eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Critical Care

Injury Prevention

Author: William B Stratbucker, MD, Assistant Professor of Pediatrics, Division of General Academic Pediatrics, Rush Medical College; Consulting Staff, Rush University Medical Center, Rush Children's Hospital
Coauthor(s): Cori M Green, MD, Staff Physician, Section of Pediatrics, Rush University Medical Center
Contributor Information and Disclosures

Updated: May 1, 2006

Introduction

Injury is the leading cause of death and disability in children and adolescents. "Injury" is not synonymous with "accident." Unlike an accident, a childhood injury is an understandable, predictable, and preventable occurrence.

Pediatric injury prevention is one of the most important and challenging aspects of child health care. Young children inherently lack mature decision-making skills to protect themselves from injury, while some older children and adolescents engage in risky behaviors in attempts to rebel against adult advice. No child is immune to all dangers that pose a threat to his or her health and safety. Statistics show that preventable childhood injuries account for 44% of all deaths in individuals aged 1-19 years. In 2002, unintentional injury resulted in the death of 20,000 children, adolescents, and young adults. Rates and statistics cited in this article are mainly from the American Academy of Pediatrics Policy Statements, Pediatrics journals, and the AAP publication Injury Prevention and Control for Children and Youth (Widome, 1997).

Prevention of childhood injury-related deaths is the responsibility of many. Pediatricians, as guides during a patient's health maintenance checkup, should address injury prevention with parents and caregivers, as well as with the children themselves when appropriate. Parents need to take an active role in preventing childhood injury in and around the home and in the car. Schools and daycare providers are responsible for minimizing hazards and providing a safe environment.

Product manufacturers are charged with making products safe for children and are held to safety standards and regulations. Communities and government bodies are responsible for enacting and enforcing child protection laws. Advocacy groups challenge the current state of injury prevention law and manufacturing practice to impact child safety. Citizens who witness violations of child safety laws should alert the appropriate authorities; in certain situations, citizens can be held responsible for not reporting a witnessed neglectful or abusive action. Finally, researchers constantly examine the current state of child safety and the prevailing statistics to identify areas of concern and apply methods to improve the science of injury prevention.

The 3 fundamental aspects of injury prevention science are epidemiology, biomechanics, and behavioral science.

• Epidemiology provides an understanding of the nonrandom distribution of injury risk among populations of children so that areas of concern can be identified and targeted interventions can be designed and implemented.
• Biomechanics provides an understanding of human vulnerability and resilience to limit energy transfer in a potentially injurious event. For example, biomechanics researchers and engineers have continually challenged and updated designs of infant car seats to provide protection in motor vehicle collisions.
• Behavioral science provides knowledge about effective and ineffective ways of altering the risk of injury by manipulating behaviors of children, adolescents, adults, and communities. For example, laws that require the use of seat belts in automobiles can be analyzed for effectiveness in curtailing childhood injury and death.

Epidemiology

Injuries, unlike accidents, are understandable, predictable, and preventable.

A fundamental concept of the science of epidemiology is the phase-factor matrix, introduced in 1972 by William Haddon. The matrix is a conceptual framework that identifies 3 stages of event-related modifiable risk factors within the science of epidemiology.

• Pre-event factors (eg, separating bicyclists from traffic)
• Event factors (eg, protection from head injuries with helmet use while bicycling)
• Postevent factors (eg, availability of emergency services and trauma center after an injury)

Haddon later examined these phases of time in how they relate to the host or victim, the agent (or vehicle), the physical environment, and the social environment. Taking all these elements into account and creating a matrix gives one a framework for how intervention can be applied within each cell of the matrix.

For instance, this matrix can be applied to firearm injuries. Pre-event aspects refer to the age of the child, the curiosity of the child about the weapon, and whether the weapon is out of reach of the child. Places to intervene during the pre-event can be analyzed within each element. The host, or child, can be taught never to play with firearms. The agent, or firearm, can have a trigger lock. In the physical environment, or child's home, the firearm can be locked away out of reach from the child. The social environment for this example can be one in which laws restrict the purchase of firearms.

