Epidemiology of Infant Injury Among Home-Visited Families in Pennsylvania

Background: Reducing child injury is a Healthy People 2020 priority. Maternal and child home visiting programs provide parent training and home safety education to reduce infant and early childhood injury and prevent maltreatment among high-risk families. A clearer picture of the epidemiology of infant injury experiences among home visited families is needed to inform quality improvement efforts for injury reduction.

Methods: Retrospective cohort analysis of first-born children of clients enrolled in Nurse-Family Partnership (NFP) in Pennsylvania from 2008-2014. Primary data sources included program enrollment files and medical assistance claims for emergency department visits and inpatient hospitalizations. Injury episodes were identified using ICD-9 codes and classified by type. All claims with the same or a related injury diagnosis occurring within a 180-day interval were counted as a single injury episode with the exception of superficial injuries and poisonings (counted within 30 days) and dislocations (within 42 days). The distributions of frequency and type of injury episodes within the first 24 months of life are reported. Additionally, injury distributions are reported within age categories corresponding with stages of mobility in months: 0-1 (newborns); 1-8 (precruisers); 9-12 (cruisers); 13-18 (walkers); and 19-24 (toddlers).

Results: A total of 8,736 children of NFP clients were observed between 2008 and 2014 with 2,149 injury episodes among them. Nearly one in five (19.8%; n=1,729) children experienced an injury episode. Of these children, 19.6% (n=339) presented with more than one injury episode. Time to first episode was on average 13 months after birth. Increased mobility was associated with a higher prevalence of injury within age categories: 0.7% of newborns, 5.5% of precruisers, 4.7% of cruisers, 9.8% of walkers, and 9.3% of toddlers presented with injury. While superficial injuries were the most common injury type across all ages (range: 56.7% of newborn episodes to 72.0% of toddler episodes), the distribution of injury types varied between younger and older children, such that higher severity injuries (traumatic brain injury, abuse) made up a larger proportion of injury episodes among newborns and precruisers (11% and 6%, respectively) than among older children (4% and 1%, respectively). Moreover, for newborns and precruisers with multiple injury episodes, 20% of subsequent episodes included head trauma and/or abuse.

Conclusions: Injury prevalence corresponds with increases in independent mobility. Home safety education should prioritize the prevention of walking-related superficial injuries among mobile youth and special attention to maltreatment prevention in early infancy is warranted.