Injuries among children in home and out-of-home care.
As the number of children receiving care in out-of-home settings increases in the United States, the risk of injury in such settings has become the subject of intense research.


OBJECTIVE
This study examined the relative safety of out-of-home care compared with care in a child's own home.


METHODS
This community based prospective cohort study of 656 families in three adjacent counties in the Piedmont region of North Carolina characterizes the patterns and rates of injuries among children less than 5 years of age in three child care settings, home care (HC), center based care (CBC), and other out-of-home care (OOHC). Information about minor and severe injuries was obtained from parents using monthly telephone interviews over a one year period. Statistical modeling designed to handle unbalanced data with correlated observations was used as the primary tool for analysis.


RESULTS
Rate of minor injuries was highest in CBC, followed by HC, and then OOHC. However, these differences for OOHC may have been due to reporting biases and errors in rate estimates. There were no significant differences in severe injury rates among the three settings.


CONCLUSIONS
The risk of serious injury among children under 5 in CBC is not different from that of children in HC or OOHC despite the fact that the risk of minor injury is higher.
Kotch
J B
JB
Department of Maternal and Child Health, University of North Carolina at Chapel Hill, 27599-7400, USA.
Dufort
V M
VM
Stewart
P
P
Fieberg
J
J
McMurray
M
M
O'Brien
S
S
Ngui
E M
EM
Brennan
M
M
D000061:Accidents, Home; D002654:Child Care / Q000706:statistics & numerical data; D002656:Child Day Care Centers / Q000706:statistics & numerical data; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012578:Schools, Nursery / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000517:prevention & control