Infants (less than one)
Infants under the age of one are more prone to certain types of injuries due to their developmental stage. At this age, infants are still developing their motor skills, coordination, and strength, which can make them more vulnerable to accidents and injuries. Additionally, infants are still learning about their environment and may not understand the dangers around them or how to avoid hazards (Kidsafe Tasmania 2014; Morrongiello & Matheis 2007).
Causes
Infants are more likely than adults to be hospitalised for injuries caused by drowning and submersion, choking and suffocation, and thermal causes. Girls make up the majority of cases caused by drowning and submersion, and thermal causes (Figure 21).
Figure 21. Injury hospitalisation rate ratios of infants aged under one compared to adults, and sex demographic proportions, by selected external cause, Australia, 2021–22
The nature of drowning risks changes quite rapidly throughout childhood:
- infants are most likely to drown or have a near-drowning experience in the bathtub (Healthy children 2019)
- toddlers and pre-schoolers are more at risk around swimming pools (Heathdirect 2023)
- older children are more at risk in natural water, such as the ocean, rivers, or lakes (Royal Life Saving Australia 2023).
Injuries from water-based activities are most common in very young children (AIHW 2023c). Infants were 7.9 times more likely than adults to be hospitalised for an injury caused by drowning and submersion (8.2 and 1.0 per 100,000 respectively). For girls, this increased to 19 times (12 and 0.6 per 100,000 respectively). Over half of injury cases caused by drowning and submersion occurred in bathtubs (52%).
Infants and young children are most at risk of injury due to choking and suffocation. Common choking hazards include food, coins and button batteries, and small toys or parts of toys. Factors that may increase risk in this population include:
- a tendency for children this age to explore their environment using their mouth (The Royal Children’s Hospital Melbourne 2018a)
- smaller airways which may get blocked easier (Denny et al. 2014)
- undeveloped teeth which hinders proper chewing (Better Health Channel 2014).
Infants had the highest rate of injury hospitalisation caused by choking and suffocation amongst children. They were 7.5 times more likely than adults to be hospitalised (38 and 5.0 per 100,000 respectively). Inhaled food was the most common threat to breathing that obstructed the respiratory tract (37%) followed by other objects (35%).
Younger children were most at risk of injuries due to thermal causes, which include burns and scalds caused by food and drink, contact with hot household appliances, and exposure to smoke, fire and flames (AIHW 2023g). Many injuries from thermal causes occur in the home, particularly in the kitchen (The Royal Children’s Hospital Melbourne 2021). Burn and scald injuries in young children can be more severe than adults due to their delicate skin (The Sydney Children’s Hospitals Network 2024).
The early years of childhood consist of rapid development of mobility and independence; As such, infants, and toddlers and preschoolers are more prone to different risks of thermal causes:
- infants are more reliant on their caregiver, and many burns and scalds occur while being held alongside the hot item, food or drink (Laitakari et al. 2012)
- toddlers and preschoolers are able to explore their environment, and are likely to touch or knock over objects containing hot substances (Better Health Channel 2019; John Hopkins Medicine 2024).
Infants were 2.9 times more likely than adults to be hospitalised for an injury from thermal causes (52 and 18 per 100,000 respectively). For girls, this increased to 4.4 times (56 and 13 per 100,000 respectively). Contact with hot drinks, food, fats and cooking oils was the most common thermal cause (36%), followed by hot household appliances (18%).
Nature of injuries sustained
Infants experience higher rates of injury hospitalisation and ED presentation than adults for certain types and sites of injuries (Figure 22). Infants are at higher risk of burns than adults, being 3.6 times more likely to have an ED presentation, and 2.5 times more likely to have an injury hospitalisation.
Figure 22: Selected rate ratios of injury emergency department presentations and hospitalisations among infants aged under one, by type of injury, 2021–22
Some types of injury vary further between children and adults by sex. When comparing girls with women, girls were:
- 1.6 times more likely than women to have an ED presentation for dislocations
- 1.3 times more likely than women to be hospitalised for intracranial injuries.
Head and neck injuries made up 70% of infant injury hospitalisations, and 63% of injury ED presentations. Infants are 3.9 times more likely than adults to have an ED presentation for an injury to the head and neck, and 1.5 times more likely to be hospitalised. Infants are also 2.4 times more likely to have an injury hospitalisation for other, multiple, and incompletely specified body regions.
AIHW (2023c) Injury in Australia, AIHW, Australian Government, accessed 23 January 2024.
AIHW (2023g) Thermal causes, AIHW, Australian Government, accessed 22 February 2024.
Better Health Channel (2014) Choking, Department of Health, State Government of Victoria, accessed 21 February 2024.
Better Health Channel (2019) Burns and scalds – children, Department of Health, State Government of Victoria, accessed 22 February 2024.
Denny S, Hodges N & Smith G (2014) Choking in the Pediatric Population, American Journal of Lifestyle Medicine, 9(6), doi: 10.1177/1559827614554901.
Healthdirect (2023) Water safety for babies and children, Department of Health and Aged Care, Australian Government, accessed 21 February 2024.
Healthy Children (2019) Infant Water Safety: Protect Your New Baby from Drowning, American Academy of Pediatrics, accessed 21 February 2024.
John Hopkins Medicine (2024) Burns in Children, John Hopkins Medicine, accessed 22 February 2024.
Kidsafe Tasmania (2014) Injury risks by stage of child development, Kidsafe Tasmania, accessed 21 February 2024.
Laitakari E, Pyörälä S & Koljonen V (2012) Burn Injuries Requiring Hospitalization for Infants Younger Than 1 Year, Journal of Burn Care & Research, 33, doi: 10.1097/BCR.0b013e31823359c4
Morrongiello B & Matheis S (2007) Understanding Children's Injury-risk Behaviors: The Independent Contributions of Cognitions and Emotions, Journal of Pediatric Psychology, 32(8), doi: 10.1093/jpepsy/jsm027
Royal Life Saving Australia (2023) National Drowning Report, Royal Life Saving Australia, accessed 21 February 2024.
The Royal Children's Hospital Melbourne (2018a) Safety: Choking, suffocation and strangulation prevention, The Royal Children's Hospital Melbourne, accessed 21 February 2024.
The Royal Children's Hospital Melbourne (2021) Burns – prevention and first aid, The Royal Children’s Hospital Melbourne, accessed 22 February 2024.
The Sydney Children's Hospitals Network (2024) Burn injuries, NSW Government, accessed 22 February 2024.