Most accidents take place in the home environment, especially in toddlers and pre-schoolers as they spend most of their time there [1, 2, 11]. This study showed that children aged 12 to 36 months of both genders had the highest overall injury rate resulting from TV-related injuries. This coincides with developmental achievements such as independent mobility and exploratory behaviours of children. Children’s relative lack of coordination at this stage of development and their still undeveloped cognitive hazard awareness and avoidance skills are the major reasons for the accumulation of injuries at this age [14]. Previous studies on TV-related injuries have had comparable results to those of our study [1, 6, 8]. Discala et al. reported that more than half (57.4%) of the children were boys, and more than three quarters (76.0%) were 1 to 4 years of age [6]. Similarly, Yahya et al. reported that 7 out of 18 children with TV-related head injuries were younger than 36 months of age, and more severe injuries occurred in this age group in their series [10]. Although home accidents can occur in all children, current evidence indicates that this specific mechanism of injury particularly affects boys younger than 36 months of age.
Previous retrospective descriptions and a prospective study have confirmed that a TV tip-over usually occurs when a curious toddler attempts to climb onto furniture, typically a dresser, on which the TV sits, causing the furniture and the TV to fall onto the child [1, 5]. Cathode ray tube TVs are not stable due to the imbalance of the intrinsic weight distribution of their design [6, 7]. The center of gravity is very close to the anterior heavy glass screen. Dotchin et al. constructed a static model of a climbing child to simulate a TV tip-over and investigated how much weight was enough to topple a TV. Suprisingly, they found that 90% of the accessible televisions could be tipped by a child 4 years of age with weight in the 90th percentile [7].
Head and facial injuries were most commonly encountered with this mechanism of injury. Sikron et al. reported that nearly three-quarters of the children (73.3%) sustained head/neck injuries, with almost half of these having a definite traumatic brain injury [3]. Our results and the other relevant studies supported this evidence [5, 11]. There may be two reasons; either the TV falls onto the child’s head, or the child hits his head on the ground during the fall. Both mechanisms of injury seem to be reasonable. We further analysed our data and found that occipital and frontal lesions, involving scalp haematomas, lacerations, and cranial fractures, were more common than lesions in other head regions. Probably, the child falls supine, facing the TV during the fall. The presence of frontal lacerations, nasal contusions, and forehead and lip lacerations are indications of the first scenario, while the presence of occipital hematomas and fractures point to the second.
Mortality and substantial long-term sequelae in TV-related injuries can be attributed to traumatic brain injuries [9, 10]. Four patients with subarachnoid bleeding all died in the hospital. Other injuries, including those of the abdomen, chest, and extremities, were mild to moderate in this study. Bernard et al. reported the highest mortality rate (38.3%) among studies concerning TV-related injuries. However, crush type injuries were also responsible for half of the mortality in their study [8]. Therefore, victims of TV-related injury should be carefully examined for possible fatal abdominal and thoracic injuries.
This study has several limitations. As a retrospective study, we could not obtain a detailed history from the parents at the time of admission. We do not know the TV screen sizes, what the TVs were placed on, and the circumstances surrounding the injury scene. Furthermore, data were extracted from our digital patient database, and some cases may have been missed, which may have affected the results. Prospective studies are necessary to have a more realistic understanding of the mechanism of injury.
In conclusion, falling TVs may cause significant morbidity and mortality in children, particularly those younger than 3 years old. Head and facial injuries are the most commonly encountered, followed by injuries to the extremities. Traumatic brain injury is the major cause of death. Preventive measures taken in the home and, more importantly, increased awareness of this potential risk of injury by the parents are the key solutions to this problem.