American Academy of Pediatrics National Conference and Exhibition
American Academy of Pediatrics National Conference and Exhibition
Perspective from Gary A. Smith, MD, DrPH
October 29, 2019
2 min read

Children in rural areas at highest risk for lawnmower injuries

Perspective from Gary A. Smith, MD, DrPH
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Photo of Ronit Shah
Ronit V. Shah

NEW ORLEANS — Lawnmower injuries disproportionately affect children in rural areas compared with those living in urban areas in the United States, according to research presented at the AAP National Conference & Exhibition. Researchers also identified higher rates for complications among children sustaining lawnmower injuries in rural areas.

“I think there are various obvious cultural differences regarding these injuries pertaining to urban and rural environments,” Ronit V. Shah, a Benjamin Fox Orthopedic Research Fellow at the University of Toledo, told Infectious Diseases in Children. “In health care settings in rural areas, it would be important for health care personnel and public health departments to focus on lawnmower injury awareness, particularly as the summer season starts. The dangers posed to young children should be broached in a culturally sensitive manner reflecting both rural values as well as health dangers.”

A study published previously in the American Journal of Emergency Medicine found that lawnmower-related injuries are common among children in the U.S., with 11.9 injuries reported per 100,000 children every year. This rate was the result of a nearly 60% decline in the annual injury rate between 1990 and 2014.

For the current study, Shah and colleagues collected data on lawnmower injures sustained by children aged 1 to 18 years in both urban and rural areas. All injuries occurred between 2005 and 2017.

Photo of a child playing with toy near adult mowing the lawn with a lawnmower 
Source: Adobe Stock

During the study period, 1,302 lawnmower-related injuries were reported. The average age of patients sustaining these injuries was 7.7 years, and 78.9% were male.

According to the researchers, the Midwest had the highest rate of lawnmower-related injuries — with 2.7 injuries per 100,000 cases reported — followed by the South (2.16 per 100,000 cases), the Northeast (1.34 per 100,000 cases) and the West (0.56 per 100,000 cases). When they further assessed geographic location, Shah and colleagues identified a higher rate of lawnmower injuries in rural areas compared with urban areas (7.26 per 100,000 cases vs. 1.47 per 100,000 cases).

Most injuries were sustained to the lower extremities (64.7%), upper extremities (22%), trunk (2.6%), head and/or neck (2.2%) and face (1.5%). Amputations accounted for 30.9% of all lawnmower-related injuries. Other common injuries included open wounds, punctures and lacerations (28.8%), as well as fractures, dislocations or bony avulsions (24.2%).

Treatment was not needed for 7.6% of injuries during the study period. However, Shah and colleagues noted that the most commonly performed treatments related to lawnmower injuries were skin, tendon, muscle graft or repair (11.3%) and amputations (11.2%). Among patients who were treated, 7.5% of patients required open reduction, 1.6% needed closed reduction, 19.8% underwent debridement and 6.1% required other treatments.


Furthermore, the researchers identified differences in treatment complications between urban and rural areas, with rural areas having higher rates of infection and inpatient stays. The rate of surgical complication was also higher in rural areas compared with urban areas (5.5% vs. 2.6%; P < .05).

“Pediatricians, orthopedic specialists and other providers should stress the increasing prevalence of lawnmower injuries, first and foremost,” Shah said. “Injuries can be best prevented in the pediatric population by exercising appropriate situational awareness as a parent on behalf of your child. It is best to avoid having children outside altogether while mowing the lawn. Furthermore, awareness of personal bias and local or regional attitudes helps in the understanding of these injuries.” – by Katherine Bortz


Shah R, et al. Urban vs. rural lawnmower injuries in children: a national 13-year study. Presented at: AAP National Conference & Exhibition; Oct. 25-29, 2019; New Orleans.

Smith GA, et al. Am J Emerg Med. 2017;doi:10.1016/j.ajem.2017.03.022.

Disclosure: Shah reports no relevant financial disclosures.