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Anna Caffarelli, MHS
Stephanie Mazzaferro, MPH
Lawrence Fung, MPH
Caitlyn Smith, MPH

Injuries are a leading cause of death among children nationwide and in New York City (NYC). NYC’s local Law 115 of 2005 and its 2012 extension requires the Child Fatality Review Advisory Team to produce an annual report on child injury fatalities in NYC. The 2025 report examines patterns, trends, and disparities in child injury fatalities from 2014 to 2023 to inform prevention strategies and address inequities in child safety.

This 2025 Child Fatality Review Advisory Team Report describes injury deaths among children aged 1 to 12 years in NYC from 2014 to 2023. Data were obtained from the NYC Health Department’s Bureau of Vital Statistics. Injury deaths were categorized by intent (unintentional, homicide, suicide, undetermined), age, sex, race/ethnicity, borough, and neighborhood poverty level. Rates were calculated using interpolated intercensal population estimates. Descriptive statistics and rate comparisons were used to identify patterns and disparities. The data set included child injury deaths in all five boroughs of NYC.

From 2014 to 2023, 332 children ages 1 to 12 in NYC died from injuries, with unintentional injuries accounting for 57% of deaths, homicides 29%, suicides 4%, and undetermined intent 10%. The annual injury death rate in NYC was 3.5 per 100,000 in 2023, significantly lower than the national rate of 7.0 per 100,000. Disparities were observed: younger children (ages 1–4), boys, Black children, those living in the Bronx, and those living in high-poverty neighborhoods experienced higher fatality rates. Most injuries occurred at home (71%), with homicides and unintentional injuries being the leading causes. Among injuries occurring outside the home, motor vehicle traffic incidents, particularly pedestrian fatalities, were predominant.

While NYC has achieved lower child injury fatality rates compared to national averages, significant racial, economic, and geographic disparities persist. These findings underscore the need for targeted prevention efforts, including promoting home safety, addressing structural inequities, and implementing community-based interventions in neighborhoods where child injury death rates are highest. By addressing these disparities, NYC can further reduce preventable child deaths and serve as a model for urban injury prevention.

1. Identify trends and disparities in injury-related child fatalities in NYC from 2014 to 2023.
2. Understand the demographic and geographic factors contributing to disparities in child injury deaths.
3. Explore evidence-based strategies to prevent child injury fatalities and address systemic inequities.

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Lois K. Lee, MD, MPH
Ayesha Dholakia, MD
Katherine Douglas, MD
Brianna Irons, MD, MPH
Jake Hodas, BA
Michael Monuteaux, ScD
Eric Fleegler, MD, MPH

Traumatic injuries are a frequent presentation for emergency department (ED) visits for US youth 0-17 years old. Firearms represent a relatively small proportion of ED visits for trauma; however, these injuries are at risk for high clinical severity and cost. The objectives of this are to compare clinical characteristics and healthcare costs of pediatric firearm vs. non-firearm injuries among U.S. ED visits.

This is a cross-sectional, retrospective study of pediatric traumatic injuries using the 2022 National Emergency Department Sample (NEDS) from the Healthcare Cost and Utilization Project (HCUP). We included youth 1-17 years old with traumatic injuries, identified by ICD-10 codes. The primary study outcomes were: 1) high acuity care (death in the ED, hospitalization, or transfer to another hospital); 2) ED costs; and 3) total hospital costs. We generated national estimates using NEDS survey weighting. We estimated costs from hospital charges using the HCUP hospital-specific cost-to-charge ratios. We estimated multivariable regression models (logistic for high acuity outcome, generalized linear models with log link for costs), reporting adjusted odds ratios (aOR) and mean percent changes with 95% confidence intervals (CI), respectively. Models were adjusted for patient factors and hospital characteristics.

