Home accidents in children aged 2–6 years with conduct disorder: the role of maternal preventive attitudes and behaviors

Authors

Abstract

AimThis study aimed to investigate the frequency of home accidents in children aged 2–6 years with conduct disorder (CD) and to evaluate the relationship between maternal preventive attitudes and behaviors and accident occurrence.
MethodsThis prospective, analytical, and observational study was conducted with 212 mother–child pairs attending primary healthcare centers. Data were collected using a sociodemographic questionnaire, the Scale for Identification of Safety Measures Taken by Mothers to Prevent Home Accidents, and the Conners Parent Rating Scale. Statistical analyses included comparative tests and correlation analyses.
ResultsThe prevalence of lifetime home accidents was 69.3%. Falls were the most common type of accident, and the head–face region was most frequently affected. Higher accident rates were observed in children of working mothers, families living in rented houses, and mothers with first aid training (p<0.05). Mothers of children who experienced accidents had significantly lower safety measure scores. A significant negative correlation was found between maternal safety measures and CD symptom severity (r = -0.257, p<0.001), indicating that increasing behavioral problems were associated with decreased implementation of preventive measures.
ConclusionHome accidents are highly prevalent among children with CD and are strongly associated with symptom severity and maternal preventive behaviors. Preventive knowledge alone is insufficient without adequate supervision. Integrating behavioral management with home safety interventions in primary care may reduce injury risk in this vulnerable group.

Keywords

Introduction

Conduct disorder (CD) is characterized by a persistent pattern of behavior in childhood involving violations of societal norms and the rights of others.¹ Early behavioral problems not only impair psychosocial functioning but also increase exposure to physical risks. Although prevalence varies across cultures, CD is more common in boys (6–16%) than in girls (2–9%), indicating a notable gender disparity.²
In children with CD, impulsivity, poor risk perception, and engagement in hazardous behaviors elevate the likelihood of injury. Within this framework, home accidents represent a significant and largely preventable public health concern.³ Defined as incidents occurring داخل the home or its immediate surroundings, home accidents account for 25–63% of all accidents, with variability across age groups and countries.⁴ In Türkiye, this proportion ranges from 11% to 70%.⁴
Young children are particularly vulnerable due to developmental factors and the substantial time spent in the home environment.^4,5,6 Household furniture and fixtures frequently serve as sources of injury, with events such as falls, collisions, entrapments, and tip-overs comprising a considerable share of childhood injuries.⁵ The predictable and preventable nature of these incidents highlights the importance of environmental modifications and caregiver practices.
Parents, especially mothers as primary caregivers, play a critical role in preventing home accidents. Maternal awareness of domestic hazards, attitudes toward safety measures, and responses to accidents significantly influence injury frequency and severity. Sociodemographic factors, including maternal education, age, and knowledge, are key determinants in prevention.^7,8
However, studies examining the frequency of home accidents and maternal safety practices remain limited. Therefore, this study aims to better identify risk factors associated with preventable home accidents in early childhood.

