A developmental examination of unintentional injury and injury‐risk behaviours among children and adolescents with haemophilia
Authors: MAYES SUNNYE , SAXENA KAPIL , RODDENBERRY ANGELA 
Published: March 2009

Objective:  To examine rates of injury risk and prevention behaviours among children and adolescents with haemophilia.

Methods:  Participants: Seventy‐six parents of children and adolescents attending appointments for Comprehensive Haemophilia Clinic were interviewed during clinic visits. Children and adolescents ranged in age from 2 to 18 years and were separated into three age groups: preschool (ages 2–4; n = 14, M = 2.5, SD = 1.65), school‐age (ages 5–11; n = 24, M = 8.38, SD = 2.06), and adolescent (ages 12–18; n = 38, M = 15.05, SD = 1.83). All participants were male; the percentage of participants with moderate to severe clotting factor deficiencies was 85.7% for the preschool group, 62.5% for the school‐age group, and 73.7% for the adolescent group.

Measures and procedure:  An IRB‐approved chart review was conducted to obtain information provided by patients during comprehensive haemophilia clinics. Information about injury risk and safety behaviours (e.g., use of all‐terrain vehicles [ATVs], seat belts and bicycle helmets) and updated injury histories are regularly collected during clinic visits. Additional variables obtained from the charts included disease type and severity, inhibitor status, and type of treatment regimen (i.e., prophylactic or on demand).

Summary:  Children and adolescents in this population reported a significant number of injury‐risk behaviours, including high rates of riding or co‐riding on an ATV (preschool = 21.5%, school‐age = 29.2% and adolescent = 48.7%). Of those who used an ATV, the school‐age group reported the most consistent helmet usage at 57.1%, whereas less than one‐third of adolescents and none of the preschoolers reported helmet use. Although 80% of the preschool children who ride bicycles reported regular use of helmets, only 17.4% of the adolescents and 22.7% of the school‐aged children reported doing so. Many children and adolescents reported involvement in organized sports; however, 21.1% of school‐age and 48.7% of adolescent athletes reported sustaining a sports‐related injury. Furthermore, two families reported that the coach was not informed that their child has a bleeding disorder. Strategies to prevent injuries, such as regular use of stretching exercises were underutilized, with only 37.5% of children and 57.9% of adolescents using any stretching, and even fewer doing so on at least a weekly basis (20.8% and 23.7%, respectively). Percentages of injuries requiring application of ice were highest among adolescents and preschoolers (34% and 33%, respectively, compared with 29% in children) and rates of bruising were consistently high, ranging from 66% in adolescents to 75% in children.

Conclusions:  Unintentional injury is a major health threat for all children and is an area of study that is just emerging among populations of children and adolescents with bleeding disorders. The current findings indicate that many children and adolescents with haemophilia regularly engage in behaviours that may result in serious injury and do not always take appropriate safety precautions. Clearly, further research in this area would serve a great benefit to clinical and preventive care for this population and may result in increased knowledge of risky activities and effective strategies for intervention.