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									www.elsevier.com/locate/jsr                          Journal of Safety Research 38 (2007) 609 – 612                                           www.nsc.org



                                                       Special Report from the CDC
                 Unintentional injuries among infants age 0–12 months☆
                               Karin A. Mack ⁎, Julie Gilchrist, Michael F. Ballesteros
     Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention,
                                          4770 Buford Hwy NE, Mailstop K 63, Atlanta, GA 30341, USA
                                                  Received 16 August 2007; accepted 16 August 2007
                                                         Available online 14 September 2007

    The Journal of Safety Research has partnered with the National Center for Injury Prevention and Control at the Centers for Disease Control and
Prevention (CDC) in Atlanta, Georgia, USA, to briefly report on some of the latest findings in the research community. This report is the eighth in a series
of CDC articles.



Abstract

    Each year an estimated 328,500 infants age 0–12 months are treated for unintentional injuries in emergency departments (EDs): one
infant every minute and a half. The leading cause, overall and by month of age, was fall-related injury. The second leading cause was
‘struck by or against.' The majority of patients were injured at home. Younger infants were more likely to be hospitalized than older ones
and more males than females were injured. Gender differences suggest that parenting practices may play a role, but ecological approaches
should be considered in an effort to understand the connection between injuries and an infant's developmental stage.
National Safety Council and Elsevier Ltd. All rights reserved.

Keywords: Unintentional injury; Infants




1. Introduction

   The leading causes of non-fatal unintentional injury in children aged b15 years treated in emergency departments (EDs)
are falls, struck by/against, and overexertion (Ballesteros, Schieber, Gilchrist, Holmgreen, & Annest, 2003). For children
b1 year of age, the five leading causes are falls, struck by/against, fire/burn, foreign body, and bite/sting injuries. In addition,
Ballesteros et al. (2003) suggest that fall injury rates were highest among infants because of their limited coordination,
exploratory nature, and potential home hazards.
   Although Sudden Infant Death Syndrome has been studied expansively (Overpeck et al., 2002; Sullivan & Barlow, 2001),
unintentional injury among infants is reported in the literature largely with product specific studies (e.g., bathtub seats
(Thompson, 2003), strollers/shopping carts (Powell, Jovtis, & Tanz, 2002b; Vilke et al., 2004), baby carriers (Pollack-Nelson,
2000), high chairs (Powell, Jovtis, & Tanz, 2002a)). Rates of pediatric injuries in 3-month intervals for children age 0–3 years
were reported with California data (Agran et al., 2003) and rates for infants as one group were reported using national data (Powell
& Tanz, 2002). Gender differences in rates of unintentional head injury in infants less than 3 months of age were assessed with
national data (Greenes, Wigotsky & Schutzman, 2001). National estimates of unintentional injuries by month of age have not


 ☆
    Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the CDC.
  ⁎ Corresponding author. Tel.: +1 770 488 4389; fax: +1 770 488 1317.
    E-mail address: kmack@cdc.gov (K.A. Mack).

0022-4375/$ - see front matter. National Safety Council and Elsevier Ltd. All rights reserved.
doi:10.1016/j.jsr.2007.08.001
610                                        K.A. Mack et al. / Journal of Safety Research 38 (2007) 609–612


