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Promoting safety in children with disabilities

Patty P Huang, MD
Dennis R Durbin, MD
Section Editor
Marilyn Augustyn, MD
Deputy Editor
Mary M Torchia, MD


Children with disabilities are at increased risk for accidental (unintentional) injuries, inflicted (intentional) injuries, and child neglect. Behavioral, physical, and cognitive characteristics of the child and environments that are not well adapted for individuals with disabilities contribute to the increased risk.

Given the prevalence of disability among children in the United States (approximately 8 percent) [1], it is important that parents, caregivers, and health care providers understand the factors that increase the risk of injury and the potential strategies to minimize it. Primary care providers play a key role in improving the safety of children with disabilities through anticipatory guidance, counseling, treatment, and referral.

The epidemiology, contributing factors, and strategies to prevent unintentional and intentional injuries in children with disabilities will be reviewed here. The principles of injury control and the biologic implications of chronic conditions in childhood are discussed separately. (See "Pediatric injury prevention: Epidemiology, history, and application" and "Children with special health care needs".)


Epidemiology — Unintentional injuries are more frequent among children with disabilities than those without disabilities. In a cross-sectional survey of 7235 children in grades 6 to 10, 16 percent identified themselves as having a disability (defined by having at least one functional difficulty due to a health condition) [2]. Students with disabilities reported more injuries than those without (67 versus 51 percent per year). They also sustained more severe injuries and required medical attention more frequently than their nondisabled peers, findings that have been noted in other studies [3-7].

Predisposing factors

Behavioral factors — Children with behavior disorders (eg, increased activity, impulsivity) are more likely than those without behavior disorders to engage in hazardous behaviors that may result in unintentional injury [8-10].

