Fall Injury Interventions

Shopping Carts


There are an estimated 25,000 injuries each year from shopping carts in the United States.28  Over 60% involve children under the age of five years. The majority of injuries are caused by falling out of the carts, striking against an object while riding a cart, or becoming caught between objects while playing in a cart basket.29  A series of 10 children from the UK found that all had head injuries and 30% required admission.30  In another series from the U.S., 18% of emergency department patients had fractures and 79% had injuries to the head.28  One intervention is the use of belts. The interventions evaluated were programs to increase belt use; unfortunately, no programs have evaluated the impact of belt use on injury rates.

Review of programs to increase belt use in shopping carts:


Ferrari and Baldwin, 1989

Study design and target population

Non equivalent control group study.

One store was control and other 2 stores were intervention

Children under 40 inches or children who looked like a toddler


Three supermarkets some of which had carts and some of which did not. Educational prompts to use carts with the belts consisted of marking equipped carts with tape, placing them separately in store, fliers prompting their use, message over the public address system every 10-20 minutes

Personal contact by an employee explaining use of belts was also tested


Belt use as observed by study personnel


Belt use increased from 1.1% at baseline to 14.4% with prompt-only to 51.3% at prompt plus personal contact (p<.001).

For non-use, OR=0.07 (0.01-0.21) for prompt group vs. baseline and OR=0.01 (0.00-0.21 for prompt plus personal contact.

Study quality and conclusions

The intervention was successful in increasing seat belt use in shopping carts.

While not randomized, this is a good controlled study with observations of outcomes.

Summary of shopping cart injury prevention studies

The study by Ferrari and Baldwin indicates that educational interventions can increase the use of seat belts on shopping carts. Unfortunately, no studies have been done to indicate that these belts are effective in decreasing injuries. The case series by Smith found that 8 of 62 injured children were properly belted, but were injured when the cart tipped over. Thus, belts alone without redesign of the carts may not be successful in eliminating these injuries.

Recommendations on seat belts in shopping carts

These cannot be recommended at the present since there are no data evaluating their effectiveness.

Recommendations for future research

A study on the effectiveness in reducing injuries is needed. This can be done as a case-control study or even as a large cohort study in large supermarkets.