Toddlers' and mothers' behaviors in an injury-risk situation: Implications for sex differences in childhood injuries

Toddlers' and Mothers' Behaviors in an Injury-Risk Situation: Implications For

Sex Differences in Childhood Injuries

B A R B A R A A . MORRONGIELLO A N D TESS D A W B E R University of Guelph

Injuries are the leading cause of death during childhood. Although many injuries to toddlers occur when children are at home and being supervised by caregivers, there has been little research examining how parents respond to children approaching injury-risk hazards. In the present study mothers and their toddlers were unobtrusively videotaped as they waited in an office containing a number of contrived hazards that could result in injury to the child. From the video records we examined when mothers attended to hazards (before or after the child approached the hazard), what they said or did (remove hazard, redirect child- verbally or physically), and children's responses to their mother's efforts to redirect them away from injury hazards. Other factors that were examined as potential influences on parents' responses included the child's injury history, the parent's report of the child's typical level of risk taking, and the child's level of receptive language development. Boys were more likely than girls to approach injury-risk hazards and were more likely immediately to touch or retrieve the item; frequency of touching hazards positively correlated with mothers' reports of children's risk taking and injury histories. Mothers used more, and more effortful, redirection strategies for boys, and boys were less compliant than girls in response to their mother's efforts to redirect them from hazards.

In the U n i t e d Sta tes and Canada , as in m o s t indus t r i a l i zed count r ies , u n i n t e n t i o n a l in jur ies

r a n k as the n u m b e r one cause o f dea th and a l ead ing cause o f vis i ts to e m e r g e n c y depar t -

m e n t s for ch i l d r en b e y o n d one yea r o f age (Baker , O ' N e i l l , & G i n s b u r g , 1992; C a n a d i a n

Ins t i tu te o f C h i l d Hea l th , 1994). T h e d i rec t and ind i rec t cos ts o f these in jur ies to soc ie ty are

s t agger ing , w i th e s t ima tes o f such cos ts p l aced at 174 b i l l ion dol la rs pe r yea r (Na t iona l

Safe ty Counc i l , 1991). A p p r o x i m a t e l y 14 m i l l i on days o f s choo l e a c h yea r are lost b y stu-

Direct all correspondence to: Barbara A. Morrongiello, University of Guelph, Psychology Department, MacKinnon Building, Guelph, Ontario N1G 2W 1 Canada <bmorrong @ uoguelph.ca>.

Journal ofApplied Developmental Psychology19(4): 625-639 Copyright© 1998 by Ablex Publishing Corp. ISSN: 0193-3973 All rights of reproduction in any form reserved.

625

626 MORRONGIELLO AND DAWBER

dents 6 to 16 years of age due to unintentional injuries (National Safety Council, 1991). Thus, unintentional injury is one of the most prevalent child health problems of our time.

Not all children, however, are at comparable risk for unintentional injuries. Probably the most striking finding in the epidemiological literature is that the incidence of injuries varies significantly with gender. For virtually every type of injury, boys sustain more frequent (e.g., Baker et al., 1992; Canadian Institute of Child Health, 1994) and more serious (Rivara, Bergman, LoGerfo, & Weiss, 1982) injuries than girls. This sex difference in injury rate starts to emerge by 3 years of age and increases throughout childhood (Baker et al, 1992; Matheny, 1991; Rivara et al., 1982). Although we have a limited understanding of why boys experience more injuries than girls (see Morrongiello, 1996 for discussion), the literature suggests several factors that contribute to sex differences in the incidence of injury.

