Risk Factors in Childhood Accidents

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Transcript Hello, and welcome to the Your Parenting Mojo podcast.  We’re mid-way through an extended series of episodes on play at the moment.  The first in the series was an interview with Dr. Stuart Brown of the National Institute for Play on the value of play, both for children and for adults.  Then we followed with a look at the research on the benefits of outdoor play, followed by an interview with Dr. Scott Sampson who wrote the book How to Raise a Wild Child, which had tons of practical advice for getting kids outside more, as well as getting outside more with your kids. Today we move on to the topic of risky play.  We’ll define it, and discuss its benefits and drawbacks, as well as things we as parents can do to encourage more risky play if we decide we want to. Before we get going, I want to acknowledge that this episode rests heavily on the work of Professor Ellen Beate Hansen Sandseter (I hope I’m pronouncing that somewhat accurately) at the Queen Maud University College of Early Childhood Education in Norway.  We’ve discussed quite a bit of research lately which relies on a single researcher’s work – I’m thinking of the Mindset and Grit episodes, and I’m also familiar with the take-down of the Power Poses research by Dr. Amy Cuddy, which is the idea that if you stand up straight and spread your arms out wide in a really physically open position before you do something scary like going to a job interview or giving a presentation, your performance will measurably improve.  After another study failed to replicate the findings of the original one, Dr. Cuddy’s own co-author ended up publishing a statement saying she didn’t believe that Power Poses were real and had any benefit.  What those researchers all had in common was a single paper or very few papers which formed the foundation for their work, and an incredible amount of exposure which, these days, is often measured in TED talk views.  Dr. Dweck of the Mindset research is the laggard in this group considering that her work has been around the longest, with only 7 million views; Dr. Cuddy leads the pack with 45 ½ million views. On the other hand, Dr. Sandseter has not given a TED talk.  The majority of her sample sizes are pretty small; she also almost exclusively works in Norway except where she occasionally collaborates with researchers from other countries so her findings may not be applicable to people in other countries where risk is viewed differently than it is there.  She has a blog but honestly it’s pretty dry reading, with most of the updates consisting of notifications about papers she’s published, which non-academics can’t access anyway because the actual papers are behind the publishing journal’s paywall.  I also haven’t found any papers criticizing her methodology or her results.  My overall impression is that she is a scholar who has slowly and patiently built up a body of research over the last decade and a half, and she’s interested in being a resource to educators in Norway rather than being a celebrity – all of which is to say that I generally trust her work. So how do we define risky play?  Dr. Sandseter tried to do exactly this in a 2007 paper, for which she followed 38 children aged 3-5 from two Norwegian preschools and also interviewed the teachers at those schools.  She selected the schools because of the variety of outdoor experiences available to the children in each of them – one of the preschools had a playground had what she calls a “typical” playground with swings, climbing tower, a play hut, switchbacks (she doesn’t say what these are) and a climbing tree.  My first thought was that I’ve never seen swings or a climbing tree in an American preschool playground because these are deemed too dangerous, so this paper is probably gonna be pretty interesting.  The other preschool was situated in a forest and had a typical playground as well as use of part of the forest that was surrounded by fences.  Both groups of students often hiked to nature areas like forests, the seaside, caves, and so on.  Dr. Sandseter observed six kinds of risky play that have since become the standard ways to define risky play – these are: play with great heights, play with high speed, play with harmful tools, play near dangerous elements like deep water, rough-and-tumble play, and play where children can ‘disappear’ or get lost.  I’m going to quote and sometimes summarize some of the parts of the paper that raised my eyebrows on some of these kinds of risky play. Regarding play from heights, when a group of 4- and 5-year-olds arrive at the beach, one of them sees some cliffs that are 7-10 feet high and says “Wow, I wanna climb up here,” so he does, and his friends follow.  They explore the cliffs, which are steep and slippery; they keep climbing over the cliffs and back into the woods above the cliffs, come down to the beach, and do it over again.  While the teachers did later describe this kind of play as risky, they watched this incident without interfering, from 20-30 feet away – so, too far away to do anything immediately if something bad happened to one of the children.  The children also described climbing to the roof of the climbing tower and jumping off, even though this was forbidden by adults in case they got hurt.  One girl said “Yes, it’s a little bit scary, but it’s great fun – I often land on my bottom, and that hurts a bit – but it’s great fun anyway.” The ‘play with dangerous tools’ section was particularly interesting – it reads “In both preschools the children were allowed to quite freely use tools that were potentially dangerous – for example, a knife for whittling, a saw for cutting down branches, or a hammer and nails for carpentry.”  Dr. Sanseter took field notes on three instances: “The fire pit is lighted and the children are gathered around it chipping with a knife each on some wooden branches.  The children use knives freely and seem used to whittling on their own.” “Alex, aged 4 and Tori, aged 5 have each got a hammer and nails and start nailing some wooden boats.  They have a great independence in their work, and the preschool teacher present seems completely relaxed even though they swing their hammers as they like.  Two younger children aged 2-3 years old also take part, and they get to play as equally independently as the two older children. “The children participate in building a wooden climbing tower.  They get to use the saws and knives as they like.  One of the boys saws into his hand but is fine after getting a band-aid.  The children also participate in tying the branches together, and then climbing on the construction when it’s built.” Sometimes the children were observed using an axe, although I was amused to see that the teachers did supervise this activity more closely than the others.  