1. ICC Code Technology Committee Meeting Reno, Nevada October 4, 2007 Alan Hedge, PhD, CPE Review Of Fall Safety of Children Between the Ages 18 Months and 4 Years In Relation To Guards And Climbing In The Built Environment

2. 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 2

3. 3 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)

4. 4 Children’s Physical Development (p. 8- 12) U.S. Children’s Anthropometric Dimensions (ages 2-4.5 years) DimensionCriteria values Standing center of gravity64 cm (25.2”) at 4.5 years Hip breadth12 cm (4.7”) at 2 years Foot breadth5.3 cm (2”) at 2 years Toehold (shoed foot)3.8 cm (1.5”) at 3 years; 0.5 cm (0.2”) protrusion Step height55.5 cm (21.9”) at 4.5 years Stature113 cm (44.6”) maximum at 4.5 years Vertical grip reach136 cm (53.5 cm) at 4.5 years

5. 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) 5

6. Children’s Climbing Skills (van Herrewegen et al., 2004) (p. 18-25 – Table 4 p. 20) 6 Age rangeClimbing activity 6 - 8 monthsRolling, 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 yearsBetter 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 yearsAll 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.

7. Children’s Climbing Skills (van Herrewegen et al., 2004) (p. 18-25 – Table 7 p. 25) 7 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

8. Children’s Climbing Skills (van Herrewegen et al., 2004) (p. 18-26 – Table 8 p. 26) 8 1-3 yearsObjects that are climbed Successive platformsHouse stairs, stairs on the slide PlatformHigh chair, normal chair, cupboard, table Wire fence, fence with railsBaby crib Irregular shaped objectsCushions, mattress, pillows, boulders Angled plane with few support pointsSmall slide 4-6 years Climbing frameClimbing frame with irregular steps, hoops Wire fenceFence Angled plane with few support pointsSmall slide Angled or horizontal rope networkClimbing rope, mesh, net Angled climbing wallPlayground climbing wall PlatformTable, climbing frame

9. 9 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.

10. Children’s Falls from Windows (U.S.A. Hospital data) (p.30-33) StudyLocationFalls% fatalities Vish et al. (2005)Chicago11/yr Istre et al. (2003)Dallas county17/yr Benoit et al. (2002) L.A. county12/yr (11% )4% (4 yrs old or less) Stone et al. (2000)Cincinnati12/yr (6.3% )4.7% Benoit et al. (2000) Northern Virginia11/yr (11%) 10 Window falls may be endemic but they are preventable with the use of window guards (Stone et al., 2000).

11. Children’s Falls from Stairs (Riley, Roys and Cayless, 1998) (p.33 – Figure 9 p. 36) 11

12. Children’s Playgrounds and Ladders (van Herrewegen and Molenbroek, 2005) (p. 36 – Figure 10 p. 37) 12 ~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.

13. Children’s Cribs (Ridenour, 2002) (p. 38 – Figures 11 & 12 p. 39) 13 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.

14. Fence Design: Australia (Nixon et al., 1979) (p.40-41- Figure 13 p.41) 14 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.

15. Fence Design: U.S.A. (Rabinovich et al., 1994) (p.41-52 – Figure 15 p. 45) 15 Young children’s ability to climb 5 different fence designs improves with age. Ornamental iron fence is most difficult design to climb.

16. Fence Design: U.S.A. (Rabinovich et al., 1994) (p.41-52. - Figure 20 p. 51) 16 Ornamental iron fence is most difficult design to climb at all heights tested.

17. Fence Design: Netherlands (Jaartsveld et al., 1995) (p.53-55. Figure 24 p. 55) 17 Vertical bar iron fence is most difficult design to climb at all ages.

18. Fence Design: New Zealand (Alchemy Engineering & Design, 2002) (p.55-57. - Figure p. 57) 18 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 yrs3 yrs4 yrs5 yrs 0% (0/1/4) 0% (0/2/2) 57% (4/3/0) 0% (0/1/0)

19. Swimming Pool Fencing (Ridenour, 2001) (p.58-60. – Figures p. 59-60) 19 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 children 3 children 1 child

20. 20 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.

21. 21 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.

22. 22 Conclusions (pages 61-64 – Table 10 p. 63) Design factors that either facilitate or inhibit climbing based on the studies reviewed. Facilitating Design ElementsInhibiting 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

23. 23 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.