Materials and Methods

Study Design and SettingThis study was designed as a prospective, analytical, and observational investigation. It was conducted among mothers of children aged 2-6 years who attended family health centers in the city center of Kahramanmaraş. Data were collected between November 1, 2022, and January 1, 2023, following approval from the ethics committee.
Study Population and SampleThe study population consisted of approximately 2,000 mother–child pairs who presented to family health centers during the study period. Based on a power analysis (α = 0.05; 1 − β = 0.80; medium effect size = 0.69), the required sample size was calculated as 300; however, 212 children and their mothers were ultimately included in the study. Exclusion criteria included the presence of a diagnosed psychiatric disorder in the mother and the inability to complete the questionnaires due to illiteracy or insufficient cognitive capacity.
Data Collection InstrumentsData were collected using a 32-item questionnaire addressing sociodemographic characteristics and home accidents, developed in line with the literature, the Scale for Identification of Safety Measures Taken by Mothers to Prevent Home Accidents (0–6 years), and the Conners Parent Rating Scale.
The Scale for Identification of Safety Measures Taken by Mothers to Prevent Home Accidents is a 40-item Likert-type instrument that evaluates maternal attitudes and behaviors regarding the prevention of home accidents. Each item is scored between 1 (strongly disagree) and 5 (strongly agree), with a total score ranging from 40 to 200. Higher scores indicate a higher level of protective attitudes and behaviors.
The Conners Parent Rating Scale, used to assess behavioral problems in children, is a 48-item instrument completed by parents. Items are scored on a scale from 0 (never) to 3 (very often). A T-score of ≥65, commonly used in the literature, was adopted as the cut-off to identify children at risk for conduct disorder; children scoring above this threshold were classified as being at risk. All data collection tools were administered face-to-face by the researcher.
Ethical ApprovalThis study was approved by the Ethics Committee of Sutcu Imam University (Date: 2022-12-14, No: 01).
Statistical AnalysisData were analyzed using SPSS version 22.0. Descriptive statistics were presented as mean, standard deviation, median, frequency, and percentage. The normality of continuous variables was assessed using the Kolmogorov–Smirnov test. For comparisons between two groups, the Student’s t-test or Mann–Whitney U test was used; for comparisons among three or more groups, one-way analysis of variance (ANOVA) or the Kruskal–Wallis test was applied. Categorical variables were analyzed using the chi-square test, and correlations were evaluated using Pearson or Spearman correlation analyses. A p-value of <0.05 was considered statistically significant.
Reporting GuidelinesThis study is reported in accordance with the STROBE guidelines.

Results

The mean age of the 212 children included in the study was 4.10 ± 1.04 years. Of the participants, 136 (64.2%) were boys, and 76 (35.8%) were girls. Regarding maternal education, 30.7% were either illiterate or primary school graduates, while 49.1% had completed high school or higher education. Among fathers, 27.8% had a primary or secondary school education, whereas 72.2% had completed high school or higher education.
Overall, 69.3% (n = 147) of the participants had experienced at least one accident during their lifetime. The number of children who had experienced a home accident was 95 within the past year and 64 within the past month. Additionally, 47 participants were reported to have at least one existing health condition. Analysis of accident types revealed that the majority were falls (n = 127), followed by burns (n = 17), aspiration (n = 9), poisoning (n = 4), and drowning (n = 4).
In terms of body regions affected, the head–face area was most commonly involved (n = 96), followed by the upper extremities (n = 33), lower extremities (n = 33), and trunk (n = 9). The mean number of lifetime home accidents was 2.96 ± 4.20, compared to 1.37 ± 2.32 in the past year and 0.53 ± 1.06 in the past month. Based on self-reports, 87.3% of the families had an income above the minimum wage.
When home accident occurrence was compared across demographic variables, no statistically significant differences were found with respect to sex, age groups, presence of siblings, maternal age, presence of a health condition in the child, family structure (nuclear/extended), household income, type of residence (detached/apartment), or heating method (p>0.05). However, the frequency of home accidents was significantly higher among children of working mothers, those living in rented homes, and those whose mothers had received first aid training (p<0.001, p=0.028, and p<0.01, respectively). Furthermore, 85% of the mothers reported having received first aid training from any institution or source prior to the study.
Comparison of the Scale for Identification of Safety Measures Taken by Mothers to Prevent Home Accident scores across demographic variables showed that mothers of children who had experienced home accidents in the past year or month, mothers of children aged 5–6 years, mothers aged 21–31 years, mothers with lower educational levels (illiterate/literate), children whose fathers had only a primary education, non-working mothers, mothers without first aid training, families with multiple children or siblings, single-child families, and families with a dependent individual requiring continuous care at home had significantly lower mean scale scores. The detailed data are provided in Supplementary Table 1 and Table 2.
When the Conners Parent Rating Scale scores were compared across categorical variables, it was found that children who had experienced at least one home accident during their lifetime, as well as those who had experienced a home accident within the past year or month, had significantly higher mean scores. Similarly, higher scores were observed among children whose mothers had low educational levels (illiterate/literate), whose fathers had only primary school education, whose mothers had a health problem, and who had siblings. These differences were statistically significant. The detailed data are provided in Supplementary Table 1 and Table 2.
Spearman correlation analysis was performed to evaluate the relationship between the Conners Parent Rating Scale and the Scale for Identification of Safety Measures Taken by Mothers to Prevent Home Accidents. The results revealed a statistically significant negative correlation between the two scales (r = -0.257, p<0.001).

