Children and Injuries
Joe L. Frost, Ed.D.

Detailed Table of Contents

Acknowledgements and Dedication
Introduction

Chapter 1: Child Development and Injuries
Joe L. Frost, Ed.D.
1.1 Introduction
1.2 Infants and Toddlers
1.3 Preschoolers
A. General development
B. Movement and motor development
1.4 School-Age Children
A. General development
B. Movement and motor development
C. Children with disabilities
1.5 Adolescence
1.6 The Roles of Adults in Children's Safety
A. Overview
B. Example cases
1.7 Conclusion
References

Chapter 2: History, Nature and Scope of Child Injuries
James A Therrell, B.A., M.S.
2.1 History
2.2 Active Agencies
2.3 Nature and Scope of Injuries
2.4 Hidden Trends and Gaps
2.5 Summary
References

Chapter 3: Medical and Biomechanical Aspects of Childhood Injuries
Raymond M. Fish, Ph.D., M.D., F.A.C.E.P.
Introduction
Part I: Injury by Body Region
3.1 Head Injury
A. Importance
B. Sequelae
C. Predicting severity of sequelae
D. Mild traumatic brain injury
E. Biomechanics of traumatic brain injury 
1. Immediate effects of trauma: primary brain injury
2. Secondary brain injury
3. Clinical recognition of traumatic brain injury
4. Intracranial edema, hemorrhage and pressure
a. Mechanism of brain swelling following trauma
b. Time course of brain swelling
c. Effects of respiration on intracranial pressure
5. Epidural hematoma
6. Subdural hematoma
3.2 Spinal Injury
A. Incidence
B. Structural versus neurological injury
C. Biomechanics of spinal injury
D. Emergency diagnosis and treatment of spinal cord injury immobilization
3.3 Airway Obstruction
A. Biomechanics of airway obstruction
1. Traumatic and nontraumatic airway obstruction
2. Mechanical trauma to the airway
3. Mechanical forces causing asphyxia
4. Foreign body ingestion
5. Decreased respiratory drive
6. Thermal trauma to the airway
7. Drowning
B. Prognosis following cardiac arrest due to respiratory arrest
3.4 Chest Injury
A. Chest trauma
1. Injury biomechanics
2. Types of chest injuries
B. Bleeding and hypovolemic shock
C. Vascular injuries
3.5 The Skin: Burns
A. Sources of burns
B. Degrees of burns
C. Electrical cord injuries 
3.6 Abdominal Injury
A. Some injuries that are more common in children
B. Splenic injuries
C. Survey of pediatric gastrointestinal injuries
3.7 Extremities: Fractures and reflex sympathetic dystrophy 
A. Fractures that are unique to children
B. Specific Fractures
1. Clavicle
2. Humerus
a. Proximal and distal physeal fractures
b. Supracondylar fractures of the humerus
3. Hip fractures
4. Femoral shaft fractures
5. Dislocations and subluxations
6. Traumatic hip dislocation
C. Reflex sympathetic dystrophy and causalgia
1. Criteria for diagnosing reflex sympathetic dystrophy
2. Types of nerves affected in reflex sympathetic dystrophy
3. Skin lesions in RSD
4. Delayed onset of reflex sympathetic dystrophy
5. Reflex sympathetic dystrophy following an electrical injury
6. Causalgia due to electrical current
7. Definitions of some signs and symptoms found in RSD and causalgia (adapted from Stedman's Medical Dictionary, 1996)
8. Abnormal response to cold in RSD
9. Edema (swelling) caused by electrical injury and RSD
10. Nerve entrapment: a sometimes late complication of RSD
11. Complex regional pain syndrome: a new name for RSD
Part II: Injury by Type of Trauma
3.8 Child Abuse
A. Categories of child maltreatment
B. Recent history of the awareness of child abuse
C. Some specific injuries
1. Traumatic brain injury
2. Bruises
3. Fracture of the humerus
D. Distinguishing abuse from accidents
E. Sudden infant death syndrome (SIDS) 
1. Intentional smothering
2. Accidental smothering
F. Determining if child abuse led to a death
3.9 Drug Abuse
A. Marijuana
B. Alcohol and other drugs in serious or fatal motor vehicle crashes
3.10 Electrical Injury
A. Increased susceptibility to electrical injury of children
B. Electric fences
1. Fence controllers with continuous AC output
2. Respiratory arrest and death from continuous AC fence current
3.11 Firearm-Related Injuries
A. Firearm injuries and statistics
B. Nonpowder firearm injuries
3.12 Microwave Injury
A. Nerve injury from microwave radiation
B. Steam burns
C. Burns due to microwave energy
1. Water content influences heating
2. Nonuniform heating 
3. Comparison of microwave and other types of burns
4. Histology
D. Case reports of children put in microwave ovens
3.13 Sports
A. Commotio cordis, a concussion of the heart
B. Ice hockey
C. Baseball
D. Trampoline injuries
3.14 Toys
A. Strangulation
B. Firecrackers and related devices
C. Baby walkers
D. Mechanisms of injury for various toys
References for Part I (Injury by Body Region)
References for Part II (Injury by Type of Trauma)
Appendix