Overall, the teachers thought playing with these tools was somewhat risky, while some of the children agreed but some didn’t, although in a subsequent study Dr. Sandseter observed that the children were there quite closely supervised when playing with all kinds of dangerous tools, that the children tended to concentrate highly when using them, and also talked with each other about the importance of using tools correctly so as not to hurt themselves or others. What these quotes and anecdotes reveal to me, of course, is not what these Norwegian preschoolers and teachers thought about risk, but the deep gulf between their perception of risk and the perception in a country like the U.S., where a knives, hammers, nails, saws, axes, and especially fire pits would NEVER be allowed within ten yards of preschool-aged children.  While Dr. Sandseter believes that allowing children’s use of dangerous tools in preschool is probably a Scandanavian phenomenon, I have personally seen twenty sets of pruning shears in a basket on the ground under the covered porch of a preschool in Reggio Emilia, Italy – I only saw the children indoors, but I can only assume that since there were enough pairs for a class full of children to use them, and they were sitting out right next to the wellies the children used in wet weather, that a class full of children probably did and do use them. I’m reminded here of an interview with Professor David Lancy, the anthropologist whose work we refer to often on the show.  He says that parents in most societies don’t intervene when children investigate a sharp knife or stray near the fire.  When ethnographers ask parents why they allow this, the parents’ reply is often “this is how they learn.”  The interviewer asks “Do you think it’s wise to let children play with knives?”, and Lancy responds “I’ve found that there is a trade-off. If parents give their children such freedom, the kids may indeed get hurt, but serious injury is rare in village societies. Children there die most often of malnutrition and illness, not accidents. Meanwhile village children happily take the initiative in learning how to use common tools like knives, setting their own pace and keenly observing those who are more competent. If parents were to play a more active and protective role in their child’s development, the children might be safer from injury, but that sense of autonomy and ability to learn independently would be undermined. The children would cease to take the initiative to learn new things and instead wait for an adult’s permission, guidance, or instruction.”  To me, this says a lot about American society, where parents generally WANT their children to look to them for permission, guidance, and instruction.  We show them how to use toys, rather than letting them figure it out for themselves.  It’s almost as if we can’t fathom that they would manage without us, because we need to feel so central in their lives. Back to Dr. Sandseter’s paper, the final issue I want to give examples on is play where the children can disappear or get lost – on one field trip a five-year-old says “I’m going to go on a walk all by myself!” and the teacher responds “That’s all right; go ahead!”.  Two other children join the first.  They walk for a short while, then one of them goes back to the group while the other two crawl through some dense bushes and announce to Dr. Sandseter, who has been following them: “Good bye!  We’ll be back at twelve o’clock!”.  While the children thought this kind of play was risky because they might get lost, they did it anyway because of the joyful fear they experienced and the teachers actually did not feel as though it was risky at all and felt in control of the situations.  Again, my mind was boggled – in the U.S., children generally aren’t allowed out of a parent’s or teacher’s eyesight in a fenced area like a playground, and when they are away from these fenced areas the boundaries become even tighter. At the heart of all this is the idea of risk, and the type and amount and risk that children are willing to take, and that parents are willing to see children take. While environments can be inherently more or less risky because a hill is more or less steep, and trees can have branches that allow small children to climb up or don’t, but there are individual characteristics associated with risk as well.  Children can choose to climb more or less high up the hill or not; they can choose to ride a tricycle fast or not; they can choose to focus and concentrate while playing or not.  Children make these choices based on the risks they subjectively perceive, and the balance between their abilities and their fears about those abilities moderate their actions.  Studies have found that there are differences between children’s tolerance for risk, a statement which perhaps seems obvious to anyone with more than one child.  Even I can see the difference in risk tolerance between my 3.5YO who thinks that jumping off the next-to-last step is pretty risky and exciting, and her friend of exactly the same age who loves to snowboard and wants to know why he can’t go on a zip line by himself.  A high activity level and a desire to engage in daring behavior are important risk factors for accident proneness and injury incidence, although perhaps the overall rate of injuries does not increase for these children as much as they otherwise might because they, too, understand what their bodies are capable of and use their abilities and fear to regulate their risk-taking behavior.  Children do tend to overestimate their physical abilities; one study that wasn’t done by Dr. Sandseter observed the link between extroversion, impulsiveness, daring, and carelessness, implying that there is a link between temperamental characteristics and childhood accidents.  The study also found that children who watched a video of another child doing four physical tasks taking a toy off a high shelf and moving under a wooden bar resting on two posts without knocking the bar off or putting their hands or knees on the floor were more conservative in judging their own abilities when the child in the video failed, rather than when the child in the video succeeded.  This implies that children get a lot of information about whether they can do something from whether their friends can do it, although this ability overestimation was more of an issue for six-year-old males and temperamental characteristics were more at play for 8-year-olds.  The study was pretty tiny – only 32 children, so it would be good to see if the findings were replicated with a larger number of