Adult supervision and pediatric injuries in the agricultural worksite

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Abstract

Appropriate supervision is recommended as a strategy to prevent pediatric farm injuries, yet virtually nothing is known about the quality of adult supervision on farms. We therefore explored the nature of adult supervision among pediatric farm injury cases using three theoretically relevant dimensions of supervision: (1) attention, (2) proximity, and (3) continuity. We examined a retrospective case series of 334 pediatric farm injury cases from Canada and the United States that resulted in death or required hospitalization. Patterns of supervision were coded according to the three dimensions. Approximately two-thirds of the injured children (231/334; 69%) had an adult supervisor available (attention). The supervisor was in close proximity of the child in only about half the cases (169/334; 51%) and it was even less common for the supervision to be continuous (37%). Thus, many injuries occurred when children were inadequately supervised. However, approximately one-third of the injured children (112/334; 34%) had what in other circumstances would be considered adequate adult supervision at the time of their injury event, defined theoretically as having supervision available, proximal, and continuous. Yet, children on farms were injured even in the presence of adequate adult supervision. These findings, along with a growing body of literature examining pediatric farm injuries, suggest a need to develop a new definition of adequate adult supervision within the context of the agricultural work environment, or to consider restricting the access of children, especially the very young, to this hazardous worksite.

Introduction

Agricultural injuries to children on farms have long been recognized as an important problem for public health. Farm children continue to experience high rates of premature mortality (Adekoya and Pratt, 2001, Brison et al., 2006, Castillo et al., 1999, Rivara, 1997), morbidity (CDC, 1998, Hendricks et al., 2005, Pickett et al., 2005), and disability (Reed and Claunch, 2000) due to injury. Each year more than 100 children in the United States die from agricultural injuries (Adekoya and Pratt, 2001) and nearly 23,000 children sustain agricultural injuries that require medical treatment or restrict their activity (Hendricks et al., 2005). Elevated risks observed in the United States are shared by populations of children internationally, for example among farm children in Canada (Brison et al., 2006), Australia (Mitchell et al., 2001), Finland (Rissanen and Taattola, 2003), and India (Tiwari et al., 2002). However, very little is understood about the etiology of these injury events beyond the mechanisms that lead to trauma. One prevention recommendation that is often cited is the need for parents to provide “more” or “better” supervision of children in the agricultural worksite (DeMuri and Purschwitz, 2000, Fisher et al., 2001, Hawk et al., 1991, Pickett et al., 1995, Salmi et al., 1989). Yet, there is virtually nothing known about the quality of adult supervision on the farm or the nature of supervision at the time of injury.

In the general pediatric injury literature, there has been increasing interest in studying supervisory behaviors by caregivers and relating these behaviors to child injury risk (Morrongiello, 2005). Although there is little agreement among professionals about what constitutes adequate supervision to prevent childhood injury (Peterson et al., 1993), prospective study designs have recently been used to track home injuries to children and to identify patterns of supervision associated with increased risk of children (Morrongiello and House, 2004, Morrongiello et al., 2004, Morrongiello et al., 2006). Based on this research, three dimensions of supervisory behaviors have emerged as important: (1) attention to the child (watching, listening), (2) proximity of the supervisor (close proximity to the child allows for greater readiness to intervene), and (3) continuity of supervisory behaviors in time (extent of sustained attention and proximity to the child over time). Thus, based upon emerging theory, adequate supervision can be operationally defined as continuous (sustained) behaviors that index attention (watching and listening) and proximity (within arm's reach) to the child. This supervision framework posits that as attention, proximity, and continuity increase, the quality of supervision increases and the risk of injury presumably decreases (Morrongiello, 2005, Saluja et al., 2004).

Building on these findings, the purpose of this study was to explore the nature of adult supervision among pediatric farm injury cases using the supervision dimensions of attention, proximity, and continuity. Our specific objectives were to review existing cases of traumatic pediatric farm injury and (1) describe the patterns of supervision by age of the child, gender of the child, child activity, and location of the injury event, and (2) determine whether patterns of supervision observed in association with these injury events were consistent with the existing principles used to describe adequate adult supervision in the general pediatric injury literature.

Section snippets

Study design

A review of two retrospective case series of pediatric agricultural injuries that had been previously assembled for a study on the efficacy of the child labor laws for injury prevention was conducted (Marlenga et al., 2007). The case series represented fatal and hospitalized injuries from Canada, as well as fatal work-related injuries from the United States. We were deliberate in examining a range of serious traumatic injuries across two main contexts: (1) when children were working on the

Full case series

There were 334 injured children in the full case series (Table 1) and more than half were 6 years or younger (172/334, 51%). The majority of injured children were male (264/334, 79%), lived on the farm (260/334, 78%), and were the children of the farm owner/operator (254/334, 76%). Most (228/334, 68%) were not involved in farm work at the time of injury. The majority of fatal injuries (119/175, 68%) involved tractors and/or farm machinery (mechanized).

Attention (availability of an adult supervisor)

An adult supervisor was available for the

Discussion

Drawing on recent research in the general pediatric injury literature, this study examined three aspects of supervision (attention, proximity, continuity) in order to assess the nature of adult supervision at the time of pediatric farm injury occurrence and determine if emerging conceptualizations of adequate adult supervision apply to the farm context (Morrongiello, 2005). Our findings showed that among cases of injured children, the quality of adult supervision was frequently compromised.

Strengths and limitations

To our knowledge, this study is the first to explore the nature of adult supervision in the agricultural worksite and it fills a critical gap in the literature. Further, we used a theoretical model of supervision that has shown utility in the general pediatric injury literature. Nonetheless, several potential limitations should be considered in interpreting the findings and planning for future research on this topic.

First, we evaluated adult supervision in cases of injury, not supervision on

Conclusion

Inadequate adult supervision was common among our case series of pediatric farm injuries. Nonetheless, even in the presence of what traditionally would be defined as adequate adult supervision according to accepted theoretical criteria (attention, proximity, continuity), children exposed to the agricultural worksite still were seriously injured or killed. Consistent with prior research on children's injuries in non-farm contexts, we found that discontinuities in supervision and inattentiveness

Acknowledgements

This study was sponsored by the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health (R01 OH008046), the Social Sciences and Humanities Research Council of Canada, and the Canadian Institutes of Health Research. The authors extend their gratitude to all the individuals who helped access the data for this case series including the National Agricultural Statistic Service, John Myers at NIOSH, and the following Provincial Coroners’ Offices and Hospitals:

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