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Flooring, beds and football top list of products/activities that cause traumatic brain injuries in children

Among 10- to 14-year-olds, the first five causes of traumatic brain injuries involved sports or recreational activities.
Photo by Ben Hershey on Unsplash
Among 10- to 14-year-olds, the first five causes of traumatic brain injuries involved sports or recreational activities.

Almost three-quarters of the nonfatal traumatic head injuries (TBIs) that send children and teens in the United States to hospital emergency rooms each year are linked in some way with everyday consumer products, especially beds and flooring, or to sports and recreational activities, especially football and bicycling, according to a study published this week in the journal Brain Injury.

“In most cases, infants and children are safe in bed and when playing sports outside, but our study highlights some of the risks and the priorities in different age groups for preventing serious head injuries,” says Bina Ali, the study’s lead author and a research scientist at the Pacific Institute for Research and Evaluation, in a released statement.

Traumatic brain injury, or TBI, occurs when a sudden bump, blow, jolt or penetrating wound to the head damages the brain. About 2.8 million Americans experience a TBI each year, including 812,000 children aged 17 or younger, according to government estimates.


Traumatic brain injuries are a leading cause of disability in the United States. Children who survive a TBI can have subsequent neurological problems that affect their memory and thinking skills and that increase their risk for developing behavioral problems.

TBIs are also a leading cause of deaths in the United States. Each year, the injuries contribute to the deaths of 56,800 Americans, including more than 2,500 children.

The greatest risk

Most nonfatal TBIs in children are the result of falls, motor vehicle crashes, being struck by a moving or stationery object, and assault. The current study was undertaken to see which of the thousands of products regulated by the U.S. Consumer Product Safety Commission (CPSC) are most likely to be involved in these injuries at different ages during childhood. CPSC-regulated items include sports and recreational equipment, such as football helmets and bicycles, but not cars and firearms, which are regulated by other government agencies.

The researchers used CPSC data collected from a large representative sample of hospital emergency departments across the country from 2010 through 2013. Based on that data, they estimated that 4.1 million children and teens were at emergency departments for non-fatal TBIs during those four years.

CPSC-regulated products were associated with 72 percent of the hospital visits. More than a quarter of the injuries — 28.1 percent — were linked to equipment used in sports and recreational activities, 17.2 percent to home furnishings (such as beds), and 17.1 percent to home structures and building materials (such as stairs and flooring). Much smaller percentages of the injuries were tied to child nursery equipment (such as baby strollers, high chairs and baby changing tables) (2.7 percent) and toys (2.4 percent), as well as various other products.

Leading causes by age

The top 10 leading products and activities contributing to the TBIs were the following:

  • floors
  • beds
  • football
  • stairs
  • bicycles
  • basketball
  • ceilings and walls
  • chairs
  • soccer
  • tables

Among infants under a year old, the leading cause of TBIs was a fall from a bed (25.4 percent of all the injuries), followed by falls on slippery or uneven flooring (14 percent) and from sofas (7.4 percent) and stairs (6.2 percent).

Car seats were fifth on the list (4.6 percent). “When car seats are used outside of the car as baby carriers and are handled inappropriately, they can pose a risk of TBI,” Ali and her co-authors explain in the study. “For example, if a car seat is placed on a high surface, such as a table or countertop, there is a risk of the car seat falling off the surface and injuring the infant.”

Among toddlers aged 1 to 4 years, stairs accounted for 9.9 percent of the injuries, followed by flooring and beds at 9.7 percent each. Bunk beds were particularly dangerous for this age group, the study found.


At older ages, the causes of TBIs were more likely to be found outside the home. Among 5- to 9-year-olds, flooring led the list (6.1 percent), but bicycles were next (5.2 percent). And among 10- to 14-year-olds, flooring dropped to sixth on the list. The first five causes of TBIs in this age group involved sports or recreational activities: football (13.7 percent), basketball (6.4 percent), bicycles (5.4 percent), soccer (4.8 percent) and baseball/softball (4.4 percent).

Football was also the leading cause of TBIs among 15- to 19-year-olds, followed by basketball (4.8 percent), soccer (3.8 percent) and bicycles (3.0 percent).

The list for older teens — 15- to 19-year-olds — was also dominated by sports and recreational activities, with football (8.8 percent) and basketball (4.8 percent) once again at the top.

Limitations and implications

The study is based on national estimates and includes only TBIs treated at hospital emergency departments. It does not include head injuries treated at urgent care clinics, doctors’ offices or school health clinics.

