Abstract

In recent years, the reduction in rates of fatal unintentional injuries to children in the USA has not only plateaued, beginning before the pandemic, but has reversed, with increases across most mechanisms of injury. This study seeks to understand the reasons for this trend, focusing on unintentional injuries to children aged 1–14 years in 2001–2023 and on injuries with the highest fatality rates and with the most substantial increases in the last few years.

The highest rate of fatalities and most substantial changes were due to motor vehicle crashes, drowning, fires and burns. Many factors that are associated with the risk of injury fatality actually decreased in prevalence over the last decade while the fatality rates were plateauing and then increasing. These include improved motor vehicle and highway and roadway safety designs, lower rates of cigarette smoking, more homes with carbon monoxide alarms, fewer mobile homes, higher life-jacket use, fewer small recreational boats and decreases in child poverty. Increases in emotional and behavioural disorders are not likely responsible for changes in unintentional injury fatalities in this age group. An important contributor to injury, particularly among the racial groups experiencing the greatest change in the mortality trajectory, is the sociocultural economic environment in which children live, learn and play. Smartphone use by teens and caregivers was the one risk factor which dramatically increased over the last decade, and distraction from mobile phone use stands out as likely the greatest culprit in this increase in fatalities.