In comparison to girls, boys have higher activity levels (Eaton, 1989), engage in more rough and tumble play, and are considered more impulsive (Block, 1983). The literature suggests too that boys engage in more exploratory and curiosity-seeking behavior than girls (Block, 1983) and that parents supervise boys less closely than girls (Fagot, 1974, 1978; Newson & Newson, 1976; Saegert & Hart, 1976), all of which may serve to increase boys' exposure to injury-risk situations. Moreover, boys not only have greater exposure to injury risk by virtue of their interests and behavior, but they also engage in more injury,risk behavior. For example, statistically correcting for sex differences in risk exposure often increases the size of the sex difference in injury rates (Rivara et al., 1982), suggesting that even when boys and girls engage in the same activities with the same frequency, boys perform these activities in a more risky fashion than girls, resulting in greater injuries. Consistent with this conclusion, naturalistic observations and laboratory studies indicate that boys engage in more risk taking (i.e., behaviors that place a person at risk of injury when there are alternatives that do not do so, cf. Furby & Beyth-Marom, 1992) than girls (Coppens & Gentry, 1991; Ginsburg & Miller, 1982; Rosen & Peterson, 1990). Recent literature suggests too that by the time children enter school, boys and girls have different beliefs and attitudes about injuries. Specifically, boys are more likely than girls to believe they will not get hurt when engaging in injury-risk behaviors, to rate the potential injury severity as low, and to attribute actual injury outcomes to bad luck as opposed to their own behaviors (Morrongiello, 1997; Morrongiello & Rennie, 1998). Thus, a number of factors contribute to boys experiencing more injuries than girls during childhood.

Research on parents' perception of children's vulnerability for injury indicates that parents are largely unaware of the scope of the child injury problem (Eichelberger, Gotschall, Feely, Harstad, & Bowman, 1990; Morrongiello & Dayler, 1996), and in the course of their daily lives they do not routinely think in terms of the potential for injuries to occur to their child (Morrongiello & Dayler, 1996). Nonetheless, when participating in research relevant to childhood injuries, parents respond in ways that suggest they are aware of the fact that children's risk of injury depends on a number of factors, including a child's developmental status and caregivers' behavioral choices (Garling & Garling, 1995; Mor- rongiello & Dayler, 1996; Peterson, Ewigman, & Kivahan, 1993; Wortel, deGeus, Kok, & Woerkum, 1994). In some laboratory studies parents report an appreciation of the need to teach young children to avoid potentially unsafe objects in the home (Gralinski & Kopp, 1993; Power & Chapieski, 1986) and to moderate their degree of supervision of children depending on the nature of the injury-risk situation and the child's developmental level

SEX DIFFERENCES IN CHILDHOOD INJURIES 627

(Fagot, Kronsberg, & MacGregor, 1985; Garling & Garling, 1993; Peterson et al., 1993). Surprisingly, however, several studies suggest that parents do not adjust safety-promotion practices for higher-risk children, such as boys or those previously injured (Glik, Kronen- feld, & Jackson, 1993), and this is true even if they recognize the child's increased risk of injury (Rosen & Peterson, 1987). In the present study we sought to further address the questions of whether parents' supervision varies for boys and girls or takes into account children's injury or risk taking histories, and we sought to do so using a more ecologically valid procedure than has been used in prior research. Specifically, we adopted a naturalistic observation approach and examined parents' supervision of their sons and daughters in an injury-risk setting when unaware of their being recorded and that the focus of the study was on parental reactions to their children's risk taking.

Although there has been little consideration given to whether parents supervise or respond to sons and daughters differently in hazardous situations, a number of findings suggest differential treatment of sons and daughters by parents in at least some circum- stances. In studies of adults' responses to boys' and girls' play behaviors, for example, it is commonly found that parents encourage boys to be involved in physically active games requiring large motor coordination, whereas girls are often steered towards calmer, safer activities (e.g., Jacklin, DePietro & Maccoby, 1984; Maccoby & Jacklin, 1974). Consistent with this, parents have been shown to respond negatively to girls when they engage in large motor activities (e.g., climbing), and respond negatively to boys when they play with dolls and other soft toys (Fagot, 1978). Many studies have found too that parental socialization practices and goals vary depending on the child's sex. Parents socialize boys to be less dependent and more autonomous than girls. For example, boys are more likely than girls to be given opportunities to play alone and assigned household chores that take them farther away from the house and the supervision of parents (Fagot, 1974; Fagot, 1978). In contrast, a review of studies on the socialization of girls suggest that girls are reinforced for dependent behaviors (Block, 1983). For example, girls are more likely to receive positive feedback for following their parents around the house and girls receive more frequent encouragement to stay close and help parents with chores (Fagot, 1978). Thus, boys appear to be less closely supervised than girls and to be socialized for greater autonomy than are girls.

