Updated July 2008
Injuries are the leading cause of death and disability for children and adolescents. Approximately 6,000 children die from injuries every year, and more than 90,000 are permanently disabled. One in four children are injured severely enough to necessitate medical attention, miss school, and/or must be on bed rest each year. For every child who dies from an injury, approximately 34 are hospitalized and 1,000 make emergency room visits. The leading causes of death for young people are motor vehicle crashes, fires/burns, drowning, falls and poisoning; injuries are also caused by firearms, bicycle crashes, pedestrian hazards and choking.
Treating childhood injuries is costly. Injuries account for an estimated 15 percent of all medical spending for children between the ages of 1 and 19. Many childhood injuries can be reduced in severity or avoided altogether. For example, bicycle helmets lessen the impact of a collision, fencing around a swimming pool can help prevent drowning, and child-resistant safety caps on medication reduce rates of accidental poisoning. Both federal and state governments have enacted laws covering many aspects of injury prevention.
Violence prevention is another key issue related to injury prevention for children and adolescents. This encompasses the issues of school violence, hazing, bullying, and internet safety.
Click here for NCSL's Youth Violence Webpage
Click here for NCSL's Children and the Internet Webpage
Childhood Injury Prevention at Home:
Carbon Monoxide || Crib Safety || Firearm Safety || Poison Prevention || SIDS || Toy Safety
Childhood Injury Prevention Outdoors:
Amusement Ride Safety || Bicycle Safety || Personal Floatation Device Regulations || Playground Safety || Swimming Pool Safety || Water Safety
Vehicle Safety:
Child Restraints || Safety Belts || Unattended Children
Other Related Topics:
Child Death Review Teams || Emergency Medical Services || Traumatic Brain Injury
Childhood Injury Prevention at Home
The home might not always be the safest place for a child, as many household hazards can lead to injury. States have enacted legislation to make products in the home safe for all ages and prevent accidental injury to children through firearm and poison prevention laws.
These issues include: Carbon Monoxide, Crib Safety, Firearm Safety, Poison Prevention, SIDS, and Toy Safety
Carbon monoxide is a colorless, odorless gas that is very harmful, causing sudden illness or even death. According to the CDC, from 1999-2005 there were on average 439 deaths per year due to carbon monoxide poisoning. In at least thirteen states, it is mandatory for health care providers to report cases of acute carbon monoxide poisoning. At least ten states have laws requiring carbon monoxide detectors in residences. Some laws mandate all residential dwellings have carbon monoxide detectors, while other laws only require specific types of dwellings or only newer buildings to be equipped with these detectors.
Click here for more information on carbon monoxide from the Centers for Disease Control and Prevention
Crib safety is critical in ensuring the safety of infants and young children. At least twelve states have established crib safety laws that prohibit the sale of unsafe cribs. These laws are based on the recommendations of the U.S. Consumer Product Safety Commission (CSPC). Some laws specifically require safety inspections for cribs sold, while other laws are more general and mandate that no unsafe children's products be sold, including cribs.
Click here for a fact sheet on Crib Safety from the U.S. Consumer Product Safety Commission
According to the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, an average of 3 children per day died in non-homicidal firearm incidents from 2000-2005. To protect children from accidents, at least 17 states have child firearm access protection and safe storage laws. These laws require that people refrain from storing loaded firearms where it is likely for minors to gain access. These laws vary from state to state in firearm owner accountability, acceptable storage methods, and vendor notification. Maryland also passed a law in 2003 requiring built in gun locks for all new handguns.
Click here for state-by-state law summaries, headlines, and resources from Common Sense About Kids and Guns
Click here for state firearm laws from the federal Bureau of Alcohol Tobacco, and Firearms
Ninety percent of poisonings happen in the home, and more than half of them involve children under age six. The federal Poison Prevention and Packaging Act applies in all states. This law authorizes the U.S. Consumer Product Safety Commission to require the use of child-resistant packaging for toxic substances used in and around the home (such as aspirin, prescription drugs, and household chemical products like drain cleaners, automobile antifreeze and turpentine).
All 50 states are served by at least one poison control center, which acts as a resource providing trained pharmacists and registered nurses to offer immediate advice about treatment for ingestion of thousands of consumer products. The most common legislative action made by states relates to funding these poison control centers. However there are other poison prevention measures states can take. For example, California's 'Children's Poison Prevention Act' requires any toxic household products without child-safety restraint closures to include a bittering agent that is nontoxic.
