ICC Code Technology Committee MeetingReno, Nevada

October 4, 2007

Alan Hedge, PhD, CPE

Review Of Fall Safetyof Children Between the

Ages 18 Months and 4 Years In Relation To Guards And Climbing

In The Built Environment

Summary of the Peer Review Literature

Benefits of a peer review process: Research study design and data

analysis have been scrutinized by independent expert reviewers

Published papers have been evaluated by independent expert reviewers

Reduced risks of “shoddy” research Minimizing of “personal bias” in

reporting results

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Peer Review Studies Sections (report pages 8-64)

> 40 peer-review studies reviewed in the report

Summary organized in 3 main sections: Children’s Physical Development (p.8-25) Children’s Interaction with the Build

Environment (p.26-60) Conclusions (p.61-64)

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Children’s Physical Development (p. 8- 12)

U.S. Children’s Anthropometric Dimensions (ages 2-4.5 years)

Dimension Criteria values

Standing center of gravity 64 cm (25.2”) at 4.5 years

Hip breadth 12 cm (4.7”) at 2 years

Foot breadth 5.3 cm (2”) at 2 years

Toehold (shoed foot) 3.8 cm (1.5”) at 3 years; 0.5 cm (0.2”) protrusion

Step height 55.5 cm (21.9”) at 4.5 years

Stature 113 cm (44.6”) maximum at 4.5 years

Vertical grip reach 136 cm (53.5 cm) at 4.5 years

Children’s Cognitive and Social Development Relevant to Climbing

(p. 12-18 - Figure 3 p. 18) Risk Taking in Children (Morrongiello and Lasenby-Lessard, 2007)

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Individual Characteristics

Age, Sex, Behavioral Attributes

Experience with activityPersonal motivations

ValuesTemperament

Family/Parent FactorsSocialization practices

Teaching practicesParent modelingParenting style

Parenting attributesSibling effects

Social/Situational factorsOral/persuasion influencesObservational influences

Situation driven motivations

Macro-level influences that affect this dynamic include neighborhood, economics and culture

Risk taking/Avoidance

Children’s Climbing Skills (van Herrewegen et al., 2004)

(p. 18-25 – Table 4 p. 20)

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Age range Climbing activity

6 - 8 months Rolling, crawling,

9 - 12 months Holding on to furniture and objects, awareness of “visual cliff”, early

aided walking

1 - 1.5 years Starting to walk unaided, negotiating small steps <8” (20 cm), pulling the

body up using vertical using rails, climbing out of crib

1.5 – 2 years Improved walking and stepping over objects, negotiating stairs

improves, climbing on a slide and sliding, maintaining balance, running

2 – 3 years Better balance, climbing higher obstacles, little or no fear of heights

3 – 4 years Good balance, jumping over objects, good and bad climbers appear,

social and cooperative play, some fear of heights and falling

4 – 6 years All the 7 aspects of climbing skills are being developed. Children

negotiate stairs and ladders unaided. Better balance. Children start

riding a 2-wheel bicycle. Some are able to climb a rope. Still little

physical difference between boys and girls.

Children’s Climbing Skills (van Herrewegen et al., 2004)

(p. 18-25 – Table 7 p. 25)

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Good climber

Aware and attentive - frequently look around, look up to where they are going

Multitasks – climbs while talking, looking , eating, playing

Often uses 2 support points (1 hand, 1 foot)

Moves with great ease and smoothness.

Does not stop during climbing and climbs fast.

Use many climbing techniques

Strong enough to carry their own weight

Dare devils and fearless

Move with rhythm

Take alternating steps when climbing

Children’s Climbing Skills (van Herrewegen et al., 2004)

(p. 18-26 – Table 8 p. 26)

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1-3 years Objects that are climbed

Successive platforms House stairs, stairs on the slide

Platform High chair, normal chair, cupboard, table

Wire fence, fence with rails Baby crib

Irregular shaped objects Cushions, mattress, pillows, boulders

Angled plane with few support points Small slide

4-6 years

Climbing frame Climbing frame with irregular steps,

hoops

Wire fence Fence

Angled plane with few support points Small slide

Angled or horizontal rope network Climbing rope, mesh, net

Angled climbing wall Playground climbing wall

Platform Table, climbing frame

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Children’s Interactions with the Built Environment (p. 26)

Nationally, falls from buildings and structures ~ 4% of fatalities (children <=14 years) – 126 cases in 1998.

Urban setting, falls from buildings and structures ~ 20% of fatalities (children <=14 years)

Preschool children usually fall from windows and older children from rooftops, fire escapes or balconies, especially during the summer months.

Fatalities seldom occur when falls are from the second storey or lower.

Major fall injury risk factors include: child’s age, sex (more boys fall), height of the fall, type of

landing surface, mechanism (child was dropped, fell on stairs or fell using a infant walker), setting (day care versus home care), bunk beds, and low socioeconomic status.

Children’s Falls from Windows (U.S.A. Hospital data) (p.30-33)

Study Location Falls % fatalitiesVish et al. (2005) Chicago 11/yr

Istre et al. (2003) Dallas county 17/yr

Benoit et al. (2002)

L.A. county 12/yr (11% ) 4% (4 yrs old or less)

Stone et al. (2000) Cincinnati 12/yr (6.3% )

4.7%

Benoit et al. (2000)

Northern Virginia 11/yr (11%)

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• Window falls may be endemic but they are preventable with the use of window guards (Stone et al., 2000).

