Pediatric injury is a broad category that refers to physical harm to a child, typically defined as someone between 1 year and 18 years of age.

Pediatric injuries have many different causes, severities, and effects.

• Some—like insect bites—can be relatively mild and may not require medical attention. Others—like motor vehicle crashes—can be severe, life-threatening, or life-changing.
• Injuries can be unintentional or accidental, such as those resulting from a fall off a bicycle. They can also be intentional or done on purpose, such as homicides, suicides, maltreatment, and violence.
• In some cases, injuries are so severe that they are fatal. When they aren’t fatal, they may lead to lifelong physical or mental health problems and disabilities, requiring intense or specialized care.

NICHD studies different factors related to pediatric injury and trauma, their causes, and different types of care required for treatment and recovery. The institute does not collect statistics on pediatric injuries but does fund studies that use statistics in developing prevention programs.

Pediatric emergency medicine focuses on the immediate care of infants, children, and adolescents with acute illness or injuries that require urgent medical attention. Treatment and care provided in hospital emergency departments are generally not long term or continuing. Pediatric emergency medicine physicians consult with physicians from other specialties to resuscitate and stabilize children who are seriously ill or injured.

EMSC is care that aims to reduce children’s disability and death from severe illness or injury by increasing awareness and enhancing capabilities among pre-hospital, health systems, healthcare providers, and the general public of the special (physiological and psychological) needs of children receiving emergency medical care.

Children who have severe or life-threatening injuries need critical care. These children may be admitted to pediatric intensive care units (PICUs) in hospitals, where they receive critical care. These units are staffed by physicians with specialized training in pediatric critical care medicine ("pediatric intensivists"). Because children can experience a broad range of injury type, severity, and complexity, and because injuries can affect multiple organ systems, PICUs are staffed by and consult with many types of specialized health care providers. These include physicians, including those trained in pediatric emergency care, pediatric trauma surgeons, pediatric anesthesiologists, cardiologists, neurologists, and others. PICUs are also staffed by pediatric nurses, social workers, psychologists, and others who help guide recovery efforts for injured children and their families.

Child unintentional injury death rates decreased 11% from 2010 to 2019, but injury is still the leading cause of death for children and teens in the United States—and some are at higher risk.

More than 7,000 children and teens age 0-19 died because of unintentional injuries in 2019. That is about 20 deaths each day. Leading causes of child unintentional injury include motor vehicle crashes, suffocation, drowning, poisoning, fires, and falls. Child injury is often preventable.

The latest data on child injury deaths

In 2018–2019, child unintentional injury death rates were highest among:

• Male children
• Babies under 1 year old and teens age 15–19 years
• American Indian and Alaska Native children and Black children

Motor vehicle crashes caused more deaths than other causes of unintentional injury.

Overall unintentional injury death rates in rural areas were higher than metro and urban areas.

Despite overall decreases in child unintentional injury death rates from 2010 to 2019, rates increased among some groups:

• Suffocation death rates increased 20% among infants overall and 21% among Black children
• Motor vehicle death rates among Black children increased 9% while rates among White children decreased 24%
• Poisoning death rates increased 50% among Hispanic children and 37% among Black children, while rates among White children decreased by 24%

Drowning was the leading cause of injury death for children age 1-4 years. Drowning death rates were 2.6 times higher among Black children age 5–9 years and 3.6 times higher among Black children age 10–14 years, when compared with White children of the same age.

Every hour, one child dies from an injury.

About 1 in 5 child deaths is due to injury.

Every 4 seconds, a child is treated for an injury in an emergency department.

Child injuries are preventable, yet more than 9,000 children died from injuries in the US in 2009. Car crashes, suffocation, drowning, poisoning, fires, and falls are some of the most common ways children are hurt or killed. The number of children dying from injury dropped nearly 30% over the last decade. However, injury is still the number 1 cause of death among children. More can be done to keep our children safe.

Problem

Injuries are the #1 cause of death among children. Car crashes, suffocation, drowning, poisoning, fires, and falls are some of the most common causes of injury. Learn how you can help save lives and prevent these injuries.

What can be done?

States and communities can

• Align efforts with the National Action Plan for Child Injury Prevention, released in 2012 by CDC and more than 60 partner organizations. Visit www.cdc.gov/safechild.
• Strengthen data collection on child injury to identify problems and track progress.
• Use strategies shown to reduce injuries such as graduated driver licenses, learn-to-swim programs, and prescription drug monitoring programs.
• Improve access to poison control centers, trauma center care, and preventive services (such as CPR/first aid training).

