Published Nov. 15, 2024

Unintentional falls are a leading cause of non-fatal injuries in children and the most common reason young children are injured at home. However, child injuries from falls happen everywhere — on the sports field, on the playground, on the farm — and they are preventable.

Last year falls accounted for 42% of traumatic injuries among children admitted to University of Iowa Health Care Stead Family Children’s Hospital. In 2023, there were nearly 300 pediatric falls leading to injuries that required hospitalization.

Kristel Wetjen is pediatric trauma program manager at the Stead Family Children’s Hospital where many of the children with traumatic injuries in Iowa are admitted. She said that the type of fall makes a huge impact on the kinds of injuries the hospital sees.

“Common injuries associated with a fall can be more minor, such as cuts or broken bones but a fall from a height can result in traumatic brain injury, spinal cord injury or even death,” Wetjen said.

Dr. Graeme Pitcher, clinical professor and pediatric trauma medical director, said falls have been a consistent problem in Iowa over the years.

“Children are navigating a growing body while also learning and understanding boundaries and safety,” he said. “These lead to children falling in many ways, from tripping and stumbling to bigger falls from playground equipment or even from home windows.”

Of children admitted to Stead Family Children’s Hospital with falls-related injuries in 2023, most had falls from slipping, tripping, and stumbling (73), followed by falls from furniture (42), such as beds and chairs, and falls from one level to another (40), such as a large or tall structure.

Falls at playgrounds were common (63), including falls from slides, swings, and jungle gyms. There were 19 falls from children being carried or supported by another person (e.g., a caregiver dropping a young child); 10 falls from stairs; and nine falls from windows.

University of Iowa pediatric falls study

In 2022, a team from with UI Injury Prevention Research Center published a study that looked at patterns of fall-related injuries among children ages 0-18 in the Iowa Trauma Registry from 2010 to 2014. This confidential registry collects certain data from Iowa hospitals about patients who have experienced significant traumatic events. In each year, falls accounted for about 19% of serious child injuries. This increased slightly in 2012 (22%).

Very young children and older children are at risk for more serious injuries.

Children under one years old and adolescents ages 15-18 years were more likely to have more severe injuries from falls. Such injuries are determined through an Injury Severity Score (ISS), a standardized score of the worst injuries in six areas of the body.

Head injuries were the most common falls-related injury (77%) in children younger than one years old. Among all other age groups, fractures constituted the majority of falls-related injuries (60%), followed by head injuries (21%).

Male children are at greater risk for serious falls-related injuries.

UI researchers found that among children ages 0-18 who experienced traumatic falls-related injury, more were male (62%) than female (38%).

Where children fall

The UI study found that Iowa children under one years old often fell from parent’s/sibling’s arms, changing tables, and other furniture. Children ages 1-4 were most often injured falling from furniture, playground equipment, and other multilevel structures (e.g., tree, stationary vehicle). Children ages 5-9 were most likely to fall from playground equipment.

Same-level falls were more common in children ages 10 -14-years (mainly slipping/tripping) and 15-18-years (mainly slipping/ tripping but also colliding, pushing, and shoving).

Socioeconomic status as a risk factor for serious falls-related injuries

While the UI study did not look at socioeconomic status, it included insurance payer source in its analysis, which can serve as a proxy for socioeconomic status. The study found that Medicaid was the primary insurance source among children younger than five years old, while commercial insurance was primary for children ages 5-18 years old.

Past research has identified socioeconomic status as a risk factor for falls-related injuries of young children.

Tips for preventing falls

Wetjen said parents can protect their children from falls by creating a safe home environment.

“This can include gates at the top and bottom of stairs, window guards, and vertical railings around balconies or decks with no more than four inches between each railing to prevent falls,” she said. “Not every fall can be prevented, so padding hard edges of coffee tables, end tables or elevated fireplace hearths can protect the children in your home.”

Pitcher said parents can also prevent heavy furniture, such as TVs, dressers, and bookshelves, from falling onto children by securing these items to the wall.

Window falls

• Keep windows closed, when possible, especially in rooms where children play.
• Open a window from the top instead of the bottom, and only open windows up to four inches.
• A window screen will not keep children from falling out of a window. The weight of a child can push through a window screen.
• Keep windows locked and use window guards and stops.
• Put furniture away from windows, so that children do not climb furniture to reach a window.
• Always supervise small children.
• Make sure your home meets window safety standards.

Playground falls

• Use playgrounds with wood chips, rubber surfacing or sand under and around it rather than ones over concrete and grass.
• Go to playgrounds with equipment that has guardrails and barriers on platforms and ramps.
• Watch out for uneven surfaces such tree roots.
• Always supervise children on playgrounds.
• Have children take off their bicycle helmets while using playground equipment so that their heads do not get stuck anywhere on the equipment.

Blog post: S.A.F.E.^TM Playgrounds: Q & A with Dr. Heather Olsen

Furniture falls

• Bunk beds: Use guardrails (at least five inches above mattress top) on both sides of the top bunk. Only let children older than age six sleep in the top bunk. Do not let kids play on the bunk or ladder. Teach children how to carefully climb the ladder and use a night light near the ladder.

• Supervise children closely and teach them not to climb furniture. Anchor furniture to the wall (such as bookshelves and dressers).
• Keep tempting objects, such as toys, from high-surface furniture to prevent children from climbing furniture to reach these objects.
• Use stable furniture that does not easily tip over.

Stairs

• Install safety gates at the top and bottom of stairs if infants or toddlers are in the house. Attach safety gates with hardware to the wall or banister.
• Make sure stairs have banisters or handrails on each side.
• Do not let children play on stairs and railings.
• Keep the stairs free of clutter.
• Wear a front carrier with babies when using the stairs and keep a hand on railing.

• Wear proper footwear to avoid slipping.

Slipping and tripping; sports falls

• Keep floors and stairs clear of toys and clutter; wipe up spills right away.
• Secure carpets and runners and use non-slip rugs.
• Keep phone and lamp cords out of the way.
• Wear slip-resistant footwear such as tennis shoes.
• Older children should be careful when on structures, especially those without protective barriers.
•  Use consistent safety practices among participants in sports and recreational activities and have adult supervision of these activities.

Some resources:

Nationwide Children’s Hospital: Fall Prevention and Falls

Harborview Injury Prevention and Research Center: Window Falls