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BooBoos Big and Small

by Tom Seman MD FAAP | February 14th, 2014 | Elementary

bandaidChildren of all ages are busy, which at some point will result in injuries. Most often these are just some scrapes and bruises that are a little uncomfortable. However, sometimes they can be more serious. Young children are fearless, do not actually look at the possible dangers associated with certain activities and are not always as coordinated as they should be for the desired activity. Preschool children have heads that are a greater percentage of their body weight than older children and adults. This results in a higher center of gravity and thus children fall more frequently and faster, often hitting their heads, falling on their arms or down stairs or other elevated areas. Preschoolers are very curious and always willing to reach for different items and explore all kinds of spaces. We have all experienced and seen these type of injuries, so why the concern?

Remember that children’s tissues are thinner and more fragile, and that they do not always brace for the fall, making the forces on them greater than on older children experiencing similar actions. They are not as strong or as balanced. Smaller children are more metabolically active, so problems can occur faster and be more severe by the time they are noticed. All of these can cause problems.

Unintentional injuries (accidents) are the leading cause of morbidity and mortality in the United States, where there are 9.2 million Emergency Room visits with 9000 deaths per year due to accidents in children between 0-19 years old. Of these deaths, a quarter of these children are under the age of four years old. So what are the major causes of unintentional injuries and deaths in this age group, the 1-4 year olds?


  1. Drownings account for 22%
  2. Pedestrian 15%
  3. Fires and Burns 14%
  4. Motor Vehicle as Occupant 13% (Motor Vehicle Unspecified 9%)
  5. Suffocation 8%



  1. Falls account for 45%
  2. Struck by or Against 19%
  3. Bites and Stings 9%
  4. Foreign Bodies 6%
  5. Cuts and Punctures/Piercings 4%

Prevention is the best cure! Keep children gated out of pools and other bodies of water; remember to empty buckets and pots of water since children can tip over into them and not be able to push themselves out. Carefully watch where the children are walking to prevent their being struck by bicycles or cars, or tripping and falling off of walls, embankments, stairs, and other obstacles. Make sure that hot objects are placed away from a child and keep track of them, especially in the kitchen where they can pull hot liquids onto themselves. Please keep children away from plastic bags and small chests that can be air tight, causing suffocation.

Of note, younger and older children have similar top five injuries with the difference being that the older child’s major injury and deaths are related to motor vehicles causing the trauma. Both groups, however, are fearless and do not always appreciate the danger in their actions.

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