Household composition and fatal unintentional injuries related to child maltreatment

To determine if household composition is an independent risk factor for fatal unintentional injuries related to child maltreatment.

A population-based, case-control study using data from the Missouri Child Fatality Review Program for 1992-1999.

Children under age five who died during the 8-year study period were eligible for study. Cases were defined as children who died of an unintentional injury that occurred when a parent or other adult caregiver: (a) was not present, (b) was present but not capable of protecting the child, (c) placed the child in an unsafe sleep environment, or (d) failed to use legally mandated safety devices. Controls were randomly selected from children who died of natural causes. Household composition was classified based on relationship of the adults living in the household to the deceased child. The five household composition categories were households with: (a) two biologic parents and no other adults, (b) one biologic parent and no other adults, (c) one or two biologic parents and another adult relative, (d) stepparents or foster parents, and (e) one or two biologic parents and another unrelated adult. Logistic regression analyses were conducted and odds ratios estimating the risk of maltreatment-related unintentional death associated with each household category compared to the reference households: those with two biologic parents and no other adults.

Three hundred eighty children met the case definition. Children residing within households with adults unrelated to them had nearly six times the risk of dying of maltreatment-related unintentional injury (adjusted odds ratio [aOR] 5.9; 95% confidence interval [95% CI] 1.9-17.6). Children residing with step or foster parents and those living with other, related adults were also at increased risk of maltreatment death (aOR 2.6, 95% CI 1.0-6.5; and aOR 2.1, 95% CI 1.0-4.5, respectively). Risk was not elevated for children in households with a single biologic parent and no other adults in residence.

Young children residing in households with unrelated adults, step-parents, or foster parents are at increased risk of fatal unintentional injury related to maltreatment. Nurses can use the findings of this study to facilitate injury prevention by identifying families at risk for fatal unintentional injuries and providing these families with targeted education or referral.