Outbreaks, Alerts and Hot Topics: Lawn Mower Injuries

Column Author: Chris Day, MD | Pediatric Infectious Diseases; Director, Transplant Infectious Disease Services; Medical Director, Travel Medicine; Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Clinical Assistant Professor of Pediatrics, University of Kansas School of Medicine

Column Editor: Angela Myers, MD, MPH | Pediatric Infectious Diseases; Division Director, Infectious Diseases; Medical Director, Center for Wellbeing; Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Clinical Assistant Professor of Pediatrics, University of Kansas School of Medicine

Right now, it is early March. Warm weather (for at least a few days!) and greening lawns suggest that this is a good time to discuss lawn mower-related injuries. A review of some of the literature does in fact suggest that this is the perfect time: these types of injuries in the United States appear to rise in April, peak in May, and then gradually decline through the summer until lawns stop growing (or slow down if you live far enough south) come fall.¹

There is a substantial literature on lawn mower injuries, likely because of their devastating and gruesome nature as well as the perception that these injuries should be largely preventable. Every year, more than 9,000 (and as many as 17,000) children in the United States are injured by lawn mowers,² and approximately 75 people are killed.³ Many are injured while operating the machines and many others are injured while riding on or being near lawn mowers in operation. Boys are much more likely to be injured than girls. There is a bimodal age distribution of these injuries with a peak in the toddler/preschool years and a second peak around 15 years of age. Rates of injury vary by region, with the Midwest (including Missouri and Kansas) appearing to have higher rates than the Northeast, South or West and with rural areas having far higher rates than urban/suburban areas (according to a review based on Pediatric Health Information System (PHIS) data).¹ Riding mowers account for a large percentage of the injuries (48% per a review of Children’s Mercy cases, though the type of mower could not be specified in another 28% of cases). In that same review, rural children were more likely to be passengers or bystanders when injured than were urban children and tended to have more severe injuries. Riding mowers were also associated with more severe injuries than push mowers.²

The physical consequences of these injuries can be lifelong for the injured child, and the psychological consequences potentially catastrophic for the person (usually a relative) who was operating the mower when the injury occurred. Lawn mower-related incidents are a leading cause of amputations in pediatric patients and the number one cause of major limb loss in children less than 10 years of age. The most severe injuries tend to be by direct contact with a rotating lawn mower blade. Contact occurs when an adult accidentally runs over a child, a child passenger falls or jumps from a riding mower, a lawn mower operator slips and their foot gets under the blade, or when a lawn mower operator gets their hands in the way of the blade while the mower is running.⁴ Other injuries, including sometimes fatal injuries, occur when lawn mower blades fling projectiles into a bystander. Children also sustain burns when touching hot engine components. Though mowers are designed to have shields to prevent this, mowers are not always used with all the proper equipment in place. Older children can be crushed when the riding mower they are operating rolls over on a slope.^3,4 Lawn mower injuries can be complicated, often requiring multiple surgeries to achieve optimized outcomes. Open fractures are frequent. Infections following these injuries may involve multiple organisms derived from soil and plants, potentially including bacteria, mycobacteria and fungi.⁵

Lawn mower safety features have been introduced over time, at least in part due to regulations issued by the Consumer Product Safety Commission. For instance, mower blades must stop turning within three seconds after the operator releases the mower’s controls and, for walk-behind mowers, the blade should turn only when the operator is holding the control. It has been recommended that blade rotation be disabled when a riding mower is in reverse; however, not all manufacturers comply with this recommendation.

Safety measures built into lawn mowers are not by themselves adequate. There appears to be little if any evidence of injury rates declining over time, and some publications have suggested increasing rates. Blades spinning at high speed can easily be made unsafe by inappropriate or inattentive use. Parents may be reluctant to update thinking, perhaps due to memories of their own childhoods, about what age is safe for children to be mowing lawns, about the advisability of small children being passengers on riding mowers, and about the safety of having toddlers in the yard while it is being mowed, perhaps because mowing-related injuries are rare enough that parents may not have first- or even second-hand experience with them.

Improved and more widespread knowledge about lawn mower safety would prevent many injuries and much consequent distress and regret. Most injuries can be avoided with proper operation of lawn mowers. It is clear that conversations about mower safety are much easier and more effective to have before there is an injury than after one occurs.

References:

1. Shah R, Talwar D, Schwend RM, et al. Lawnmower injuries in children: a national 13-year study of urban versus rural injuries. J Am Acad Orthop Surg. 2020;28(9):e387-e394. doi:10.5435/JAAOS-D-19-00233
2. Fletcher AN, Schwend RM, Solano M, Wester C, Jarka DE. Pediatric lawn-mower injuries presenting at a level-I trauma center, 1995 to 2015: a danger to our youngest children. J Bone Joint Surg Am. 2018;100(20):1719-1727. doi:10.2106/JBJS.18.00096
3. Hendrickson RJ, Janik JP, Janik JS, Goldberg J, Georgopoulos G, Bensard DD. Ride-on lawnmower accidents causing significant torso and extremity injuries in childhood: case report and review. J Trauma. 2004;56(6):1345-1347. doi:10.1097/01.TA.0000035088.44723.C5
4. Khansa I, Pearson GD, Bjorklund K, Fogolin A, Kirschner RE. Pediatric lawnmower injuries: a 25-year review. JPRAS Open. 2021;29:135-143. PMID: 34222574. PMCID: PMC8246087. doi:10.1016/j.jpra.2021.05.001
5. Harkness B, Andresen D, Kesson A, Isaacs D. Infections following lawnmower and farm machinery-related injuries in children. J Paediatr Child Health. 2009;45:525-528. doi:10.1111/j.1440-1754.2009.01552.x
6. Starr S. Is your child ready to take on mowing the lawn? AAP News. July 1, 2013:34(7):24. https://publications.aap.org/aapnews/article/34/7/24/24697/Is-your-child-ready-to-take-on-mowing-the-lawn