Effectiveness of parental supervision to prevent injuries in children

Conclusion: Indications for effectiveness

There is some indirect evidence in support of the notion that supervision serves a protective function and can reduce children’s injury risk (Morrongiello et al., 2009). A lapse in caregiver attention is a possible contributing factor for a variety of types of injuries affecting children, including drowning, pedestrian injuries, poisoning, choking, playground injuries, dog bites, escalator injuries, falls, and injuries from handling dangerous substances in grocery stores or at home. Notions of supervision are based on intuitive grounds as opposed to convincing evidence (Morrongielloet al., 2009 and Petrass et al., 2009). Epidemiological findings also support the case that supervision influences risk of injury: there is frequency of injuries for children living in families with only a single parent or with multiple siblings at home, which are both characteristics that can decrease the potential for supervision.

Some studies have shown that when young children are injured there is often reduced supervision at the time (Morrongiello et al., 2009, Petrass et al., 2009 and Schwebel et al., 2009). In a prospective study of children’s minor injuries in the home, the patterns of supervision provided by parents to 2- to 3-year-olds at the time of injury revealed 5 levels of supervision, and as supervision level decreased, there was an increase in the frequency of children’s injuries. Similarly, research relating reports of supervision on a questionnaire measure (PSAPQ) to children’s injury histories revealed that mothers who more strongly endorsed statements indicative of supervision (eg, “I keep a close watch on my child”) had children with a history of fewer injuries. Most recently, in a study applying a casecontrol design, the supervision provided to “injured children” (cases) at the time of injury was compared with that experienced by same-age/sex-matched “uninjured ill children” (controls) the last time they did the play activity that resulted in injury to their matched case, with all children recruited at the same hospital emergency department to match for demographic characteristics. Results revealed significantly lower levels of supervision for injured than uninjured children, and this pattern emerged across several measures of supervision. The results of an prospective study in young elementary-school children suggests that caregiver supervision influences risk of injury across a broad age range throughout childhood (Morrongiello et al., 2011).

The relation between supervision and childhood injury is complex. Not all children incur injuries under reduced supervision conditions. The level of supervision often interacts with children’s behavioral attributes to influence risk of injury. Also the level of environmental risk is critical. What constitutes adequate supervision may need to reflect a consideration of the interactions between the environment and caregiver and child characteristics (Morrongiello et al. 2009 and Saluja et al., 2004).

Recommendations (for research & practice)

Research recommendations:
- Further research is required to confirm or refute the findings that reduced supervision does indeed increase injury risk. Future work must use appropriate definitions of supervision; validated tools to measure supervision, preferably with some validation of selfreported supervision by observation; a control group that minimises the potential for selection bias (ie, community controls); a large sample size which allows statistical power to explore potential interactions between a range of factors and supervision, such as child age, gender, behaviour and temperament, safety behaviours and risk-taking, safety equipment and environmental hazards, and caregiver mental health; and a study population which maximises study generalisability (eg, a wide range of medically attended injuries, from multiple healthcare providers, providing services to varied populations). Further exploration is also needed of the potential explanations for why a positive attitude towards supervising is associated with a reduced risk of injury.
- Researchers should try to unpack the relative contributions of each part of the supervision taxonomy—attention, proximity and continuity—and investigate how each might work independently and concurrently to decrease paediatric injury risk.
- Hearkening the classic temperament theory of ‘‘goodness of fit’’, future research might study the interactions between caregiver factors, child factors and the environment, and how these interactions together translate to injury risk.
- There is a need to translate knowledge into practice. As we continue to gain insights into how the process of supervision reduces paediatric injury risk, we should simultaneously translate that knowledge into theoretically-based intervention and prevention programmes, designed to improve supervision of children at risk for injury and evaluate these programmes using rigorous methodology.

Recommendations for practice:
It is becoming evident that caregivers providing direct attention, with closest proximity on a continual basis, best ensures child safety. However research findings make it difficult to prescribe a fixed set of guidelines for what constitutes adequate supervision.

Review Date: 02/07/2012
Version: 1.1
Status: Publish

Articles (reviews) and reports were included that were published between 1980 and 2011, in English and Dutch. The outcomes of the study were reviewed by the Dutch Consumer Safety Institute.

Strategy: An online literature search was performed by a researcher of the Consumer Safety Institute and after this a more thorough search was performed by the documentation centre of CSI (Catalog CenV, Pubmed, Injury lit, Google, Websites, 'Grey' literature). Results of each search were compared on differences and potential missed studies were added. First the titles and then abstracts were scanned in order to include relevant studies. In the case of insufficient information obtained from abstracts the full text articles were obtained. Relevant articles were scrutinized and background documents were created. In addition, relevant references of included articles were checked on new and relevant articles (i.e., snowball search).

The outcomes of the study were reviewed by an expert in the field of child safety in the summer of 2012.

Background documents

Caregiver supervision and injury risk for young children: time to re-examine the issue (version 1.0)
D.C. Schwebel, D. Kendrick (2009)

Child injury : the role of supervision in prevention (version 1.0)
Barbara A. Morrongiello, Stacey L. Schell (2009)

Parent/Caregiver supervision and child injury: a systematic review of critical dimensions for understanding this relationship (version 1.1)
Lauren Petrass, Jenny D. Blitvich, Caroline F. Finch (2009)

"I think he is in his room playing a video game" : parental supervision of young elementary-school children at home (version 1.0)
Barbara A. Morrongiello, Alexa Kane, Daniel Zdzieborski (2011)