Injury in the First Year of Life: Risk Factors and Solutions for High-Risk Families

Background: Injury is one of the leading causes of death for infants younger than 1 year of age. We investigated potential contributing factors for injury among children born to high-risk families. Methods: The Fragile Families and Child Wellbeing Study is a longitudinal cohort of approximately 5000 children from mostly unwed parents across the United States. Data from interviews with mothers conducted shortly after birth and follow-up surveys at 1year were used for this analysis. Injuries sustained in the first year of life that required medical attention were studied. Multivariate regression analysis was used to identify independent risk factors for injury in this population. Results: A total of 13.7% of mothers reported that their child had sustained an injury in the first year of life. We identified 17 potential maternal, paternal, and environmental risk factors for injury, including socioeconomic, mental health, relationship violence, criminal justice system involvement, and substance abuse challenges. Multivariate regression analyses revealed two significant independent risk factors, maternal alcohol use (odds ratio 2.15, P = 0.044) and mother spanking child in the previous month (odds ration 2.32, P = 0.027). Conclusions: Among this higher-risk group, injury in the first year of life is more than twice the national incidence. Predisposing factors to injury often are complex and interrelated, but with focused education and prevention efforts, including discussions of maternal alcohol use and attitudes toward physical discipline, we may decrease the burden of infant injury in this vulnerable population.