The event would be the child firing the gun. The amount of harm and damage that would result from this event can be minimized by the host, or victim, wearing bulletproof clothing. The agent, or vector, can have bullets of a less dangerous caliber. The physical environment can include bulletproof glass to also minimize damage and harm from the event. As for the postevent, the extent of injury depends on the host's age and physical condition. The environmental factors involved with the postevent are availability of the Emergency Medical Services (EMS) systems and proximity of trauma centers and pediatric intensive care units.

The 3 forms of injury prevention interventions are as follows:

• Active intervention - An action taken on the part of the child or parent to prevent injury (eg, placing medications out of the child's reach)
• Passive intervention - No action required for the intervention to be successful (eg, packaging of medications in nonlethal amounts)
• Mixed intervention - Part active and part passive (eg, bike helmets inherently protect the cyclist's head, but they must be worn correctly)

Generally, the more effort required on the part of the child or parent, the less successful the intervention.

Racial considerations

American Indian and Alaskan Native children are at a higher risk of unintentional injury than children of other races in the United States. These 2 ethnic groups also have a higher rate of injury-related death. Approximately 1,100,000 children in the United States are either American Indian or Alaskan Natives. In 2002, a total of 378 injury related deaths occurred in these populations. This rate is equal to 33.79 per 100,000 children compared with a rate of 21.72 per 100,000 children in all races. The rate of motor vehicle injury in American Indian and Alaskan Native children is 16.2 per 100,000 children compared with 9.9 per 100,000 in all other races.

However, African American children aged 0-19 years have the highest rates of death secondary to drowning, firearms, and other violence-related injuries. In 2002, approximately 13,000,000 children in the United States were African American. That year, 1,123 African American children died secondary to a firearm, a rate of 8.5 per 100,000 compared with a rate of 2.6 per 100,000 white children and 4.6 per 100,000 American Indian or Alaskan Native children.

Biomechanics

Reducing the risk and severity of injuries are the twin goals of biomechanics research and development.

Energy is the primary enemy of injury prevention efforts. Energy can be mechanical, thermal, chemical, or electrical, or it can consist of ionizing radiation. Mechanical energy is responsible for most injury morbidity and mortality in children. Examples of strategies to minimize the effects of mechanical energy include seat belts and car seats in motor vehicles, properly worn bicycle helmets, and energy-absorbing surfaces under playground equipment.

Questions such as if an infant would be safer in the event of a motor vehicle collision if he or she were seated facing the rear are the types of questions that are investigated and challenged through biomechanics research. The deduction based on that question is that impact direction in a motor vehicle collision is an important determinant of infant morbidity and mortality. For example, lateral impacts to the head cause more axonal injury than impacts from other directions; therefore, side-impact airbags were developed in cars. Since most severe car collisions are frontal, infant safety seats face backward.

Behavioral Sciences

Persuading persons at risk of injury to alter their behavior (eg, to wear seat belts, to install smoke detectors) is an incredible challenge.

Requiring behavior change by law (eg, seat belt and motorcycle helmet laws, building codes for fire exits and smoke detectors) is an attempt by government bodies to force healthy decisions to be made by society in order to improve public health.

Advocacy groups use behavioral techniques in public service announcements and other outlets to provide education to parents and children in an attempt to encourage good decision-making. Two examples are the Buckle Up America campaign and Poison Prevention Week.

Behavior science deals mostly with active injury prevention strategies or strategies that require the parent or child to actively alter his or her activity or make a healthy decision (eg, buying, wearing, and replacing bicycle helmets.)

Health and injury prevention education materials are available from a variety of sources, including pediatricians, consumer books, and Web sites.

In medical office-based education and counseling, the pediatrician is key in influencing parental behavior to reduce the risk of injury. Effective counseling is developmentally focused and understandable, prioritizing injuries for the particular age group receiving counseling. It engages the parent, patient, or both in a dialogue so that a sense of responsibility and importance is developed. Parents with younger children must be convinced that the active injury prevention intervention is worthwhile.

The American Academy of Pediatrics (AAP) assists pediatricians in their attempts to decrease childhood injury by providing materials for parents and by providing physicians with updated product information and educating them of new dangers. The AAP developed The Injury Prevention Program (TIPP), which consists of the following 3 elements:

• The AAP policy statement on injury prevention, which prioritizes injuries by age group, focuses on common injuries with known intervention strategies, and makes injury prevention counseling a standard of care
• Childhood safety counseling schedules
• Safety information sheets (ie, TIPP sheets) that are age-specific and topic-specific for parents and children

Because parents and children learn by example in many ways, the pediatrician's office should be a model of child safety.

