Lise Olsen

Risky Play and Children’s Safety: Balancing Priorities for Optimal Child Development

Injury prevention plays a key role in keeping children safe, but emerging research suggests that imposing too many restrictions on children’s outdoor risky play hinders their development. We explore the relationship between child development, play, and conceptions of risk taking with the aim of informing child injury prevention. Generational trends indicate children’s diminishing engagement in outdoor play is influenced by parental and societal concerns. We outline the importance of play as a necessary ingredient for healthy child development and review the evidence for arguments supporting the need for outdoor risky play, including: (1) children have a natural propensity towards risky play; and, (2) keeping children safe involves letting them take and manage risks. Literature from many disciplines supports the notion that safety efforts should be balanced with opportunities for child development through outdoor risky play. New avenues for investigation and action are emerging seeking optimal strategies for keeping children “as safe as necessary,” not “as safe as possible.” This paradigm shift represents a potential for epistemological growth as well as cross-disciplinary collaboration to foster optimal child development while preserving children’s safety.

Attention-Deficit Hyperactivity Disorder in Children and Youth: A Quantitative Systematic Review of the Efficacy of Different Management Strategies

Objective: To obtain estimates of the relative efficacy of 3 main treatment strategies for attention-deficit hyperactivity disorder (ADHD) in children and youth (age < 18 years). Methods: Design: quantitative systematic review of randomized trials. Subjects: 999 patients with ADHD from 26 randomized trials. Interventions: medications alone, behavioural interventions alone, and a combination of these 2 modalities. Main outcome measure: differences in scores between treatment groups on commonly used teacher- and parent-completed behaviour rating scales. Results: Medication-only therapy was efficacious in ADHD. Behavioural therapies used alone appeared not to be efficacious in ADHD. Combination therapy was more efficacious than placebo or no treatment for parent but not teacher ratings, not more efficacious than drug therapy alone, and more efficacious than behavioural treatments alone based on parent but not teacher ratings. Conclusion: Though stimulant medications were found to be an effective treatment strategy for ADHD in children and youth, it proved difficult to assess the relative benefits of behavioural interventions alone and combined medication and behavioural therapy because of the paucity of treatment studies other than medication-only treatment studies and heterogeneity of various kinds that exist in relation to ADHD studies and treatments.

Strategies for prevention of soccer related injuries: a systematic review

Objectives: To examine evidence on the effectiveness of current injury prevention strategies in soccer, determine the applicability of the evidence to children and youth, and make recommendations on policy, programming, and future research. Methods: Standard systematic review methodology was modified and adopted for this review. Research questions and relevance criteria were developed a priori. Potentially relevant studies were located through electronic and hand searches. Articles were assessed for relevance and quality by two independent assessors, and the results of relevant articles were abstracted and synthesised. Results: A total of 44 potentially relevant articles from electronic (n  =  37) and hand (n  =  7) searches yielded four that met inclusion criteria. These four studies addressed a range of intervention strategies and varied with respect to results and quality of evidence. Conclusions: Some of the strategies look promising but lack adequate evaluation or require further research among younger players. Practice, policy, and research recommendations are provided as a result of the synthesis.

A randomized trial to assess the effectiveness of an infant home safety programme

The aim of this study was to test an intervention aimed at addressing the risk of injury in infants 2 – 12 months of age. A non-blinded, randomized controlled trial was conducted, whereby parents were randomly assigned to either a control or one of two intervention groups. Parents completed questionnaires regarding safety behaviours and injuries at the 2 (baseline), 6 and 12 month immunization visit at the community health unit. During the 2 month visit to the health unit, the two intervention groups received a home safety kit containing nine items, an instructional brochure and a risk assessment checklist. Subjects randomized to the safety kit plus home visit group also received a standardized home visit from a community health nurse. Two of the 14 parental safety behaviours showed a significant increase in use among parents in the intervention groups. Neither of the interventions was associated with a reduction in parent-reported injuries among children. It was concluded that home visitation may provide a beneficial adjunct to the provision of safety devices and may increase use by parents.

Men on Fathering in the Context of Children’s Unintentional Injury Prevention

Injuries are a leading cause of death for children, and parental safety behaviors are fundamental to child injury prevention. Fathers’ perspectives are largely absent. Our novel research connects masculinities, fathering, and childhood injury. Sixteen fathers of children aged 2 to 7 years in two Canadian urban settings participated in photo-elicitation interviews detailing activities they enjoyed with their children and concerns regarding child safety. Participants described how elements of risk, protection, and emotional connection influenced their approach to fathering as it related to injury prevention. Most men considered engaging children in risk as key to facilitating development and described strategies for protecting their children while engaging in risk. Many men identified how the presence of an emotional connection to their children allowed them to gauge optimal levels of risk and protection. There exists a tremendous opportunity to work with fathers to assist in their efforts to keep their children safe.