In the present study mothers and toddlers (2 to 31/2 years) were unobtrusively videotaped in a laboratory setting containing contrived hazards. The only other study that used a similar methodology (Cataldo, Finney, Richman, Riley, Hook, Brophy, & Nan, 1992) compared the behavior of mothers of previously injured children with that of mothers of uninjured children in unstructured play in a simulated hazards setting. However, the mothers were fully aware of the purposes of the study, that the hazards were not real, and that their behavior was being video recorded, all of which may have biased their behavior. Cat- aldo et al. found that injured children were more disruptive, more active and had more contacts with hazards, whereas uninjured children had more appropriate behavior. Unfor- tunately, the authors did not assess for sex differences in children's behaviors, or whether this influences mothers' behaviors at all. Mothers of injured children had lower rates of play activities with their children. However, mothers of injured and uninjured children did not differ in the incidence of hazard warnings issued to their children, a finding that may reflect the knowledge mothers had of the purposes of the study. Moreover, unfortunately,


the authors did not report on children's responses to their mother's warnings or on what other strategies, if any, mothers used to moderate their child's interest in the hazards.

Although the present study used a similar methodology to that in the Cataldo et al. (1992) study, there were several unique aspects to the present study. First, the parent and toddler were video-taped unobtrusively and the parent was naive as to the focus of the study on children's risk taking, thereby increasing the likelihood that the hazards were interpreted as real by mothers and provoked naturalistic parental responses to the child's behavior. Second, in the present study we examined not only the child's injury history, but a number of additional factors that we reasoned might influence parental supervision and responses to injury hazards, including: parents' beliefs about the child's risk taking tenden- cies (Injury Behavior Checklist, cf. Speltz, Gonzales, Sulbacher, &Quan, 1990) and the child's level of receptive language development (Peabody Picture Vocabulary Test, PPVT- R, cf. Dunn & Dunn, 1981).

There were a number of questions we sought to answer in this study. First, we wished to determine if boys and girls differed in the frequency of their approaching hazards and/or in how they responded after approaching hazards, whether mothers respond differently to sons' as opposed to daughters' approaching hazards, and whether sons and daughters show differential compliance with their mother's intervention strategies. Second, we sought to examine the extent to which parents' responses to hazards were proactive (i.e., the parent removes the hazard before the child notices or approaches it, or diverts the behavior before an injury can occur) or reactive (i.e., the parent responds after the child has already approached or interacted with the hazardous item). We expected that parents might be more proactive for children they judged to be likely to engage in risk taking behaviors or who had a history of prior injuries. Finally, we sought to determine influences on parents' responses, including a consideration of the child's previous injury history, the parent's beliefs about the child's likelihood of engaging in risk taking behaviors that could lead to injury, and the child's receptive language level. Relating the mother's verbal responses to the child's level of receptive language development was expected to reveal if parents are more inclined to use verbal redirection strategies with more verbally advanced children. In addition to contrived hazards, a number of non-hazardous items that we expected to be of interest to children also were present. These non-hazardous items served to prevent the parent from becoming alerted to the aims of the study; the primary focus in analyses was on children's and parents' behaviors relevant to the hazardous items.

METHOD

Subjects

The sample comprised 30 mother-child pairs, including 30 normally developing toddlers, 15 boys and 15 girls between the ages of 21/2 and 31/2 years (M= 33 months, S D =

4 months); the boys and girls were matched for age, within one month, and all were first borns. No child had ever been hospitalized due to injury.

The sample was a diverse one, as indicated by maternal education and family income levels. The level of education reported by mothers in the sample ranged from high school to some graduate school: 23% had finished high school or taken some college courses, 60% had finished college or university, and 17% had completed some graduate or post-graduate


training. The family income level for the sample comprised 10% with a family income level in the less than 25,000 range, 47% with a family income in the 40 to 60,000 range, 30% with an income in the 60 to 80,00 range and 13% of the sample reporting family incomes greater than 80,000.

The sample was randomly drawn from a larger database of suburban families who expressed an interest in participating in child development research at the time the child was born; families were recruited for the database from a local hospital at the t ime of the chi ld ' s birth, with the hospital serving a community of approximately 100,000 people and covering a broad range of socioeconomic levels.

