The death rate from falls among children ages 14 and under declined by 33 percent from 1987 to 1997. However, falls remain the leading cause of unintentional injury for children. Children ages 14 and under account for one-third of all fall-related visits to hospital emergency rooms. More than half of all nonfatal injuries to children are associated with falls, and falls are the leading cause of nursery product-related injuries among children ages 5 and under. The majority of falls occur from furniture, stairs, baby walkers, playground equipment, windows and shopping carts.

The severity of a fall-related injury is determined by the distance of the fall and the landing surface. Head injuries are associated with the majority of deaths and severe injuries resulting from falls. Because falls are associated with a child’s curiosity and development of motor skills, children ages 10 and under are at the greatest risk of fall-related death and injury.

DEATHS AND INJURIES

• In 1997, 112 children ages 14 and under died from falls. Children ages 4 and under accounted for more than half of these deaths.
  
• Each year, more than 2.5 million children ages 14 and under are treated in hospital emergency rooms for fall-related injuries. Children ages 5 and under account for more than half of these injuries.
  
• Nine percent of fall-related injuries associated with products (e.g., baby walkers, windows, playground equipment) result in hospitalization, more than two times the hospitalization rate of all other product-related injuries.
  

WHEN AND WHERE FALLS DEATHS AND INJURIES OCCUR

• Infants are at greater risk from falls associated with furniture, stairs and baby walkers. Toddlers are predominantly at risk from window-related falls and older children tend to suffer from playground equipment-related falls.
  
• More than 80 percent of fall-related injuries among children ages 4 and under occur in the home. Among older children, ages 5 to 14, 45 percent of fall-related injuries occur in the home and 23 percent occur at school.
  
• The majority of falls occur between noon and early evening, the most common playtime for children.
  

Baby Walker Falls

• Since 1973, at least 34 children have died from injuries associated with baby walkers.
  
• In 1998, more than 12,800 children were treated in hospital emergency rooms for baby walker-related injuries. Nearly all of these injuries occurred among children ages 5 to 15 months. Baby walkers account for more injuries than any other nursery product in this age group.
  
• The majority of children aged less than 15 months sustaining baby walker-related injuries fall down stairs (76 percent) or tip over (12 percent). Injuries associated with falls down stairs are the most severe and are more likely to result in head injury and hospitalization.
  
• Nearly 80 percent of infants who suffer baby walker injuries are being supervised at the time of the incident; more than half of the caregivers are in the same room as the child.
  
• It has been estimated that as many as 90 percent of children ages 5 to 15 months will use a baby walker and up to half of these children will sustain a baby walker-related injury.
  

Window Falls

• Children are more likely to die or be severely injured from window-related falls than falls associated with any other product.
  
• Each year, approximately 18 children ages 10 and under die from window fall-related injuries. An estimated 4,700 children ages 14 and under are treated in hospital emergency departments annually for injuries sustained from falling out of windows. Head injuries account for the majority of these injuries.
  
• The majority of window fall-related deaths (70 percent) occur during the spring and summer months.
  
• Children falling from windows are more likely to be male, under age 3 and playing unsupervised at the time of the fall.
  
• Window falls tend to occur in large urban areas, low-income neighborhoods, and deteriorating and overcrowded housing. Children living in apartment buildings have the highest number of window fall incidences; five times more than that of children living in residences.
  

Playground Falls

• Each year, nearly 20 children ages 14 and under die and more than 230,000 are treated in hospital emergency rooms for playground equipment-related injuries. Children ages 5 to 14 account for 70 percent of these playground-related injuries.
  
• More than 70 percent of playground-related injuries involve falls to the surface and 9 percent involve falls onto equipment.
  
• Falls account for 90 percent of the most severe playground-related injuries (mostly head injuries and fractures) and one-third of fatalities. Head injuries are involved in 75 percent of all fall-related deaths associated with playground equipment.
  

Bleacher Falls

• In 1998, over 12,000 children were treated in hospital emergency rooms for bleacher-associated injuries. Over half of bleacher-associated injuries are reported to involve falls.
  
• At least four children have died from bleacher-associated falls since 1988.
  

WHO IS AT RISK

• In general, children ages 10 and under are injured from falls at a rate of about twice that of the total population. Preschoolers are at the greatest risk.
  
• Males are twice as likely as females to die from fall-related injuries.
  
• Black children ages 14 and under have a fall-related death rate that is one and a half times higher than that of white children.
  
• Low-income children are more likely to be injured from falls due to deficiencies in the environment, including aging or deteriorating housing.
  

FALLS PREVENTION EFFECTIVENESS

• Window guards are effective at preventing falls. In New York City, an education and window guard distribution program, combined with window guard legislation, demonstrated a 35 percent reduction in window fall-related fatalities after two years.
  
• Protective surfacing under and around playground equipment can prevent the incidence and reduce the severity of playground fall-related injuries.
  

FALLS PREVENTION LAWS AND REGULATIONS

• All baby walkers manufactured after June 30, 1997, must meet all American Society for Testing and Materials’ (ASTM) voluntary and mandatory standards in order to be certified by the Juvenile Products Manufacturers Association.
  
• The New York City Board of Health has mandated the installation of protective window guards on all windows not designated as emergency exits in all multiple dwellings where children ages 10 and under reside.
  
• Playground equipment guidelines have been developed by the U.S. Consumer Product Safety Commission, ASTM and the Consumer Federation of America. Four states - California, Michigan, North Carolina and Texas - have enacted playground safety legislation mandating many of these guidelines.
  

HEALTH CARE COSTS AND SAVINGS

• Falls account for the largest share of injury costs for children ages 14 and under, accounting for more than one-fifth of all unintentional injury-related costs.
  
• The total annual cost of fall-related deaths and injuries among children ages 14 and under is nearly $44 billion.
  

PREVENTION TIPS

• Never use baby walkers on wheels. Use stationary activity centers or walker alternatives.
  
• Use safety gates at the top and bottom of stairs if there are infants or toddlers in the home.
  
• Move chairs and furniture away from windows. Consider installing window guards on windows located on the ground floor and up, unless designated as emergency fire exits.
  
• Avoid asphalt, concrete, grass and soil surfaces under playground equipment. Acceptable loose-fill surfacing, such as hardwood fiber mulch or chips, pea gravel, fine sand or shredded rubber, should be maintained at a depth of 12 inches and should extend a minimum of 6 feet in all directions around stationary equipment.
  

12/99 This information was compiled by the National SAFE KIDS Campaign.