Chapter 1 Index

A. General Information about the well child examination

B. Nutrition Issues

C. Sleep Issues

D. Dental Issues

E. Anticipatory Guidance
--Discipline: Normal Toddlers
--Discipline: To Spank or Not to Spank
--Toilet Training: or Once Upon a Potty
--Reach Out and Read
--Anticipatory Guidance: Other Items to Ask Birth – 6 years of age
--Smoking: Adverse Effects on Children
--What’s New in Car Seats in 2002
--Water Safety: Prevention and Treatment of Drowning
--Common Accidents

The Problems Associated with Walkers

Drs. Shulstad, Watkins, Finch, Sims and Tran

Introduction: In 1997 mobile walkers in the US could only be made if they are more than 36 inches wide (the usual door frame width): this has led to a decrease of 56% injuries since that time. However, this restriction is voluntary, so mobile walkers are still made. The AAP has called for a ban on the manufacture of mobile walkers.  However, serious injuries still occur.  Walker injuries in 1999 accounted for 8800 ER visits per year – this is between 12% and 40% of infants who use walkers or 8.9 per1000. Average age of child injured is 9 months.

Mechanism and types of Injury:

1. Trauma:  96% are associated with falling down stairs, but other means include falling off a curb or porch, or even going over an uneven area in the house (rug, door jam) or outside. 

Presence of a stairway gate does not decrease the number falling down the stairs.

A.  Falls:

• contusions and abrasions, pinch injuries to fingers: 59%
• concussion and head injuries: 13%
• lacerations: 12%; skull fracture: 10%
• epistaxis: 3%; clavicle, ulna, radius fracture, avulsed teeth: 1.5%
• others: eye injury

B.  Crushing injuries: fingertips caught

2. Burns: children can reach ovens, stoves, and hot water much more easily from a walker.

3. Ingestions: because of mobility, children can get to items left out on counters, etc.

4. Drowning: reported cases have occurred because of the increased mobility of children

Alternatives to Walkers: Stationary play stations rotate and go up and down, but the walker doesn’t move.  These are safe.  Other toys such as “Jump-up” contraptions that hang on door moldings are also considered safe for this age group.

The Canadian Solution: The Canadians were the first to pass a law that walkers have a larger base than the standard size basement door.(1989) These were so bulky that walkers stopped being produced in such volumes in that country. Unfortunately, parents merely crossed into the US and bought US walkers; while decreased, injuries from walkers are still common in Canada. An attempt by the AAP to ban production of walkers has not been listened to.

Why Parents Like Walkers:

1. Walkers keep infant quiet and happy - this is true.
2. Promote walking: this is untrue.  A number of studies showing a relationship with use of walkers and delayed onset of walking.  EMG study: EMG changes in locomotive pattern - walkers allowed gross mechanical errors without impeding bipedal locomotion.
3. Keep children “safe”: as seen from data above, this is untrue.

The Problem with Anticipatory Guidance:

1. 59% of parents know that walkers are dangerous before using them.
2. 32% of parents continue to use walker even after injury.

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Department of Pediatrics  |  Medical College of Georgia
Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004