Discussion

In this study, we examined the prevalence of home accidents, associated sociodemographic factors, and maternal preventive safety attitudes in children aged 2–6 years with conduct disorder (CD). Home accidents were highly prevalent (69.3%) in this group. Contrary to the literature, parental education level showed an inverse relationship with safety attitudes, while prior accident experience significantly increased maternal attitude scores (p<0.001). Additionally, the negative correlation between CD symptom severity and maternal safety measures suggests that increasing clinical severity complicates effective environmental risk management.
The lifetime prevalence of home accidents in our sample (69.3%) is consistent with previous studies reporting rates such as 62.4% in similar age groups.^4,9,10 The relatively higher rate in our study may be related to the inclusion of children with CD. Core behavioral features of CD, such as impulsivity, hyperactivity, and impaired risk assessment, may constitute stronger risk factors for home accidents than sociodemographic characteristics.^1,2
Among accident types, falls were overwhelmingly predominant (86%), consistent with findings reported by Silva et al. in Brazil.³ The head and face being the most commonly affected body regions (65%) may be explained by the fact that body proportions in this age group have not yet reached adult configuration, and balance development remains incomplete.
No statistically significant differences were found in the frequency of home accidents with respect to many demographic variables, including gender, age group, presence of siblings, family structure, and income level. This finding suggests that home accidents are a multidimensional phenomenon that cannot be explained solely by sociodemographic factors and highlights the determining role of individual behavioral risk factors and the physical home environment.⁶
In our study, children of working mothers had a significantly higher frequency of home accidents (p<0.001). This finding may be directly related to the reduced duration of maternal supervision in the home environment. Studies by Balogun et al. and Tekin et al. have shown that the level of parental supervision directly affects the risk of childhood injuries and that shorter supervision duration significantly increases the likelihood of accidents.^7,11
A notable finding of our study is that working mothers had significantly higher scores on the “Scale for Identification of Safety Measures” than non-working mothers (180.33 ± 16.25 vs. 174.77 ± 12.48; p=0.002). Although this indicates greater theoretical knowledge and protective attitudes, such awareness may not translate into effective prevention, likely due to reduced physical presence. Thus, knowledge alone may be insufficient to minimize accident risk in children with behavioral disorders, and continuous supervision remains essential.
Another striking finding is that children of mothers who had received first aid training had a significantly higher frequency of home accidents (p < 0.001). While seemingly paradoxical, this may reflect reverse causality, whereby mothers seek training after experiencing an accident. Consistent with this, a large proportion of mothers (85.0%) reported prior training, suggesting that accident experience is a key motivator for education.
Ma et al. reported that the relationship between parental knowledge of home accident prevention and protective behaviors is not always linear but shaped by multiple mediating factors.¹² Similarly, Ji et al. suggested that parental supervision may partially mediate this relationship, with behavioral variables influencing risk–outcome associations.¹³ This may explain the paradox observed in our study, where knowledge does not always translate into practice due to constraints such as limited time and increased workload. Moridi et al. showed that Health Belief Model–based education improves mothers’ preventive behaviors,⁸ indicating that first aid training should be structured not only as a post-accident response but also as a preventive primary care service.
In our study, higher maternal and paternal education levels were associated with significantly higher safety measure scores (p=0.014 and p<0.001, respectively). The effect of paternal education supports the view that home safety is a shared responsibility. Our findings are consistent with Bayomy et al..¹⁴ and other studies demonstrating that educational interventions improve maternal safety attitudes and behaviors, with higher scores among those with greater education.^15,16,17 These results highlight the need for targeted educational interventions for parents with lower education levels within primary care.
A key finding of our study is that children who experienced home accidents had significantly higher Conners Parent Rating Scale scores than those who did not, across all time frames—lifetime, past year, and past month (p<0.001). This indicates that greater severity of CD symptoms is associated with increased accident frequency. Core features of CD, such as impulsivity, rule-breaking, and risk-taking, may directly elevate this risk.^1,2 Therefore, clinical evaluation should extend beyond behavioral management to include home safety planning and individualized preventive strategies. Effective control of CD symptoms may thus serve as an indirect approach to reducing childhood injuries and related morbidity.
Another important finding is the statistically significant relationship between the Conners Parent Rating Scale and the Scale for Identification of Safety Measures Taken by Mothers (r = -0.257; p<0.001). This indicates that as the severity of CD symptoms increases, mothers’ implementation of home safety measures decreases. This relationship may be explained by the concept of caregiver burden, often described as parental burnout in the literature. Meltzer et al. reported that parents of children with conduct disorder experience significantly higher levels of caregiving burden compared to other groups.¹⁸ Mikolajczak et al. demonstrated that parental burnout is directly associated with neglect and inadequate supervision.¹⁹ Taken together, these findings suggest that the demands of managing CD-related behaviors may reduce parents’ motivation and capacity to implement preventive environmental safety strategies.

