Horses & Children - Safety Packet

Horses and Children Table of Contents

Population at Risk

The American Horse Council has reported that there were 258,434 youth involved in 4-H horse and pony programs in 1994 and 13,000 youth members of the United States Pony Clubs.¹ Youth at risk for horse-related injury is much greater than these numbers suggest because many children who are involved with horse-related activities are not registered horse owners or members of equestrian organizations.

The American Horse Council estimates that there are 1.9 million horse owners in the United States. 3.6 million persons are involved in showing; 4.3 million in recreational activities. Approximately 619,400 persons are directly employed by the horse industry.²

The most common equestrian group receiving treatment for equestrian-related injury is young female riders.^3,4 It has not been determined whether this is attributable to the ratio of female to male youth riders or other factors.

Participants in a 1991 survey research study reported more girls than boys and more children involved in English style riding than Western wore helmets regularly. Reliable information on helmet use among occasional riders is not available.⁵

The most common cause of death and serious injury in all riders is head injury; the percentage of these injuries causing death and serious injury is higher in young riders.^3,6

Cost of Injury

The cost of horse-related injuries among children and adults younger than 25 years seen in emergency departments in 1996 is estimated at over $88 million. The average cost per injury is estimated at $7,411.⁶

National Injury Estimates

In 1996, 25,446 emergency department visits were made by individuals in the U.S. younger than 25 years as a result of horse-related injuries.⁷ The most common types of horse-related injury treated in emergency departments in 1996 to individuals in the U.S. younger than 25 years included contusions, fractures, and strains.⁷

In 1996, emergency department visits by individuals in the U.S. younger than 25 years involved in horse-related injuries involved head/neck (25%), upper body (55%), and lower body (20%).⁸

Selected Studies

Emergency department studies show that a high percentage of equestrian injuries tend to be serious in nature, with up to 38 percent (dependent upon study cited) resulting in hospitalization and 28 to 48 percent involving fractures.³

Most serious injuries to equestrians are caused by being separated from (e.g., propelled from or fall off) the horse while riding or by falling with the horse.³

Many children are injured during non-riding activities such as leading, grooming, and feeding.⁹ In one study, 15 percent of the children hospitalized had been kicked by a horse^.10

A population-based study in rural Wisconsin revealed that 30 percent of those under 19 years who sought treatment for horse-related injuries were injured while engaged in non-riding, horse-related activities. The injury rate for children in this study was 5.6 per 10,000 person years.¹¹

The highest proportion of injury events resulting in multiple injuries occurred as a result of riding animals - a higher proportion than bicycling, in-line skating, or sports-related falls. ¹²

In a review of all equestrian fatalities in Alberta, Canada, 1975-1990, 47.4 percent of the fatalities were younger than 20 years, with seven children (18.4 percent of total fatalities) younger than six years.¹³

A survey of 2,195 frequent riders showed a high prevalence of hospitalization and prolonged disability among injured equestrians.¹⁴

A study of 557 frequent riders younger than 25 years estimated an injury rate of 0.6 per 1,000 riding hours.¹⁵ In contrast, the overall injury rate for persons age 15-24 years is 0.05 per 1,000 working hours.⁵

Related Issues

Approximately two-thirds the injuries were attributed to the horse's behavior, with "spooking" being the most common horse behavior. Additional primary causes were attributed to human behavior or practices.¹⁵

Prevention

Consistent use of secured, ASTM* standard, SEI^† certified equestrian helmets will lead to a decrease in equestrian deaths and serious injuries.^{3,9,13,14,17,19}

Bicycle helmets reduce traumatic brain injuries in bicyclists by 88 percent.²⁰ The effectiveness of ASTM/SEI equestrian helmets is estimated to be comparable.¹⁷

The American Academy of Pediatrics (AAP) recommend that young riders in all organizations and activities that promote or sanction horseback riding wear helmets that meet the 1988 ASTM testing standard as certified by SEI when riding horses.²¹