From the NEDS sample of 5,911,798 US pediatric ED visits in 2022, an estimated 1,144,076 (19.3%) were for pediatric traumatic injuries. This resulted in a population estimate of 4,942,841 (95%CI 4,528,368-5,356,313) non-firearm (99.8%) and 11,772 (95%CI 9,805-13,740) firearm (0.2%) injuries. For non-firearm trauma 54.7% of patients had public insurance and for firearm trauma 72.9% had public insurance (Table 1). For non-firearm injuries the median ED charge was $2,012 (95%CI 1,142-3,503) and median total charge was $2,026 (95%CI 1,149-3,610). For firearm injuries the median ED charge was $6,524 (3,428-16,243) and median total charge was $18,877 (95%CI 6,214-61,899). In the multivariable models, for the outcome of high acuity care, firearms had increased odds (aOR 15.59, 95%CI 13.13- 18.52) compared to non-firearm trauma. The ED costs of firearm injuries were nearly 2 times greater (adjusted mean percent difference: 171%, 95%CI 146% - 198%) compared to non-firearm trauma. For total costs, there was a four-fold increase associated with firearm injuries (aOR 413%, 95%CI 342% - 495%) compared to non-firearm injuries (Table 2).

In 2022, traumatic injuries accounted for nearly one in five pediatric ED visits. Firearms represented a small proportion but had much higher acuity and costs. A multi-pronged approach for injury prevention is essential to decrease injuries among youth.

1) Describe the epidemiology of pediatric ED visits for trauma, including non-firearm and firearm injuries.
2) Examine differences in high acuity ED outcomes for traumatic injuries between non-firearm and firearm injuries.
3) Analyze differences in ED and total hospital costs for traumatic injuries between non-firearm and firearm injuries.

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Christine Lopez, MD
Meghan Davis, DVM, PhD, MPH
Vanya Jones, PhD, MPH
Joanna Cohen, MD
Justine Gately, MAT CPSTI-I
Mary Beth Howard, MD, MSc
Creason Walter, MPH, CHES, CPST
Laura Prichett, MHS, PhD
Debra Skultety- Robinson, DNP
Lindly Theroux, DO
Leticia Ryan, MD, MPH

Dog bites are a common cause of injury and emergency department visits in children. The aim of this study was to describe the epidemiology and clinical characteristics of dog bite injuries among children resulting in emergency department (ED) evaluation.

In this retrospective cohort study, we reviewed data from the pediatric trauma registry of a level 1 mid-Atlantic pediatric trauma center for pediatric emergency department (ED) patients evaluated for dog bite-related injuries from January 2023-December 2025. Descriptive statistics were used to summarize demographic characteristics including age, sex, race/ethnicity. bodily location of injury (as determined from ICD-10 codes), treatment and disposition.

During the three year study period, there were 391 emergency department encounters for dog bite injuries; the number of visits was similar yearly. Most patients arrived to the ED with their dog bite injury in the 18:00-23:59 time frame. Males accounted for the majority of injuries (59%) and the largest age group represented was age five to nine (35%). Head, face and neck injuries were present in 50% of patients and were common in younger children, affecting 85% of children < 1 year and 66% of children 1-4 years. Extremities were involved in 31.5% of patients, with hand injuries specifically involved in 9.7% of patients. The majority of patients were discharged from the ED (84%), but 14% had inpatient or operating room needs.

Our results are consistent with national epidemiologic data showing a higher prevalence of dog bite injury resulting in ED evaluation in children under 9 years of age and male children. Our data also demonstrate high rates of head, face and neck injuries. Further research should focus on prevention efforts prioritizing supervision around dogs, the importance of dog training and education surrounding risk to young children.

1. Describe epidemiology of pediatric dog bite injuries resulting in emergency department evaluation.
2. Identify common injury patterns by age group.
3. Recognize prevention strategies for pediatric dog bites.