 Table 1
 Disposition of nonfatal unintentional injuries for infants (age 0–12 months) treated in U.S. emergency departments, NEISS-AIP, 2001–2004
                 Case disposition
 Age             Treated and released     Transferred           Hospitalized          Observation            Left w/o being seen     Unknown
 (in months)     Percent (95% CI)         Percent (95% CI)      Percent (95% CI)      Percent (95% CI)       Percent (95% CI)        Percent (95% CI)
 1⁎              91.4 (89.2–93.2)         3.2   (2.1–4.8)       3.7 (2.7–5.3)         0.9 (.4–1.8)           0.7   (.3–1.5)
 2               92.3 (89.3–94.5)         2.3   (1.0–5.3)       4.7 (3.3–6.0)         0.2 (.1–.5)            0.4   (.1–1.4)          0.2 (0–1.3)
 3               93.7 (90.3–95.9)         2.4   (1.2–4.6)       2.6 (1.4–5.0)         0.2 (.1–.6)            0.9   (.3–2.6)          0.2 (0–1.2)
 4               94.1 (91.7–95.9)         2.7   (1.5–4.8)       2.4 (1.3–4.5)         0.3 (.1–1.1)           0.4   (.1–1.4)
 5               95.7 (93.6–97.2)         0.7   (.3–1.8)        2.1 (1.1–3.9)         0.7 (.2–2.3)           0.8   (.4–1.7)
 6               96.0 (94.5–97.2)         1.1   (.6–2.0)        2.1 (1.2–3.8)         0.1 (0–.3)             0.6   (.3–1.3)
 7               94.6 (93.0–95.9)         1.5   (.9–2.5)        2.2 (1.4–3.6)         0.6 (.3–1.3)           0.9   (.4–1.7)          0.1 (0–.8)
 8               96.1 (94.6–97.1)         1.1   (.6–2.1)        1.9 (1.2–2.9)         0.2 (.1–.7)            0.7   (.3–1.3)
 9               96.0 (94.7–97.1)         0.9   (.5–1.7)        2.1 (1.2–3.6)         0.2 (.1–.6)            0.5   (.3–1.1)          0.2 (0–.6)
 10              95.8 (94.8–96.7)         1.4   (.9–2.3)        1.4 (1.0–2.0)         0.4 (.1–.9)            0.9   (.6–1.5)
 11              96.6 (95.7–97.4)         1.0   (.6–1.6)        1.4 (.9–2.0)          0.1 (0–.2)             0.8   (.4–1.6)          0.1(0–.4)
 12⁎             96.4 (95.6–97.0)         1.2   (.8–1.7)        1.3 (.8–2.1)          0.4 (.2–.8)            0.8   (.4–1.5)
 ⁎The one month old group includes infants 0–7 weeks and the 12 month old group includes infants 48–55 weeks.




 been reported. This study presents national estimates of unintentional injuries for infants by month of age and identifies potential
 risk factors involved in the injury events.

 2. Methods

    Data come from the 2001–2004 National Electronic Injury Surveillance System—All Injury Program (NEISS-AIP). NEISS-
 AIP is a stratified probability sample of all hospitals in the United States and its territories having at least six beds and providing 24-
 hour emergency services. NEISS-AIP is a collaborative effort between the Centers for Disease Control and Prevention's National
 Center for Injury Prevention and Control and the U.S. Consumer Product Safety Commission. Data elements include cause, gender,
 diagnosis, disposition, brief narrative, body part injured, location of injury, month/day of ED visit, and age (in months). NEISS-AIP
 has been described in more detail in previously published reports (Quinlan et al., 1999; Vyrostek, Annest, & Ryan 2004) and more
 information is available at http://www.cdc.gov/ncipc/wisqars/nonfatal/datasources.htm. Estimates were weighted and analyses
 conducted using SPSS Complex Samples to account for the sampling design.

 3. Results

    Each year, an estimated 328,500 infants age 0–12 months are treated for unintentional injuries in emergency departments
 (EDs). The leading cause, overall and by month of age, was fall-related injury. About 168,500 infants are seen in U.S. EDs
 annually for injuries sustained in unintentional falls. The second leading cause was ‘struck by or against' resulting in an
 estimated 44,663 visits annually. The majority of patients were injured at home (68.5%; 95% CI = 62.2-74.2%). More than
 one-fourth (27.1%) of the patients were 12 months of age (95% CI = 21.1-34.1%) compared to 3.5% that were 2 months of age
 (95% CI = 3.1-4.0%). Nearly one-fifth of the infants could be classified as having a traumatic brain injury (TBI) (17.8%), and
 87% of the TBIs resulted from a fall.
    Younger infants were more likely to be hospitalized than older ones (Table 1). Nearly 4% (3.7%) of infants b 1 month were
 hospitalized (95% CI = 2.7-5.3%) compared with 1.3% of those 12 months of age (95% CI = 0.8-2.1%). Younger infants were
 also more likely to be transferred (3.2% of those b 1 month; 85% CI = 2.1-4.8) than older infants (1.2% of those 12 months of
 age; 95% CI = .8-1.7%) Causes significantly higher among the hospitalized than the non-hospitalized included motor-vehicle
 crashes, poisoning, inhalation/suffocation, drowning, and foreign body.
    Overall, the patients were more likely to be male (55.2%; 95% CI = 54.5-55.8%) than female (44.8%; 95% CI = 44.1-
 45.5%). Lacerations were slightly higher in males than females. Dislocations were slightly higher in females than males. We
 observed no other differences in diagnoses by gender.