Health care systems can

• Use technology, such as electronic medical records, to improve the speed and quality of care for injured children, and to monitor the number and severity of injuries.
• Include child safety education for new parents and at all pediatric visits.

Employers can

• Protect all employees, including youth, from workplace injuries by complying with existing safety standards and regulations.
• Provide proper safety training, education, and protective equipment for each job task.

Everyone can

• Take steps to prevent child injury where you live, work, and play.
• Be a good role model—wear a seat belt, use a helmet, and follow other safety tips.

Some common causes of non-fatal pediatric injury, as reported by CDC, include:

• Motor vehicle crashes: According to CDC, nearly 150 children ages 0 to 19 are treated every hour in U.S. emergency departments for crash-related injuries.
• Suffocation (being unable to breathe): This category includes strangulation and choking on food and other objects.
  • Accidental suffocation or strangulation in bed (ASSB) is a leading cause of sudden unexpected infant death (SUID), a category of causes of death that includes previously called sudden infant death syndrome (SIDS). CDC notes that about 26% of all SUID in in 2017 resulted from ASSB.
  • Injuries have also been reported from improper use of infant sitting devices, such as car seats, swings, and bouncers—especially when they are used for routine sleep.
• Drowning: CDC notes that about one-half of children treated for drowning in emergency departments require hospitalization or transfer for further care, and many are left with permanent disabilities from brain injuries.
• Poisoning: Common sources of poisoning include household cleaners and medicines.
• Burns: According to CDC:
  • Younger children are more likely to be burned by hot liquids or steam.
  • Older children are more likely to be burned from direct contact with fire.
• Falls: CDC reports that falls are the most common cause of nonfatal injuries for children ages 0 to 19.
• Violence: According to CDC, about 1,300 young people are treated in emergency departments each day for nonfatal assault injuries.

Please note that causes of nonfatal pediatric injury are not necessarily the same as causes of fatal pediatric injuries. Injuries resulting from the causes listed here can be fatal, but they are not necessarily the most common causes of pediatric death.

Child unintentional injury death rates decreased 11% from 2010 to 2019, but injury is still the leading cause of death for children and teens in the United States—and some are at higher risk.

More than 7,000 children and teens age 0-19 died because of unintentional injuries in 2019. That is about 20 deaths each day. Leading causes of child unintentional injury include motor vehicle crashes, suffocation, drowning, poisoning, fires, and falls. Child injury is often preventable.

The latest data on child injury deaths

In 2018–2019, child unintentional injury death rates were highest among:

• Male children
• Babies under 1 year old and teens age 15–19 years
• American Indian and Alaska Native children and Black children

Motor vehicle crashes caused more deaths than other causes of unintentional injury.

Overall unintentional injury death rates in rural areas were higher than metro and urban areas.

Despite overall decreases in child unintentional injury death rates from 2010 to 2019, rates increased among some groups:

• Suffocation death rates increased 20% among infants overall and 21% among Black children
• Motor vehicle death rates among Black children increased 9% while rates among White children decreased 24%
• Poisoning death rates increased 50% among Hispanic children and 37% among Black children, while rates among White children decreased by 24%

Drowning was the leading cause of injury death for children age 1-4 years. Drowning death rates were 2.6 times higher among Black children age 5–9 years and 3.6 times higher among Black children age 10–14 years, when compared with White children of the same age.

You can keep children safe

Everyone—including parents, health care providers, teachers, and neighbors—can take steps to prevent injury where children live, learn, and play.

Also, injuries like falls and motor vehicle crashes can cause concussions in children and teens. A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth.

Motor Vehicle Crashes: A Leading Cause of Death for Children

In 2019, 608 child passengers age 12 and younger died in motor vehicle crashes, and more than 91,000 were injured. Of the children 12 and younger who died in a crash (for whom restraint use was known), 38% were not buckled up. Parents and caregivers can make a lifesaving difference by checking whether their children are properly buckled on every trip.

