Early emotional and behavioural problems and risk of unintentional injuries among children in Sweden

Background

Emotional and behavioural problems in children represent a significant public health problem and have been linked to an increased risk of unintentional injuries. However, most research on this topic has focused on school-aged children, and Swedish prospective studies on preschool children are scarce. We examined the link between emotional and behavioural problems during preschool years and the risk of unintentional injuries in a Swedish context.

Methods

This cohort study included 6954 children aged 3–5 years, with emotional and behavioural problems assessed using the Strengths and Difficulties Questionnaire. Children were followed for a mean of ≈7 years, with injury data from the Patient Register. The primary outcome was any unintentional injury, including transport injuries, falls, burns, drowning, suffocation, and poisoning. Cox regression models were applied to estimate hazard ratios (HR) and 95% confidence intervals (CI).

Results

During follow-up, 2016 children (32.9%) experienced at least one unintentional injury. Emotional symptoms rated by mothers were associated with a reduced risk of unintentional injuries (HR: 0.86, 95% CI: 0.74–0.98). In contrast, hyperactivity/inattention rated by mothers (HR: 1.22, 95% CI: 1.07–1.38) and fathers (HR: 1.22, 95% CI: 1.09–1.37) was associated with an increased risk of such injuries. Hyperactivity/inattention was further related to an increased risk of falls (mothers: HR: 1.17, 95% CI: 1.02–1.34; fathers: HR: 1.22, 95% CI: 1.08–1.38), and emotional symptoms rated by preschool teachers were linked to a reduced risk of pedestrian or cyclist injuries (HR: 0.58, 95% CI: 0.34-0.99).

Conclusions

Hyperactivity/inattention symptoms in young children were associated with an increased risk of unintentional injuries, whereas emotional symptoms were associated with a reduced risk. Our findings may highlight the importance of considering hyperactivity/inattention in injury prevention strategies.

Key messages

• Hyperactivity and inattention symptoms during preschool years were related to an increased risk of unintentional injuries.

• The association between early symptoms of hyperactivity and inattention and later unintentional injuries may be considered in injury prevention strategies.