Young riders should be supervised and matched with horses appropriate for their levels of cognitive development and riding ability.²¹

*American Society of Testing Materials, ASTM F-1163

^†Safety Equipment Institute, SEI

References

1. Horse Industry Directory. (1996). Washington, DC: American Horse Council.
2. Horse Industry Directory. (1997). Washington, DC: American Horse Council.
3. Nelson, D. E. & Bixby-Hammett, D. (1992). Equestrian injuries in children and young adults. American Journal of Diseases in Children. 146, 611-614.
4. Chitnavis JP, Gibbons CLMH, Hirigoyen M, Lloyd Parry J. & Simpson AHRW (1996). Accidents with horses:What has changed in 20 years? Injury 27(2): 103-105.
5. Computation from annual injury rates in Rice, P., MacKenzie, D. P. and Associates (1989). Cost of Injury in the United States: A Report to Congress.
6. U.S. Consumer Product Safety Commission (1997). Cost estimate injury model for 0-24 year olds emergency room injuries on horseback 1996: National Electronic Injury Surveillance System, Washington, D.C.
7. U.S. Consumer Product Safety Commission (1997). Horseback riding injuries ages 0-24 1996: National Electronic Injury Surveillance System, Washington, D.C.
8. U.S. Consumer Product Safety Commission (1997). Unpublished tabulation and analysis of 1996 national electronic injury surveillance system data, horseback riding injuries ages 0-24, 1996. Children's Safety Network Rural Center, Marshfield, WI: NFMC 1997.
9. Firth, J. L. Equestrian injuries. (1985). In: Schneider, R. C., Kennedy, J. C., Plant, M. L. eds. Sports Injuries: Mechanism, Prevention and Treatment. Baltimore, MD: Williams and Wilkins, 431-439.
10. Barone, G. W. & Rodgers, B. M. (1989). Pediatric equestrian injuries: A 14-year review. The Journal of Trauma, 29(2), 245-247.
11. Young NB, Stueland DT, Berg R, Follen M, and Wittman L. (1996) Surveillance of riding and non-riding equestrian injuries at a rural medical center. Poster presented at American Public Health Association Annual Meeting, 1996.
12. Bijur PE, Trumble A, Harel Y, Overpeck MD, Jones D, and Scheidt PC (1995) Sports and recreation injuries in US children and adolescents. Archives of Adolescent Medicine, 149:1009-1016.
13. Aronson, H. & Tough, S. C. (1993). Horse-related fatalities in the Province of Alberta, 1975-1990. The American Journal of Forensic Medicine and Pathology 14(1), 28-30.
14. Nelson, D. E., Rivara, R. P., Condie, C., & Smith, S. (1994). Injuries in equestrian sports. The Physician and Sportsmedicine, 22(10).
15. Christey, G. L., Nelson, D. E., Rivara, F. P., Smith, S. M., & Condie, C. (1994). Horseback riding injuries among children and young adults. The Journal of Family Practice, 39(2).
16. Thompson JM and Von Hollen B (1996). Causes of horse-related injuries in a rural western community. Canadian Family Physician, 42:1103-1109.
17. Center for Disease Control and Prevention (1990). Injuries associated with horseback riding: United States, 1987 and 1988. MMWR 39(20), 329-332.
18. Center for Disease Control and Prevention (1996). Horseback-riding-associated traumatic brain injuries - Oklahoma, 1992-1994. MMWR 45(10), 209-11.
19. Bond GR, Christoph RA, Rodgers BM (1995). Pediatric equestrian injuries: Assessing the impact of helmet use. Pediatrics, 95(4), 487-489.
20. Thompson RS, Rivara FP, Thompson DC (1989). A case-control study of the effectiveness of bicycle helmets. New England Journal of Medicine 1989;320:1361-7.
21. American Academy of Pediatrics. 1992. Horseback riding and head injuries (Statement from the Committee on Sports Medicine and Fitness). Pediatrics 89(3), 512.

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