Risk Factors for Child and Teen Passengers

• Of the children who died in a crash:
  • Restraint use (like car seat, booster seat, or seat belt use) varies by age. In 2019, 43% of 8–12-year-olds were not buckled up, compared to 41% of 4–7-year-olds and 27% of children less than 4 years old (for whom restraint use was known).
  • Black and Hispanic children have higher proportions of unrestrained child deaths compared with White children. A study of data from 2009–2010 indicated that 45% of Black children and 46% of Hispanic children were not buckled up, compared with 26% of White children (among children 12 and younger).
• Alcohol-impaired driving is a threat to the safety of child passengers. In 2019, 23% of child passenger deaths among children age 14 years and younger in the United States­­­ involved alcohol-impaired driving (blood alcohol concentration ≥0.08 g/dL); 64% of the time, it was the child’s own driver who had been drinking.
  • Among children who died in alcohol-impaired driving crashes, a higher proportion of those riding with impaired drivers were unrestrained (58%) compared with those riding with sober drivers (37%).
• Restraint use among young children often depends on the driver’s seat belt use. In 2019, 67% of fatally injured children riding with unbelted drivers were also unrestrained (based on known restraint use).
• Child restraint systems are often used incorrectly. An estimated 46% of car seats and booster seats are misused in a way that could reduce their effectiveness.

Buckling children in age- and size-appropriate car seats, booster seats, and seat belts reduces the risk of serious and fatal injuries.

• Car seat use reduces the risk for injury in a crash by 71–82% for children, when compared with seat belt use alone.
• Booster seat use reduces the risk for serious injury by 45% for children age 4–8, when compared with seat belt use alone.
• For older children and adults, seat belt use reduces the risk for death and serious injury by about half.

Preventing Motor Vehicle Injuries in Children​​​​​​

• The Community Preventive Services Task Force recommends child restraint laws to increase restraint use and decrease injuries and deaths among child passengers, based on strong evidence of effectiveness.
• Child restraint laws require children riding in vehicles to use approved restraint devices such as car seats, booster seats, or seat belts that are appropriate for their age, height, and weight.
• Strengthening current laws with booster seat provisions that require children who have outgrown car seats to use booster seats until at least age 9 helps reduce injuries and deaths.
  • Children age 4–8 years in states with booster seat laws were over four times as likely to be using age-appropriate restraints and were 20% less likely to die than children in states without booster seat laws.
  • A study among children involved in crashes found that restrained children were 66% more likely to be buckled in appropriate restraints if their state law followed best practice recommendations.
  • Observed booster seat use among children age 4–7 years increased by 19 percentage points after booster seat laws were implemented in Milwaukee County, Wisconsin.
  • The death rate among 7-year-olds was 25% lower for the children in states with booster seat laws compared to states without booster seat laws.
  • The rate of children using car seats and booster seats increased nearly three times in five states that increased the booster seat use age requirement to 7 or 8 years. The rate of children who sustained fatal or incapacitating injuries decreased by 17% in these states.
• Car seat distribution plus education programs also are recommended for increasing restraint use. Distributionplus education programs help parents and caregivers obtain new, unused car seats and learn how to properly use and install them.These programs often include hands-on demonstrations, which can help increase proper use and installation.
• Short-term, high-visibility enforcement of child restraint laws are similar to those used for seat belt use (such as Click It or Ticket). Effective programs are short-term, highly visible in the community, and advertised widely in the media.
• Incentive and education programs reward parents or children with coupons or other prizes for correctly using car seats. Programs offer print materials, videos, or other instructional aids for parents and caregivers.

Know the Stages

CDC provides guidance to ensure children are properly buckled in a car seat, booster seat, or seat belt— whichever is appropriate for their age, height, and weight.