Chapter 4: Standards, Regulations and Safety Guidelines
to Protect Children from Injury
William F. Kitzes, J.D., C.P.S.M.
4.1 Introduction
4.2 The Beginning of Regulations
A. The Consumer Product Safety Act
B. The National Electronic Injury Surveillance System
4.3 Section 15--Substantial Product Hazards
4.4 Elements of a Recall
A. Section 37 reports
1. Cribs
2. Small parts
3. Baby walkers
4. Drapery cords
5. Cigarette and multipurpose lighters
6. All-terrain vehicles (ATVs)
7. Lawn darts
8. Drawstrings on children's clothing
B. Injuries caused by products not intended for use by children
C. The Flammable Fabrics Act, 15 USC ÛÛ1191 et seq.
D. The Poisoning Prevention Packaging Act
4.5 Recalls of Children's Products
A. Baby carrier
B. Batting tee
4.6 Regulations, Standards and Product Liability Litigation
A. Baby rattle
B. Bunk beds
C. Child seating systems
Endnotes

Chapter 5: Children and Injuries in the Home
Deborah Tinsworth, B.S., M.S.
5.1 Analysis of Injuries and Recommendations for Injury Prevention
A. Nursery or bedroom
1. Cribs
2. Soft bedding 
3. Bunk beds
4. Adult beds
5. Clothing strings
B. Kitchen
1. Highchairs
2. Buckets
3. Ranges and ovens
C. Bathroom
1. Tap water scalds
2. Bath seats
3. Poisoning
D. Living areas
1. Fires
2. Window cords
3. Toys
4. Baby gates 
5. Baby walkers
6. Play yards
7. Strollers
E. Garage
5.2 Evaluating the Safety of Consumer Products
Endnote

Chapter 6: Childhood and Classroom Injuries
Lynn Marotz, Ph.D., R.N.
6.1 Introduction
A. Scope
B. Setting agency
C. Mitigating factors and effort
6.2 Child Care Licensing Regulations
A. State primacy
B. Application, inspection, exemptions and turnover
6.3 Risk Associations and Management
A. Injury associations
B. Recognition of risks
C. Role
6.4 Physical, Social, Cognitive and Other Factors as Contributing Elements
A. Children's physical development
B. Children's social and cognitive development 
C. Other factors
1. Adult supervision
2. Adult-to-child ratio
6.5 Building and Classroom Settings
A. Site factors
B. Building and classroom factors
C. Other rooms and features
D. Furnishings and play equipment
E. Poisonous substances
6.6 Risk Management: Principles and Practices
A. Prevention strategies and evaluation
B. Four principles of safety management
C. Teacher observations and children's health
D. Staff training
E. Policy and procedures
6.7 Early Education Teachers and Liability
A. Failure of duty to supervise
1. Standard of care
2. Foreseeable harm
B. Failure of duty to maintain a safe environment
6.8 Concluding Remarks
References

