Injury and health among toddlers in vulnerable families

Injury is consistently a leading cause of death for young children, and social stressors can increase injury risk. We investigated the incidence of injury and developmental and health outcomes among children up to 3 years of age in a cohort of vulnerable families.

The Fragile Families and Child Wellbeing Study is a longitudinal cohort of approximately 5,000 families across the United States, which deliberately oversamples unwed couples and lower income families. Data from interviews with mothers conducted shortly after birth and follow-up surveys at 1 year and 3 years were used for this analysis. Multivariate regression analysis was used to identify independent risk factors for injury.

Three-year follow-up data on injury were complete for 3,153 families. Three hundred nineteen children (10.2%) were injured in the first year and 386 (12.4%) in the third year. Eighty-one children suffered injuries noted in both survey periods. Children injured in the first year were twice as likely to have been reinjured in the third year, and previous injury was the strongest predictor of subsequent injury (OR, 1.96; 95% confidence interval, 1.41-2.71; p < 0.01). Injured children who were healthy as infants were nearly twice as likely to have "poor" or "fair" health as uninjured children in their third year (p < 0.01).

Children in vulnerable families are at high risk for injury. In particular, children injured within the first year of life are at high risk for recurrent injury and poor health outcomes. Increased support and targeted interventions may improve outcomes and decrease childhood injury burden among at-risk families.