Falls in the

Pediatric
Population
How to Best Plan (And Prevent!) Falls Upon
Discharge from IPR

Catherine R. Stump, SPT

 • Unintentional falls are the leading cause of nonfatal injury in kids < 14 years old in
the United States.
• Males > Females are 3x as likely to get injured.
• Children < 5 years old are at the greatest risk of sustaining a fall related injury.
• 80% of falls occur in the home.
o Falling from furniture, the bed, or stairs are the most common.

Miscellaneous • Mainly occur in warmer months but can happen at any time.

Fall Facts • Children from low-income families are more likely to be injured due to lack of
safety equipment or poor housing (e.g., baby gates, window guards, etc.)
• Additional predisposing factors include:
o History of previous unintentional injury
o Neurological disorders (seizures, developmental delay, hyperactivity)
o Neglect
o Stressors (recent move, job change, illness)
 • The mortality rate increases from
1% for falls from <15 feet to 2.5%
for falls from >15 feet.
• Head and neck injuries and
orthopedic injuries are common
from higher levels.

In the Home PREVENTION:

• Install window guards or stops

- Falls From to prevent falling through a

window

Windows
• Educate on maximum window
opening (<4 inches), opening
windows from the top (if
possible), supervise young
children, avoid placing furniture
under or near windows.
 •Approx. 90% of children injury their head or neck with falls from using
infant walkers.
• Sustain a skull fracture (38%)
• Sustained a closed head injury (29%)
• Concussion
•Most falls (74%) are a result from falling down the stairs.
Falls in •The number of infant walker injuries have decreased due to:
• Mandatory Safety Standards
Infant • Decreased infant walker use
• Increased utilization of stationary activity centers
Walkers
PREVENTION:
• Use of infant walkers should be discouraged.
• If parents/caregivers use an infant walker, demonstrate understanding of
the safety standards.
• Walker base should be >36 inches
• Require a braking mechanism to stop the walker's progression if an
event that 1 or more wheels dropped over the edge of a step.
 Falls from Furniture
• One of the most frequent type of falls among
children ages 3 months to 4 years old.
• Falls in highchairs are common when the child
attempts to stand up or when the chair tips over.
• Children <6 years old should not sleep in bunk
beds (top bunk) d/t falling risk.
PREVENTION:
• Using preinstalled restraints on highchairs or
improving chair stability.
• Supervise your children when on furniture.
• Use guard rails on cribs, changing tables, and
beds.
• Place infant seats on floor vs. Tables or
counters
• Keep highchairs away from counters or
tables to prevent pushing and/or tipping over.
Falls in the Bathtub
• Most common cause of bathtub related injury between
ages of 4 months to 16 years old are falls.
• Of bathtub related injuries, lacerations were most
common injury (67%), head, face, and
neck were involved, and adult supervision was
present in 85% of these injuries for children <5 years
old.

•PREVENTION:
• Continue to promote adult supervision with children in
the bathtub
• Stay within arm's reach whenever a baby is in or near
water.
• Add a slip-resistant device to increase surface friction
to reduce chance of falls.
• Never lift tub seat with baby in it.
• Baby Seats should only be used for children who can sit
unassisted.
 • Greatest risk of falling occurs
between ages of 5 to 9 years
old.
• Falls from climbing
equipment, monkey
bars, swings, and slides are
the leading cause of
Falls from
playground related injuries.
• Intentional jumping or
dismounting from
Playground
equipment.
Equipment
• Playground injuries <5 years
old involved injuries to the
head and neck
• Wrist, lower arm, elbow
fractures
• Risk of injury is related to
height of equipment
(increased rate of injury from
equipment >5 to 6 feet)
• Safe playground surfaces
include loose fill materials
(wood chips) and synthetic
rubber mats
Falls from Playground
Equipment Prevention
• Advocating for energy-absorbing
materials, decreasing the height of
playground equipment, regular
inspections, and increased supervision of
children on playgrounds.
• Implementation of guardrails or protective
barriers should be provided for elevated
surfaces.
• Avoid using concrete, grass, asphalt
under playground equipment.
 • Common recreational activities PREVENTION
that children get injured in are • Use of protective
skating, skateboarding, equipment (helmet, knee
trampolines, and riding and elbow pads,
nonmotorized scooters. wrist guards).
• Most injuries are due to: • Always have adult
• Loss of balance supervision (new skill vs.
Falls during • Inability to stop Novice)
Recreational • Speeding out of control • Educate on safety and
where to ride/play (rinks,
Activity • Doing tricks
sidewalks, cul-de-sacs)
• 2/3 of injuries result in fractures
• No flips or
- FOOSH Injuries
somersaults on
trampolines.
TEAMWORK = DREAM
WORK!
• Article published in 2016 -
https://doi.org/10.2522/ptj.20150213
o Interdisciplinary Approach to Fall Prevention
in High-Risk inpatient Pediatric Population
• The study developed and implemented a fall
prevention program to decrease total falls with
family/caregivers present.
• Red Light, Green Light Program – which resulted
in a reduction of falls, falls with family members,
an increase in staff awareness and collaboration.
• Created a safe environment for pediatric patients.
 Posey Belts
PROS: CONSIDERATIONS
• Assist with posture and/or positioning • Facilitate vs. Restraint
• Reducing sliding when sitting • Cognition, Emotional or Psychological problems
• Good for already active, fairly mobile patients • Medical History (Ostomy, G-tubes, COPD or other
respiratory conditions)
CONS: • Age
• Poor body mechanics for clinicians if using with
small children
• Not the greatest grip at times
• Increased fall risk if not fasted properly
 PROS CONSIDERATIONS
• Enhance body • Age
mechanics with • Cognition Level
movement
• Functional Mobility
• Increased stability level
• Increases amount of • Impulsive behavior
patient freedom with
• Diagnosis and/or
functional mobility
Gait Belts • Prevent falls
surgery

CONS
• Increase pain or
discomfort if used
incorrectly
• Increase fall risk if not
secured
References

Gill A, Kelly N, Misra S, Blake D. Prevention of falls and fall-related injuries in children.
Haarbauer-Krupa J, Haileyesus T, Gilchrist J, Mack KA, Law CS, Joseph A. Fall-related traumatic brain injury in children ages 0-4 years. J Safety Res.
2019;70:127-133. doi:10.1016/j.jsr.2019.06.003
Stubbs KE, Sikes L. Interdisciplinary Approach to Fall Prevention in a High-Risk Inpatient Pediatric Population: Quality Improvement Project. Phys Ther. 2017;97(1):97-104.
doi:10.2522/ptj.20150213

https://f.hubspotusercontent40.net/hubfs/8218994/IFU/Restraints%20and%20Restraint%20Alternatives/Posey-Wrap-Around-Belt.pdf
https://medtrica.com/what-is-gait-belt-how-to-use-and-benefits-of-using-gait-belt/
https://www.childrenssafetynetwork.org/child-safety-topics/falls