Highchair Accidents
ABSTRACT & COMMENTARY
Synopsis: Serious injuries associated with highchair use may occur and in the past they accounted for as many as 1-2% of young children seen at emergency departments because of trauma. Preinstalled child restraints, better manuals for users, and increased highchair stability are possible accident prevention strategies.
Source: Mayr JM, et al. Highchair accidents. Acta Paediatr 1999;88:319-322.
Mayr and associates from the department of Pediatric Surgery at the University of Graz in Austria retrospectively reviewed 103 children seen in their accident and emergency department (ED) over a five-year period for highchair-related injuries. There were a number of serious injuries: 15.5% had skull fractures, 13.6% had brain concussions, 2.0% had limb fractures, and 68.9% had a simple head contusion or lacerations of the face or scalp. Questionnaires were sent to the families asking about the kind of injury, the type of highchair used, whether restraints were being used, the age when the highchair was used and the age that the child walked, and any sequelae of the accident. The questionnaire was completed by 63 families. The mean age of the children at the time of injury was 13 months (range, 7-30 months). A parallel survey concerning highchair use and accidents was conducted in 163 families of children with non-highchair-related injuries.
In the parallel survey it was found that 90% of girls and 94% of boys had used highchairs. The average age of first use of highchairs was 8 months (range, 5-12 months). Highchair use was continued to an average of 24 months (range, 12-48 months). Of the families who had used highchairs, 18% had equipped their chairs with child restraints, usually restraints that were taken from strollers and attached to the highchairs to prevent the child from standing up. An additional 7.3% of families reported fixing the highchair to a table to prevent tipping.
The families of children who had sustained highchair-associated injuries reported that 50.8% of the injured children had tried to stand up in the chair shortly before the injury. About 25% of the children fell forward, half to the side, and 20% backward over the backrest. Only two families of injured children (3.2%) had highchairs equipped with child restraints of any sort. Nine children (14.3% with a mean age of 16 months; range, 9-30 months) were injured when their highchair tipped over.
Highchairs are widely used and highchair injuries mainly cause head injuries. Highchairs should be prequipped by the manufacturer with effective infant restraints such as adjustable safety belts in combination with a crotch strap and a proper locking mechanism, which are readily adjustable and easy to clean.
Comment by David T. Bachman, MD, FAAP
Use of highchairs is nearly universal in the United States and Europe because they facilitate the feeding of an infant and also permit the child to join the family and socialize during meals (although I admit we usually fed our infants before the family dinner to reduce noise and chaos!). However, this is not without a potential risk. In 1989, highchairs accounted for 3700 reported accidents and 1.1% of all injuries in children from 0-5 years of age in the United States. Most of these injuries involved the head and included skull fractures and cerebral concussions. The study of Mayr et al is from Austria, where there is apparently no governmental standard for highchair safety. They found a sizable number of infants and young children who had sustained significant injuries from falls from their highchairs. The bottom line is clear: highchairs should be designed to be tip-proof, and effective child restraint belts should be installed by the manufacturer.
Unfortunately, we still see highchair-related injuries in our EDs in the United States. These accidents are almost always a result of not using the child restraints or involve somewhat older, more active children who learn to manipulate the child restraint mechanisms and who are left unattended in their highchairs. This is just one more feature of anticipatory guidance in accident prevention that should be included by pediatricians in their discussions with parents of infants.
Highchair-related injuries:
a. most frequently result in fractures of the long bones.
b. can be reduced by proper child restraints.
c. are rarely serious.
d. are due to tipping of the chair in most instances.
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