An Observational Study of Fall Injuries among Infants in Special Reference to the Incidence and Risk Factors
Objective: The objective of the study was to assess the incidence and risk factors of fall injuries among infants admitted in
Design: Review of data from a large injury database.
Setting: The Emergency Department Injury Surveillance System.
Patients: A total of 2672 injured infants. Interventions Children’s guardians were interviewed using a questionnaire. The
results of an independent survey of 777 mothers of non-injured children younger than 2 years attending the same emergency
departments were used to allow quantification of the role of specific nursery equipment in the causation of infant fall injuries.
Main Outcome Measures: Annual rate of injury by falling in infants, overall and by cause.
Results: An annual incidence rate of 44 injuries per 1000 infants. The incidence of falls increases with increasing infant age. A
high percentage of severe injuries was detected, most of them concussions (14.3%) and fractures (9.4%). Approximately 10%
of infants with fall-related injuries required hospitalization. More than 36% of fall injuries involved nursery equipment. Infant
walker use was associated with a higher incidence of falls (about 9/1000 infant-years), and these falls occasionally involved
stairs and caused serious injuries.
Conclusions: Falls are a common cause of serious infant injuries, and nursery equipment is frequently involved in the injurycausing
Public Health 2000;90:523-6.
2. Kypri K, Chalmers DJ, Langley JD, Wright CS. Child injury morbidity in
New Zealand, 1987-1996. J Paediatr Child Health 2001;37:603.
3. World Health Organization. The World Health Report, 2002; 2003.
Available from: http://www.who.int/whr/2002/annex/en. [Last accessed on
2003 Oct 15].
4. American Academy of Pediatrics. Committee on Injury and Poison
Prevention. Injuries associated with infant walkers. Pediatrics
5. Mayr JM, Seebacher U, Schimpl G, Fiala F. Highchair accidents. Acta
6. Chiaviello CT, Christoph RA, Bond GR. Infant walker-related injuries: A
prospective study of severity and incidence. Pediatrics 1994;93:974-6.
7. Macgregor DM. Injuries associated with falls from beds. Inj Prev
8. Smith GA, Bowman MJ, Luria JW, Shields BJ. Babywalker-related
injuries continue despite warning labels and public education. Pediatrics
9. Watson WL, Ozanne-Smith J. The use of child safety restraints with nursery
furniture. J Paediatr Child Health 1993;29:228-32.
10. Tarantino CA, Dowd MD, Murdock TC. Short vertical falls in infants.
Pediatr Emerg Care 1999;15:5-8.
11. Mathers LJ, Weiss HB. Incidence and characteristics of fall-related
emergency department visits. Acad Emerg Med 1998;5:1064-70.
12. Powell EC, Jovtis E, Tanz RR. Incidence and description of high chairrelated
injuries to children. Ambul Pediatr 2002;2:276-8.
13. Emanuelson I. How safe are childcare products, toys and playground
equipment? A Swedish analysis of mild brain injuries at home and during
leisure time 1998-1999. Inj Control Saf Promot 2003;10:139-44.
14. Wickham T, Abrahamson E. Head injuries in infants: The risks of bouncy
chairs and car seats. Arch Dis Child 2002;86:168-9.
15. Ridenour MV. Ages of young children who fall down stairs. Percept Mot
16. National Statistical Service of Greece. Distribution of parents, during 1998,
by age, educational level, and place of residence. In: Natural Movement of
the Population of Greece. Athens: National Statistical Service of Greece;
1998. p. 129-34.
17. Dessypris N, Petridou E, Skalkidis Y, Moustaki M, Koutselinis A,
Trichopoulos D. Countrywide estimation of the burden of injuries in Greece:
A limited resources approach. J Cancer Epidemiol Prev 2002;7:123-9.
18. National Center for Injury Prevention and Control. Unintentional Fall
Deaths and Rates Per 1,00,000. United States: National Center for Injury
Prevention and Control; 2001. Available from: http://www.webappa.cdc.
gov/sasweb/ncipc/mortrate10_sy.html. [Last accessed on 2003 Oct 15].
19. WHO Statistical Information System (WHOSIS); 2003. Available from:
http://www.who.int/whosis/menu.cfm. [Last accessed on 2003 Oct 05].
20. Shendut IH, Tan KK, Rivara F. Baby walker associated scalding injuries
seen at University hospital Kuala Lumpur. Med J Malaysia 1995;50:192-3.
21. Petridou E, Simou E, Skondras C, Pistevos G, Lagos P, Papoutsakis G.
Hazards of baby walkers in a European context. Inj Prev 1996;2:118-20.
22. Thomas SA, Rosenfield NS, Leventhal JM, Markowitz RI. Long-bone
fractures in young children: Distinguishing accidental injuries from child
abuse. Pediatrics 1991;88:471-6.
23. Dalton HJ, Slovis T, Helfer RE, Comstock J, Scheurer S, Riolo S.
Undiagnosed abuse in children younger than 3 years with femoral fracture.
Am J Dis Child 1990;144:875-8.
24. Trogan I, Dessypris N, Moustaki M, Petridou E. How common is abuse
in Greece? Studying cases with femoral fractures. Arch Dis Child
25. Cooper CL, Jennifer D. Development of an evidence-based paediatric fall
prevention program. J Nurs Care Qual 2007;22:107-12.
26. Fall Prevention for Infants and Young Children. Available from: http://
children.htm. [Last accessed on 2004 Mar 10].
27. Conners GP, Veenema TG, Kavanagh CA, Ricci J, Callahan CM. Still
falling: A community-wide infant walker injury prevention initiative.
Patient Educ Couns 2002;46:169-73.
28. Watson WL, Ozanne-Smith J. The use of child safety restraints with nursery
furniture. J Paediatr Child Health 1993;29:228-32.
29. Ten Leading Causes of Hospitalization by Age Group, Minnesota; 2001.
Available from: http://www.health.state.mn.us/injury/pub/ed2001/
ed01appena7.pdf. [Last accessed on 2004 Mar 10].
30. Leading Causes of Death and Hospitalization in Canada. Available from:
html#per. [Last accessed on 2004 Mar 10].