Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Pediatric injury prevention: Epidemiology, history, and application

Anne C Gill, DrPH, MS, RN
Nancy R Kelly, MD, MPH
Section Editor
Teresa K Duryea, MD
Deputy Editor
Mary M Torchia, MD


Injuries are a leading cause of death for infants and children in the United States and around the world [1]. Treated as diseases, both intentional and unintentional injuries are cured by prevention. The clinician's role in injury prevention includes education, instruction, and even advocating for changes to improve child safety [2,3].

Pediatric injuries are such a significant health care problem that major authorities, including the American Academy of Pediatrics (AAP), the American Medical Association, the American Academy of Family Physicians, and the US Preventive Services Task Force, have issued recommendations that injury prevention counseling be provided as a part of the well-child exam [2,4-6]. The AAP developed a policy statement recommending age- and locale-appropriate injury prevention anticipatory guidance for all infants, children, and adolescents [2]. Although the contributing factors for intentional injuries (ie, gun-shot wounds, assault) differ from those for unintentional injuries, many of the principles of injury prevention are the same [7].

The epidemiology of pediatric injuries, historical trends, and principles of injury control are reviewed here. Evidence-based interventions for specific mechanisms of injury are discussed separately.

(See "Bicycle injuries in children: Prevention".)

(See "Firearm injuries in children: Prevention".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Aug 21, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Norton R, Kobusingye O. Injuries. N Engl J Med 2013; 368:1723.
  2. Gardner HG, American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Office-based counseling for unintentional injury prevention. Pediatrics 2007; 119:202.
  3. Committee on Child Abuse and Neglect, Committee on Injury, Violence, and Poison Prevention, Council on Community Pediatrics. American Academy of Pediatrics. Policy statement--child fatality review. Pediatrics 2010; 126:592.
  4. Guidelines for Adolescent Preventive Services. American Medical Association, Chicago 1994.
  5. American Academy of Family Physicians. Clinical Preventive Services. www.aafp.org/online/en/home/clinical/exam.html (Accessed on September 10, 2011).
  6. Safety counseling in children and adolescents. U.S. Public Health Service. Am Fam Physician 1995; 51:429.
  7. Rivara FP, Grossman DC. Prevention of traumatic deaths to children in the United States: how far have we come and where do we need to go? Pediatrics 1996; 97:791.
  8. Centers for Disease Control and Prevention (CDC). Vital signs: Unintentional injury deaths among persons aged 0-19 years - United States, 2000-2009. MMWR Morb Mortal Wkly Rep 2012; 61:270.
  9. Web-based Injury Statistics Query and Reporting System (WISQARS). Fatal Injury Reports. Centers for Disease Control and Prevention, Atlanta, GA. Available at: https://www.cdc.gov/injury/wisqars/fatal.html (Accessed on July 03, 2017).
  10. Spady DW, Saunders DL, Schopflocher DP, Svenson LW. Patterns of injury in children: a population-based approach. Pediatrics 2004; 113:522.
  11. Mack KA, Gilchrist J, Ballesteros MF. Injuries among infants treated in emergency departments in the United States, 2001-2004. Pediatrics 2008; 121:930.
  12. Centers for Disease Prevention and Control, Health, United States, Injury, 2014. Available at: www.cdc.gov/nchs/hus/injury.htm (Accessed on August 28, 2015).
  13. Discharge rate in nonfederal short-stay hospitals, by sex, age, and selected first-listed diagnosis: United States, selected years 1990 through 2009–2010. Available at: www.cdc.gov/nchs/data/hus/2014/089.pdf (Accessed on August 28, 2015).
  14. Bernard SJ, Paulozzi LJ, Wallace DL, Centers for Disease Control and Prevention (CDC). Fatal injuries among children by race and ethnicity--United States, 1999-2002. MMWR Surveill Summ 2007; 56:1.
  15. Gilchrist J, Parker EM, Centers for Disease Control and Prevention (CDC). Racial/ethnic disparities in fatal unintentional drowning among persons aged ≤ 29 years - United States, 1999-2010. MMWR Morb Mortal Wkly Rep 2014; 63:421.
  16. Centers for Disease Control and Prevention. National Center for Injury Prevention and Control. National action plan for child injury prevention. An agenda to prevent injuries and promote the safety of children and adolescents in the United States. www.cdc.gov/safechild/pdf/National_Action_Plan_for_Child_Injury_Prevention.pdf (Accessed on August 28, 2015).
