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The Injury Prevention Program significantly reduced parent-reported injuries among children in Black, Hispanic, and low-income families, according to findings.

The American Academy of Pediatrics (AAP) initiative to prevent injuries in children, The Injury Prevention Program (TIPP), significantly reduced parent-reported injuries among children in Black, Hispanic, and low-income families, according to findings recently published in Pediatrics.

“We wanted to learn whether the TIPP intervention works to prevent injury in young children,” Eliana Perrin, MD MPH, Bloomberg Distinguished Professor of Primary Care in the Department of Pediatrics at the Johns Hopkins University Schools of Medicine and Nursing, told Physician’s Weekly. “We also wanted to learn about the pattern of injury in the first two years of life. What types of injuries are most common? And we wanted to learn about all injuries, not just the ones that come to medical attention.

Perrin and colleagues noted in their manuscript that although TIPP has existed since 1983, it has never been tested in a randomized, controlled trial. They performed a stratified, cluster-randomized trial of children at four academic medical centers. Researchers randomly assigned two centers to train resident care providers in using TIPP and randomly assigned another two centers to be attention placebo groups. Perrin and colleagues enrolled children when they were 2 months old, and at each well-child check when the children were aged 2 to 24 months, researchers asked parents how many times their child had been injured since their last doctor visit. They also asked parents if the injuries were serious enough to warrant medical attention. Researchers used proportional odds regression analysis to examine whether households that received TIPP training and resources had fewer injuries than the control groups. Perrin and colleagues adjusted their analysis for baseline child characteristics parent-related and household factors.

Households That Use TIPP Have Fewer Injuries

The study included 781 infant-parent pairs. These pairs were 28% Black and 51% Hispanic. Most (87%) had Medicaid insurance.

Households whose children visited doctors at the TIPP institutions showed a significant reduction in injuries compared to controls, the researchers reported (P=0.05). At four months old, children in TIPP households had an adjusted odds ratio (aOR) of 0.77 (95% CI, 0.66-0.91) compared with placebo, with aORs of 0.60 (95% CI, 0.44-0.82) at 6 months, 0.32 (95% CI, 0.16-0.62) at 12 months, 0.26 (95% CI, 0.1-0.53) at 18 months, and 0.27 (95% CI, 0.14–0.52) at 24 months.

“We found that the TIPP intervention worked to prevent injury in young children. Families at TIPP sites (where providers were trained in TIPP and used TIPP materials) reported significantly fewer injuries in the first two years of life,” Perrin explained. “The estimated risk of reporting injury averaged across all ages was 30% in the control group and only 14% in the TIPP group. We also found that injuries are common, especially falls and heat-related injuries like scalds and burns, as well as ones that don’t fit into any neat category like ‘a plant fell on my child’ or ‘my child was scratched by another child.’ Injuries ramp up in the second year of life, likely as they are more mobile. Only a fraction of injuries – 16% – come to medical attention.”

The researchers acknowledged that the study may have been subject to social desirability bias, with parents potentially downplaying their child’s injuries after receiving TIPP training; however, they noted that their research was designed partly to mitigate such a bias. The study may also have been subject to recall bias because it required parents to report injuries, they wrote.

A ‘Development-Based Approach’

Perrin recommends that parents and care providers adjust safety measures according to children’s growth.

“Taking a developmentally-based approach—in other words, helping parents think through adding stair gates before their children learn to crawl, raising the side of the crib before their children learn to pull to stand—is important,” Perrin said. “If pediatricians think in terms of development and use the AAP’s TIPP program, which offers developmentally based guidance, the full range of injuries can be prevented.”