Children’s Falls from Stairs(Riley, Roys and Cayless, 1998) (p.33 – Figure 9 p. 36)

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CLIMB STAIRObserve hazardous

situation – stair guarding

Factors affecting desire to climb:· Personality· Observation of others doing so· Able to see over/through

guarding· Maturity· Desire to experiment· Motivation

Restrictions to climb:· Guardian behavior· Safety of environment· Maturity· Permission to climb/irrelevance

of permission· Belief in ability

Ability to climb:· Height· Age· Agility· Leg and arm length· Strength

DO SOMETHING ELSE

Attempt climb of guarding

Unsuccessful climb onto guarding

Successful climb onto guarding

Climb off guarding

Fall off other side of guarding

Potential major injury

Unable to climb guarding

Stable on stairsFind something to aid the climb

Fall off same side of guarding

Fall down stairsPotential major

injury

Potential minor injury

0

10

20

30

40

50

60

70

80

90

100

30cm 40cm 50cm 60cm 70cm

% C

limb

ing

Su

cc

es

s

First rung height

12-24 mths

24-30 mths

30-36 mths

36-48 mths

Children’s Playgrounds and Ladders(van Herrewegen and Molenbroek, 2005) (p. 36 – Figure 10 p. 37)

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• ~50% of 3 year olds can climb a vertical ladder with the first run set at 70cm (27.5”).

• Slanted ladders are more frightening to climb than vertical ladders.

Children’s Cribs(Ridenour, 2002) (p. 38 – Figures 11 & 12 p. 39)

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• Children aged 17-32 months observed climbing from crib. • Barrier height was 50cm (20”). • 98% used corner climbing some of the time.• 90% consistently used corner climbing.

Fence Design: Australia(Nixon et al., 1979) (p.40-41- Figure 13 p.41)

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• Young children’s ability to climb 7 different fence designs improves rapidly with age.

• Gender is not an important determinant of climbing in young children.

Fence Design: U.S.A.(Rabinovich et al., 1994) (p.41-52 – Figure 15 p. 45)

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• Young children’s ability to climb 5 different fence designs improves with age.

• Ornamental iron fence is most difficult design to climb.

Fence Design: U.S.A.(Rabinovich et al., 1994) (p.41-52. - Figure 20 p. 51)

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• Ornamental iron fence is most difficult design to climb at all heights tested.

Fence Design: Netherlands(Jaartsveld et al., 1995) (p.53-55. Figure 24 p. 55)

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• Vertical bar iron fence is most difficult design to climb at all ages.

Fence Design: New Zealand(Alchemy Engineering & Design, 2002) (p.55-57. - Figure p. 57)

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• Vertical bar iron fence (1.1 m high) is most difficult design to climb at all ages.

• Tables shows % Climbing Success (success/total attempts + no attempts) & (# successes/# failures/ # no attempts)

Test

Barrier

2 yrs 3 yrs 4 yrs 5 yrs

0%

(0/1/4)

0%

(0/2/2)

57%

(4/3/0)

0%

(0/1/0)

Swimming Pool Fencing(Ridenour, 2001) (p.58-60. – Figures p. 59-60)

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• 15 children (42-54 months) asked to attempt to climb a 1.2 m (48”) swimming pool wall.

• 6 failed to climb wall, 5 climbed wall without any aid, 3 climbed wall using pool filter; 1 climbed wall using safety ladder frame.

5 children3 children

1 child

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Conclusions(pages 61-64)

“The human child is built to climb and loves to do so!” (Readdick and Park, 1998).

Climbing is involved in the child’s physical, psychological and social development.

Climbing skills are often taught and encouraged by parents, especially with boys

Climbing is a part of physical education at school. No evidence of a gender difference in either

climbing skill or climbing speed in young children.

Difficult barrier designs merely present a greater challenge to the determined child.

Studies also generally agree that it is probably impossible and most likely undesirable to render any environment completely "safe" from children’s climbing.

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Conclusions(pages 61-64)

Limitations of Research Studies: Most epidemiological research has focused

on window falls in young children because these are the greatest risk.

Estimates of the incidence of falls vary widely between studies.

Virtually all studies have focused on the nature of the injuries and on the general category of the fall (e.g. window, stair) and have neglected specific design details of where and how the incident occurred.

Falls from balconies mostly have been in low income older housing stock that was built long before the current building code for balconies was enacted.

Not a single research study has evaluated the impact that the current building code has had on reducing the incidence of falls.

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Conclusions(pages 61-64 – Table 10 p. 63)

Design factors that either facilitate or inhibit climbing based on the studies reviewed.

Facilitating Design Elements Inhibiting Design Elements· Low barrier height (less than 1

m).

· Higher barrier height (1 m plus).

· Easily graspable top rail. · Top rail that is difficult to grasp, and not

broad enough for a child to stand on.

· Horizontal rails spaced to serve

as rungs.

· Horizontal rails with very close or very wide

spacing.

· Vertical rails.

· Openings to flat surfaces that

serve as stable footholds.

· Openings that are too small for footholds

· Steeply angled surfaces

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Conclusions(pages 61-64)

The physical design of a barrier is only one component in the etiology of children’s falls.

A comprehensive safety education program for young children and their families, especially during the warmer months, may have the greatest impact on minimizing the incidence of falls.