Materials

The session took place in a laboratory, which was set up to resemble an office with a sitting area. A video camera fitted with a wide angle lens was located in the ceiling hidden from the view of the participants, and provided a full view of the room (see Schematic diagram in Figure 1). The camera was located at one end of the room, the end at which many hazards were located, thereby providing a clear view of the child approaching hazards and making it easy to see which items were being touched by the child. Three microphones were unobtrusively placed in the room to provide an audio record of the session. Twelve contrived hazards (three for each of three injury types: bums, poisons, cuts, falls) and twelve non-hazardous items that pilot-test mothers rated as ' l ikely to recruit the chi ld ' s

Table 1. List of Hazardous and Non-Hazardous Items in the Room

NonHazardous Hazardous

Injury Item

fancy sunglasses Burn funny shape cup child's alarm clock child's picture frame child videotape boxes Cut interesting purse funny key ring coat with teddy bear

in the pocket keyboard Poison fun bookmarker in book children's books opened

to specific pages funny decoration on Fall

monitor

matchbook (empty) "hot" cup of tea (cold) "hot" coffee pot (cold)

scissors (dulled) stapler (empty) knife (dulled)

Windex (colored water) white out (empty) cigarette butts (fake)

stepladder with mobile above it chair pulled back from desk

(child would have to climb on chair and stretch to reach desk items)

opened briefcase (reaching for child book in briefcase looked like it could result in briefcase top falling on the child although the top was secured)


L_

Figure 1. Schematic Diagram of the Office/Waiting Room Showing the Location of the Chairs for the Mother and Child and the 12 Hazardous Items, Three Each for Falls (F), Burns (B), Cuts (C) and Poisonings (P)

interest' were present in the room (see Table 1). The decision to include hazards that could result in burns, poisoning, falls and cuts derived from the epidemiological findings indicating that toddlers are particularly at risk for falls, poisonings, and burns (Rivara, 1995).

Measures

Mothers were asked to complete two questionnaires while they were in the waiting room with their toddlers (Demographic sheet, PPVT-R Parent Version). All other questionnaires were completed following the lab session.


PPVT-R. In order to determine the child's receptive language ability level the Pea- body Picture Vocabulary Test-Revised was completed with the child after she completed the waiting room task (Dunn & Dunn, 1981). The PPVT-R involves showing the child four illustrated pictures and asking the child to point to the picture that best represents the word stated by the examiner. For purposes of this study, age-equivalent scores in months were computed and analyzed.

PPVT-R Version For Parents. The Peabody Picture Vocabulary test for parents consisted of a list of words from the PPVT-R from which the parents were asked to indicate which words they believed their child knew. Again, age equivalency scores were computed and analyzed.

Demographic Sheet. This questionnaire assessed parent's level of education and family income (see Subject section).

The Child Injury History. This questionnaire provided a measure of the frequency of the child's injuries, that is, injuries requiring medical (doctor's office visit or trip to emergency department) or dental intervention. The higher the score, the more injuries the child had sustained.

Injury Behavior Checklist (IBC). The Injury Behavior Checklist is a standardized questionnaire that yields a summary score that indexes the extent to which children engage in risk-taking behaviors that could result in injury, such as playing with matches or running into the street (cf. Speltz et al, 1990). This questionnaire uses a 5 point Likert scale ranging from 0-4, with 0 indicating not at all and 4 indicating very often. The summary scores range from 0 to 96, with higher scores indicating more risk taking behavior is common for the child.

Memory for Hazards in Waiting Room and Degree of Worry about these Items Questionnaire. This questionnaire served to assess which hazards parents attended to and which of these items they worried about as 'potential' sources of injury to their child while in the office waiting area. A percent correct memory for hazardous items was deter- mined based on this 24-item questionnaire (i.e., 12 hazards and 12 filler items).

Procedure

All measures and procedures were reviewed and approved by a university-based eth- ics review board. Upon calling the mothers to recruit their participation, they were informed that we were studying mother-child interaction and communication, including: how mothers and toddlers negotiate disagreements with each other and how mothers com- municate to toddlers when their children engage in behaviors that meet with their approval and disapproval. Moreover, they knew that they and their toddlers would be video and audio taped so that we could study sequences of interactions, such as how parents react to what their child is doing and how children comply with parents' requests. The only things they did not know was when we would be doing the video and audio taping and that we were specifically interested in mother-child exchanges related to children's injury-risk behaviors.


