Health literacy can affect new parent's ability to protect infants from injury

A new parent's health literacy, defined as their ability to obtain, interpret and understand basic health information, can affect their ability to follow recommendations to protect infants from injury, finds a new study in the American Journal of Preventive Medicine.

"Sudden infant death syndrome or SIDS and unintentional injury are leading causes of infant deaths and have been for a long time," said lead study author William Heerman, M.D., clinical instructor in internal medicine and pediatrics at Vanderbilt University Medical Center in Nashville, Tenn.

"Peak incidence of injuries happen toward the end of the first year of life and during the second year," he said. "We wanted to better understand the timing of when pediatricians should counsel about injury prevention."

Data was collected on over 800 English and Spanish speaking caregivers of 2 month old children served by four pediatric clinics. Caregivers were assessed for adherence to seven of the American Academy of Pediatrics injury prevention recommendations for infants: car seat position and use, sleeping position, home fire alarms, hot water temperature settings, firearm safety and fall prevention. Caregiver health literacy was assessed with the Short Test of Functional Health Literacy in Adults.

Health literacy level is considered a growing factor in the adoption of healthy behaviors. The authors noted that nearly 80 million U.S. adults have low health literacy and that nearly 30 percent of U.S. caregivers have "below basic or basic health literacy." Previous research has found that caregivers with lower literacy have worse health outcomes, are less likely to understand health information and instructions, and may be less likely to follow recommendations related to preventive behaviors.

The researchers found a relationship between caregiver health literacy and some injury prevention behaviors. Those with low health literacy were less likely to position the child's car seat correctly and to know if the smoke detector was working. However, they were more likely to practice safe fall prevention. The authors found no association between health literacy and other injury prevention measures.

Lack of knowledge about safety among caregivers remains troubling, Heerman noted, "Nearly 90 percent of families don't know their hot water heater setting, even though checking that temperature is part of standard newborn discharge instructions. Plus nearly 43 percent of parents reported not putting children to sleep safely—on their back—and that's too high a number."

The authors don't know why parents don't comply with the recommendations. "Health literacy played an important role with some behaviors, but it doesn't seem to be the primary driver—and we still don't fully understand what is."

"Injury prevention is so important, and the fact that many parents are not consistently following recommendations should alarm pediatricians," said Richard White M.D., an assistant professor of internal medicine and pediatrics at the Mayo Clinic Florida. "It is possible that parents, especially new ones, may be overwhelmed by the volume of information provided during well-care visits. Low health literacy may compound these issues and should alert providers to ensure their instructions are understood."