title: Childhood accidents: the relationship of family size to incidence, supervision, and rapidity of seeking medical care.
abstract: BACKGROUND
  Large family size may be a risk factor for childhood accidents. A possible association with quality of child supervision and rapidity of seeking medical care has not been fully evaluated.
  
  
  OBJECTIVE
  To determine whether children with multiple siblings are at increased risk for accidents, to assess whether quality of child supervision varies with family size, and to evaluate the relationship of family size with the rapidity of seeking medical care after an accident.
  
  
  METHODS
  We prospectively studied 333 childhood accidents treated at TEREM (emergency care station) or the Shaare Zedek Medical Center. Details on family composition and the accident were obtained through parental interview. Family size of the study population was compared with that of the Jerusalem population. Families with one to three children (Group 1) and four or more children (Group 2) were compared with regard to type of supervision and different "Gap times" - the time interval from when the accident occurred until medical assistance was sought ("Gap 1"), the time from that medical contact until arrival at Shaare Zedek ("Gap 2"), and the time from the accident until arrival at Shaare Zedek for those children for whom interim medical assistance either was ("Gap 3A") or was not ("Gap 3B") sought.
  
  
  RESULTS
  Children from families with 1, 2, 3, 4 and > or =5 children comprised 7.2%, 18.3%, 14.4%, 18.6% and 41.4% of our sample compared to 20.4%, 21.8%, 18.4%, 14.7% and 24.7% in the general population respectively. Children from Group 2 were less often attended to by an adult (44.5% vs. 62.0%) and more often were in the presence only of other children at the time of the accident (27.0% vs. 10.5%). Gaps 1, 2 and 3A in Group 2 (6.3 hours, 16.5 hours, 27.8 hours respectively) were longer than for Group 1 (2.7, 10.7, 13.3 hours respectively).
  
  
  CONCLUSIONS
  The risk for accidents is increased among children from families with four or more children. The adequacy of child supervision in large families is impaired. There is a relative delay from the time of the accident until these children are brought for treatment.
authors.affiliation: Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel. sls909@yahoo.com
authors.forename: Shepard
authors.initials: S
authors.lastname: Schwartz
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Eidelman
authors.forename: Amin
authors.initials: A
authors.lastname: Zeidan
authors.forename: David
authors.initials: D
authors.lastname: Applebaum
authors.forename: David
authors.initials: D
authors.lastname: Raveh
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data*; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005191:Family Characteristics; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D007557:Israel / Q000453:epidemiology; D008297:Male; D017678:Sex Distribution; D013997:Time Factors; D014947:Wounds and Injuries / Q000145:classification