Limitations

This study was conducted in a single province, and therefore, the findings cannot be generalized to all of Türkiye. The data collection period covered only two months, and the potential impact of seasonal variations on home accident frequency could not be controlled. As the timing of first aid training was not assessed, the causal relationship between this variable and accident frequency could not be clearly established. Data on home accidents were based on parental reports, and recall bias cannot be excluded. Finally, the Conners scale was used as a screening tool for conduct disorder risk rather than for clinical diagnosis, which should be considered when interpreting the findings.

Conclusion

This study demonstrates that the severity of CD symptoms is significantly associated with home accidents and negatively affects mothers’ implementation of safety measures (r = -0.257; p<0.001). High levels of maternal safety awareness and positive attitudes alone are not sufficient to minimize accident risk in children with CD, particularly in the context of impulsivity and limited supervision. Primary care professionals should not focus solely on behavioral symptoms in the management of children with CD; routine follow-up should also include proactive home safety education and assessment of parental psychosocial support needs. Effective management of CD symptoms should be considered a key preventive health intervention to reduce childhood home accidents and related morbidity.

Declarations

Abbreviations

ANOVA: analysis of variance
CD: conduct disorder
SPSS: statistical package for the social sciences
STROBE: strengthening the reporting of observational studies in epidemiology

References

1. Ünal H. Davranım bozukluğu tanısı alan ilköğretim öğrencilerine okullarda sunulan danışmanlık hizmetlerinin incelenmesi [Evaluation of school-based counseling services provided to primary school students diagnosed with conduct disorder]. Çukurova Üniversitesi Sosyal Bilimler Enstitüsü Eğitim Bilimleri Anabilim Dalı. Unpublished master’s thesis. 2006.
   PubMed Google Scholar
2. Abalı O, Onur M, Gürkan K, Çelik Ö, Yüzün ÜD. İlköğretim çağı çocuklarındaki davranım bozukluğu semptomlarının sosyodemografik verilere göre değerlendirilmesi [Symptoms and socio-demographic factors of conduct disorder in elementary school population]. Dusunen Adam. 2006;19(1):14-19.
   PubMed Google Scholar
3. Silva ANE, Nogueira LT, Silva ARVD. Domestic accidents due to children’s falls: a cross-sectional study. Rev Esc Enferm USP. 2024;58:e20240192. doi:10.1590/1980-220x-reeusp-2024-0192en
   Article PubMed Google Scholar
4. Alhadrami LM, Habib HS, Osman BK, et al. Maternal knowledge and awareness of preventive measures for domestic accidents among children in Jeddah, Saudi Arabia. Cureus. 2024;16(10):e71226. doi:10.7759/cureus.71226
   Article PubMed Google Scholar
5. Tosun MÇ, Oral B, Balcı E. 4-6 yaş çocuk annelerin ev kazalarını önlemeye yönelik önlemleri, ev kazaları ve ilkyardım konusundaki bilgi, tutum ve davranışlarına eğitimin etkisi: müdahale çalışması [4-6 year age children mothers’ measures to prevent home accidents, knowledge, attitudes and behaviours regarding domestic incidents and first aid: an intervention study]. Hipokrat Tip Derg. 2025;5(3):103-110.
   PubMed Google Scholar
6. Jones M, Orton E, Taylor MJ, et al. Cost-effectiveness of the “Stay One Step Ahead” home safety programme for the prevention of injuries among children under 5 years. Inj Prev. 2024;31(1):45-51.
   PubMed Google Scholar
