Still falling: a community-wide infant walker injury prevention initiative
Introduction
Although the dangers associated with use of infant walkers have been recognized since 1982 [1], [2], their use remains widespread [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17]. Consumers purchase about 1.2 million new infant walkers at a cost of about US$ 40 million each year (data courtesy National SAFEKIDS Campaign). Parental decision making regarding the use of infant walkers is not clearly understood [18]. Parents may acquire infant walkers with the belief that their use accelerates development of independent walking skills, although there is evidence to the contrary [19]. Imparting both mobility and speed to a normally non-ambulatory infant, walker use has been associated with falls down stairs, tip overs, collisions with objects, burns, and poisonings [11], [12], [14], [16], [17]. In the US, walker use is among the most common mechanisms of injury for children under 18 months old [7], [14], leading to thousands of emergency department visits each year [20]. Although most walker-related injuries are relatively minor, fractures and serious head injuries are not uncommon [1], [7], [12], [15], [16]; the deaths of at least two American children per year are attributed to the use of infant walkers [11].
Because of the associated risk of injury, efforts have been made to discourage infant walker use. The American Medical Association has recommended that physicians counsel parents regarding this risk [21]. The American Academy of Pediatrics has recommended a ban on the sale of infant walkers in the US, along with educational efforts and community programs to dispose of existing walkers [11].
Pediatricians from the Rochester, NY community were among the first to call attention to the hazards of infant walkers nearly two decades ago [1]. However, the numbers of children requiring evaluation in Rochester’s pediatric emergency departments (PedEDs) because of infant walker-related falls down stairs has remained high. This paper describes a community-wide educational intervention designed to reduce the number of infant walker-related injuries by increasing public and health care provider awareness of the hazards of infant walkers and an evaluation of its effect on the numbers of children presenting to the PedEDs because of walker-related falls down stairs.
Section snippets
Methods
A coalition of Rochester area health care providers (“Too Many Tumbling Tots Coalition”) was formed to address the continuing problem of injuries related to the use of mobile infant walkers. The goal of the coalition was to reduce the number of infant walker-related injuries in Monroe County (Rochester, NY). Methods for achieving this goal included public and health care provider education regarding the dangers of infant walker use, reducing the number of walkers in use, and encouraging parents
Results
During the 30 months prior to the intervention, 132 children (52.8 annually) were evaluated in the PedEDs for falls down stairs while in an infant walker (see Table 1). During the 12 months following the intervention, 38 children were evaluated for infant walker-related falls, a 28% mean annual reduction (P<0.001). Although the large majority (90%) of these 160 children were treated and released from the PedEDs, two children sustained traumatic brain injuries requiring intensive care unit
Discussion
Despite the well-known risk of injury from the use of infant walkers, walker use remains popular and associated injuries are common, occurring in 12–40% of users [2], [7], [11], [24]. In one of the earliest such studies, Kavanagh and Banco reported in 1982 that 31% of the Rochester, NY-area children they studied who used walkers had suffered walker-associated injuries [1]. Despite the compelling message of these local data and national anti-walker efforts [11], [21], infant walker-associated
Conclusions
Following a well-publicized community-wide multifaceted educational intervention to promote parent and physician awareness of the dangers of infant walkers, PedED visits for walker-related falls down stairs declined by 28%. In light of a concurrent decline in walker-related injuries nationally, we are unable to determine the magnitude of this decline solely attributable to the intervention. Even if entirely attributable to the intervention, the magnitude of this reduction, which is consistent
Acknowledgements
This project was supported in part by grants from the Kessler Foundation and the Children’s Hospital at Strong. It was presented in part at the American Academy of Pediatrics Annual Meeting, San Francisco, CA, 16–21 October 1998; it was also presented in part at the “Health Policy and Health Services Research: Nursing’s Essential Contribution” conference of the American Academy of Nursing and Columbia University, New York, NY, 12–14 May 1999. Thanks to Regina Graziani for her administrative
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