Upon arrival, mothers and toddlers were told that the waiting/play room was not available that day and were asked to wait in an office nearby until it was their turn to par- ticipate in the study for which they had come to the laboratory. The mothers were asked to fill out two questionnaires during this time (Demographic sheet, PPVT-R Parent Ver- sion); this was done to ensure that they would be somewhat distracted in the contrived- hazard environment. The mother was directed to a chair and the child was directed to an adjacent chair, with three children's books located next to their chair (see Figure 1). The Research Assistant then apologized that the office was not set up for children and mothers were told to make themselves and their child comfortable while waiting, and to feel free to move anything around in the room to ensure their own and their child's comfort and safety.

The interaction between mother and child in the waiting room was unobtrusively video and audio taped for ten minutes; no one reviewed these tapes as they were being recorded. Subsequently, the experimenter entered the room and informed the parent about the video and audio taping, and provided the mother a more elaborate description of the purposes of the study. Mothers were then asked to provide consent to include their video and audio data in the study. All participants agreed to have their data included and none of the parents indicated any awareness of what was going on or the purpose of having them wait in the office.

While the mother filled out the remaining questionnaires the child's receptive-language ability level was assessed by the experimenter using the PPVT-R. The child was then given a toy and a lollipop for her cooperation.

Data Reduction and Reliability

The primary coder transcribed the child's and the parent's behaviors from the video records by making a running list of exactly what the child and parent did, and in what order. A second coder transcribed five videotapes to confirm the accuracy of the primary coder's transcriptions (99% agreement); the video deck had slow motion capabilities, making it very easy to transcribe accurately. Subsequently, the primary coder worked from her transcripts and counted the frequency of the children's approaching different hazards, the nature of their approach (look, point, touch/retrieve the hazard, with the latter category taken to imply 'interacting' with the hazard), the mother's behavior in response to the children approaching hazards (ignore, verbal redirection, physical redirection, removal of the hazard either proactively before the child expressed an interest in it or reactively after the child expressed an interest in the hazard), and the child's compliance with the parent's request to ignore the hazard (compliant or not); note that we did not differentiate between children's touching and retrieving hazards because virtually all touches led to retrievals, making these behaviors non-independent. The frequency of children's approach to non- hazardous items were also coded.

A second coder independently conducted similar tallies for eight transcripts (27% of sample), resulting in a reliability estimate of 94% (Kappa statistic), with the range of reli- abilities varying between 92% and 97% across these categories of behaviors. The data of the primary coder were analyzed.


RESULTS

Injury History

In order to determine if boys experienced more injuries than girls a univariate Analysis of Variance (ANOVA) was applied to children's Injury History Scores. Results revealed that boys experienced more injuries than girls (M = 1.0 and 0.5, SD = 1.2 and 0.7, respectively). However, this did not reach statistical significance, probably because of the age range of children in this sample; prior research indicates that sex differences in injury rates usually start to emerge around 3 years of age and the differences increase thereafter (Baker et al., 1992; Matheny, 1991; Rivara et al., 1982).

Maternal Reports of Children's Risk Taking (IBC Scores)

An ANOVA was conducted to examine if sex differences existed in children's reported risk taking (IBC scores). Consistent with the injury rate data, results revealed that mothers reported significantly more (F(1,29) = 16.9, p < .001) risk taking by boys (M = 32.1, SD = 9.5) than girls (M = 18.0, SD = 9.3).

Receptive Language

In order to determine if there was a difference between mothers' Estimated PPVT-R score and their child's Actual PPVT-R score for boys and girls, a Multivariate Analysis of Variance (MANOVA) was applied to the age-equivalent scores. Results revealed an interaction between child sex and source of PPVT-R score (F(1,28) = 9.3, p < .05). An ANOVA applied to the Actual PPVT-R scores did not reveal a significant difference between the receptive language level of boys and girls (M= 3.1 and 3.2 years, respectively). However, an ANOVA conducted on mothers' Estimated PPVT-R scores revealed a trend (F(1,29) = 3.6, p = .07) for mothers to believe that boys (M = 2.9 years, SD = 0.9) had poorer receptive language skills than girls (M- 3.4 years, SD = 0.9).