Click here for NCSL's Summary of Poison Control Center Laws
Click here for more information from Poison Prevention.Org
A safe sleeping environment is essential to reducing the risk of Sudden Infant Death Syndrome (SIDS) and preventing infant suffocation. SIDS is the leading cause of postneonatal mortality in the United States, accounting for approximately one-third of all infant deaths. Many states have laws related to sudden infant death syndrome. Most commonly, states have laws that provide guidance for coroners or medical examiners and set protocol for autopsies of SIDS victims. Many states also require that a SIDS expert participates in child fatality review committees. In addition, several states have SIDS advisory councils, education programs or counseling programs. Still other states require data collection or research on SIDS.
Click here for NCSL's 50 State Summary of SIDS Laws
Click here for general information about SIDS from the National Sudden Infant Death Resource Center
The federal Child Safety Protection Act, which relates to the banning or labeling of toys that pose a choking hazard to small children, applies in all states. Another measure used by states to keep children safe is toxic toy bans. These bans are to protect children from poisoning. The 2007 and 2008 legislative sessions saw a major increase in introduced bills related to banning toxic chemicals in toys. Some state legislation would ban toys containing lead, cadmium, arsenic, mercury and PVC plastic chemicals.
Click here for NCSL's Environmental Health page
Click here for more information from the U.S. Consumer Product Safety Commission Toy Safety Publications
Childhood Injury Prevention Outdoors
There are various hazards outside that may be regulated to ensure children's safety.
These issues include: Amusement Ride Safety, Bicycle Safety, Personal Floatation Devices, Playground Safety, Swimming Pool Safety, and Water Safety.
According to the U.S. Consumer Product Safety Commission, in 2006 there were approximately 8,789 injuries among children ages 2 to 15 on amusement rides. The CPSC is authorized to oversee and regulate all traveling amusement park rides through a federal mandate. However, the regulation of fixed-site rides is left to each state. Currently at least 8 states have mandates about fixed-site amusement park rides pertaining to inspection, upkeep, rider respect, and/ or owner responsibility. Although not all states have statutory regulations mandating amusement park safety measures, at least 42 states have inspection systems in place to regulate fixed-site amusement rides. These systems are intended to identify unsafe and defective rides prior to incidents of injury.
Please contact NCSL for more information on amusement ride safety (legislators and staff only)
Click here for Directory of State Amusement Park Officials from the U.S. Consumer Product Safety Commission
Bicycle helmets can reduce the risk of a head injury by 85 percent and brain injury by 88 percent. Helmet laws are proven to increase helmet use, thus reducing serious injury and fatality rates. Twenty-one states and the District of Columbia have state-wide bicycle helmet laws. Fifteen additional states have local laws requiring helmet use.
Click here for NCSL's Pedestrian and Bicycle Safety webpage from the Transportation Program
Personal flotation devices, more commonly known as life jackets, are a safety measure to prevent drowning on recreational water vehicles. According to the Department of Homeland Security United States Coast Guard Boating Statistics 2005 report, approximately 90 percent of drowning deaths occurred when individuals were not wearing personal flotation devices. There is a Federal Coast Guard Personal Floatation Device rule that requires all children twelve and under to wear personal flotation devices while aboard recreational vehicles. According to Safe Kids USA in addition to this federal mandate, forty-eight states and the District of Columbia have laws pertaining to enforcement and stipulating exceptions to the use of personal flotation devices for both recreational boats and personal watercraft for children.
Each year in the U.S. over 200,000 children receive emergency room care from injuries sustained on playground equipment. The Consumer Product Safety Commission has standards for playground safety. At least fifteen states have passed legislation regarding playground safety, developed from the CPSC standards.
Click here for a list of playground standards adopted by states from the National Program for Playground Safety
Click here for a report on Injuries and Deaths Associated with Children's Playground Equipment from the U.S. Consumer Product Safety Commission
According to the U.S. Consumer Product Safety Commission, about 260 children under age 5 drown in swimming pools every year, and another 2,725 children suffer pool submersion injuries. To prevent these injuries and deaths, the CPSC recommends layers of protection around pools. At least 12 states have laws related to swimming pool safety. All the laws vary in provisions and enforcement. However, each requires certain public or private pools to take one or more safety measures including certified lifeguards on duty, fences, alarms, safety covers, light fixture requirements, and safe spa and pool drain standards.
Please contact NCSL for more information on swimming pool safety (legislators and staff only)
Click here for information on pool and spa safety from the U.S. Consumer Product Safety Commission
Drowning is the leading cause of death for children under age 5. Water safety is most prominently addressed legislatively through swimming pool regulations and personal flotation device mandates. To address a less recognized drowning hazard for young children, the U.S. Consumer Product Safety Commission recommends placing warning labels written in both English and Spanish on 4 to 6 gallon buckets. The warning labels address the drowning hazard these buckets pose to young children. As a result California, for example, has developed a law requiring these warning labels to be placed on all 4 to 6 gallon buckets sold in the state.