The National Center for Injury Prevention and Control (NCIPC) is a part of the Centers for Disease Control and Prevention (CDC) established in 1992. This group assists state and local health departments and community groups to define areas of concern and help direct targeted interventions. The NCIPC treats a new childhood injury danger as if it were a viral outbreak handled by the CDC.

Injury Prevention/Intervention Strategies

Motor vehicle safety

Injury from a motor vehicle collision is the leading cause of death in children aged 1-19 years and accounts for more than 8,000 deaths annually. Each year, motor vehicle collisions result in approximately 5,000 deaths among persons aged 16-20 years. In the United States in the year 2002, 2,542 children younger than 5 years died in motor vehicle collisions. Almost half were unrestrained, and many more were inappropriately restrained.

A study by the National Highway Traffic Safety Administration in the fall of 2001 found overall misuse of child safety seats for children less than 80 pounds to be 73%. In particular, they found that children aged 4-8 years were the least likely to be restrained properly. The study showed misuse measures to be the age and weight appropriateness of the child restraint system (CRS), direction of the CRS, placement of the CRS in relation to air bags, and the security of the CRS in relation to the automobile's seat and safety belt.

The safest place in a motor vehicle for an infant or child is in the back seat. In all 50 of the United States, the law requires that infants be in a car seat while riding in a motor vehicle. An infant should never be placed in a rear-facing car seat in the front seat of a car equipped with a passenger-side air bag. If a child must sit in the front seat, the seat should be moved back as far as possible, away from a passenger-side air bag (if present), and the child should be properly belted in a booster seat if needed.

Children are at a higher risk for air bag–related injuries because of their size and the positioning of their seat belts, which place the child's face and neck full velocity in the path of a deploying airbag. The National Highway Traffic Safety Administration published statistics that as of April 1, 2003, there were 244 incidents in which deployment of an airbag resulted in a fatal injury. Of these incidents, 143 involved children, and 121 of those children were not properly restrained in a rear-facing safety seat. Front airbags appear to offer more harm than protection to children younger than 13 years who are seated in the front seat.

Infants younger than 1 year and weighing less than 20 pounds should be placed in the back seat in a rear-facing child-restraint car seat (see Image 1). Forward-facing car seats can be used for children older than 1 year and weighing more than 20 pounds until the child is aged 4 years and weighs at least 40 pounds (see Image 2). To ensure that the installed seat belt is properly used by children younger than 8 years who do not require a car seat, booster seats placed in the back seat are recommended (see Image 3). In some communities, car seat safety checks are periodically available so that parents can have their car seat installation checked. A good car seat is the right size for the infant or child, fits into the car appropriately, works with the car's seat belt system, is easy for the parent toinstall, meets all federal safety standards, and has not previously been in a car that was involved in acollision.

Societal changes have begun to improve safety in regards to child restraints. For instance, in 2001, only 2 states had laws requiring booster seats to be used by children who graduated from a convertible car seat. In 2004, 22 states had implemented laws requiring booster seats. In addition, ongoing improvements of new vehicle safety restraints have been developed, including side-impact air bags and Lower Anchors and Tethers for Children (LATCH). LATCH is a system that allows the installation of child safety seats without the use of the vehicle's seat belt. However, it is important to continue to educate parents, caretakers, and technicians about proper restraint use. Also, local and national resources are available to aid parents in proper restraint use (eg, 1-866-SEAT-CHECK, www.seatcheck.org).

In a motor vehicle collision, children are 3 times more likely to die in a pickup truck than in another type of automobile. Compared with a properly restrained cabin passenger, a child in the cargo area of a pickup truck is 8 times more likely to die in a crash.

Traffic safety

When near traffic, young children should hold hands with an adult at all times. Deaths have occurred in the driveway of the home when a family member or guest unintentionally backed a car over a child.