Chapter 7: Injuries in Organized Sports for Children and Adolescents
Robert M. Malina, Ph.D.
7.1 Introduction
7.2 Organized Youth Sports in the United States 
7.3 Universal Tasks of Childhood and Adolescence
7.4 Benefits and Risks Associated with Participation in Organized Sports
A. Potential benefits
1. Growth and maturation
2. Regular physical activity
3. Motor skill and physical fitness
4. Self-concept and self-worth 
5. Social competence
6. Moral and ethical competence 
7. Other potential benefits 
B. Potential risks
1. Growth and maturation
2. Psychological stress
3. Risk of injury
7.6 Injuries in Youth Sports
A. General surveys
B. Sport-specific studies
1. Multiple sports
2. Baseball
3. American football
4. Soccer 
5. Ice hockey
7.7 Sudden Deaths in Young Athletes
7.8 Risk Factors for Injury
A. Risk factors related to the athlete
B. Risk factors related to the sports environment
7.9 Overview and Recommendations
References
Tables

Chapter 8: Children and Playground Injuries
Donna Thompson, Ph.D. and Susan Hudson, Ph.D.
8.1 Introduction
A. Defining the issues
B. Defining the organizations
8. 2 Overview of Playground Injuries
A. Scope of the problem
1. Who is being injured? 
2. What injuries are children sustaining?
3. On what type of equipment are children injured?
4. Where are children being injured?
5. When are children being injured?
B. Effect on various environments
1. Legal system
2. Political system
3. Social implications
4. Economics
8.3 Contributing Factors to Injuries
A. Supervision
1. What are the guidelines and standards for supervision? 
a. Consumer Product Safety Commission
b. National Association for the Education of Young Children
c. State regulations
d. National Program for Playground Safety
2. What are the key concepts?
a. Ages of children
b. Indoor and outdoor settings
c. Ratio
d. Training
e. Policy
3. What is the nature of incidents?
a. Example #1: Supervision at a public school
b. Example #2: Supervision at home
B. Age-appropriate design
1. What are the guidelines and standards for age-appropriate design?
a. Handbook for Public Playground Safety
b. ASTM F1487-98 Standard Consumer Safety Performance Specification for Playground Equipment for Public Use
c. National Program for Playground Safety
2. What are the key concepts?
a. Ages of children
b. Characteristics of children
c. Risk confused with challenge
d. Mauffette applications
e. Benefits of using playground equipment
f. Movement integration with playground equipment
3. What is the nature of incidents?
a. Example #1: Age-appropriate design of public playground equipment
b. Example #2: Age-appropriate design of home playground equipment
C. Falls to surfaces
1. What are the guidelines and standards?
a. Consumer Product Safety Commission
b. ASTM 1487-98 Standard Consumer Safety Performance Specification for Playground Equipment for Public Use
c. ASTM 1292-98 Standard Specification for Impact Attenuation of Surface Systems Under and Around Playground Systems
d. National Program for Playground Safety
e. National Playground Safety Institute
2. What are the key concepts?
a. Suitable surfacing
b. Height
c. Depth
d. Use zone
3. What is the nature of incidents?
a. Example #1: Incident at a public playground regarding surfacing
b. Example #2: Incident at a home playground regarding surfacing
D. Equipment and surfacing maintenance
1. What are the guidelines and standards?
a. Handbook for Public Playground Safety
b. ASTM F 1487-98 Standard Consumer Safety Performance Specification for Playground Equipment for Public Use
c. National Program for Playground Safety
d. National Playground Safety Institute
2. What are the key concepts?
a. Age of equipment
b. Frequency of use
c. Importance of following manufacturer's instructions
d. Importance of creating a maintenance policy
3. What is the nature of incidents?
a. Example #1: Public playground equipment and surfacing maintenance
b. Example #2: Home playground setting regarding equipment maintenance
8.4 Prevention Techniques
A. Policy
1. Supervision
a. Who
b. What
c. When
d. Where
e. How
2. Age-appropriate design
a. Selection
b. Criteria
c. Maintaining age-appropriate areas
3. Fall surfacing
4. Equipment maintenance
B. Implementation of policy
1. Who is responsible?
2. Consequences of not developing policies
a. Legal consequences
b. Political consequences
c. Social consequences
d. Economic consequences
8.5 Conclusion
References
Figures
Tables
Appendix A: America's Playgrounds Safety Report Card
Appendix B: Playground Safety Recommended Resources