  17. Gore FM, Bloem PJ, Patton GC, et al. Global burden of disease in young people aged 10-24 years: a systematic analysis. Lancet 2011; 377:2093.
  19. Wilson MH, Levin-Goodman R. Injury prevention and control. In: Oski's Pediatrics. Principles and Practice, 4th ed, McMillan JA, Feigin RD, DeAngelis C, Jones MD (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.134.
  20. Rivara FP. Developmental and behavioral issues in childhood injury prevention. J Dev Behav Pediatr 1995; 16:362.
  21. National Center for Injury Prevention and Control. Ten Leading Causes of Death, 1997. Centers for Disease Control and Prevention; US Dept of Health and Human Services, Atlanta, GA 1999.
  22. Haddon W Jr. On the escape of tigers: an ecologic note. Am J Public Health Nations Health 1970; 60:2229.
  23. Haddon W Jr. Energy damage and the ten countermeasure strategies. J Trauma 1973; 13:321.
  24. Cushman R. Injury prevention: the time has come. CMAJ 1995; 152:21.
  25. Haddon W Jr. Editorial: Strategy in preventive medicine: passive vs. active apprroaches to reducing human wastage. J Trauma 1974; 14:353.
  26. Dannenberg AL, Fowler CJ. Evaluation of interventions to prevent injuries: an overview. Inj Prev 1998; 4:141.
  27. Stylianos S, Eichelberger MR. Pediatric trauma. Prevention strategies. Pediatr Clin North Am 1993; 40:1359.
  28. Rivara FP, Grossman DC, Cummings P. Injury prevention. First of two parts. N Engl J Med 1997; 337:543.
  29. Ehiri JE, Ejere HO, Hazen AE, et al. Interventions to increase children's booster seat use: a review. Am J Prev Med 2006; 31:185.
  30. Zaza S, Sleet DA, Thompson RS, et al. Reviews of evidence regarding interventions to increase use of child safety seats. Am J Prev Med 2001; 21:31.
  31. Frieden TR. A framework for public health action: the health impact pyramid. Am J Public Health 2010; 100:590.
  32. McDonald EM, Mack K, Shields WC, et al. Primary Care Opportunities to Prevent Unintentional Home Injuries: A Focus on Children and Older Adults. Am J Lifestyle Med 2016; 2016.
  33. Chen J, Kresnow MJ, Simon TR, Dellinger A. Injury-prevention counseling and behavior among US children: results from the second Injury Control and Risk Survey. Pediatrics 2007; 119:e958.
  34. Quinlan KP, Sacks JJ, Kresnow M. Exposure to and compliance with pediatric injury prevention counseling--United States, 1994. Pediatrics 1998; 102:E55.
  35. Kendrick D, Mulvaney CA, Ye L, et al. Parenting interventions for the prevention of unintentional injuries in childhood. Cochrane Database Syst Rev 2013; :CD006020.
  36. Kendrick D, Young B, Mason-Jones AJ, et al. Home safety education and provision of safety equipment for injury prevention. Cochrane Database Syst Rev 2012; :CD005014.
  37. Stewart TC, Clark A, Gilliland J, et al. Home safe home: Evaluation of a childhood home safety program. J Trauma Acute Care Surg 2016; 81:533.
  38. Special Tabulation, 1991: National Ambulatory Medical Care Survey, National Center for Health Statistics, Hyattsville, MD 1994.
  39. Morrongiello BA, Hillier L, Bass M. 'What I said' versus 'what you heard': a comparison of physicians' and parents' reporting of anticipatory guidance on child safety issues. Inj Prev 1995; 1:223.
  40. Cheng TL, DeWitt TG, Savageau JA, O'Connor KG. Determinants of counseling in primary care pediatric practice: physician attitudes about time, money, and health issues. Arch Pediatr Adolesc Med 1999; 153:629.
  41. Cohen LR, Runyan CW, Downs SM, Bowling JM. Pediatric injury prevention counseling priorities. Pediatrics 1997; 99:704.
  42. Grossman DC, Rivara FP. Injury control in childhood. Pediatr Clin North Am 1992; 39:471.
  43. Orton E, Whitehead J, Mhizha-Murira J, et al. School-based education programmes for the prevention of unintentional injuries in children and young people. Cochrane Database Syst Rev 2016; 12:CD010246.
  44. Dowswell T, Towner EM, Simpson G, Jarvis SN. Preventing childhood unintentional injuries--what works? A literature review. Inj Prev 1996; 2:140.
  45. Miller TR, Galbraith M. Injury prevention counseling by pediatricians: a benefit-cost comparison. Pediatrics 1995; 96:1.
  46. Dickey LL, Kamerow DB. Primary care physicians' use of office resources in the provision of preventive care. Arch Fam Med 1996; 5:399.
  47. Bass JL. TIPP--the first ten years. Pediatrics 1995; 95:274.
  48. Hansen K, Wong D, Young PC. Do the Framingham Safety Surveys improve injury prevention counseling during pediatric health supervision visits? J Pediatr 1996; 129:494.
  49. Powell EC, Tanz RR, Uyeda A, et al. Injury prevention education using pictorial information. Pediatrics 2000; 105:e16.