Bicycle safety

An estimated 44 million children and adolescents younger than 21 years in the United States ride bicycles. Each year, approximately 200 children are killed in bicycle crashes and another 350,000 are seen in emergency departments for bicycle-related injuries. Two-thirds of bicycle-related deaths are due to traumatic brain injury. The use of a bicycle helmet can reduce the occurrence of serious brain injuries by 88%. However, it is estimated that only 20% of children in the United States actually wear bicycle helmets. The frequency of helmet use in children rises dramatically if helmets are worn by parents, caregivers, friends, or other relatives. Community helmet campaigns with incentives and school-based interventions have been created to promote helmet use, but these have had mixed success. Laws mandating helmet use are being enforced in local communities. Helmets do need to be replaced if they have been involved in a crash.

Firearm safety

Firearm-related deaths account for the highest percentage of injury death in individuals aged 10-19 years. In 2002, 2893 firearm-related deaths occurred in the United States in individuals 20 years or younger. This is a decline from 1999, when 4223 firearm-related deaths were reported. The number of deaths from firearms increased 31.8% from 1980-1985 to 1986-1992 and has declined each year from 1993-1997. Of the 4223 childhood deaths in 1997, 61% (2576) were homicides, 30% (1267) were suicides, and 7% (306) were unintentional (of which 20 were unintentional deaths of children <5 y). Of all firearm-related deaths in children younger than 5 years, 24% are unintentional; of those in children aged 5-9 years, 26% are unintentional; of those in children aged 10-14 years, 21% are unintentional; and of those in children aged 15 years and older, 5% are unintentional.

Most unintentional firearm-related deaths are caused by children who are unsupervised in a home with a handgun (70%). Risk factors associated with childhood firearm death include exposure to family violence, history of antisocial behavior, depression, suicidal ideation, drug and alcohol use, poor school performance, bullying, withdrawal, and isolation from peer groups.

Teenage homicides in 2001 involved a handgun 83% of the time, a long gun 10% of the time, and another type of firearm 7% of the time. In 1997, 22.5% of all injury deaths in children aged 1-19 years were firearm-related. Of children aged 15-19 years, 32.2% of injury deaths were firearm-related. In black males aged 10-34, injuries from firearms are the number one cause of death. Firearms are much more likely to result in harm to the owner or relative than they are to be used to defend the family against an intruder.

In general, parents should be advised to eliminate firearms from the home if children are present. If a gun is to be kept in the home, it should be placed unloaded in a locked cabinet and separated from the locked-up ammunition.

Home safety

Home childproofing should be encouraged for parents with a child as young as 6 months. Important strategies to encourage include covering outlets, padding table corners, placing stair gates to prevent falls, removing dangling cords, and eliminating hot temperature exposures (eg, heated vaporizers). The most recently identified concern within the home is the use of self-activating paper shredders into which a small child could place their fingers.

Parents should not leave doors open or unlocked at night, especially in winter. Toddlers can get out of bed and leave the home unattended.

A fall from a window, roof, or balcony is a way that a child can become injured or die. Although falls are the most common cause of injury in childhood, they are unlikely to be fatal; nevertheless, approximately 140 fatalities attributable to falls occur each year in children aged 15 years or younger. Annually, approximately 3 million children visit an emergency department (ED) because of a fall. Window guards that keep children in yet allow for egress during a fire are recommended. To prevent some falls, the maximum spacing in railings has been set at 4 inches. Almost all children younger than 6 years can fit through a railing with 6-inch spacing, and almost no child older than 1 year can fit through a railing with 4-inch spacing.

Lawn and garden equipment should be used with caution. Lawnmowers pose a threat to toddlers who don't realize their danger. Approximately 9400 injuries per year occur from lawn and garden equipment in children younger than 18 years; one fourth of these injuries are in children younger than 5 years.

Each year, an estimated 300,000 to 4.5 million dog bites result in 1% of all ED visits. Children are at an increased susceptibility of getting bitten because of their smaller size, relative inability to defend themselves, interest in animals, and unintentional (or intentional) abuse of animals. The highest frequency of dog bites comes from dogs that are younger than 1 year old, male, and unneutered. German shepherds, pit bulls, and chow chows are the most common dogs that bite; 50% of deaths from dog bites in the United States are from pit bull–type dogs and Rottweilers. To reduce injury, children should be taught about dog behaviors, and the public should be educated about the selection of dogs and their training, care, and socialization. In addition, dogs should be properly immunized and regularly taken to a veterinarian to minimize the chance of spreading disease via a bite.