Frequency of Risk Taking in the Contrived Hazards Setting

In order to address the question of whether boys approached more hazardous items than girls, a MANOVA with type of item (2: total number of hazardous items approached and the total number of non-hazardous items approached) and the child's sex (2) as factors was conducted. A significant interaction term revealed that boys and girls differed in the items they approached (F(1,28) = 6.8, p < .01. Follow-up ANOVAs indicated there was no sex difference in the frequency of toddlers approaching non-hazardous items (M = 5.9, SD

= 3.4). However, boys approached significantly more hazards than girls (M = 9.1 and 5.6, SD = 4.1 and 3.9, respectively, F(1,29) = 5.7,p < .05).

Although one might expect that children who were reported to have more injuries would approach more hazards, these scores did not significantly correlate (r = . 17, p > .05), probably because of the low incidence (i.e., restricted range) of children's injuries at this young age. Similarly, the total number of hazards approached did not correlate with mothers' reports of children's risk-taking (IBC scores; r = .15, p > .05). However, children's


Table 2. Average Number of Behaviors (look, point, touch-retrieve) as a Function of Type of Injury Hazard (bum, cut, poison, fall) and

Child's Group (boys, girls)

Group

Type of Behavior

Injury Hazard Look Point Touch-Retrieve

Boys

Girls

Burn 0.7 0.1 1.8 (1.0) (0.3) (1.8)

Cut 0.2 0.1 1.5 (0.4) (0.3) (1.4)

Poison 0.4 0.3 2.0 (0.6) (0.6) (1.5)

Fall 0.3 0.1 1.7 (0.6) (0.3) (2.4)

Burn 0.2 1.1 0.I (0.4) (0.6) (0.3)

Cut 0.1 0.1 0.1 (0.3) (0.3) (0.3)

Poison 0.4 1.6 0.1 (0.6) (1.2) (0.3)

Fall 0.5 0.7 0.8 (0.7) (1.1) (1.1)

Note: Standard deviations are in parentheses

behavior after approaching hazards related to injury history and risk taking in several important ways.

Children's Behavior After Approaching Hazards

To examine if boys and girls behaved differently after approaching hazards, a M A N O V A with child sex (2), type of injury hazard (4: burns, cuts, falls, poison), and type of behavior (3: look, point, touch/retrieve) was applied to the data. A significant three-way interaction indicated that boys and girls expressed different behaviors depending on the type of hazard (F(6,23) = 4.5, p < .001). These data are shown in Table 2.

Follow-up ANOVAs revealed a number of sex differences in how children interacted with injury hazards. For burn hazards, girls did more looking and pointing than boys (F(1,29) = 4.0 and 17.7, p < .05 and < .01, respectively) and boys did more touching- retrieving than girls (F(1,29) = 13.3, p < .001). For cut hazards, there was no sex differences in looking or pointing, but boys showed more touch-retrieve behavior than girls (F(1,29) = 15.4, p < .001). For poison hazards, boys and girls looked at hazards a comparable number of times, but girls did more pointing than boys (F(1,29) = 14.1, p < .001) and boys did more touching-retrieving of these hazards than did girls (F(1,29) = 23.8, p < .001). For fall hazards, girls were more likely than boys to point these out to their mother (F(1,29) = 4.1, p < .05), but there were no sex differences in looking or touching hazards that could result in fall-related injuries.

In order to determine if children with high risk taking (IBC) scores were more likely to interact in risky ways with hazards than those with lower risk taking scores, the chil-


dren's total scores for touch-retrieve hazards were correlated with their risk taking scores. Results revealed these positively correlated (r = 0.43, p < .05). Similarly, touch-retrieve scores were positively correlated with Injury History scores (r = .36, p < .05). Thus, children with a history of risk taking and of injuries interacted in more hazardous ways with potential injury items, in comparison to children who reportedly engage in less risk taking and had experienced fewer injuries.

Mother's Responses to Children Approaching Hazards

To determine if mothers of sons and daughters differed in the frequency of their responding to children approaching hazards, an ANOVA was performed with sex (2) as a factor. Results did not reveal any differences due to a child's sex. On average, mother's responded to intervene when their child approached a hazard for 79% of hazard approaches; the remaining hazard approaches were ignored or unnoticed.

