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From the Centers for Disease Control and Prevention
January 28, 1998

Toy-Related Injuries Among Children and Teenagers—United States, 1996

JAMA. 1998;279(4):265. doi:10.1001/jama.279.4.265-JWR0128-3-1

MMWR. 1997;46:1185-1189

1 table, 2 figures omitted

EACH YEAR, approximately two billion toys and games are sold in the United States1. Although most toys are safe when risks are measured against the frequency of their use, children are at risk for some toy-related injuries and deaths. To characterize the magnitude of this problem, CDC analyzed data from the U.S. Consumer Product Safety Commission (CPSC) for 1996. This report summarizes this analysis and underscores the importance of parental participation in the selection and use of toys.

CPSC collects product-related injury data from numerous sources, including a probability sample of U.S. hospitals with a 24-hour emergency department (National Electronic Injury Surveillance System [NEISS]), Medical Examiner and Coroner Alert Program (MECAP), newspaper clippings, death certificate files, telephone reports, and other written and electronic correspondence.2 CDC analyzed these data to compile the frequency of toy-related injuries and deaths that occurred during 1996 among persons aged <20 years. Products included toys and games intended for use by children.

During 1996, a total of 13 toy-related deaths among children were reported to CPSC. An estimated 116,800 (95% confidence interval=98,500-135,100) nonfatal injuries requiring emergency department care were reported through NEISS. Of these, 76,000 (65%) occurred among males. Most cases (65,500 [56%]) involved children aged 0-4 years, followed by 33,500 (29%) among those aged 5-9 years, 12,000 (10%) among those aged 10-14 years, and 5800 (5%) among those aged 15-19 years.

Most (approximately 45%) toy-related injuries were lacerations; injuries also included abrasions or contusions (21%), ingestion or lodging of a foreign body (12%), fractures or dislocations (7%), sprains or strains (5%), and miscellaneous injuries (10%). Approximately two thirds of all injuries occurred above the neck and involved the face (32%), head (15%), mouth (11%), and eye (5%); fingers accounted for 5% of injuries. Approximately 1% of children injured were admitted to the hospital for further treatment.

Reported by:

Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC.

CDC Editorial Note:

Children use toys for recreation, learning, exercise, psychosocial development, expression, and fantasy play. Most toys are designed, manufactured, and used safely. Surveillance for toy-related injuries and deaths can be useful to manufacturers, consumers, and persons who supervise use of toys.

At least four strategies can be employed to prevent toy-related injuries. First, because children can be injured while using toys designed for an older child, children should use only toys that are age appropriate. Second, children should be directly supervised when playing with balloons, which result in seven to 10 deaths each year.2 Balloons should be stored out of reach of children, should not be inflated by children, and should be deflated and discarded after their use. An adult or competent adolescent should supervise activities when potentially dangerous household objects (e.g., sharp knives) are required for use with a toy (e.g., to build a model airplane). Third, because characteristics of the environment in which an age-appropriate toy is used may be associated with increased risk for injury, parents should ensure that toys are used in a safe and proper environment. Finally, because of the involvement of the head and face in toy-related injury, parents should be especially cautious when children are using projectile toys (e.g., dart guns).

CPSC has developed manufacturing standards that address toy hazards, such as those associated with small parts, sharp points and edges, electronic components, pacifiers, rattles, lawn darts, clacker balls, caps, and toys containing lead-based paint (D. Tinsworth, Division of Hazard Analysis, CPSC, personal communication, 1997). In addition, the Child Safety Protection Act,* which was designed to reduce toy-related chokings, requires manufacturers to place small parts and choking hazard warning labels on balloons, marbles, small balls, and games with small parts intended for use only by children aged ≥3 years. This act also requires manufacturers, importers, distributors, and retailers to notify CPSC about choking incidents involving such products. CPSC also monitors the manufacture and sale of toys in the United States. When toys fail to meet safety regulations or are associated with increased risk for injury, CPSC is authorized to take corrective action, including recalls and issuing public warnings.3 From 1995 through 1997, CPSC issued 310 recalls and corrective actions for toys that violated mandatory safety standards or that presented substantial product hazards.

Although governmental regulation has been useful in protecting children from toy-related injuries, parents and caregivers are primarily responsible for ensuring the safety of children. Parents and other caregivers can prevent toy-related injuries by making informed decisions about the correct type of toy to buy and periodically monitoring children's use of toys to ensure that toys are being used safely. Additional information about the safety of toys and corrective actions is available from CPSC, telephone (800) 638-2772; or on the World Wide Web, http://www.cpsc.gov/cpscpub/prerel/prerel.html.

*Public Law 103-267, 1994.
Toy Manufacturers of America Inc, Toy industry fact book, 1997-1998.  New York Toy Manufacturers of America1997;
US Consumer Product Safety Commission, A description of the injury or potential injury incident data base (IPII).  Bethesda, Maryland US Consumer Product Safety Commission December1989;
US Consumer Product Safety Commission, Corrective action handbook.  Bethesda, Maryland US Consumer Product Safety Commission October1988;