Home fire safety and burn prevention

Fires and burns combined are the third most common cause of unintentional childhood injury death, behind motor vehicle collisions and falls. In Illinois, for example, between 1989 and 1998, burn injury from fires was the leading cause of death for children younger than 5 years. Each year in the United States, approximately 1000 children aged 15 years and younger die in residential fires. Children younger than 5 years are twice as likely to die in a residential fire than the rest of the population.

Smoke detectors should be installed near each sleeping area and on each floor of the home, including in the basement. These detectors should be in working order and regularly checked for proper functioning. Families should develop a home escape plan in the event of a fire. Children should be taught to feel a door for warmth; stay close to the ground if smoke is present; and to stop, drop, and roll if their clothing begins to burn. More information in English and Spanish is available at the US Fire Administration (www.usfaparents.gov).

Burns should be treated by cooling as soon as possible with cool running water and by applying a clean dressing. Burn severity is described in terms of degrees. If there is any question of a moderate- or high-degree burn, medical attention should be sought.

The risk of scalding burns can be lowered by instructing the parent to set the hot water heater in the home to 120°F (49°C) or lower. Before 1980, manufacturers routinely set water-heater temperatures at 140°F (60°C) or higher. At this temperature, a full-thickness burn in an adult would occur in about 2-5 seconds; in children, only about ½ second to 2 seconds is required for a similar burn.

Fireworks are dangerous for individuals of any age but particularly for young children. In 2003, approximately 9300 people were treated in emergency departments for injuries from fireworks; of those people, 45% were younger than 14 years.

Consumer product and toy safety

Many items available for purchase or use must meet safety standards prior to marketing. For example, items such as bunk beds, gas grills, garage-door openers, hair dryers, infant carriers, shopping carts, and self-locking toy chests all carry specific hazards for children.

Mobile infant walkers are universally not recommended by the American Academy of Pediatrics. They do not help an infant learn to walk, and they pose a serious danger of falls down stairs. In 1999, approximately 8800 children younger than 15 months went to the emergency department because of injuries related to infant walkers. Stationary infant activity centers are recommended as an alternative to mobile infant walkers.

Trampolines are so strongly associated with childhood injury that the American Academy of Pediatrics has advised that no parent consider purchasing one. In 1996, approximately 83,400 injuries in the United States were caused by trampoline use; 66% of these injuries were in children aged 5-14 years, and 10% were in children younger than 5 years. Most of the serious injuries involved bone fractures. Trampoline injuries that are fatal are usually due to spinal cord and head trauma.

Parents can check on updates about consumer products and toy recalls at the U.S. Consumer Product Safety Commission's Web site (http://www.kidsource.com/CPSC) or by telephoning 800-638-CPSC (800-638-2772).

Ingestion prevention and choking

Children learning to crawl or walk should be protected from all dangerous chemicals and substances found in the home. These should be put out of reach from children, and the use of child protective devices to prevent opening of cabinets should be encouraged.

All babies and toddlers should avoid small objects and foods because of the threat of choking. Batteries, buttons, jewelry (especially necklaces and hoop earrings), coins, certain holiday decorations, and small toys should be eliminated from the small child's environment. The most dangerous foods include peanuts, popcorn, hot dogs and sausages, whole grapes, raisins, bites of apple and meat, carrots, and candy.

The phone number for a poison control center should be known to all parents and readily available to call in the case of poison ingestion. The AAP recommends that ipecac no longer be routinely used as a poison treatment intervention in the home, and pediatricians should advise parents who do have ipecac at home to dispose of it. Inducing a child to vomit certain chemicals can make the injury worse. In some situations, giving a child ipecac delays presentation to the emergency department and in some cases has delayed use of more effective substances such as activated charcoal. Parents and caregivers should always call the poison control center before administering any therapy to a child with a toxic ingestion.

Unintentional acetaminophen toxicity in children can occur, and counseling for parents by pediatricians on the correct dosing procedures for all over-the-counter drugs, including acetaminophen, is recommended. Medications used by family members are a particularly common source of ingestion by children. Parents should be cautioned to make sure each home in which the child spends substantial time is safe.

