Study: Different Risk Factors for Falls Among Children vs. Adults

The reasons that hospital patients fall can differ depending on whether the patient is an adult or a child.

That’s the conclusion of a new research collaboration between staff at the University of California San Francisco (UCSF) Benioff Children’s Hospital San Francisco and the UC San Francisco School of Nursing.

While falls can be extremely dangerous for patients of any age, prevention depends at least partly on understanding why patients fall and the circumstances surrounding their falls.

In an April news announcement about the research, study participants said statistics show pediatric patients who are hospitalized fall less often than adult patients do. Nevertheless, children who fall are still at risk of injury, including concussions.

Researchers pointed out that “normal developmental changes” among very young patients, such as learning to walk or climb onto and off of a toilet, can contribute to falls. So can behaviors typical to children: “Younger children may run through halls or bounce on beds, while teens, who typically want privacy, are at greater risk because they often resist the requirements that someone remain with them while they use the toilet or shower and are reluctant to ask for help.”

UCSF Medical Center has used a tool called the Schmid Fall Risk Assessment to evaluate adult patients, but there was no comparable tool for evaluating children. Maureen Buick, who has served as the medical center’s director of nursing education and performance improvement, worked with a group of colleagues to adapt the Schmid assessment for adults into one for children — and the “Little Schmidy” assessment tool was born.

Over the years, Little Schmidy was adopted by other medical centers. In 2011, Buick decided to study the tool to ensure that it was measuring fall risk in children accurately.

In five years, Buick and the research team gathered information on 5,000 pediatric patients with 151,000 data points on Little Schmidy risk scores and actual falls.

In the April news announcement, the team said some fall risk factors are common to adults and children – but that some factors such as cognitive impairment and mental activity were not effective at predicting fall risks for children.

Researchers did determine that older rather than younger children were at greater risk of falling, and that children who had neurological disorders or a history of more than one hospitalization were also at greater risk.

The study team has since revised Little Schmidy so it’s easier to use and score, and participants hope their findings will spur further research that could lower fall risk for future pediatric patients.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at

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