Rough sledding

In November 2014, a 6-year-old boy was sledding at a popular Wisconsin park. Halfway down the run, an adult rider crashed into him from behind, throwing him from the sled and fracturing his skull. The boy was flown to the Level I Pediatric Trauma Center at Mayo Clinic's campus in Rochester, Minnesota. Despite treatment at Mayo's Brain Rehabilitation Clinic, he continues to experience post-concussive syndrome, mild hearing loss and behavioral challenges.

The case belies the Norman Rockwell image of rosy-cheeked children merrily coasting down pristine hillsides. And unfortunately, it isn't unique. Each year in the United States, 25,000 children under age 15 are seen in the emergency department for sledding injuries, many of them severe.

In a study published in Pediatric Surgery International in 2015, University of Michigan researchers looked at 52 children hospitalized with sledding injuries at their Level I Pediatric Trauma Center over an eight-year period. Of these, 37 percent had head injuries with an average injury severity score of 13.1 percent. Most were admitted to the ICU. Three children had permanent disabilities, and two others required long-term hospital rehabilitation.

But it's not only kids who get hurt. From 2011 to 2015, 23 people were treated for sledding injuries at the Level I Trauma Center at Mayo Clinic's campus in Minnesota. Forty-four percent were older than 15 and some were adults.

"We focus on children, and they certainly account for most of the sledding injuries seen at trauma centers," says Kimberly (Kim) J. Lombard, injury prevention coordinator at Mayo Clinic's campus in Minnesota. "But adult sled riders and observers can be injured, too, sometimes severely."

The most common mechanism of injury is a run-in with a tree, followed by riders colliding with each other, according to Denise B. Klinkner, M.D., M.Ed, a pediatric surgeon at Mayo Clinic's campus in Minnesota. Both types of accidents can cause serious damage, including limb and vertebral fractures, solid organ injuries, and head trauma — the most frequent and potentially fatal sledding injury.

"Young children have proportionately larger heads and higher centers of gravity than older children and teens, which is why they're so prone to injury," Dr. Klinkner says. Lombard adds, "Sleds can reach speeds of 25 miles an hour. With nothing protecting you, that's a major impact."

Safe sledding

Lombard says despite the statistics, most sledding accidents can be prevented. Here's what she recommends:

Choose a safe hill

Many communities have designated sledding hills that are free of rocks, trees, fences and other obstacles, with long, clear run-outs at the bottom that don't lead into a pond or street. Hills should be checked daily and closed if conditions are too risky. There should be clearly marked areas for sledding and safe areas to walk back up the hill, Lombard says.

Look for safe sleds

Choose sleds with a steering mechanism and avoid toboggans and snow tubes, which are harder to maneuver. Lombard encourages parents to teach kids to sled the right way, noting, "When children ride on their tummies, they have no control, and if there is a crash, they could hit head first. Instead, they should sit upright, and place both hands on the sides of the sled to steer. If a sled was designed to hold only one person, it should be used that way."

Supervision and helmets are key

"Parents should accompany children to the sledding area, choose an age-appropriate hill and model safe behavior," Lombard says. She also strongly encourages the use of helmets, noting that the American Association of Orthopaedic Surgeons, Safe Kids Worldwide and other organizations recommend helmets for all sledders. The U.S. Consumer Product Safety Commission recommends ski, bicycle or skateboard helmets for sledding.

"You need a safe environment and safe behavior as well as other protective factors," Lombard says. "Sledding is great fun, and it's a great way for families to be active together, but you need to be aware that there are risks and how to prevent them."

For more information

Herman R, et al. Sledding injuries, a practice-based study: Is it time to raise awareness? Pediatric Surgery International. 2015;31:237.