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Literature review current through: Nov 2017. | This topic last updated: Mar 03, 2017.
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  1. U.S. Department of Health and Human Services. The 2005 Surgeon General's Call to Action to Improve the Health and Wellness of Persons with Disabilities: Calling You to Action. U.S. Department of Health and Human Services, Office of the Surgeon General 2005.
  2. Raman SR, Boyce W, Pickett W. Injury among 1107 Canadian students with self-identified disabilities. Disabil Rehabil 2007; 29:1727.
  3. Petridou E, Kedikoglou S, Andrie E, et al. Injuries among disabled children: a study from Greece. Inj Prev 2003; 9:226.
  4. Alden NE, Rabbitts A, Rolls JA, et al. Burn injury in patients with early-onset neurological impairments: 2002 ABA paper. J Burn Care Rehabil 2004; 25:107.
  5. Braden K, Swanson S, Di Scala C. Injuries to children who had preinjury cognitive impairment: a 10-year retrospective review. Arch Pediatr Adolesc Med 2003; 157:336.
  6. Limbos MA, Ramirez M, Park LS, et al. Injuries to the head among children enrolled in special education. Arch Pediatr Adolesc Med 2004; 158:1057.
  7. Lee LC, Harrington RA, Chang JJ, Connors SL. Increased risk of injury in children with developmental disabilities. Res Dev Disabil 2008; 29:247.
  8. Schwebel DC, Gaines J. Pediatric unintentional injury: behavioral risk factors and implications for prevention. J Dev Behav Pediatr 2007; 28:245.
  9. Bijur PE, Stewart-Brown S, Butler N. Child behavior and accidental injury in 11,966 preschool children. Am J Dis Child 1986; 140:487.
  10. Langley J, McGee R, Silva P, Williams S. Child behavior and accidents. J Pediatr Psychol 1983; 8:181.
  11. Baghdadli A, Pascal C, Grisi S, Aussilloux C. Risk factors for self-injurious behaviours among 222 young children with autistic disorders. J Intellect Disabil Res 2003; 47:622.
  12. Rowe R, Maughan B, Goodman R. Childhood psychiatric disorder and unintentional injury: findings from a national cohort study. J Pediatr Psychol 2004; 29:119.
  13. Slayter EM, Garnick DW, Kubisiak JM, et al. Injury prevalence among children and adolescents with mental retardation. Ment Retard 2006; 44:212.
  14. Sherrard J, Tonge BJ, Ozanne-Smith J. Injury risk in young people with intellectual disability. J Intellect Disabil Res 2002; 46:6.
  15. Sherrard J, Tonge BJ, Ozanne-Smith J. Injury in young people with intellectual disability: descriptive epidemiology. Inj Prev 2001; 7:56.
  16. Gaebler-Spira D, Thornton LS. Injury prevention for children with disabilities. Phys Med Rehabil Clin N Am 2002; 13:891.
  17. Ramirez RJ, Behrends LG, Blakeney P, Herndon DN. Children with sensorimotor deficits: a special risk group. J Burn Care Rehabil 1998; 19:124.
  18. Schwebel DC, Brezausek CM. Brief report: unintentional injury risk among children with sensory impairments. J Pediatr Psychol 2010; 35:45.
  19. Mann JR, Zhou L, McKee M, McDermott S. Children with hearing loss and increased risk of injury. Ann Fam Med 2007; 5:528.
  20. Xiang H, Zhu M, Sinclair SA, et al. Risk of vehicle-pedestrian and vehicle-bicyclist collisions among children with disabilities. Accid Anal Prev 2006; 38:1064.
  21. Roberts I, Norton R. Sensory deficit and the risk of pedestrian injury. Inj Prev 1995; 1:12.
  22. Bull M, Agran P, Laraque D, et al. American Academy of Pediatrics. Committee on Injury and Poison Prevention. Transporting children with special health care needs. Pediatrics 1999; 104:988.
  23. Bull MJ, Weber K, Stroup KB. Safety seat use for children with hip dislocation. Pediatrics 1986; 77:873.
  24. Korn T, Katz-Leurer M, Meyer S, Gofin R. How children with special needs travel with their parents: observed versus reported use of vehicle restraints. Pediatrics 2007; 119:e637.
  25. O'Neil J, Yonkman J, Talty J, Bull MJ. Transporting children with special health care needs: comparing recommendations and practice. Pediatrics 2009; 124:596.
  26. Huang P, Kallan MJ, O'Neil J, et al. Children with special health care needs: patterns of safety restraint use, seating position, and risk of injury in motor vehicle crashes. Pediatrics 2009; 123:518.
  27. Huang P, Kallan MJ, O'Neil J, et al. Children with special physical health care needs: restraint use and injury risk in motor vehicle crashes. Matern Child Health J 2011; 15:949.
  28. Kirby RL, Ackroyd-Stolarz SA, Brown MG, et al. Wheelchair-related accidents caused by tips and falls among noninstitutionalized users of manually propelled wheelchairs in Nova Scotia. Am J Phys Med Rehabil 1994; 73:319.
  29. Gaal RP, Rebholtz N, Hotchkiss RD, Pfaelzer PF. Wheelchair rider injuries: causes and consequences for wheelchair design and selection. J Rehabil Res Dev 1997; 34:58.