To see if mother's reacted differently to boys and girls approaching hazards an ANOVA with child sex (2) was performed on the average number of redirection statements issued by parents in response to their child approaching a hazard. Results revealed that mothers used more verbal redirection strategies for girls than boys (M= 1.0 and 0.27, SD = 0 and 0.47, respectively; F (1,23)= 31.8, p < .001). By contrast, they used more physical redirection strategies (i.e., going to the child and physically moving them away from the hazard) for boys (M = .55, SD= .42) than girls (M = .20) in response to the child approaching a hazard, with 11 mothers using this strategy to redirect sons from hazards and only one mother doing so for her daughter.

The likelihood of mothers using verbal-redirection strategies was compared with Esti- mated PPVT-R and the children's Actual PPVT-R scores. Neither PPVT-R score correlated with the mother' s use of verbal redirection strategies.

It is also interesting to note that there were no sex differences in parents' memory for the hazards in the room (M = 73% correct, SD =16 %), or their knowledge of possible injury outcomes if their child were to interact with a particular hazard. Mothers' scores for correctly identifying the potential injury for each of the 12 hazards was comparably high for mothers of boys (M= 78% correct, SD = 24 %) and for mother's of girls (M = 93% correct, SD =12%). Moreover, mothers' ratings of the potential severity of these injuries (maximum severity score = 5.0) did not vary by child gender, although it did vary by type of injury (F (1,23) = 5.9, p < .05). Consistent with survey data suggesting that mothers believe that fall related injuries are more normative and non-serious than other types of injuries (Pollak & Morrongiello, 1996), mothers rated the potential severity of poisonings (M=3.8, SD = 1.4), burns (M=3.6, SD =1.1) and cuts (M=3.5, SD = 1.3) to be higher than the potential severity of injuries resulting from falls (M= 2.9, SD = 1.1; t(26) = 3.2, 3.1, and 2.8, respectively, ps < .05, two tailed).

It should be noted that although mothers were told to make whatever changes in the room they wished to, proactive removal of hazards were extremely infrequent (for both sons and daughters), resulting in too few instances for analysis; this result is noteworthy because mothers often readily moved the chairs and some non-hazardous items (e.g., teddy bear, children' s books, child' s alarm clock). Consequently, we were unable to perform any correlations to assess the relation between proactive strategies and other variables of interest (e.g, injury history, risk taking score).


Child's Compliance with their Mother's Redirection Efforts

Addressing the question of child compliance with parent redirection strategies was difficult because so few parents of daughters used physical redirection strategies (N=I). Nonetheless, examining the percent of times children complied with a parent's efforts to redirect them from a hazard using verbal strategies revealed that sons complied 25% of the time, whereas daughters complied 99% of the time (p < 0.05). For the physical redirection strategies, sons complied 60% of the time. Failures in compliance often resulted in mothers of sons removing the hazard completely. Every mother of a son who did not comply on at least one occasion (N=14 sons) subsequently removed the hazard from the area for at least one occasion, with 3.1 (SD =1.1) being the average number of hazard removals for sons who did not comply with verbal and/or physical redirection strategies.

DISCUSSION

The present research reveals a number of behavioral differences between boys and girls that may explain, in part, why boys experience more injuries than girls during the preschool years. First, consistent with other findings indicating that boys engage in more risk taking than girls (e.g., Ginsburg & Miller, 1982), boys more frequently approached hazards than girls. The fact that there was no difference in children's approaching interesting, non- hazardous items suggests that boys were not simply more active, curious and exploratory than girls. Rather, it seems that they were especially drawn to items that could result in injury. This may reflect an interest in novelty, to the extent these represented off-limits items in their homes for which parents restricted children's access (e.g., Gralinski & Kopp, 1993; Power & Chopieski, 1986). Alternatively, boys may have learned, based on prior experiences with their mothers in hazardous situations, that approaching hazards not only recruits their mother's attention but often leads mothers to offer them more interesting play alternatives.

Second, upon approaching hazardous items, boys often immediately touched and retrieved these items, whereas girls more often simply looked at these or drew their mother's attention to these by verbalizing and pointing to the items. The quickness with which boys interacted with hazardous items certainly suggests that keeping them safe in an injury-risk environment may pose a greater challenge for parents, in comparison to the efforts required to ensure girls' safety in such environments. Reactive strategies (e.g., removal of the hazard, issuing a verbal warning or redirective) may suffice to keep girls safe at these young ages, since they were less likely to immediately interact with hazards. However, such strategies would not work as effectively to ensure the safety of boys. Rather, the findings suggest that parents may need to emphasize proactive safety practices and preventive planning in order to minimize the likelihood of boys coming into the proximity of hazards at all, thereby minimizing injury-risk to boys during the preschool years. Consistent with these results, the frequency of touch/retrieve contacts with hazards correlated both with risk taking and injury history scores. Apparently, it was not the act of approaching a hazard per se that differentiated among children at risk for injury, but how the child interacted with the hazard once they approached it.