Chapter 9: Cause and Prevention of Playground Injuries and
Litigation: Case Studies
Joe L. Frost, Ed.D. and Theodora B. Sweeney, B.S., M.A.
9.1 States
9.2 Nature of Injuries
9.3 Cause of Injuries and Fatalities
9.4 Equipment Involved in Injuries
9.5 Location of Injuries
9.6 Ages and Sex of Children
9.7 CPSC/ASTM Violations
9.8 Disposition of Litigation
9.9 Conclusions
9.10 Recommendations
References

Chapter 10: Children and Water Injuries
Annie Clement, J.D., Ph.D.
10.1 Introduction
10.2 Results of Court Decisions
A. Birth to two years of age
B. Three-year-olds
C. Four-year-olds
D. Five-year-olds
E. Six-year-olds
F. Seven-year-olds
G. Eight-year-olds
H. Nine-year-olds
I. Ten-year-olds
J. Eleven-year-olds
K. Twelve-year-olds
L. Thirteen-year-olds
M. Fourteen-year-olds
N. Fifteen-year-olds
O. Summary of the results of court decisions
10.3 Evaluating Safety in Pools, Streams, Lakes, and Ponds
10.4 Preventing Child Water Incidents
10.5 Safety Standards, Regulations, Codes, and Guidelines
A. Effect of regulations, codes, and guidelines
B. State codes and regulations
C. Guidelines
10.6 Preparing and Conducting Litigation in Water Incidents
10.7 Identification and Use of Experts in Water Incidents
References

Chapter 11: Hazardous Playthings Causing Injury to Children
James A. Swartz, Esq.
11.1 Children: the Ultimate "Captive Consumers"
11.2 Defining a Child's Plaything
11.3 Illustrative Cases
A. The case of the toy figurine
B. The case of the "magic wand"
11.4 Safety First
11.5 Myth versus Fact
11.6 Checklist: Investigation of Injuries Related to a Child's Plaything
11.7 Injuries Caused by Defective Playthings
11.8 Must Accidents Happen?
11.9 Common Ingredients and Solutions for Injuries Stemming from Defective Playthings
Endnotes

Chapter 12: Children and Traffic Injuries
Raymond M. Fish, Ph.D., M.D., F.A.C.E.P. 
and Jerry Eubanks, A.C.T.A.R.
12.1 Motor Vehicle Injury
A. Infant and convertible child safety seats for young children
B. Seating position
C. Lap belt injuries
D. Airbag injuries
1. Reasons children are at risk
2. Airbag module covers
12.2 Children as Pedestrians
A. Overview
B. Pedestrian versus motor vehicle accidents
12.3 Motorized Recreational Vehicles
A. Minibikes, minicycles, trailbikes, and trailcycles
B. Snowmobiles
C. Personal watercraft
12.4 Bicycle Injuries
A. Reasons for injuries
B. Bicycle struck by motor vehicle
C. Handlebar injury
D. Cervical spine injury and helmet use (for bicycle and motorcycle riding)
References

Chapter 13: Children and Injuries in Public Places
Barry L. Richard, C.S.P.
13.1 Introduction
A. Injuries in public places
B. Common factors in child injuries in public places
1. Lack of adult supervision
2. Improper design of equipment and facilities
3. Improper operation
4. Improper maintenance
13.2 Amusement Parks and Carnivals
A. NEISS-reported injury summary
1. Developmental factors
2. Coasters
a. Physical size
b. Failure to observe safety rules
c. Medical conditions
3. Auto cars and bumper cars
4. Spinning rides
5. Water rides
6. Bouncing and climbing attractions
B. What people can do to reduce the chance of injury
13.3 Water Parks
A. Slides
1. Stairs and ladders
2. Slides
3. Riding tubes
B. Exiting the slide
C. Water park summary
13.4 Go-Cart Tracks 
A. Overview
B. Hazards and issues
1. Clothing 
2. Hair
3. Seat belts
4. Shoulder restraints 
5. Roll bars
6. Seats
7. General mechanical condition
8. Track condition
9. Speed
10. Track rules
13.5 Malls, Shopping Centers and Grocery Stores
A. Escalators
B. Elevators
13.6 Risk and Risk Management in Public Places
13.7 Litigation Issues
A. Supervision
B. Design issues
C. Operational issues
D. Maintenance issues
E. Environmental issues
13.8 Summary
Endnotes