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Gina S. Lowell, MD, MPH
Sumihiro Suzuki, PhD
Rojin Ahadi, MPH
Kyran Quinlan, MD, MPH

Sudden Unexpected Infant Death (SUID) is the leading cause of death for infants once discharged home after birth, causing ~3700 infant deaths yearly in the United States. Inclined sleep products have been implicated in a number of these deaths, and biomechanics studies have demonstrated that inclined surfaces facilitate infant rolling, which may lead to accidental suffocation. These insights informed the manufacturing ban of inclined sleep products in the US, and the Infant Sleep Product Rule safeguards that all infant sleep products have a sleep surface angle of ten degrees or less. However, little is known about the risk related to inclined sleep unrelated to such products. This study describes those SUID in Cook County, IL who were placed to sleep on an incline and subsequently died.

The narrative and scene photo for each sleep-related infant death in the Cook County SUID Case Registry from 2019-2024 were analyzed for indications that the infant was placed to sleep on an estimated sleep surface angle of more than ten degrees. Two reviewers (GL and KQ) categorized the likelihood of inclined sleep as 1) Definite, inclined sleep was clearly indicated; 2) Probable, inclined sleep was probably indicated; 3) Possible, inclined sleep was suggested; 4) Not indicated; 5) Unknown. Deaths categorized as “definite” and “probable” were considered inclined sleep.

Among 247 sleep-related infant deaths, 87 (35%) occurred after an infant was placed to sleep on an incline [definite (69, 28%), probable (18, 7%)]. Inclined surfaces were created by adult pillows (40, 46%); a parent’s arm/chest (20, 23%); a pillow product (15, 17%) such as nursing pillows (9), pregnancy pillows, infant neck pillows, or boppy loungers; and inclined products (11, 13%) such as car seats (5), swings, bouncers, or inclined sleepers. Infants were placed to sleep on inclines in adult beds (57, 66%) and couches/futons (9, 10%), and 58 (67%) infants were surface sharing with adults and/or other children. After being placed to sleep on an incline, 30 (34%) infants were subsequently found unresponsive on their side (14) or stomach (16). Twenty-three (26%) deaths were attributed to accidental suffocation. Inclined sleep deaths peaked at 1-2 months old, and 74 (85%) of these deaths occurred before 6-months-old. These deaths occurred among infants who were born preterm (21/86, 24%); had prenatal and/or household tobacco smoke exposure (17/68, 25%); and had maternal substance use history (30/81, 37%). Infants were placed to sleep on an incline by one of their parents (79, 91%).

More than one-third of sleep-related infant deaths in Cook County occurred when infants were placed to sleep on an incline largely unrelated to an infant sleep product. Inclined sleep products have received needed attention resulting in their recall, but most incline deaths typically involve pillows or a parent’s body while bedsharing. Prevention messaging must be broadened to specifically raise awareness of the danger of inclined sleep unrelated to inclined sleep products.

1. Inclined sleep contributes to more than one-third of sleep-related infant death in Cook County, IL.
2. Inclined sleep surfaces are largely created by pillows or a parent's arm/chest.
3. Implications include broadening prevention messaging and evaluating the biomechanics of inclined sleep unrelated to inclined sleep products.

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Morgan Marsh, BS
Melissa Kwan, MD, FAAP

Drowning is one of the leading causes of injury-related death among young children in the United States. For the second year, we hosted a free water safety advocacy event for families of children from 5-12 years old at a community hospital in a large metropolitan area. Not only did this community-based event provide vital education to parents and kids, but we also provided various layers of protection such as providing life jackets and CPR education. We hope to continue improving the event to better serve the community. We conducted this quality improvement (QI) project to learn more about care givers’ opinions about Big Splashy Day to enhance the event and contribute to lowering the childhood drowning statistics.

The 3-hour event was hosted in conference rooms at the community hospital. The day started with a keynote speaker from a local drowning prevention organization, followed by stations that included sizing for life jackets, CPR training, engaging activities to learn about water safety, and multiple vendors disseminating injury prevention information. The QI project was a survey given to adult attendees at the end of the event via a QR code.

