding: Fakulteten för Hälsa och samhälle, Malmö högskola
Timeframe: 2008-01-01 -- 2010-03-19
Research profile: Hälsa och sociala villkor i ett livsförloppsperspektiv
Faculty/Department: Faculty of Health and Society, The Department of Care Science
Subject: Medicin

The overarching aim of this PhD-thesis was to increase the knowledge concerning children’s (0-6 years old) exposure to accidents at home by describing parents self-reported precautions taken at home to decrease the risk of child injuries (Ι), the extent of burn and scalds (ΙΙ), the parents’ opinions about the course of events in child accidents (ΙΙΙ) and in an intervention study investigate the effect individual-based extended information has on mothers’ attitudes towards child injury and injury prevention (ΙV) and to taking precautions at home (V).

The data collected in the five papers all comes from a city in southern Sweden. The study (Ι) has a cross sectional survey design. The data in paper Ι were collected from the answers by parents of 10 month old children to a questionnaire. The questionnaire prompted responses related to parents’ background and socio-economic factors as well as questions about any precautions they had taken to decrease accident risks in their home. The questions focused on actions parents had taken after receiving advice concerning child accident prevention given to them during the eight-month Child Health Care-nurse assessment in which they had taken part. Thirty-two percent of the parents complied with less than half of the suggested precautions.  Univariate odds ratios (OR) and 95% confidence intervals (95% CI) were calculated to investigate the associations between compliance and the parents’ different background and socio-economic characteristics. The variables: foreign born, low occupational level, 12 years education or less, rented housing and information provided by Child Health Care-clinics proved to be statistically significant for the non-compliant group.  Multiple logistic regression analysis was performed in order to adjust the estimated odds ratios for the influence of potential confounders such as parents’ nationality, educational and occupational level, where they had received the information and their type of habitation. After adjustment, the variable nationality and educational level remained significant. The data in paper ΙΙ was collected from medical records from a retrospectively designed register study. Children injured by burns (0-6 years old) consulting a University Hospital or one of the Health Care Centres (n=21), during the year 1998 and the year 2002, were included. The chi-squared test was used to analyse differences in nominal data and cross-tables were used to analyse the proportions between the characteristics of the injuries and the sex, age and nationality of the child.

There were 148 children injured by burns of which 80% suffered scalds, caused by hot liquid (71%) or hot food (29%). The largest group was boys between one and two years old. Children of foreign born parents were more frequently affected and the extent of their injuries was often greater. The data collection method used in paper ΙΙΙ, was tape-recorded interviews with a qualitative interview study design, analysed by content analysis, with parents of 20 children (0-6 years old) who had recently suffered from scalds. Parents spoke of their perceptions about the causes of the scalds. The analysis resulted in eight categories and two themes. One theme was ‘Deviation from the normal’ and could be described as when something unusual happened like a sudden visitor or when a family member was tired, stressed or ill. It could also be when something had broken in the kitchen or routines were changed. ‘Misjudgement of the child’s capabilities’ was the other theme; this concerned the children’s preventive capacity, rapidity and reach. It was noted that it can be hard for the parents to keep up with the speed of the development of their young children (9 month- 2 years). The parents expressed that they often didn’t realise their child’s capacity until the accident occurred. The intervention study with a comparison group has a quasi-experimental design (ΙV, V). Individual-based extended information, with empowerment as the approach, was given to a group mothers at home-visits and workshops, living in two separate areas of the city and with a low level of education. In total, 99 mothers of children under the age of seven months participated. The mothers were selected through the local Child Health Care authorities. Observations were made and bivariate analyses were established to see if the intervention had an influence on the mothers’ attitudes towards child injuries and injury prevention at home (ΙV) and the precautions they took against child accidents at home (V). Mothers who received the intervention significantly improved their attitudes toward the first question that asked were child injuries happen this also compared with the mothers in the comparison group (OR=2.3, CI=1.3-4.3). However, no significant improvement of attitudes toward child injury prevention was noted neither in relation to the mothers’ SOC-scores (ΙV). The results showed that the intervention had a significant impact on improving the precautions the participating mothers introduced to protect their children against burn and scald injuries in the home and further, in relation to a comparison group (V).

Beskrivning på svenska

Syftet med avhandlingen var att beskriva barns (0-6 år) utsatthet för olycksfallsrisker i hemmiljö genom att fokusera på föräldrars uppgifter om egen följsamhet till olycksförebyggande råd (studie Ι), omfattningen av bränn- och skållskador (studie ΙΙ), föräldrars uppfattningar om påverkande faktorer till olyckshändelser (studie ΙΙΙ), samt effekten av individanpassad information om barnolycksfalls (studie ΙV och V).

Den första studien bygger på enkätsvar från föräldrar och urvalet gjordes så att det skulle vara representativt för Malmö som helhet. Studie ΙΙ bygger på en granskning av barnens journaler avseende bakgrundsdata och diagnos. I studie ΙΙΙ intervjuades föräldrar till barn som skållskadats. Den fjärde studien (studie ΙV och V) är en interventionsstudie med en jämförelsegrupp och designen är quasi-experimentell.

Drygt 30 % av föräldrarna i studie Ι uppgav att de till mindre än 50 % följde de förebyggande råden som sjuksköterskan från barnhälsovården förmedlat. Föräldrarnas bakgrund och socioekonomiska situation hade betydelse, särskilt deras utbildning, för i vilken utsträckning de följde råden.
De barn som oftast drabbades av brännskador (studie ΙΙ) var 1-2 år gamla och pojkar (64 %). Barn till utlandsfödda föräldrar drabbades oftare än barn till svenskfödda föräldrar. 81 % av brännskadorna var skållskador.

Föräldrarnas uppfattningar om faktorer som påverkat att barnen drabbades av skållskador (studie ΙΙΙ) kan beskrivas i två teman: ”Avvikelse från det normala” och ”Missbedömning av barnets förmåga”. En av faktorerna som enligt föräldrarna påverkat att olyckan hände kunde vara att något oförutsatt inträffade, som ett oväntat besök eller att någon familjemedlem var trött eller stressad. Föräldrarna beskrev att de ofta överskattade sina barns förmågor att förstå faror och inte var medvetna om vad barnen kunde förmå att göra förrän barnen hade gjort det. Det handlade om missbedömningar av barnets snabbhet och räckvidd men också av barnets preventiva förmåga. Föräldrarna uppgav att de hade svårt att följa med i barnets snabba utveckling, särskilt under de två första levnadsåren.
Individanpassad utökad information i samband med hembesök, vid behov underlättade av hälsoinformatörer visade sig ha en mindre inverkan på mödrarnas attityder till barnolycksfall (studie ΙV) men en större inverkan på vidtagna åtgärder i hemmet för att minska risken för barnolycksfall (studie V).

Den viktigaste slutsatsen som kan dras från resultatet av studierna är att mödrarna både underskattar och överskattar barnens förmågor och aktiviteter i hemmet och att riktad och individanpassad rådgivning kan motivera mödrarna att vidta fler olycksförebyggande åtärder i hemmet. Vidare väcks frågan hur barnhälsovården når och möter föräldrarna med sin information om förebyggande åtgärder. Kunskaperna från dessa studier, stödjer barnhälsovården att arbeta mer individanpassat.

Senast uppdaterad av Magnus Jando