# Epidemiological characteristics and risk factors for severity of product-related injuries in children during COVID-19: a non-pharmaceutical intervention study

## TL;DR

This study shows how pandemic lockdowns changed where and how children get injured, with more severe injuries at home from toys and appliances.

## Contribution

The study reveals how non-pharmaceutical interventions during the pandemic altered injury patterns and severity in children.

## Key findings

- During NPIs, 56.38% of injuries occurred at home, with more foreign body and burn injuries.
- Injuries from toys and household appliances were significantly more severe during the NPI period.
- Post-NPI, injuries at schools and public places were less severe compared to pre-pandemic.

## Abstract

This study utilized the “natural experiment” created by the COVID-19 pandemic to assess the impact of non-pharmaceutical interventions (NPIs) on the epidemiological characteristics and determinants of the severity of product-related injuries among children.

We analyzed data on product-related injuries in children aged 1 to 17 years from the Xiamen Injury Surveillance System between 2016 and 2024. The study period was categorized into three phases: pre-pandemic, during NPIs, and post-NPIs. Multivariable logistic regression models were constructed, adjusting for demographic and injury-related confounders. Interaction terms (period × injury location, period × product category) were included to analyze the independent effect of the NPIs period on the risk of severe injury (requiring hospital admission) and its effect modification.

A total of 39,245 cases were included. During the NPIs period, the proportion of injuries occurring at home peaked at 56.38%, with notable increases in the proportions of foreign body injuries and burns/scalds. In the post-NPIs period, the proportion of injuries occurring at schools and public places rebounded to 18.07%. While the NPIs period was not independently associated with injury severity in the main effects model, interaction analysis revealed that, compared to furniture-related injuries in the pre-pandemic period, the risk of severe injury was significantly higher during the NPIs period for injuries involving agro-forestry-fishery products (aOR = 15.59, 95% CI: 4.70–51.75), household appliances (aOR = 4.20, 95% CI: 1.37–12.88), and children’s toys (aOR = 3.47, 95% CI: 1.29–9.33). Conversely, the severity risk of injuries occurring at schools and public places in the post-NPIs period was significantly lower than in the pre-pandemic period (aOR = 0.47, 95% CI: 0.23–0.99).

NPIs reshaped the risk landscape of childhood injuries, significantly increasing the severity of injuries associated with specific home-related products (e.g., toys and household appliances). These findings underscore the necessity of integrating targeted product safety interventions within the home environment during public health emergency responses.