Guidance on lawn mower safety fails to reduce injuries

Despite AAP guidelines for safe lawn mowing, the incidence of lawn mower-related injuries in children has remained unchanged over the last two to three decades.

From 2004-’13, an average of 9,351 youths ages 20 years and younger suffered lawn mower-related injuries each year, according to a review of data from the National Electronic Injury Surveillance System (NEISS) of the U.S. Consumer Product Safety Commission (Bachier M, Feliz A. Am J Surg. 2016;211:727-732).

About one-third of the injuries occurred in children younger than 12. There was a bimodal age distribution, with peaks at 3 years and 16 years of age.

About 80% of injuries occurred in males of all ages, although the difference was more pronounced in preadolescents and adolescents, which may be due to a preponderance of adolescent male operators.

The anatomic areas most commonly involved were hand/fingers (30%), lower extremity (17%) and face/eye (14%). Amputations (RR: 11.5) and fractures (RR: 2.82) combined accounted for 12.5% of injuries and were more likely to require hospitalization.

Although the incidence of injuries caused by ride-on mowers was 2.5 times higher than those caused by walk-behind mowers, the type of mower was not specified in over 70% of cases, making a true determination of relative risk nearly impossible.  

Another review of injuries treated over a 30-year period at a children's hospital in Australia showed the number of injuries per five-year interval decreased from 26 in 1975-’79 to 13 in 2000-’04 (Nguyen A, et al. ANZ J Surg. 2008;78:759-766). However, the percentage of ride-on mower injuries increased from 24% to 60% with an increase in acuity and amputations. With these more severe injuries came more hospital transfers for higher level of care, admissions and surgical interventions.  

While fractures and amputations are the most dramatic injuries, they certainly are not the only ones reported. An analysis of NEISS data from 1990-2004 showed the majority of lawn mower injuries were cuts, other soft-tissue injuries and burns (Vollman D, Smith GA. Pediatrics. 2006;118:e273-e278). 

Also reported in this study were foreign body injuries. A typical 26-inch lawn mower blade traveling at 3,000 rotations per minute possesses three times the muzzle kinetic energy of a .357 magnum pistol slug (Park WH, DeMuth WE. J Trauma. 1975;15:36-38). That’s enough energy to fire a bullet through the engine block of an automobile, according to the authors. The force certainly is enough to impale objects into a child’s body, even from a good distance away.  

Pediatricians should advise patients and parents about the risk of using a lawn mower. AAP guidelines suggest that children under age 12 should be kept away from lawn mowers altogether. Children can use a push mower starting at age 12 and a ride-on mower at age 16 if they show good judgment, maturity, strength and coordination.   

Following are additional AAP recommendations for parents and children:

• Wear close-toed shoes and glasses or goggles.

• Do not mow wet grass or during bad weather.  

• Mow across a slope when using a push mower, and mow up and down when using a ride-on mower. 

• Do not pull the mower backwards or mow in reverse. 

• Be careful when performing maintenance or refueling as many parts can be hot and can burn the skin or cause fuel to catch fire. 

Mowing can be fun, a good source of income for adolescents and a help to families, so make sure to give an ounce of prevention to avoid having to receive a pound of cure.  

Drs. Jarka and Adamczyk are members of the AAP Section on Orthopaedics. The section’s Committee on Trauma contributed to this article.