• Rear-facing car seat: Birth until age 2–4.
  Infants and toddlers should be buckled in a rear-facing car seat with a harness, in the back seat, until they reach the maximum weight or height limit of their car seat. This offers the best possible protection. Check the car seat manual and labels on the car seat for weight and height limits. Never place a rear-facing car seat in the front seat. Front passenger air bags can injure or kill young children in a crash.
• Forward-facing car seat: After outgrowing the rear-facing car seat and until at least age 5.
  When children outgrow their rear-facing car seats, they should be buckled in a forward-facing car seat with a harness, in the back seat. They should stay in the forward-facing car seat until they reach the maximum weight or height limit of this seat. Check the car seat manual and labels on the car seat for weight and height limits.
• Booster seat: After outgrowing the forward-facing car seat and until the seat belt fits properly.
  When children outgrow their forward-facing car seat, they should be buckled in a belt-positioning booster seat with a seat belt, in the back seat, until the seat belt fits properly without a booster seat. A seat belts fits properly when the lap belt is across the upper thighs (not the stomach) and the shoulder belt is across the center of the shoulder and chest (not on the neck/face or off the shoulder). This typically does not occur until children are age 9–12.
• Seat belt: When the seat belt fits properly without a booster seat.
  Children no longer need to use a booster seat when the seat belt fits them properly. A seat belt fits properly when the lap belt is across the upper thighs (not the stomach) and the shoulder belt is across the center of the shoulder and chest (not on the neck/face or off the shoulder). This typically does not occur until children are age 9–12. Seat belt fit can vary by vehicle so check belt fit in all vehicles to make sure the child no longer needs to use a booster seat. It could be that a child might need a booster seat in one vehicle but not another. Keep children properly buckled and in the back seat through age 12 for the best possible protection.
• Install and use car seats & booster seats properly.
  Install and use car seats and booster seats according to the car seat/booster seat manual, or get help installing them from a certified child passenger safety technician
• Find a child passenger safety technician
• Don’t seat children in front of an air bag.
  Air bags can kill young children riding in the front seat. Never place a rear-facing car seat in front of an air bag.
• Buckle children in the back seat.
  Properly buckle all children age 12 and younger in the back seat.
• Always buckle older children who use booster seats or seat belts with a lap and shoulder belt. Both the lap and shoulder belt are needed for proper protection.
• Buckle children in the middle of the back seat.
  Properly buckle children in the middle seating position of the back seat when possible, because it is the safest position in the vehicle.
  • If the middle seating position contains only a lap belt, older children using booster seats or seat belts should sit in a different seating position in the back seat where they can use both a lap and shoulder belt.
  • Most rear-facing and forward-facing car seats can be safely installed in the middle seating position using the lap belt only, so younger children using these types of seats can be safely positioned in the middle.
• Use proper restraints on every trip.
  Buckle children in car seats, booster seats, or seat belts on every trip—no matter how short the trip.
• Parents and caregivers: Always wear a seat belt.
  Set a good example by always using a seat belt.

Make an escape plan

It is important to have a plan when there are children in your home. Children sometimes need help getting out of the house. They may not know how to escape or what to do unless an adult shows them.

• Have a plan for young children who cannot get outside by themselves. You will need to wake babies and very young children and help them get out. In your plan, talk about who will help each child get out safely.
• It is important to find two ways out of every room in your home, in case one exit is blocked or dangerous to use.
• Choose a meeting place outside your home. Children should know what to do when they hear a smoke alarm and there is no adult around. Help them practice going to the outside meeting place. Teach them to never go back inside a building that is on fire.

Keep children safe from fire and burns

Some children are curious about fire. There are simple steps you can take to keep you and the people you love safer from fire and burns.

• Keep children 3 feet away from anything that can get hot. Space heaters and stove-tops can cause terrible burns. Keep children at least 3 feet away from stoves, heaters or anything that gets hot.
• Keep smoking materials locked up in a high place. Never leave cigarette lighters or matches where children can reach them.
• Never play with lighters or matches when you are with your children. Children may try to do the same things they see you do.

About 50,000 young children end up in emergency rooms each year because they got into medicines while an adult wasn’t looking. These emergency visits can be prevented by always putting every medicine up and away and out of children’s reach and sight every time you use it.

Families take medications and vitamins to feel well and to stay well. However, any medication, including those you buy without a prescription, can cause harm if taken in the wrong way or by the wrong person. Practicing safe medication storage, while at home and when on-the-go, can help keep children safe.

Protect your children. Here’s how:

• Put medicines up and away and out of children’s reach and sight.
  • Children are curious and put all sorts of things in their mouths. Even if you turn your back for less than a minute, they can quickly get into things that could hurt them.
  • Pick a storage place in your home that children cannot reach or see. Different families will have different places. Walk around your house and decide on the safest place to keep your medicines and vitamins.
• Put medicines away every time.
  • This includes medicines and vitamins you use every day. Never leave medicine out on a kitchen counter or at a sick child’s bedside, even if you have to give it again in a few hours.
• Make sure the safety cap is locked.
  • Always relock the cap on a medicine bottle. If the bottle has a locking cap that turns, twist it until you hear the click or cannot twist anymore.
  • Remember, even though many medicines have safety caps, children may be able to open them. Every medicine must be stored up and away and out of children’s reach and sight.
• Teach your children about medicine safety.
  • Teach your children what medicine is and why you or a trusted adult must be the one to give it to them.
  • Never tell children medicine is candy to get them to take it, even if they don’t like to take their medicine.
• Tell your guests about medicine safety.
  • Ask family members, houseguests, and other visitors to keep purses, bags, or coats that have medicine in them up and away and out of sight when they are in your home.
• Be prepared in case of an emergency.
  • Call your poison control center at 800.222.1222 right away if you think your child might have gotten into a medicine or vitamin, even if you are not completely sure.
  • Program the Poison Help number into your home and cell phones so you will have it when you need it.
• Take Action.
  • Visit the Up and Away Campaign’s website to learn more about storing medications safely while at home and when traveling with young children. Share these safe storage tips with family and friends.

