EPIDEMIOLOGY

Unintentional falls are the leading cause of nonfatal injury in children younger than 14 years of age in the United States (table 1) [1]. Fall-related mortality in children has declined since 1987; nonetheless, according to the National Center for Injury and Prevention Control in 2009, 93 fall-related deaths occurred in children younger than 15 years: 65 in children younger than five years, 126 in children between 5 and 10 years, and 16 in children between 11 and 14 years [2]. Boys are more than twice as likely as girls to die from fall-related injuries [2,3].

Emergency department and outpatient surveillance systems indicate that falls are one of the most common injuries requiring medical care and the most common nonfatal injury requiring hospitalization [4-6]. Each year, 2.9 million children are treated in emergency rooms for fall-related injuries, with children younger than five years of age representing the largest proportion of visits (table 1) [1,7-11].

Children younger than 10 years of age are at the greatest risk of incurring fall-related injury; they are injured in falls at approximately twice the rate as that of the total population (except individuals older than 65 years, who have fall-related injury rates similar to those of children) [1]. Falls are also the most frequent cause of any injury during infancy (an estimated 35.1 per 1000 infant-years) [12]. The combination of curiosity, immature motor skills, and lack of judgment renders preschool children particularly susceptible to falling (eg, as they climb on furniture to obtain toys that are out of reach).

Falls by children occur mainly in the warmer months [13-15]. The location and mechanism of injuries caused by falls vary depending upon the age of the child. More than 80 percent of fall-related injuries in children younger than four years of age occur in the home; among children aged 5 to 14 years, approximately one-half of the injuries occur at home and one-quarter at school. Infants are at risk for falling from furniture or stairs [14,16,17], toddlers are at risk for falling from windows, and older children are at risk for falling from playground equipment.

Children from low-income families are more likely to be injured from falls due to lack of safety equipment (eg, window guards) or deteriorating housing [3,18,19]. Additional predisposing factors for fall injuries identified in case series include history of previous unintentional injury, neurologic disorder (eg, seizures, developmental delay, hyperactivity), documented parental neglect, and acute stressors (eg, recent move, illness, or job change) [20-23].