Water safety

Infants and children need to be watched at all times when around any water. Instances of toddlers drowning in containers of water as small as a bucket have been reported. Because they are top-heavy, children who put their heads into a bucket may be unable to right themselves and can easily drown in the water or other liquid the bucket contains.

Leaving a child unattended while he or she is bathing is a particularly common, yet extremely dangerous, occurrence. Eight percent of all childhood drownings occur in bathtubs.

For both a fun activity and to increase awareness of water safety, swimming lessons are generally encouraged for children older than 4 years. Swimming programs with proper supervision are encouraged for infants and toddlers, but they have not been shown to decrease the risk of drowning. Of recreational activities, swimming carries the highest risk for children. Ideally, public swimming pools should have a lifeguard in attendance. Private swimming pools should be fenced so that unsupervised children–especially those aged 18-30 months, who are most vulnerable–cannot gain entrance. The fence should be 4 feet tall or higher. The distance between the bottom of the fence and the ground should be fewer than 4 inches. The gate of the pool fence should be self-latching and self-closing.

Sports safety

Studies of sports injuries show that the most dangerous sports for children are football, gymnastics, wrestling, and ice hockey. Proper coaching and instruction as well as proper use of protective gear, including helmets, face masks, and mouth guards, are essential to help prevent injury.

Concussions during football are common, and the proper response to treat a player with a concussion is the responsibility of the coaches and trainers for the team. Concussion scoring systems exist to help a coach or trainer properly diagnose the severity and decide on a plan for return to play if appropriate.

Approximately 4.8 million children aged 5-14 years play baseball or softball. In 1995, an estimated 162,000 children visited the emergency department after a baseball- or softball-related injury. The peak age for injury in these sports was 12 years. Approximately 43% of injuries were from a ball-chest impact; 24% were from a ball-head impact; 15% were from a bat impact; 10% were from a ball-neck, ball-ear, or ball-throat impact; 8% were unknown.

Soft baseballs are designed to lessen the impact and potentially decrease the injury from being hit by a baseball. In addition, soft baseballs can potentially decrease the risk of commotio cordis. This is the syndrome associated with a youth baseball player being hit in the chest and experiencing the oftentimes fatal cardiac arrhythmia, ventricular fibrillation. From 1978-1995, commotio cordis was reported to cause 88 deaths (approximately 4 per year). Researchers believe that children are more prone to this phenomenon because their thoraces are relatively more elastic and more easily compressed by an impact than those of an adult.

Soft baseballs should be considered for use by children aged 14 years and younger. Padded chest protectors are also undergoing testing, but not enough information is known about them for them to be universally recommended. Catchers must wear protective gear to protect themselves from the pitched ball and swinging bat. Additionally, all youth baseball players should wear batting helmets.

Baseball is the leading cause of sports-related eye injuries. For this reason, polycarbonate eye protectors are advised for batting helmets and should be required for any player with a history of eye surgery or 1-eye blindness. Breakaway bases are encouraged, and headfirst slides are discouraged. Benches and dugouts should be protected, and the use of an "on-deck circle" should be discouraged, unless it is enclosed by a fence. "Little-league elbow" is one particular injury that is mainly seen in pitchers who are not yet skeletally mature. Medial elbow pain develops in these athletes. Many guidelines are available to determine the appropriate age to start throwing certain pitches, how many pitches to throw, and how much rest is needed between pitching outings.

Gymnastics injuries can be minimized with good coaching and floor padding around equipment. In 2002, the number of cheerleading participants increased 18%. This increase in participation, along with new cheerleading styles, has increased the number of gymnastic-related injuries by 110%. An estimated 7.5 injuries occur per 1000 participants aged 6-17 years. Most injuries involve upper and lower extremities and include fractures, dislocations, avulsions, and lacerations. Because cheerleading styles have changed to include more gymnastic-type moves, there is also a risk of concussion, neck, and closed head injuries. It is recommended that coaches complete a safety training and certification program.

Youth ice hockey players are advised to avoid "checking" until they are at least aged 16 years.

