Patient Presentation
A 4-year-old male came to the emergency room after being backed over by a riding lawnmower. Earlier he had been playing at the next door neighbor’s home. He returned to his home for lunch. The 12 year old neighbor was mowing the lawn using a riding lawn mower and was unaware that the boy had returned to the property.
The pertinent physical exam showed his right foot and leg in an extremity air compression cast. He had scrapes and bruising to his abdomen and elbows.
The diagnosis of multiple fractures of the foot and a compound femur fracture were made.
The patient’s clinical course included being taken semi-emergently to the operating room where a partial amputation of his foot was completed along with a rod stabilization of his femur fracture.
In the pediatric intensive care unit, he is currently receiving minimal blood pressure support by a dopamine drip, sedation medication, a morphine drip for pain control, antibiotics and he has had 2 transfusions of packed red blood cells.
Figure 16 – AP (left) and lateral (right) radiographs of the right femur shows a metaphyseal fracture of the right femur with an associated soft tissue defect.
Figure 17 – AP (left) and lateral (right) radiographs of the right foot shows an amputation of the right midfoot with multiple associated fractures and soft tissue defects.
Discussion
Lawn mower injuries are unfortunately common and have a high potential for moribidity and mortality when they happen.
From 1990-1999, approximately 68,000 injuries were due to lawn mowers. About 9,400 were in children < 18 years of age.
These injuries occur in all age groups: < 5 years = 24%, 5-12 years – 36%, 13-17 years = 40% of injuries. Males account for 75% of the injuries.
All types of injuries occurred and all body parts are injured; 7% of the injuries are amputations and avulsions. Hands and fingers have the highest rate of injuries at 31%, legs = 19% of injuries and feet/toes = 18% of injuries.
Seven percent of pediatric injuries require hospitalization.
Walk-behind mowers including push (or hand) mowers and walk-behind power mowers frequently injure children. The mean age of injuries for walk-behind power mowers is 9 years and 74% are male.
Ride-on power mowers (which includes riding mowers, lawn tractors and garden tractors) are very dangerous for children as they are larger, more powerful and more mechanically complex to operate than walk-behind mowers.
Of ride-on power mower injuries, 20% were in children < 15 years and 12% of these required hositalization. The overall rate of injury for ride-on power mower operators who are 5-14 years is more than twice that of operators who are 15-64 years.
Unfortunately 8% of deaths for ride-on power mowers are for passengers or bystanders whose average age is 4-6 years.
Industry impovements in lawn mower safety designs have lead to decreased injury rates for some types of mowers.
The National Children’s Center for Rural and Agricultural Health and Safety publishes a set of guidelines for children’s participation in farm activities.
These NAGCAT guidelines (The North American Guidelines for Children’s Agricultural Tasks) are for a variety of farm tasks from simple activities such as lifting objects to weeding a garden to very complex activities such as using hydraulic equipment and haying.
The guidelines have been shown to be effective in injury prevention if used by families. The guidelines include use of farm tractors including lawn mower tractors.
Learning Point
There are currently no age-specific criteria established by industry or government for use of lawn mowers.
The American Academy of Pediatrics recommends that:
- All young children should not be allowed to play in, or be in adjacent areas to where lawn mowers are being used. Children < 6 years old should be kept indoors during this activity.
- Children should not be allowed to ride as passengers or be towed behind mowes in carts or trailers. They should not be permitted to play on or around mowers when in use or in storage.
- Most children and adolescents will not be able to operate:
- A hand mower until at least 12 years of age
- A walk-behind power mower until at least 12 years of age
- A ride-on power mower until at least 16 years of age
- Children and adolescent need to demonstrate the necessary levels of maturity, judgement, strength and coordination to successful operate these machines.
- Children and adolescents should be educated in proper use and safety of these machines and should be supervised by adults before they use the machines by themselves.
The NAGCAT guidelines says that children as young as 12-13 years MAY use a power lawn mower that is less than 20 horsepower with no implements attached. They do emphasize that the child must again demonstrate maturity, judgement, strength, and coordination for the task, and that parents must provide appropriate education and supervision.
To see specific NAGCAT recommendations, see To Learn More below.
Other appropriate safety precautions include:
- Long hair should be tied up
- Use proper eye protection
- Use proper hearing protection
- Wear non-skid closed toed shoes
- Operate the lawn mower
- Only during daylight hours
- Not in bad weather
- In a location with no hazards such as slopes, ditches, fences, gravel, downed tree limbs, etc.
Questions for Further Discussion
1. At what ages should children and adolescents drive all-terrain vehicles?
2. At what ages should children and adolescents drive motorcycles?
Related Cases
- Disease
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Lawn Mower Injury
Child Safety
Fractures
Foot Injuries and Disorders
Safety Issues
- Symptom/Presentation
- Specialty
- Age
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
American Academy of Pediatrics. Technical Report: Lawn Mower-Related Injuries to Children. Pediatrics 2001:107;e106. Available from the Internet at: http://www.pediatrics.org/cgi/content/full/107/6/e106 (rev. 06/01/2001, cited 5/4/2005).
Gadomski AM, Ackerman S. Burdick P. Jenkins P. Preventing Farm Injury: A Randomized Field Trial of the North American Guidelines for Childhood Agricultural Injury Prevention. Pediatric Academic Societies Annual Meeting. San Francisco, CA. May 1-4, 2004.
National Children’s Center for Rural and Agricultural Health and Safety. Tractor Fundamental, Tractor Operation. Available from the Internet at: http://www.nagcat.org/poster/TracFund/tracoperation.htm (cited 5/4/05).
National Children’s Center for Rural and Agricultural Health and Safety. Tractor Fundamental, Driving a Farm Tractor. Available from the Internet at: http://www.nagcat.org/poster/TracFund/driving_a_farm_tractor.htm (cited 5/4/05).
Author
Donna M. D’Alessandro, MD
Associate Professor of Pediatrics, Children’s Hospital of Iowa
Date
June 20, 2005
Pediatric Education 