March 15, 2012: A first study to examine the national scope of stair-related injuries in young children found there are an estimated 93,000 incidences per year (equating to 1 every 6 minutes) in which a U.S. child younger than 5 years old is taken to an emergency department (ER) after falling down stairs.
Researchers at the Center for Injury Research and Policy (CIRP), Nationwide Children's Hospital, Columbus, Ohio, analyzed data from 1998 to 2008 from the National Electronic Injury Surveillance System (NEISS) (a national probability sample of hospitals with data from every ER visit involving an injury associated with consumer products, by the U.S. Product Safety Commission).
CIRP is one of eleven Injury Control Research Centers funded by the Centers for Disease Control and Prevention; its primary focus is on injuries to children and adolescents.
The study, "Stair-Related Injuries to Young Children Treated in US Emergency Departments, 1999 -2008," by senior author, Gary Smith, M.D., Dr.P.H., above, professor of pediatrics and founding director of CIRP, and lead author, Ashley E. Zielinski, was published online this month in Pediatrics.
Among the findings was an 11.6% decrease in the number of stair-related injuries per year. Smith explained the findings to California's Children, saying that the use of babywalkers, the main source of child stair-related injury in the 1990s, has dropped significantly; however, when researchers adjusted for babywalker injuries, there was still a decline in the numbers.
Smith sees the fact that 93,000 stair-related injuries still bring children to the ER each year as a public health issue that needs to be addressed. Somehow instead of seeing stair-related injuries as a public health problem, says Smith, caregivers are quick to blame themselves for something that is inherently hazardous in the house. He described the public health campaign to reduce the use of baby-walkers as remarkably successful (stair-related injuries caused by baby-walkers declined from 25,000 in the mid 1990s to 1,300 in 2008) and he would like to see the same attention brought to stair-related injuries in young children.
The largest portion of injuries were in babies under 1 year and baby walker use still contributed to 16% of injuries under 12 months; however, 25% occurred while being carried down the stairs, and these children were 3 times more likely to be hospitalized as a result of the injury.
Overall, 76% of children had injuries to the head and neck region, soft tissue injuries (sprains, bruises and hematomas) accounted for 35% of cases and 3% of patients were hospitalized as a result of the injury.
A sobering statistic is the finding that 32% of children under 12 months suffered a closed head injury (for e.g., concussion); the NEISS data however is limited, explained Smith, because it does not indicate the severity of the injury, which can fall in a broad range. As a former pediatric emergency physician, Smith has seen children, who may have been dazed or even vomited after the fall, but are feeling fine with no external bruising by the time they reach the ER. Although this kind of closed head injury can seem mild, there is no way to tell how these children do once they leave the ER (another limitation of the data). Even mild Traumatic Brain Injury from a fall has been known to have long-term effects on executive function, noted Smith, which can result in cognitive and behavioral problems; therefore, it is just not possible to get a clear picture from the data of the true impact of head injuries from stair-related injuries.
One pattern researchers did not expect to find was an increase in the rate of injuries from being carried on the stairs. Smith said it could be because caregivers are multi-tasking more, but this would take further investigation to establish any link.
Smith emphasized the more people are aware of the hidden hazards in a house, the less they can be lulled into a false sense of security (the study found 94% of the injuries occurred at home). He recommends fixing defects that make the steps uneven and replacing large banisters that children find difficult to grip properly. Houses are usually designed for the convenience of adults with child safety as an after-thought, he noted, for e.g., new houses should have fitted stair gates as part of standard building code.
Below, a CIRP informational video for caregivers on the potential dangers of stairs:
Read a list of Stair-injury prevention tips by the Child Injury Prevention Alliance, a CIRP partner organization.
Written for California's Children by Elizabeth J. Carlyle.