Farm life dangerous for kids

Farms are dangerous places, especially for the more than 1 million children in the United States who live and work there. Every day, about 38 young people are injured in a farm-related accident and every third day, one child dies.

Aodhnait (Adi) S. Fahy, B.M.B.Ch., Ph.D., a surgical resident at Mayo Clinic's campus in Rochester, Minnesota, thought some injuries and fatalities might be prevented if risk factors and patterns of injury could be identified. One of her mentors, Scott P. Zietlow, M.D., a trauma surgeon at Mayo Clinic's campus in Minnesota, had looked at the same question in the 1990s. But with increasing mechanization on farms, she thought the situation might have changed. So Dr. Fahy and her colleagues retrospectively examined the records of 4,000 injured children who presented to Mayo Clinic from 2003 to 2013. Of these, 93 (2 percent) were involved in farm-related incidents.

"We wanted to see how serious farm injuries were compared with nonfarm injuries and what placed farm children at risk," Dr. Fahy explains. "What we found was surprising. First, we expected that most agricultural injuries would occur among teenagers working on the farm. But the highest risk was for kids ages 6 to 14. We also found that regardless of age, injury severity scores were twice those of nonfarm children — 12.9 versus 6.1 percent — and the mortality rate was five times higher. The mortality rate for nonfarm children was very low, about 1 percent. For farm kids, it was more than 5 percent."

Farm-injured youth fared worse on most other measures, too. They were more likely to go to the OR within 24 hours, be admitted to the ICU and stay in the hospital longer. They were also more than twice as likely to have a rehabilitation unit discharge.

"These children were more seriously injured at a young age and had a higher risk of death, so we tried to look at why," Dr. Fahy says. "By far the most common mechanism of injury — 60 percent — was machinery, especially augers, which can cause severe extremity injuries. Tractors, hay loaders, combines, harvesters and balers can also cause significant injuries. These are all big machines, and it's hard to imagine young children working on them, so it's more likely they were walking or playing nearby. On Amish farms, kids can be injured by nonmechanized wagons and carts."

Other mechanisms of injury included animals (20 percent), falls (10 percent) and drowning.

"We also tried to find out when injuries were happening so we could be prepared and also so we would know how to focus our prevention efforts with parents and schools. As you might expect, injuries occurred mainly on weekends, in the summer and, to a lesser extent, in the fall during harvesting," Dr. Fahy says.

Dr. Fahy says she undertook her research because she was dismayed by the severe extremity injuries and amputations she and pediatric surgeons Christopher Moir, M.D., and Michael B. Ishitani, M.D., saw in pediatric patients and because she wanted to identify what was contributing to those injuries in order to try to prevent them.

"If parents are more aware of the risks, I think we can make real progress, but I'm not sure how easy that is to accomplish," she says. "Other articles that have looked at farm safety have found it difficult. We do know that we have to educate the parents rather than the children. And awareness is the first step. Children who are living and playing on farms can experience life-changing finger and arm amputations and quite significant head injuries that require long-term rehabilitation. We really need to try to change that."

Dr. Fahy presented her research, which was also mentored by Martin D. Zielinski, M.D., and Donald Jenkins, M.D., at the Pacific Association of Pediatric Surgeons conference in South Korea in May 2015.