  30. American Academy of Pediatrics: Committee on Injury and Poison Prevention. School bus transportation of children with special health care needs. Pediatrics 2001; 108:516.
  31. Leland NL, Garrard J, Smith DK. Comparison of injuries to children with and without disabilities in a day-care center. J Dev Behav Pediatr 1994; 15:402.
  32. Children's Safety Network at Education Development Center, Inc. Injuries in the school environment: A resource guide, 2nd ed, Children's Safety Network, Education Development Center, Inc, MA 1997.
  33. Ramirez M, Peek-Asa C, Kraus JF. Disability and risk of school related injury. Inj Prev 2004; 10:21.
  34. Marshall SW, Runyan CW, Bangdiwala SI, et al. Fatal residential fires: who dies and who survives? JAMA 1998; 279:1633.
  35. Jacobson JW. Problem behavior and psychiatric impairment within a developmentally disabled population I: behavior frequency. Appl Res Ment Retard 1982; 3:121.
  36. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention, American Academy of Pediatrics Council on School Health, Agran PF. School transportation safety. Pediatrics 2007; 120:213.
  37. Rotz LD, Dotson DA, Damon IK, et al. Vaccinia (smallpox) vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2001. MMWR Recomm Rep 2001; 50:1.
  38. Initial impact of the Fast Track prevention trial for conduct problems: II. Classroom effects. Conduct Problems Prevention Research Group. J Consult Clin Psychol 1999; 67:648.
  39. Greenberg P, Kusche C. Preventive intervention for school-age deaf children: the PATHS curriculum. J Deaf Stud Deaf Educ 1998; 3:49.
  40. Fire safety for people with disabilities. Available at: www.usfa.dhs.gov/citizens/disability (Accessed on October 28, 2008).
  41. Piazza CC, Hanley GP, Bowman LG, et al. Functional analysis and treatment of elopement. J Appl Behav Anal 1997; 30:653.
  42. Sullivan PM, Knutson JF. Maltreatment and disabilities: a population-based epidemiological study. Child Abuse Negl 2000; 24:1257.
  43. Spencer N, Devereux E, Wallace A, et al. Disabling conditions and registration for child abuse and neglect: a population-based study. Pediatrics 2005; 116:609.
  44. Mandell DS, Walrath CM, Manteuffel B, et al. The prevalence and correlates of abuse among children with autism served in comprehensive community-based mental health settings. Child Abuse Negl 2005; 29:1359.
  45. Sullivan PM, Knutson JF. The association between child maltreatment and disabilities in a hospital-based epidemiological study. Child Abuse Negl 1998; 22:271.
  46. Hibbard RA, Desch LW, American Academy of Pediatrics Committee on Child Abuse and Neglect, American Academy of Pediatrics Council on Children With Disabilities. Maltreatment of children with disabilities. Pediatrics 2007; 119:1018.
  47. Anderson C. IAN Research Report: Bullying and Children with ASD. Available at: www.iancommunity.org/cs/ian_research_reports/ian_research_report_bullying (Accessed on March 19, 2013).
  48. Rodriguez C, Murphy L. Parenting stress and abuse potential in mothers of children with developmental disabilities. Child Maltreat 1997; 2:245.
  49. Theodore AD, Runyan DK. A medical research agenda for child maltreatment: negotiating the next steps. Pediatrics 1999; 104:168.
  50. Howlin P, Jones DP. An assessment approach to abuse allegations made through facilitated communication. Child Abuse Negl 1996; 20:103.
  51. Sullivan PM, Brookhouser PE, Scanlan JM, et al. Patterns of physical and sexual abuse of communicatively handicapped children. Ann Otol Rhinol Laryngol 1991; 100:188.
  52. Orelove FP, Hollahan DJ, Myles KT. Maltreatment of children with disabilities: training needs for a collaborative response. Child Abuse Negl 2000; 24:185.
  53. Sobsey D. Violence and Abuse in the Lives of People with Disabilities. The End of Silent Acceptance?, Paul H Brookes, Baltimore 1994.
  54. Grisso T. Adolescent offenders with mental disorders. Future Child 2008; 18:143.
  55. Petersilia J. Justice for all? Offenders with mental retardation and the California corrections system. Prison J 1997; 77:358.
  56. Biklen D. Myths, mistreatment, and pitfalls: mental retardation and criminal justice. Ment Retard 1977; 15:51.
  57. Perske R. Observations of a water boy. Ment Retard 2003; 41:61.
  58. Linhorst DM, McCutchen TA, Bennett L. Recidivism among offenders with developmental disabilities participating in a case management program. Res Dev Disabil 2003; 24:210.
  59. The Arc of New Jersey. The Developmentally Disabled Offenders Program. Available at: http://www.arcunion.org/resources/pdfs/ithddadwarenessforofficers.pdf (Accessed on January 05, 2012).