Inj Prev 16:293-295 doi:10.1136/ip.2009.024802
  • Commentary

Care giver supervision and child injuries: consideration of different contexts when translating knowledge into practice

  1. Masao Ichikawa2
  1. 1Department of Preventive Medicine, St Marianna University School of Medicine, Kawasaki, Japan
  2. 2Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba-shi, Ibaraki-ken, Japan
  1. Correspondence to Dr S Nakahara, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan; snakahara{at}
  1. Contributors SN conceived the ideas in this paper; SN and MI contributed equally to preparing and critically revising the manuscript.

  • Accepted 3 May 2010
  • Published Online First 19 July 2010


Accumulating evidence shows that appropriate care giver supervision can reduce child injury risk.1–4 In an editorial, Schwebel and Kendrick5 indicated the necessity of translating such knowledge into practice, taking into consideration cultural and societal differences. This consideration is crucial when we transfer knowledge obtained in high-income countries (HICs) to low- and middle-income countries (LMICs) with differences in culture and society, living environments, and childcare patterns.

The editorial cited a debate in this journal 13 years ago that argued a lack of evidence to call for greater parental supervision, noting the abundance of empirical evidence available today compared with the scarcity at that time.6 The older debate between Roberts6 and Levene7 raised two practical issues that should be clarified in devising culturally appropriate interventions, issues that we think are still valid: how childcare responsibilities should be shared among family members and society, and how strategies should be effectively balanced between supervision and environmental approaches. Without such considerations, the necessity of greater supervision may not be translated into practice, particularly in societies where care givers, mainly mothers, are overburdened with conflicting tasks, including household chores, and are faced with hazardous environments necessitating constant vigilance to protect their children.8–11 Mothers will have problems providing better child protection unless they have access to childcare support. Thus, in this article, we explore ways to better achieve child safety by alleviating the difficulties that care givers face in protecting children.

Challenges in LMICs

In LMICs, parents tend to have more difficulties than their counterparts in HICs in providing appropriate child supervision. This is mainly because of poor infrastructure and insufficient public policies to support families. For example, in rural areas where access to water …

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