Please contact NCSL for more information on water safety (legislators and staff only)
Vehicle Safety
According to the CDC, the leading cause of death for children age one to nineteen is in motor vehicle crashes. For more information on teen driving and legislative action see the NCSL Transportation Program Teen Drivers webpage. Non-collision vehicle injuries and deaths are common as well. To address these issues, states have developed child restraint laws, safety belt laws and unattended children laws.
These issues include: Child Restraint Laws, Safety Belt Laws, and Unattended Children.
Click here for information on child passenger safety from the Centers for Disease Control and Prevention
Child restraints include car seats and booster seats for older children. According to the CDC, properly used child safety seats can reduce the risk of death in an auto accident by 71 percent for infants and 54 percent for toddlers, and 59 percent for children age four to seven. It is essential that these restraints are used properly. About 72 percent of child restraint seats are improperly used. All states, the District of Columbia, and Puerto Rico have laws mandating child restraint use. However, these laws do vary in specific requirements for age, weight, height, and whether the restraint is front or rear facing.
Click here for NCSL's compilation of state laws on child restraint use
Forty-nine states, the District of Columbia, and Puerto Rico have safety belt laws. Twenty states have primary laws where an individual may be ticketed for not wearing a seat belt; twenty-nine states have secondary laws allowing seat belt citations if the individual is pulled over for another offense. These laws also vary by the age of passengers required to wear safety belts, specification of front or rear seats, and amount of citation fines.
Click here for NCSL's compilation of state laws on safety belt use
Click here for NCSL's Occupant Protection webpage from the Transportation Program
At least four children are killed in a non-traffic automobile accident every week. To address this issue the Cameron Gulbransen Kids and Cars Safety Act of 2007 was established. This federal act requires power window safety, rearward visibility, prevention in vehicle rolling, and upkeep of a database recording non-crash, non-traffic events involving motor vehicles. At least fourteen states have established specific laws to address unattended children left in vehicles. Even in states without unattended children statutes, individuals may be prosecuted in all states for leaving young children unattended in vehicles through child endangerment laws.
Click here for more information on unattended children from Kids and Cars
Other Related Topics
These issues include: Child Death Review Teams, Emergency Medical Services Laws, and Traumatic Brain Injury Laws.
The majority of young children die from preventable injuries. To address this issue, Child Death Review systems have been established within states and communities to examine the situation surrounding each child death. The goal of Child Death Review teams is to identify how these children died, and often also to find preventative measures to avoid future child deaths under similar circumstances.
Click here for state-by-state information from the National MCH Center for Child Death Review
Emergency Medical Service laws are intended to improve access and quality of emergency care services. Forty-seven states, the District of Columbia, Guam, and Puerto Rico have enacted legislation relating to Emergency Medical Services. Although most laws apply to the general public, some states have Emergency Medical Service Laws that apply directly to children. In 1998, Kentucky, for example, established an Emergency Medical Services for Children Program as well as an advisory committee to oversee that program.
Click here for NCSL's Summary of State Laws on Emergency Medical Services for Children webpage
Traumatic brain injury occurs when a sudden trauma causes damage to the brain. Various disabilities may result from a traumatic brain injury. The National Institute of Neurological Disorders and Stroke has information on traumatic brain injury treatment, prognosis, and additional research.
States have a variety of approaches that may be used to address traumatic brain injuries. For example, Tennessee maintains a central registry of those who sustain traumatic brain injury. The purpose of the registry is to collect information to facilitate the development of injury prevention, treatment, and rehabilitation programs. The registry is also intended to give people with traumatic brain injury information on public or private agencies that provide rehabilitation services. Another example is the Massachusetts law that designates October as 'Head Injury Awareness Month' in an effort to shed light on the issue.
Resources:
Children's Safety Network
The Children's Safety Network's State Injury Prevention Profiles webpage contains state-by-state public health department injury prevention information including key contacts, state resources, and injury topics addressed by the department.
Centers for Disease Control and Prevention, Injury Prevention Webpage
The CDC Injury Prevention webpage contains information on a broad range of injury prevention issues with data and statistics, publications, and other useful tools.
U.S. Consumer Protection Safety Commission
The CPSC website provides reports about unsafe products and safety tips on a variety of issues.
Safe Kids USA
The Safe Kids USA website contains a public policy database with state and federal laws and regulations encompassing various children's injury prevention issues.
NOTE: NCSL provides links to other Web sites from time to time for information purposes only. Providing these links does not necessarily indicate NCSL's support or endorsement of the site.
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