Understanding Childhood Injuries: [Key Concepts, Background Information]

Childhood injuries are the leading cause of childhood death and disability. Designed for Head Start health managers and other program staff, this learning activity allows for a review of information on topics related to injuries and how they relate to child development. Questions for discussion or individual reflection are included.

Key Concepts
Why Injuries Matter
The Relationship Between Childhood Injuries and Development
Understanding the Causes of Injuries
Specific Factors
     Common Risk Factors for Injury
Questions for Discussion/Reflection


Key Concepts

Injury is the leading cause of childhood death and disability.

  • Injuries result from an unsafe encounter between a child, the cause of the injury, and the environment.

  • Injuries are related to child development:

    • They tend to result from a child's growing, developing, and exploring the environment.

    • A child's risk for injury and the measures needed to prevent injury differ according to the child's age and development.

Background Information

A. Why Injuries Matter

Injuries are one of the most serious health, social, and economic problems across all groups in the United States. Injuries lead to one in four emergency room visits, one in eight hospitalizations, and comprise the second highest lifetime health care expense.

Childhood injuries-from motor vehicle crashes to falls, burns, poisoning, drowning, choking, and violence-are of special concern. Injury is the leading cause of death and disability in children over one year of age, accounting for more than half of childhood deaths. And deaths represent only the "tip of the iceberg." For every fatal injury, it is estimated that there are over 100 non-fatal injuries, many of which result in significant disability and suffering for children and families.

For several decades, the United States has been making great progress in preventing injuries. Safety education and interventions-such as child car seats, seat belts, child-proof medicine containers, safe playground equipment design, bicycle helmets, and swimming pool fencing-have reduced childhood injury rates dramatically. In fact, all major causes of childhood death (both injury and disease) have declined over the past 30 years except one-violence. Homicide of young children has doubled; and homicide and suicide of older children has nearly tripled. The United States Public Health Service and Centers for Disease Control and Prevention have identified violence as a major public health crisis.

B. Terminology

"Accident" vs. "Injury"

Historically, "accident" was used to describe incidents that caused physical harm such as falls, drownings, poisonings, and car crashes. It has come to mean an unpredictable event, bad luck, careless behavior, or an "act of God" that resulted in unintended harm. The common phrase, "accidents will happen..." implied that the incident and any harm done were entirely beyond our control.

However, health experts today say that "injury" is a more appropriate term. Studies show that many factors cause harmful incidents to happen, and many measures can be taken to prevent them.

It is unrealistic to expect to entirely prevent injuries, but Head Start programs and families can take many steps to significantly reduce the risk and impact of childhood injuries. "Injury prevention" measures can reduce the chance that harmful incidents will happen...and effective "injury management" can reduce the severity of the physical and psychological consequences of the injuries.

"Unintentional" vs. "Intentional" or "Inflicted" Injuries

Some experts categorize injuries as being "unintentional" vs. "intentional." "Unintentional" injuries result from an unintended or "accidental" incident such as a child drowning in a flood, choking on a small toy, or getting burned by formula heated in a microwave. "Intentional" injuries are caused by one person inflicting harm on another person, such as one child biting another child or an adult physically abusing a child. Although a harmful act might be intentional, the resulting injury might not actually be intentional. For example, perpetrators of child abuse commonly say, "I didn't mean to hurt her, I only meant to teach her a lesson." For this reason, many experts believe that "intentional" injuries might be better defined as "inflicted" injuries.

C. The Relationship Between Childhood Injuries and Development

Childhood involves growing, developing, exploring the environment, and acquiring new knowledge and skills. Children learn by taking risks and challenging themselves beyond their current capabilities. Meeting new challenges is important and fun for children. Unfortunately, it sometimes results in injury. However, adults can take steps to ensure that children have the chance to explore, face challenges, and have fun in a safe setting.

Children's risks for injury and the safety measures needed differ according to age. By understanding child development, we can recognize common injury risks for children at different ages and developmental stages. Adults must also understand how an individual child's temperament, interests, capabilities, family, and environmental factors can shape the child's risk for injuries and need for particular prevention measures.

Infants and toddlers are at particular risk for injuries because their skills are developing so rapidly. Their motor abilities can change from one day to the next, which can make it challenging for caregivers to anticipate their behavior and make their environment safe. The first time a child tests a new skill might lead to an injury. For example, parents often say that the first time their infant rolled over was off the bed or changing table; the first time their infant crawled, she pulled an electric cord and a lamp crashed down; or the first time their toddler climbed was when they found him standing on the kitchen counter.