Nor does it identify the severity of the injuries associated with different products and activities.


Still, the findings should help policymakers develop priorities for TBI prevention programs, the study’s authors write.

The findings can also help parents take actions to reduce hazards in their home. “Simple measures such as removing trip hazards, using stair gates and guard rails, avoiding hard surface playgrounds and wearing helmets could help reduce the risk of injury,” says Ali.

Although, as other research has shown, football and other sports-related helmets offer protection against severe skull fractures, but they cannot prevent concussions.

FMI: The study can be found at Brain Injury’s website. For tips, including a video, on how to protect children and teenagers from brain injuries, go to the Centers for Disease Control and Prevention’s website.

Comments (5)

  1. Submitted by Ray Schoch on 07/31/2019 - 10:08 am.

    This makes the American enthusiasm for contact sports, especially football, among children all the more puzzling, given the usual expressions of concern for the physical welfare of children typically heard in other, non-sport, contexts.

  2. Submitted by Mark Kulda on 07/31/2019 - 01:20 pm.

    A 1-4 year old in a bunk bed??? What kind of parent thinks that’s okay?

  3. Submitted by Paul Yochim on 08/01/2019 - 07:38 am.

    Hockey?

  4. Submitted by Paul Udstrand on 08/01/2019 - 09:12 am.

    This isn’t a peer reviewed study, and the numbers are kind of funky.

    They run a lot of rate per 100k calculations that are just more confusing than they’re worth, and the numbers themselves are goofy. For instance if you look the “self harm” category you see that only one age group, 15-19 has any reports, and it’s 3. Yet when you look at the total they have 1 per 100k? How to do get from a total of 3 down to 1? It’s possible that the “3” is a product of calculating the rate among that discrete age group (15-19) and the “1” is a product of all of the age groups combined… but they don’t say that, the title indicates the age range as <1-19.

    The total numbers make no sense at all. They claim there are 700k TBI's per year, but that adds up to less than 3 million, and they go on to claim there are over 4 million TBI's. It's impossible to figure out what their sample size is because they don't tell us, and it's way way way smaller than the numbers they claim to be working with. For instance they sample 500k emergency room/department visits per year, but that's a total number of ER/ED visit, what percentage of those are TBI's?

    A quick search reveals that there are 145 million ER visits per year. We'll say 800k of those fall within our age range of TBI, so that works out to: .55% of all ER visits. In a sample of 500k that yields a sample be 2,750 TBI's per year, which works out to a "n" (number) of 11,000. These guys are giving us "n"s of 1 million to 4 million. Obviously their extrapolating but you don't do that in your analysis, you do that in your conclusion. The analysis has to stick to the actual data set and sample. You have to tell us what your actual sample size is, they pretend they've sampled the whole country as if they're sample size was in the millions. You run an analysis on extrapolated numbers, you analyze your sample.

    None of this means that this study is garbage, but it's not a clear analysis and the perspective is blurred. For instance instance according the CDC there were 23k TBI hospitalizations among children in 2014. If 3% (according to this study) of those were bicycle related that works out to 690, and that works out to to 30 per 100,000 in 2014. See, wasn't that simple?

    • Submitted by Paul Udstrand on 08/02/2019 - 08:14 am.

      “How to do get from a total of 3 down to 1? ”

      I was just giving this a quick a scan when I wrote my comment yesterday, turns out upon closer inspection these authors get their 3 per 100k down to 1 per 100k by averaging the number over the 3 years. The problem is the column on their table is described as “Totals” not a averages. The problem is again, we don’t know if there really was one instance of self harm per year. That’s important because if there wasn’t, let say there was one year with all 3 instances, then THAT year might be an outlier rather than the “norm” averaging implies.

      Look:, the whole point of tables and graphs in research is present information in a clear and digestible fashion, this table is a disaster, and the rest of the tables aren’t much better because they imply that millions of records were examined when in fact it could only have bee a few thousand.

      While the over-all conclusion of this study may be more or less reliable, the scale and perspective is distorted and obscured by the presentation and the funky numbers. One advantage to peer review is that reviewers act as editors, they don’t just check the work and methodology. A peer reviewer might have sent this back for revisions saying: “You gotta clean up these tables, and you can’t pretend you examined millions of cases when your sample was only ten thousand or so.” It doesn’t change the results necessarily but it makes the research more comprehensible.

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