Chapter 14: Evaluating Child Loss in Child Injuries and Fatalities:
Roles of a Economic Expert
Thomas R. Ireland, Ph.D. and John O. Ward, Ph.D.
14.1 Introduction
14.2 Damages Standards in a Typical Personal Injury to a Child
A. The basic structure of a personal injury damages analysis for a child
1. Elements of a personal injury analysis for a child
2. Development of an earnings loss basis for a child 
3. Use of a net discount rate method with statistical worklife tables
4. Alternative methods for dealing with wage increases and discount rates
5. Methods for dealing with periods of capacity for damages
B. Educational scenarios for a child's earnings loss
1. Preinjury assessment
2. Choosing reasonable preinjury scenarios
3. Postinjury assessment 
4. Composite scenarios
5. Career track and "mommy track" scenarios for female children 
6. The final steps in a lost earnings calculation
14.3 Damages Standards for the Wrongful Death of a Child
A. The fundamental damages problem in the death of a minor child 
1. Losses in conventional wrongful death actions
2. Losses in pure survival actions states
3. Losses in personal maintenance states
B. The lost accumulations-to-an-estate approach
C. The parental investment approach
14.4 Remaining Issues
A. Parental loss of consortium in a personal injury--the Gallimore case
B. Wrongful pregnancy or wrongful birth
14.5 Jack Ward's Sample Letter to a Client for a Wrongful Death Case 
Endnotes
References
Tables

Chapter 15: Preparing and Conducting Litigation in Child Injury Cases
Jimmy Simien, Esq.
15.1 Unique Proof Issues in Child Injury Cases
A. Lack of reliable witnesses, the inherent problems with other children as witnesses to a traumatic event
B. The role of the parent
15.2 Special Types of Proofs in Child Injury Cases
A. Child developmental experts, on fault of the child and supervision of the parent
B. Staging and preserving the accident for re-creation
15.3 Gathering and Preserving the Evidence
A. Gathering existing records and proof of injury
B. Tapes of radio communications
C. Gathering of early records
D. Gathering early adverse party statements
E. Gathering early witness accounts
F. Other accidents and their relevance
15.4 The Discovery Process During Litigation
A. General types of discovery
B. Expert witness discovery
C. Automatic mandatory disclosures
15.5 Types of Experts to Consider in Serious Injury Cases and the Use of Demonstrative Evidence
15.6 Use of Expert in Proof of Pecuniary Damages
A. The role of the economist
B. The role of the vocational rehabilitation expert
C. The loss of income to the family
D. The life care plan and expert (the need for medical review)
E. Future psychological cost related to the family and the stressors associated with the injury
15.7 Proving Nonpecuniary Damages of the Child and His Family
A. Brain injuries, cognitive state and awareness issues
B. Use of the day-in-the-life video
15.8 Presentation of the Theory of the Case, Jury Charges and Jury Consulting, the Need for Early Consideration
A. Theory of the case and its early development, flow and use
B. Jury charges
C. Importance of working with the jury consultant and the use of mock trials in developing case strategy
15.9 Coordination of Experts
A. Early meetings and evaluation of the experts
B. Sharing and updating the theory of the case
C. Providing adequate information, such as medical records and videotapes
D. Updating the experts on case developments
E. Site inspections
F. Daubert and its challenges
15.10 Motions in limine
15.11 The Opening and Closing, the Development and Refinement
15.12 Conclusion

Appendices
Appendix A: General Resources and References
Appendix B: Hospital Emergency Room Treated Injuries
Appendix C: Playground Rating System

About the Authors
Index

Return to book page and ordering link