 4. Conclusions

    Every minute and a half, an infant age 0–12 months is seen in an emergency department for a nonfatal unintentional injury.
 Falls were the leading cause of unintentional injury for infants at every month of age. These findings corresponded with
                                               K.A. Mack et al. / Journal of Safety Research 38 (2007) 609–612                                                      611



previous work (Agran et al., 2003; Ballesteros et al., 2003; Powell & Tanz, 2002). We found that younger infants were more
likely to be hospitalized than older ones. The severity of the injury may be part of the reason, but another explanation could be
that physicians exercise more caution when treating the youngest infants.
    Patients were more likely to be male than female. These results are consistent with Greenes et al. (2001). Gender
differences at even this young age suggest that parenting practices may play a role (Greenes et al., 2001).
    Results of this study are subject to limitations. First, NEISS-AIP only includes injuries treated in hospital EDs and
excludes those treated in homes, physician offices, or outpatient clinics. Thus, our results are an undercount of the total
injuries sustained by infants in the United States. About 31% of children younger than 15 years of age are treated in EDs, and
the remaining 69% are treated in primary care offices, surgical specialty offices, medical specialty offices, and outpatient
departments (Centers for Disease Control and Prevention [CDC], 2006). Therefore, the number of infants medically treated
for injuries each year may approach one million. Second, NEISS-AIP only provides national estimates—not state or local
estimates. Yet, causes and circumstances of infant injuries may vary by community and location. Finally, NEISS-AIP does not
provide detailed sociodemographic information on individuals, limiting our ability to analyze key factors such as
socioeconomic status or family structure. These results represent only unintentional injuries and do not include injuries to
infants related to violence.
    Our results set the stage for future research on unintentional injury prevention during the first year of life. Applying an
ecological model of life course development to prevention suggests that the safety of infants during the first 12 months
depends primarily on two factors: adequate parenting and safe environments, implying the need for interventions at home and
in the community (Doll, Bonzo, Mercy, & Sleet, 2007; Mercy, Sleet, & Doll, 2006). Safety attributes most likely to influence
injuries among infants include strong emotional bonds between infant and caregivers, use of positive reinforcement to
promote safe behaviors, high caregiver awareness and knowledge of home safety measures, active supervisory style by the
caregiver, absence of home hazards, environmental protection, and home visitation programs (Sleet & Mercy, 2003). Our
study showed the need to understand the connection between these factors and an infant's developmental stage. For example,
changes in mobility in the first year of life present an enormous challenge. Attributes that increase safety in homes and
communities must be adapted for the infant's stage of development.

References

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Ballesteros, M. F., Schieber, R. A., Gilchrist, J., Holmgreen, P., & Annest, J. L. (2003). Differential ranking of causes of fatal versus non-fatal injuries among U.S.
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Centers for Disease Control and Prevention [CDC]. (2006). Ambulatory Care Visits to Physician Offices, Hospital Outpatient Departments, and Emergency
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Doll, L., Bonzo, S., Mercy, J. A., & Sleet, D. A. (Eds.). (2007). Handbook of injury and violence prevention. New York: Springer.
Greenes, D. S., Wigotsky, M., & Schutzman, S. (2001). Gender differences in rates of unintentional head injury in the first 3 months of life. Ambulatory
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    adolescents: Research, practice and advocacy (pp. 1−14). Washington, DC: American Public Health Association.
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Karin A. Mack, received her Ph.D. in Sociology from the University of Maryland and is currently a Behavioral Scientist at CDC’s Injury Center. Dr. Mack’s
recent research focuses on fall prevention in older adults, unintentional injuries in children, and the factors of a healthy home.
612                                          K.A. Mack et al. / Journal of Safety Research 38 (2007) 609–612



 Dr. Julie Gilchrist is a Pediatrician and Medical Epidemiologist with the National Center for Injury Prevention and Control at the CDC. She graduated from
 Rice University with degrees in Human Physiology and Sports Medicine before attending U.T. Southwestern Medical School in Dallas, TX. She completed a
 pediatrics residency at the University of Pennsylvania’s Children’s Hospital of Philadelphia and an epidemiology fellowship at CDC. She has been with CDC
 since 1997. In her current work at the CDC’s Injury Center, she is responsible for research and programs in drowning prevention, sports and recreation-related
 injury prevention, and dog bite prevention.


 Michael F. Ballesteros, Ph.D. joined the Centers for Disease Control and Prevention (CDC) in 2001 as an Epidemic Intelligence Service Officer stationed for
 two years in CDC's National Center for Injury Prevention and Control (NCIPC) in the Division of Unintentional Injury Prevention. He is presently an
 epidemiologist and a team lead at NCIPC. Dr. Ballesteros received a Ph.D. in epidemiology from the University of Maryland at Baltimore and is the author of
 over 25 peer-reviewed publications.

								
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