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Injuries among children in home and out-of-home care
J B Kotch1, V M Dufort, P Stewart
1Department of Maternal and Child Health, University of North Carolina at Chapel Hill, 27599-7400, USA.
Insights
Child care safety was compared between out-of-home care and home care settings. While minor injuries were more frequent in center-based care, severe injury risks were similar across all settings for children under five.
Area of Science:
- Pediatric safety research
- Child development studies
- Public health surveillance
Background:
- Increasing use of out-of-home care settings for children in the U.S.
- Growing concerns about injury risks in non-parental care environments.
Purpose of the Study:
- To compare the safety of out-of-home care settings versus in-home care for young children.
- To analyze injury patterns and rates across different child care arrangements.
Main Methods:
- Prospective cohort study involving 656 families in North Carolina.
- Data collected via monthly telephone interviews over one year for children under 5.
- Analysis of minor and severe injuries in home care (HC), center-based care (CBC), and other out-of-home care (OOHC) using statistical modeling.
Main Results:
- Minor injury rates were highest in center-based care (CBC), followed by home care (HC), then other out-of-home care (OOHC).
- Potential reporting biases may influence OOHC injury rate estimates.
- No statistically significant differences were found in severe injury rates among the three care settings.
Conclusions:
- The risk of severe injury for children under 5 is comparable across center-based care, home care, and other out-of-home care.
- Despite higher minor injury rates in center-based care, serious harm is not more likely compared to other settings.
Unlabelled:
As the number of children receiving care in out-of-home settings increases in the United States, the risk of injury in such settings has become the subject of intense research.
Objectives:
This study examined the relative safety of out-of-home care compared with care in a child's own home.
Methods:
This community based prospective cohort study of 656 families in three adjacent counties in the Piedmont region of North Carolina characterizes the patterns and rates of injuries among children less than 5 years of age in three child care settings, home care (HC), center based care (CBC), and other out-of-home care (OOHC). Information about minor and severe injuries was obtained from parents using monthly telephone interviews over a one year period. Statistical modeling designed to handle unbalanced data with correlated observations was used as the primary tool for analysis.
Results:
Rate of minor injuries was highest in CBC, followed by HC, and then OOHC. However, these differences for OOHC may have been due to reporting biases and errors in rate estimates. There were no significant differences in severe injury rates among the three settings.
Conclusions:
The risk of serious injury among children under 5 in CBC is not different from that of children in HC or OOHC despite the fact that the risk of minor injury is higher.