The survey received 11 responses. Most heard about Big Splashy Day because they worked at the hospital and attended because they wanted their child(ren) to learn about water safety. 87.8% said the booths were their favorite part of the event. Each aspect of the event was given a rating of 1 being not helpful to 10 being very helpful, as shown in Table 1. 100% felt confident that they could identify things that might be dangerous for their child around water and 100% felt confident that they knew where to find help or tools to make their home safer. 63.6% said the event significantly changed how they thought about drowning risk. 90.9% felt that the length of the event was just right and felt that each booth had adequate time. 72.7% strongly agreed that the event was easy to find and navigate. 100% of responders said they would attend other injury prevention events.

This project found that many caregivers found the event highly effective and able to translate a high amount of information in a short period of time. All respondents felt confident in identifying dangers, and the highest rated event was the life jacket fittings which gave families new life jackets donated from a partner organization. Aspects in which we can improve are our promotion of the event, navigation of the venue, and to enhance the stations to have more activity booths for kids that facilitate learning. These findings will help optimize future events to what the community finds most interesting and most helpful to improve water safety.

Describe what aspects of an advocacy event community participants find most helpful.

Discover ways to improve community advocacy events.

Evaluate the impact of a community advocacy event.

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Kaytlin Hanson, MS, CCC-SLP

Firearm-related mass casualty incidents (MCIs) are increasing nationwide, emphasizing the need for structured, system-level injury prevention programs. In 2021, our health system experienced record-high firearm injury rates, prompting the development of a coordinated Gun Violence Prevention Workgroup. This program was designed to address both the immediate and long-term impacts of firearm injury through a public health framework integrating clinical care, advocacy, and community-based prevention strategies.

In 2022, a hospital-wide, interdisciplinary Gun Violence Prevention Workgroup was established. Key program components included legislative advocacy, survivor engagement, expansion of hospital-based violence intervention programs (HVIPs), and integration of safe firearm storage education into clinical care. Process measures included: • Number of patients with gunshot wounds (GSWs) treated annually • Legislative activity (testimony and policy contributions) • Expansion of HVIP services to partner hospitals • Implementation of standardized safe storage counseling during well-child visits Outcome measures focused on changes in firearm injury volume, pediatric injury trends, and system-level capacity to respond to MCIs.

Following program implementation, total GSW cases decreased from 396 patients in 2021 to 202 in 2025, with pediatric cases decreasing from peak levels of 34 annually (2023–2024) to 26 in 2025. At the state level, firearm deaths increased from 437 in 2018 to 573 in 2021, then declined to 525 in 2023, with approximately 70% attributed to suicide. Programmatic successes included contribution to the passage of a comprehensive gun violence prevention bill in 2024 and expansion of HVIP services through contract services with metro hospitals, increasing access to evidence-based interventions. Safe firearm storage education was successfully integrated into routine clinical care, with providers and residents delivering standardized counseling and distributing gun locks during well-child visits. Following a firearm-related mass casualty incident (MCI) in 2025, this workgroup enabled an immediate and coordinated response, including provider testimony at the state legislature, centralized information dissemination, and rapid identification of organizational leadership to guide prevention efforts. These efforts supported passing of an omnibus gun violence bill through the state Senate but unfortunately did not reach a vote in the House prior to the conclusion of the session.

A structured, interdisciplinary gun violence prevention program using a public health framework can reduce firearm injury burden and strengthen system readiness for MCIs. Injury prevention professionals play a key role in sustaining these efforts by linking clinical care, advocacy, and community strategies to produce measurable improvements in population health outcomes.

1. Discuss the role of injury prevention during and after firearm–related MCIs.
2. Demonstrate how prevention workgroups support response, prevention, and recovery after a firearm related MCI.
3. Highlight the impact of this group on clinical practice, policy, and community interventions to reduce firearm related injuries.