Research In Action

In my practice, I spend a significant amount of time discussing and treating behaviors that could lead to unsafe behaviors. My patients are at higher risk for injuries due to their developmental delays, behavioral issues, or both. It is because of this that I read with interest a recent study examining the safety-related concerns of parents of children with a variety of disabilities.

This study caught my eye because previous studies tended to examine health concerns specific to different conditions, but this study's authors felt that a non-categorical approach was important and could help to inform the development of a shared intervention strategy among families of children with a variety of health conditions. 

The study used a qualitative approach to assess the safety-related concerns of parents of children with various health conditions and developmental disabilities, and examined how those concerns were related to the characteristics of the child's health problem (e.g., delayed development, behavioral difficulties, or chronic health condition).

Participants were 16 mothers and two fathers, all residents of the greater Vancouver metropolitan area of British Columbia, Canada, who were parents of a 1- to 5-year-old child with a chronic condition or disability. The child had to have received services within the past year from the provincial pediatric hospital or health center or from a physician related to their health condition (and who had a working knowledge of English). A child disability was defined as limitations related to mobility, hearing, seeing, or developmental delay; in addition, daily activities had to have been impacted for more than 6 months. 

In-person semi-structured interviews by two researchers consisted of 13 open-ended questions, addressing the nature of the child's health conditions and the parents' safety related concerns and challenges associated with the health conditions. 

From this study, three major themes of safety concerns emerged:

1. Child's understanding of danger: Both a child's awareness of the safety risks in his environment and the ability to effectively communicate the risks of injury was relevant among parents whose children had "poor cognitive awareness," and particularly among parents of children with conditions that included both behavioral difficulties and cognitive delays (e.g., fetal alcohol syndrome). Though this theme was not voiced by a majority of parents, it was a very significant concern among those who did. 

2. Child's interactions with physical environment:

• Child movement: Both increased and decreased levels of movement/motor ability were associated with safety concerns described by more than two-thirds of the parents. Movement-related concerns included falls, burns, and being hit by a moving vehicle. Concerns were voiced among parents of children with a variety of both behavioral and other chronic conditions, like diabetes.
• Ingestions: Concerns about ingestion, including choking, aspiration, and poisoning, were also voiced among parents with children who had a variety of conditions. For parents of children with developmental delays, concerns tended to be related to aspiration and choking. For parents of children with behavioral issues, concerns tended to be related to ingestion of foreign objects and nonfood items.

3. Child's interactions with social environment: Just as with the theme of a child’s understanding of danger, concerns about how a child interacts with his social environment (e.g., stranger abduction or lack of stranger anxiety) were not reported as widely among the parents, but those parents who did report these concerns expressed that they caused significant stress and required much more intensive child monitoring.

More research in this area is needed, but my initial takeaway from this study is that for our clinic, we could consider creating anticipatory guidance materials for all families related to ingestions and physical movement, since these concerns were shared more widely among families impacted by a variety of conditions. However, for danger awareness and social environmental risks, a more individualized and tailored approach remains appropriate.

For more safety tips for children with special needs, visit the Safe Kids website.