Soccer is a relatively safe sport; almost all deaths reported occurred because of an impact with a goal post. From 1979-1993, 18 fatalities were reported, with the mean age of 10 years. Soccer is second only to basketball in the number of orofacial and dental injuries. Another risk is that goal posts can tip and fall on children. Whether "heading" the ball in soccer causes cognitive deficits remains controversial.

Recreation safety

Steel lawn darts and motorized 3-wheeler ATVs are examples of recreational items that had flawed designs. Production of these items is prohibited.

Skateboarding, scootering, inline skating, snowboarding, and skiing are increasingly popular recreational sports that require proper equipment and protective gear to adequately protect children from injury. Approximately 50,000 emergency department visits per year are attributable to skateboard injuries, and approximately 9400 emergency department visits due to nonmotorized scooter-related injury were reported between January and August 2000. For skateboard and scooter safety, avoiding traffic, wearing proper protective gear, and having adequate supervision are advised. No child younger than 10 years should be allowed to skateboard unsupervised, and no child younger than 8 years should be allowed to ride a scooter without supervision.

Inline skating has become very popular; in 1996, approximately 17 million children younger than 18 years participated. In the same year, approximately 76,000 emergency department visits were related to inline skating injuries in persons aged 21 years or younger. Of those injuries, 37% were wrist injuries, and 66% of those wrist injuries were fractures. Fatalities are rare and almost always associated with a motor vehicle collision. Since 1992, 31 of 36 reported fatalities were due to a motor vehicle collision.

Snowmobiling is a particularly dangerous sport for teenagers and younger children. It is not recommended for anyone younger than 16 years because of the coordination and upper body strength required to manipulate the machine. Most snowmobile injuries are head injuries, and most deaths associated with snowmobiles are from head injuries.

Personal watercraft such as jet skis, should be operated only by individuals aged 16 years or older. Individual states have laws outlining specific regulations regarding all watercraft. Some require completion of a water safety course prior to operating a motorized watercraft, depending on the individual's age.

Children participating in horseback riding should be encouraged to wear a proper helmet to prevent against head injury.

Special environments

Schools and daycare facilities are held to state safety regulations. Protecting children on playgrounds is a particular challenge. Each year, emergency departments treat more than 200,000 children aged 14 and younger for playground-related injuries. Supervision is crucial. Padded or soft surfaces under playground equipment are helpful.

Farm safety is encouraged. Children who work in agriculture are particularly prone to a variety of injuries while working around dangerous farm equipment.

The importance of proper use of sunscreen in the summer and protective clothing in the winter should be stressed to parents.

Neglect and abuse prevention

Injuries that occur in the context of an abusive or neglectful environment are difficult to prevent. Parents can be counseled on the harm of shaking a baby, and they can be taught strategies for diffusing a stressful situation without resorting to harming the child.

Patient education

For excellent patient education resources, visit eMedicine's Children's Health Center; Back, Neck, and Head Injury Center; Environmental Exposures and Injuries Center; and Sports Injury Center.

Multimedia

(Enlarge Image)

Media file 1: Rear-facing infant car seat.

(Enlarge Image)

Media file 2: Forward-facing infant car seat.

(Enlarge Image)

Media file 3: Platform booster seat.

Keywords

injury control, childhood injury, pediatric injury, unintentional injury, motor vehicle safety, traffic safety, bicycle safety, firearm safety, home safety, fire safety, burn prevention, consumer product safety, consumer product recall, toy recalls, toy safety, choking prevention, water safety, sports safety, recreation safety, child neglect prevention, child abuse prevention, injury prevention science

• Search for CME/CE on This Topic »

• Back, Neck, and Head Injury Center
• Sports Injury Center
• Environmental Exposures and Injuries Center

• Baseball Preseason Shoulder Strength Screening Can Offer Red Flags for Potential Pitcher Injuries
• Deadly Duo: Suicide Linked With Alcohol Abuse
• Vast Increase in ED Visits for Head Injuries Seen After Natasha Richardson's Death

• Intravascular Temperature Modulation as an Adjunct to Secondary Brain Injury Prevention in a Patient with an Epidural Hematoma
• Poisoning in Children
• Pool Chemical-Associated Health Events in Public and Residential Settings -- United States, 1983-2007