Falls

Scope of the Problem

In children under the age of five, falls are a common cause of emergency department visits.^1,2 Emergency department and outpatient surveillance systems indicate that falls are the most common injury requiring medical care. In contrast, falls are an infrequent cause of childhood death, accounting for approximately 300 deaths per year in the U.S.³ The case fatality rate for children hospitalized for falls is seven-fold lower than that for other, non-fall related injuries. Hospitalizations for falls are intermediate in relative frequency compared to emergency department visits and fatalities, with one study finding that falls account for 29% of hospital admissions for trauma to children and adolescents 19 years of age and under.³ Another study from New Zealand found that falls were the leading cause of injury hospitalization in children under the age of 15, accounting for 36.7% of hospitalizations in the North Health region.⁴

The most common type of fall leading to hospitalization is fall from one level to another, such as from playground equipment, beds, table, and chairs. Baby walkers are a common cause of injuries in young children, in which children in walkers fall down stairs or off porches.^5,6 Falls resulting in severe or fatal injuries are usually due to falls from second story or higher windows. The mean height for a fatal injury is 5-6 stories.⁷ Window screens are made to pop out for fire safety reasons, and do not serve as a barrier to prevent children from falling out of windows.⁸

While much is known about fall injuries, few strategies have been examined to prevent these injuries from occurring. Strategies considered here include:

Education

1. Physician based
2. Community based
3. School based

Product/environmental modification

1. Eliminating baby walkers
2. Stair gates
3. Window guards
4. Belts in shopping carts
5. Building codes
6. Fencing
7. Playground design and surfacing materials

Legislation/regulation

1. Window guard regulations
2. Day care regulation

In this review, we examine the effectiveness of the following interventions or areas to prevent falls among children:

Prevention Interventions

• Window bars
• Playgrounds
• Footwear
• Walkers
• Shopping carts

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