School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
BMC Pediatr. 2013 May 24;13:88. doi: 10.1186/1471-2431-13-88.
Unintentional poisoning in young children is an important public health issue. Age pattern studies have demonstrated that children aged 1-3 years have the highest levels of poisoning risk among children aged 0-4 years, yet little research has been conducted regarding risk factors specific to this three-year age group and the methodologies employed varied greatly. The purpose of the current study is to investigate a broad range of potential risk factors for unintentional poisoning in children aged 1-3 years using appropriate methodologies.
Four groups of children, one case group (children who had experienced a poisoning event) and three control groups (children who had been 'injured', 'sick' or who were 'healthy'), and their mothers (mother-child dyads) were enrolled into a case-control study. All mother-child dyads participated in a 1.5-hour child developmental screening and observation, with mothers responding to a series of questionnaires at home. Data were analysed as three case-control pairs with multivariate analyses used to control for age and sex differences between child cases and controls.
Five risk factors were included in the final multivariate models for one or more case-control pairs. All three models found that children whose mothers used more positive control in their interactions during a structured task had higher odds of poisoning. Two models showed that maternal psychiatric distress increased poisoning risk (poisoning-injury and poisoning-healthy). Individual models identified the following variables as risk factors: less proximal maternal supervision during risk taking activities (poisoning-injury), medicinal substances stored in more accessible locations in bathrooms (poisoning-sick) and lower total parenting stress (poisoning-healthy).
The findings of this study indicate that the nature of the caregiver-child relationship and caregiver attributes play an important role in influencing poisoning risk. Further research is warranted to explore the link between caregiver-child relationships and unintentional poisoning risk. Caregiver education should focus on the benefits of close interaction with their child as a prevention measure.
儿童意外伤害是一个重要的公共卫生问题。年龄模式研究表明,0-4 岁儿童中,1-3 岁儿童的中毒风险最高,但针对这一年龄组的具体危险因素的研究较少,且所采用的方法差异很大。本研究旨在采用适当的方法,研究 1-3 岁儿童意外伤害的广泛潜在危险因素。
将一组病例组(经历过中毒事件的儿童)和三组对照组(受伤、患病和健康的儿童)及他们的母亲(母子对)纳入病例对照研究。所有母子对均参加了 1.5 小时的儿童发育筛查和观察,母亲在家中回答一系列问卷。将数据分为三组病例对照对子进行分析,采用多变量分析控制儿童病例与对照组之间的年龄和性别差异。
最终的多变量模型中包含了五个危险因素,这些危险因素在一个或多个病例对照对子中出现。三个模型均发现,在结构化任务中,母亲在互动中使用更多积极控制的儿童,中毒的几率更高。两个模型表明,母亲的精神健康困扰会增加中毒风险(中毒-受伤和中毒-健康)。单独的模型确定了以下变量为危险因素:在冒险活动中母亲的监督不那么近(中毒-受伤),浴室中储存药物的位置更容易拿到(中毒-患病),育儿压力总水平较低(中毒-健康)。
本研究的结果表明,照顾者与儿童的关系性质和照顾者特征在影响中毒风险方面起着重要作用。需要进一步研究探索照顾者与儿童关系与意外伤害风险之间的联系。照顾者教育应侧重于与孩子密切互动的好处,作为预防措施。