D. Understanding the Causes of Injuries

From a scientific perspective, injuries can be understood according to the model of diseases. They result from the interaction of three factors: the child, the cause (or agent), and the environment.

Injuries are caused by an unsafe interaction between the child and the cause of the injury (e.g., the peanut that a child chokes on or a fire that burns the child). The cause of injury comes into contact with the child because of factors in the surrounding physical and social environment (e.g., lack of adult supervision, no fence around a hazard, or bad weather).

The relationship between these three factors is described as the "Injury Triangle:"

A hurt child, his or her environment, and the cause - each on one point of a triangle.

Analyzing the interactions among the child, the cause, and the environment can help to identify the specific factors that lead to an injury. For example: A three-year-old child is playing ball on the sidewalk in the early evening. When his ball bounces into the street, he darts out to retrieve it, is hit by a speeding car with a drunk driver, and sustains a serious head injury. The unsafe factors include:

Specific Factors

  • child

    • focus on playing with the ball

    • limited awareness of traffic

    • limited understanding of hazards and safety rules

    • high physical energy and agility

  • cause (driver and car)

    • drunk driver

    • speeding car

    • poor visibility at night

  • environment

    • no adult supervision

    • no enclosed play area

Understanding the specific factors that cause an injury can help identify the measures needed to prevent the injury. This three-year-old child's injury could be prevented by adult supervision, playing in a fenced area, safety rules, and police enforcement of driving safety laws.

E. Common Risk Factors for Injury

Injuries can happen in any setting. However, certain factors lead to higher risk for childhood injuries:

  • Child:

    • Developmental or physical abilities that are atypical for the child's age: unusual physical ability, developmental delay, sensory deficits (e.g., hearing, vision, touch), movement disorders, seizures, relational difficulties, and extensive care needs.

    • Temperamental characteristics: curiosity, risk-taking, high physical activity level, impulsivity, and distractibility.

  • Causes:

    • Adult equipment or items that should be inaccessible to unsupervised children: motor vehicles, farm equipment, firearms, knives, cigarette lighters and matches, stoves, chemicals, and medicines.

    • Child items that should be inaccessible to younger children: climbing structures, toys, and food.

    • Surfaces that should be inaccessible for children to fall onto or into: pavement, concrete or hard-packed dirt, and water.

  • Environment:

    • Places and facilities: bodies of water, swimming pools, cliffs, playgrounds, kitchens, bathrooms, open windows, garages, and construction sites.

    • Natural disasters: floods, tornados, hurricanes, blizzards, earthquakes, or extreme cold or heat.

    • Activities and times of day: late morning, late afternoon, and evening when children are tired and hungry, during transitions between activities, when the routine is disrupted (e.g., field trips, absent teacher, sick or injured child), and while adults are busy doing other things (e.g., cooking dinner, socializing, attending to another child).

    • Inadequate adult supervision: insufficient adult-child ratio, lack of knowledge of child development and safety, fatigue, alcohol and other drug use, mental illness, history of abuse, or family stress (e.g., problems with relationships, finances, employment, health, remarriage, birth of a sibling, incarceration).

Questions for Discussion/Reflection

The relationship between childhood injuries and child development is very complex. Developmental challenges and changing capabilities can lead to particular childhood injuries (e.g., infant grasping and mouthing behavior can lead to choking on small objects). In turn, an injury can affect a child's development (e.g., a near-drowning experience could instill a fear of swimming). Children learn attitudes about safety from the adults in their lives (e.g., when adults protect children, the children learn to protect themselves; when adults do not adequately protect children, the children might learn to place themselves at risk for injuries). Children can also learn from an injury (e.g., a child whom a dog bites on the face might learn not to put his face near unfamiliar dogs).

From your own experience with children, can you think of examples in which:

  • a child's developmental stage might have led to an injury?

  • a child's injury might have affected the child's development?

  • a child learned unsafe attitudes and practices from an adult?

  • a child learned safer practices after getting injured?

"Understanding Childhood Injuries: [Key Concepts, Background Information]." Safety First: Preventing & Managing Childhood Injuries. Training Guides for the Head Start Learning Community. HHS/ACF/OHS/NCH. 2000. English.

Last Reviewed: May 2009

Last Updated: February 24, 2015