A Case Against High Chairs

Despite increasingly elaborate technology, babies are falling too often.
Joe Shlabotnik/flickr

In the December 9 issue of Clinical Pediatrics, researchers announced that the number of pediatric emergency department visits associated with high chairs increased 22 percent from 2003 to 2010. Not surprisingly, 93 percent of these injuries occurred when children fell from the chairs. Approximately 9,400 children suffer such injuries every year—one per hour—and most injuries are associated with landing on wood or hard tile floors.

What can parents do to decrease the probability and severity of such injuries?  One step is to make sure that the high chair has not broken or been recalled. Another is to make sure that the child is properly strapped in. And another is simply to keep an eye on the child. In most cases, such injuries—which range from serious brain injuries and fractures to simple cuts and scrapes—can be traced to children climbing or standing on the chairs.

While such preventive efforts can pay big dividends, they may not go far enough. Relying on parents and other caregivers to police their children’s high chair practices appears not to be effective. Instead we would do well to explore more systematic, fail-safe options.

No high chair, not even the top one on the market, is risk free. The number one danger associated with high chairs is clear: height. As any physicist knows, the kinetic energy with which an object—in this case, the body of a small child—strikes the ground is directly related to the height from which it falls. The greater the height, the greater the impact. By decreasing height, we can dramatically lower the severity of injuries that such falls produce. Simply put, it seems time to convert high chairs to low chairs.

A child who falls from a height of 7.2 inches strikes the floor with one-fifth the energy as the same child falling from a height of 36 inches. Every time we reduce by half the height from which the child falls, we reduce the energy of impact—the force transmitted to the child’s body—by a corresponding fraction. 

And we needn't stop there. An even better way to reduce such injuries would be to carry this fundamental physical principle to its logical conclusion. Simply put, the way to maximally protect children from injuries associated with falling from a high chair is simply to do away with the chair entirely and put children on the floor. By definition, children who are already sitting on the floor cannot fall down to it. They may topple over, but they cannot fall onto a floor on which they are already sitting.

Of course, such a proposal will naturally attract its share of detractors. For one thing, sales of high chairs would naturally fall, and this could negatively impact the global baby-care market, which is otherwise expected to amount to $67 billion per year by 2017. The ripple effect could be substantial, costing jobs in the manufacturing, distribution, and sales segments of the baby sector. But the safety of our children is worth some economic pain.

Another group that might resist this proposal are parents, who would be forced to stoop or even sit on the floor to handle such routine baby care tasks as feeding. Lower-back pain is one of the most common complaints in medicine, and is estimated to cost the nation over $100 billion per year in direct medical costs and lost productivity. The low chair would undoubtedly drive these up, but the resultant increase in health sector employment might compensate somewhat for lost high chair manufacturing jobs.

A final source of dissatisfaction might be infants and toddlers themselves. While most will be unable to articulate their displeasure, there are definite drawbacks to spending more time on the floor. For one thing, it is more difficult to see what is going on. It is also more difficult to engage the gaze of adults when children are positioned far below their eye level. And being on the floor increases the risk of being stepped or fallen on, which might offset some of the reduction in high chair fall-related injuries.

On balance, however, the case seems compelling. By cutting the height of high chairs, we would reduce the severity of injuries. Optimally, we would place children on the floor. If this is not possible or desirable, we need to begin manufacturing lower chairs. To answer the marketing department’s criticism that the term “low chair” has little zing to it, we can simply introduce consumer-oriented terminology, such as the “floor-hugging chair” or “gravity-friendly chair.”

Presented by

Richard Gunderman, MD, PhD, is a contributing writer for The Atlantic. He is a professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy, and vice-chair of the Radiology Department, at Indiana University. Gunderman's most recent book is X-Ray Vision.

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