When parents think of the risks of flying, they usually think of turbulence, emergency landings or horrific crashes. Hot coffee probably doesn't top the list. But when children are injured on airlines, they're most likely to get hurt the same ways they do on the ground.
The most likely cause of injury is burns from hot drinks, according to data presented Monday at the American Academy of Pediatrics conference. That accounted for 39 percent of injuries. Meal service was the most likely time. Sometimes the drinks splashed while they were being passed from person to person. Other times, rambunctious kids bumped tray tables, spilling scalding coffee everywhere.
Other injuries reflect ones seen at home, too. Children were hurt tripping and falling, or hit when objects fell out of overhead bins or when laptops slid off tray tables.
In conjunction with doctors at MedAire, a company that provides medical services for passengers on planes, Dr. Alexandre Rotta, chief of pediatric and critical care medicine at University Hospital Rainbow Babies and Children's Hospital in Cleveland, examined MedAire's database of in-flight medical emergencies from January 2009 to January 2014. They looked at 114,222 emergencies, 12,226 of which involved people under age 18. Most of the time, the child needed medical help because of a health problem he or she had before boarding the plane like a stomach bug or the flu. All told, they found 400 cases where a child was injured in-flight.
Younger children were much more likely to be injured than older children, according to Rotta. Infants held on laps were the most likely to be hurt — they made up 35.8 percent of the cases. Some of the injuries happened during turbulence, but some happened when babies simply fell off their parents' laps.
"People who have children are very much in tune with the fact that you cannot hold your child in your lap in a car," Rotta says. "Somehow, that wisdom doesn't apply to planes. Nobody thinks twice about it."
Alarmingly, five infants in the dataset died with symptoms consistent with sudden infant death syndrome. Co-sleeping, when parents let children sleep on top of them or with them, can put a baby at risk for SIDS or suffocation if there is soft bedding or an adult rolls over or changes positions. The American Academy of Pediatrics recommends that parents avoid sleeping with infants, particularly in chairs and couches. This study shows that "the dangers of co-sleeping are present on airplanes, too," says Rotta.
Rotta suggests booking an extra seat for infants under age 2 if parents can afford it, and putting them in a bassinet or a car seat approved by the Federal Aviation Administration.
Dr. Benjamin Hoffman, a pediatric injury-prevention specialist, says the injuries reflect ones he sees in emergency rooms.
"I think this is a really important reminder that the same things you need to worry about at home, you should worry about on a plane," says Hoffman, who is the medical director of the Tom Sargent Safety Center at Doernbecher Children's Hospital in Portland, Ore. "Kids have things fall on them. They're burned with hot liquids. And if they sleep somewhere unsafe, we know it puts them at risk."
More than three-quarters of the injuries occurred on international flights and flights longer than six hours. Hoffman thinks this could be because kids get antsy on long flights or because parents get tired.
Overall, many of these injuries can be easily prevented, says Rotta. Putting a child in a window seat rather than an aisle or middle seat can make a big difference.
If infants and children are in the window seat, the odds of having a hot beverage spilled on them go way down, since drinks aren't being passed overhead. They're also protected from things that could fall from overhead compartments, their fingers and arms can't get crushed by passing food service carts and they can't wriggle their way off a parent's lap and into the aisle.
"Also," adds Rotta, "the window seat is more entertaining." Keeping kids entertained can make the flight more enjoyable for everyone, and help stop toddlers from escaping travel-weary parents and getting into trouble.
Although it's important for parents to be aware on airplanes, Rotta thinks kids should keep flying. After all, he notes, other modes of transport are much more dangerous. "There are about 100 children injured on airplanes each year. It's not a big number, but it's not negligible," he says.
And since so many of these injuries are preventable, he hopes the number will be even lower in the future.