Fathers on Child’s Play Urban and Rural Canadian Perspectives

Social trends show that contemporary fathers are spending increased time with their children and that active play and outdoor recreation are important features of their relationships. Dominant ideals of masculinity can differ by settings, which in turn guide men’s understandings and practices of fathering regarding the functions of and opportunities afforded by active play. This article draws on individual interview data from a study of fathers residing in three Canadian settings—large urban, small urban, and rural—to elucidate father masculinities and highlight similarities and differences in how men describe connections between fathering and active play with their children. Findings suggest that for large urban, small urban, and rural fathers, respectively, play functions as a means of emotional engagement, development of capacity for outdoor activities, and teaching children survival skills. We propose that the sociostructural and cultural dynamics of place shape masculine identities and influence men’s understandings of fathering.

Heterosexual Gender Relations In and Around Childhood Risk and Safety

Injuries are a leading cause of child death, and safety interventions frequently target mothers. Fathers are largely ignored despite their increasing childcare involvement. In our qualitative study with 18 Canadian heterosexual couples parenting children 2 to 7 years old, we examined dyadic decision making and negotiations related to child safety and risk engagement in recreational activities. Parents viewed recreation as an important component of men’s childcare, but women remained burdened with mundane tasks. Most couples perceived men as being more comfortable with risk than women, and three negotiation patterns emerged: fathers as risk experts; mothers countering fathers’ risk; and fathers acknowledging mothers’ safety concerns but persisting in risk activities. Our findings suggest that contemporary involved fathering practices privilege men in the outdoors and can erode women’s control for protecting children from unintentional injury. We recommend promoting involved fathering that empowers both parents and developing injury-prevention strategies incorporating both fathers’ and mothers’ perspectives.

Barriers and Enablers to Enacting Child and Youth Related Injury Prevention Legislation in Canada

Injury prevention policy is crucial for the safety of Canada’s children; however legislation is not adopted uniformly across the country. This study aimed to identify key barriers and enablers to enacting injury prevention legislation. Purposive snowball sampling identified individuals involved in injury prevention throughout Canada. An online survey asked respondents to identify policies that were relevant to them, and whether legislation existed in their province. Respondents rated the importance of barriers or enablers using a 5-point Likert type scale and included open-ended comments. Fifty-seven respondents identified the most common injury topics: bicycle helmets (44, 77%), cell phone-distracted driving (36, 63%), booster seats (28, 49%), ski helmets (24, 42%), and graduated driver’s licensing (21, 37%). The top enablers were research/surveillance, managerial/political support and professional group consultation, with much variability between injury topics. Open-ended comments emphasized the importance of a united opinion as an enabler and barriers included costs of protective equipment and inadequate enforcement of legislation. The results highlighted the importance of strategies that include research, management and community collaboration and that injury prevention topics should be addressed individually as information may be lost if topics are considered together. Findings can inform the process of turning injury prevention evidence into action.

Fathers’ views on their financial situations, father–child activities, and preventing child injuries

Unintentional injuries are a leading public health problem for children, particularly among those living at lower socioeconomic levels. Parents play an important preventive role, and the aim of this study was to examine fathers’ views on the role of their family financial situation in preventing children’s injuries. In-depth interviews were conducted with 15 fathers of children 2 to 7 years living in western Canada. Questions solicited fathers’ views about their financial situation and their child injury prevention efforts. Data analysis was underpinned by masculinity theory and guided by constant comparative grounded theory methods. Findings included that fathers living with fewer financial limitations emphasized use of safety equipment and aligned themselves with provider and protector masculine ideals. Fathers with moderate financial constraint described more child-centered safety efforts and efforts to manage finances. Those facing greatest constraint demonstrated aspects of marginalized masculinities, whereby they acknowledged their economic provider limitations while strongly aligning with the protector role. These findings hold relevance for development of interventions aimed at reducing child injury risk inequities. Taking into account how masculinities may shape their beliefs and practices can inform design of father-centered interventions for men living at different points on the socioeconomic spectrum.

“It’s Good for the Kids” Fathers Consider Risk and Protection in Their Own and Their Children’s Lives

We conducted a qualitative inquiry to better understand how fathers of young children consider risk in their own life and in the lives of their 2- to 7-year-olds. Interview data were collected from 64 fathers from rural and urban Canada. Fathers’ discourse was considered in the context of masculine identities as well as the implications for father-focused health promotion and safety education. We found that most fathers considered risk taking to be an essential component of their own and their fathering identities. Some fathers held negative views about risk taking in their own and their children’s lives or were inconsistent in risk considerations for themselves compared to their children. For these fathers, identity construction was a somewhat fluid and contradictory process. Overall, we conclude that health promotion programs should support and bolster fathering identities and practices that involve engaging children in physical risk taking while employing appropriate safety strategies.