Home safety measures and the risk of unintentional injury among young children: a multicentre case-control study

Background: Young children may sustain injuries when exposed to certain hazards in the home. To better understand the relation between several childproofing strategies and the risk of injuries to children in the home, we undertook a multicentre case-control study in which we compared hazards in the homes of children with and without injuries. Methods: We conducted this case-control study using records from 5 pediatric hospital emergency departments for the 2-year period 1995-1996. The 351 case subjects were children aged 7 years and less who presented with injuries from falls, burns or scalds, ingestions or choking. The matched control subjects were children who presented during the same period with acute non-injury-related conditions. A home visitor, blinded to case-control status, assessed 19 injury hazards at the children's homes. Results: Hazards found in the homes included baby walkers (21% of homes with infants), no functioning smoke alarm (17% of homes) and no fire extinguisher (51% of homes). Cases did not differ from controls in the mean proportion of home hazards. After controlling for siblings, maternal education and employment, we found that cases differed from controls for 5 hazards: the presence of a baby walker (odds ratio [OR] 9.0, 95% confidence interval [CI] 1.1-71.0), the presence of choking hazards within a child's reach (OR 2.0, 95% CI 1.0-3.7), no child-resistant lids in bathroom (OR 1.6, 95% CI 1.0-2.5), no smoke alarm (OR 3.2, 95% CI 1.4-7.7) and no functioning smoke alarm (OR 1.7, 95% CI 1.0-2.8). Interpretation: Homes of children with injuries differed from those of children without injuries in the proportions of specific hazards for falls, choking, poisoning and burns, with a striking difference noted for the presence of a baby walker. In addition to counselling parents about specific hazards, clinicians should consider that the presence of some hazards may indicate an increased risk for home injuries beyond those directly related to the hazard found. Families with any home hazard may be candidates for interventions to child-proof against other types of home hazards.