March 6, 2000
Children more vulnerable to trauma after injury to a sibling
Children are more likely to suffer unintentional injuries within 90 days of a sibling?s injury, according to a study conducted at the Harborview Injury Prevention and Research Center published in the March 2000 issue of Pediatrics. Shared exposures to certain social and environmental factors may lead to this clustering, and these risk factors may be amenable to injury-prevention programs.
“Injuries are a leading cause of death and disability in childhood, yet unlike other causes of pediatric death and disability, injuries are almost totally preventable,” explains Dr. Brian D. Johnston, principal investigator for the study and a University of Washington (UW) acting assistant professor of pediatrics. “Knowing that there appears to be a pattern to injuries to siblings can help us focus attention on children during specific periods of vulnerability.”
Researchers looked at data over a 12-month period involving children up to the age of 16 who lived in King County and were eligible for Medicaid. During this period, 5,003 injuries suffered by 4,162 children required emergency-room care or hospitalization.
“These were unintentional injuries,” explains Johnston, “We excluded intentional injuries that resulted from child abuse or other inter-personal violence.” Researchers found that children whose siblings were injured up to 90 days earlier were considerably more likely to suffer their own injuries, compared with children with uninjured brothers or sisters.
“The risk of injury to a second child is at its greatest (224 percent) the second week after a sibling?s injury and still is 50 percent greater for the month following the first injury,” Johnston says. “Thinking of a child as being ?accident-prone? simply blames the victim, when, in fact, there may be elements in a child?s social or physical environment that account for his or her increased risk of injury.”
Stressful events, such as a parent?s marriage, divorce or illness, or the birth of another child have been associated in previous studies with the increased risk of medical problems, including unintentional injuries. The new study adds a recent injury to another sibling as a key risk factor, possibly because of the stress resulting from the first injury or because of changes in adult supervision while caring for the first injured child.
Possible interventions after the injury to a first child might include home visits by public-health nurses to assess risks posed by the physical environment and social stresses that may be present in the family. Depending on the risk factors identified, nurses could make recommendations or referrals to community resources in an effort to decrease a second child?s vulnerability to injury. “And since the period of vulnerability is short, interventions could conceivably be brief, targeted and quite cost-effective,” says Johnston.
In addition to Johnston, the study was written by Dr. David Grossman, a UW associate professor of pediatrics and co-director of the Harborview Injury Prevention and Research Center; Dr. Frederick Connell, a UW professor and director of Maternal & Child Health; and Dr. Thomas Koepsell, a UW professor and chairman of Epidemiology.