Surprisingly, although boys were likely to approach hazards and immediately touch and attempt to retrieve the hazards, parents used proactive strategies extremely infre-


quently, whether for boys or girls. Because of this, we were unable to determine if usage of proactive strategies relates to children's injury or risk taking histories. Perhaps, even though they were told to make whatever changes they wished to in the room, parents were uncomfortable to do so, resulting in a superficially low incidence of proactive removal of hazards. Although this seems unlikely in light of the fact that parents readily moved other items around in the room (e.g., chairs, non-hazardous items), this explanation of our results cannot be dismissed and should be addressed in future research. Suffice it to say, in this study, parents did not seem to draw on proactive strategies to ensure their child's safety, even for children whose parents rated as high in risk taking behaviors and as having a history of prior injuries. Possibly, parents assume that children, even at these young ages, will learn risk avoidance from injury experiences (cf. MorrongieUo & Dayler, 1996) or recall rules prohibiting touching of potentially unsafe items (cf. Gralinski & Kopp, 1993; Power & Chopieski, 1986), thereby eliminating the need for parents to act in ways to restrict the child' s access to injury-relevant hazards. Longitudinal research in progress should allow us to address these important questions.

Evidence in support of the notion that boys may require not only different, but also more effortful, strategies than girls in order to curtail their interactions with hazardous items comes also from examining mothers' redirection efforts and children's compliance with these efforts. Verbal redirectives issued by mothers to sons resulted in compliance only 25% of the time, as compared to 99% compliance by daughters. Not surprisingly, therefore, mothers used more physical redirection strategies (i.e., going to the child and moving them away from the hazard) with sons than daughters, although, even in this case compliance by sons still reached only 60%, with non-compliance often resulting in mothers subsequently removing the hazard altogether from the child's proximity. Thus, the picture that emerges from these data suggests that boys at these young ages are more per- sistent than girls in their interest in and exploration of injury-hazards, resulting in greater challenges for parent supervision in injury-risk contexts.

Surprisingly, mother's use of verbal redirection strategies did not correlate with their child's receptive language level. However, this notion merits further consideration in future research for several reasons. Although there were no differences in actual level of language understanding, there was a trend for mothers of boys to rate their child's language as lower than mothers of girls. Perhaps, mothers interpret boys' non-compliance with verbal redirectives in positive terms that serve to diminish the likelihood of their becoming angry with their sons. Specifically, they interpret the non-compliance as due to the child's lack of understanding what is being asked of them, thereby under-rating the child's receptive language skills. This would be consistent with the findings that mothers did not appear to become angry in response to their sons' non-compliance, and they also did not persist in restating verbal redirectives. Typically, they made one attempt at verbally redirecting the child and if this did not achieve compliance, they abandoned that approach and moved on to another strategy, either physical redirection of the child away from the hazard, removal of the hazard, or both.

In summary, the present findings suggest a number of ways that boys and girls differ in their behaviors in injury-risk environments that may have implications for why boys are injured more often and severely than girls at these young ages. Boys were more likely than girls to approach hazards and to immediately proceed by touching-retrieving these hazards. Similarly, efforts by mothers at redirecting their children away from hazards proved more


difficult for sons than daughters. Sons required more, and more effortful, intervention efforts by mothers, and even these did not result in the high compliance levels that mothers of daughters achieved with fewer and less effortful strategies. Overall, the findings suggest that ensuring the safety of sons may be a more challenging task than is the case for daughters due, in part, to the nature of sex differences in toddler's behaviors in injury-risk situations.

Acknowledgements: This research was supported by grants from the Social Sciences and Humanities Research Council of Canada. The authors extend their thanks to Dawn Guthrie for help with data collection and to the toddlers and their mothers for their enthu- siasm and support of our research.

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Toddlers' and mothers' behaviors in an injury-risk situation: Implications for sex differences in childhood injuries