Playground Safety Tips for Parents

As a parent, you play an important role in keeping your child safe on the playground. Learn how to spot a concussion and protect your child from concussion or other serious brain injury each time you take your child on an outdoor play adventure.

Be HEADS UP on the Playground

WHAT IS A CONCUSSION?

A concussion is a type of traumatic brain injury—or TBI— caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move quickly back and forth. This fast movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging the brain cells.

HOW CAN I HELP KEEP MY CHILD SAFE?

Playgrounds are important places for children to have fun, explore, and grow. Children learn through play and need opportunities to take risks, test their limits, and learn new skills through free play. Playgrounds can also put children at risk for concussion.

On the playground, children are more likely to get a concussion or other serious brain injury when using:

1. Monkey Bars
2. Climbing Equipment
3. Swings

To help keep children safe:

• Use playground equipment that is right for your child’s age.
• Make sure there are guardrails to help prevent falls.
• Check that playgrounds have soft material under them, such as wood chips, sand, or mulch.
• Look out for things in the play area that can trip your child, like tree stumps or rocks.

HOW CAN I SPOT A POSSIBLE CONCUSSION?

After a fall or a bump, blow, or jolt to the head or body, look for one or more of these signs and symptoms of a concussion:
Signs Observed by Parents:

• Appears dazed or stunned.
• Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent.
• Moves clumsily.
• Answers questions slowly.
• Loses consciousness (even briefly).
• Shows mood, behavior, or personality changes.
• Can’t recall events prior to or after a hit or fall.

Symptoms Reported by Children:

• Headache or “pressure” in head.
• Nausea or vomiting.
• Balance problems or dizziness, or double or blurry vision.
• Bothered by light or noise.
• Feeling sluggish, hazy, foggy, or groggy.
• Confusion, or concentration or memory problems.
• Just not “feeling right,” or “feeling down."​​​​​

​​​​​WHAT ARE SOME MORE SERIOUS DANGER SIGNS TO LOOK OUT FOR?
In rare cases, a dangerous collection of blood (hematoma) may form on the brain after a bump, blow, or jolt to the head or body and can squeeze the brain against the skull. Call 9-1-1 or ensure that the child is taken to the emergency department right away if, after a bump, blow, or jolt to the head or body, he or she has one or more of these danger signs:

• One pupil larger than the other.
• Drowsiness or inability to wake up.
• A headache that gets worse and does not go away.
• Slurred speech, weakness, numbness, or decreased coordination.
• Repeated vomiting or nausea, convulsions, or seizures (shaking or twitching).
• Unusual behavior, increased confusion, restlessness, or agitation.
• Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously.

Parents can reduce the risk of sleep-related causes of infant death and injury in the following ways:

• Always place infants on their backs to sleep.
• Use a firm and flat sleep surface, such as a mattress in a safety-approved crib, covered by a fitted sheet with no other bedding or soft items in the sleep area.
• Share your room with baby, but not your bed. Keep baby in your room close to your bed, but on a separate surface designed for infants, ideally for baby’s first year, but at least for the first 6 months.
• Do not put soft objects, toys, crib bumpers, or loose bedding under baby, over baby, or anywhere in baby’s sleep area.
• Do not let your baby get too hot during sleep. Use sleep clothing that keeps baby warm without the need for loose blankets in the sleep area. Keep objects from covering baby’s face and head.
• Think about giving your baby a pacifier for naps and nighttime, but do not attach it to anything—like a string, clothing, toy, or blanket—that carries a risk of suffocation, choking, or strangulation.
• Avoid products that go against safe sleep recommendations, especially those that claim to prevent or reduce the risk for SIDS, suffocation, or reflux.