Children’s Injury Risk Is Greater After Injury to a Sibling

Children are more likely to suffer unintentional injuries in the 180 days following a sibling’s injury, according to a study by researchers at the Harborview Injury Prevention and Research Center published in the January 2003 issue of the Journal of Pediatrics.

The researchers tracked 16,335 children below the age of 16 enrolled in Group Health Cooperative of Puget Sound between 1995 and 1997. Of this group, 5,851 children sustained 8,973 injuries. Children whose siblings had sustained recent injuries had a 36 percent greater chance of needing medical care for an injury over the next six months.

“Injuries are a leading cause of death and disability in childhood, yet unlike other causes of pediatric death and disability, injuries are almost always preventable,” says Dr. Brian Johnston, principal investigator for the study. Johnston is chief of pediatrics at Harborview Medical Center and a University of Washington (UW) assistant professor of pediatrics. “Knowing that there’s a pattern of injuries among siblings can help us focus on ways to help these children during a period of increased vulnerability.”

Family stress, decreased adult supervision, or temporary exposure to a hazardous environment may all be factors increasing a child’s risk after a sibling has been injured. Using the first injury as a clinical marker, a physician or nurse could make initiate a brief, targeted intervention to decrease the injury risk for a second child.

“The number needed to treat” is the hypothetical number of children to whom the intervention would be applied in order to prevent one injury event, Johnston explains. “If we had an intervention that effectively addressed the increased risk, ‘the number needed to treat’ would be about five,” he says.

“This number is within reason for a cost-effective intervention program,” Johnston says. “And since the period of vulnerability is short, interventions could conceivably be brief and targeted.”

Possible interventions after the injury to a first child might include home visits by public-health nurses to assess risks posed by the physical environment and social stresses that may be present in the family. Depending on the risk factors identified, nurses could make recommendations or referrals to community resources in an effort to decrease a second child’s vulnerability to injury.

In addition to Johnston, the investigators were Dr. David Grossman, a UW professor of pediatrics and director of the Harborview Injury Prevention and Research Center, and Dr. Robert S. Thompson of the Center for Health Studies at Group Health Cooperative of Puget Sound.