7. Balogun OJ, Bello OO, Nkhata LA, Conran J. Maternal knowledge and attitude towards unintentional childhood injury among children under five. Afr J Disabil. 2025;14:1617. doi:10.4102/ajod.v14i0.1617
   Article PubMed Google Scholar
8. Moridi E, Fazelniya Z, Yari A, et al. Effect of educational intervention based on health belief model on accident prevention behaviours in mothers of children under 5 years. BMC Womens Health. 2021;21(1):428. doi:10.1186/s12905-021-01573-1
   Article PubMed Google Scholar
9. Al-Bshri SA, Jahan S. Prevalence of home-related injuries among children under 5 years old and practice of mothers toward first aid in Buraidah, Qassim. J Family Med Prim Care. 2021;10(3):1234-1240. doi:10.4103/jfmpc.jfmpc_2265_20
   Article PubMed Google Scholar
10. Megahed MA, Khalil NA, Ibrahem RA, El Disoki RS. Knowledge, attitude and practice of rural mothers towards home injuries among children under 5 years of age in Menouf District-Menoufia Governorate, Egypt. Menoufia Med J. 2016;29(4):1033-1039.
    PubMed Google Scholar
11. Tekin FC, Acar D, Uğur C, et al. Clinical characteristics and socioeconomic determinants of unintentional childhood injuries: an emergency department perspective. Turk J Trauma Emerg Surg. 2026;32(3):315-326. doi:10.14744/tjtes.2026.65814
    Article PubMed Google Scholar
12. Ma X, Zhang Q, Jiang R, et al. Parents’ attitudes as mediators between knowledge and behaviours in unintentional injuries at home of children aged 0-3 in Shanghai, Eastern China: a cross-sectional study. BMJ Open. 2021;11(12):e054228. doi:10.1136/bmjopen-2021-054228
    Article PubMed Google Scholar
13. Ji J, Yang H, Zeng C, Chen O, Lu Q. Bridging the gap: parental supervision as a mediator between home environment and unintentional injuries in children under 3 years. Int J Public Health. 2025;70:1606726. doi:10.3389/ijph.2025.1606726
    Article PubMed Google Scholar
14. Bayomy HE, Alshalan MMT, Alanazi WK, et al. Domestic injuries among children: knowledge, attitudes, and practices of first aid among mothers in Arar, Saudi Arabia. BMC Pediatr. 2025;25(1):300. doi:10.1186/s12887-025-05583-y
    Article PubMed Google Scholar
15. Celep G, Yardımcı F. Annelerin evde gerçekleşen istenmeyen yaralanmaların önlenmesine ilişkin aldıkları güvenlik önlemleri [Safety measures adopted by mothers to avoid undesired injuries at home]. STED. 2021;30(2):96-106. doi:10.17942/sted.793063
    Article PubMed Google Scholar
16. Özbey MY, Ener D. Frequency of home accidents of children between 0-6 years and levels of diagnosis of mothers’ safety measures. Med Rec. 2022;4(3):266-273. doi:10.37990/medr.1070345
    Article PubMed Google Scholar
17. Demirköse H, Uğraş Dikmen A, Özkan S. 0-6 yaş grubu çocuğu olan annelerin ev kazalarına yönelik güvenlik önlemlerini tanılama düzeyleri ile sağlık okuryazarlığı ilişkisi [The relationship between safety measures for home accidents and health literacy]. ESTUDAM Halk Sagligi Derg. 2022;7(1):112-121.
    PubMed Google Scholar
18. Meltzer H, Ford T, Goodman R, Vostanis P. The burden of caring for children with emotional or conduct disorders. Int J Family Med. 2011;2011:801203. doi:10.1155/2011/801203
    Article PubMed Google Scholar
19. Mikolajczak M, Brianda ME, Avalosse H, Roskam I. Consequences of parental burnout: its specific effect on child neglect and violence. Child Abuse Negl. 2018;80:134-145. doi:10.1016/j.chiabu.2018.03.025
    Article PubMed Google Scholar

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About This Article

Received:

March 18, 2026

Accepted:

April 24, 2026

Published Online:

April 24, 2026