Injuries from wearing heavy backpacks are not common in school-aged children
***As a commenter below noted, as of 9/22/17 the link to the AOTA infographic with dubious information is broken/has been removed and now serves a 404 error. Hopefully this is an indication that there will be more care in the future about quoting statistics. The removal of the infographic does not address the question about whether or not there may be more impactful injury prevention efforts than concern with wearing heavy backpacks. (edited, 9/22/17, CJA).
According to the American Occupational Therapy Association, heavy backpacks can cause serious injury to children. The AOTA claims that heavy loads carried by 79 million students across the United States "can cause low back pain that often lasts through adulthood." The AOTA also claims that according to 2013 statistics from the US Consumer Product Safety Commission nearly 22,200 strains, sprains, dislocations, and fractures from backpacks were treated in hospital emergency rooms, physicians' offices, and clinics. (Source: https://www.aota.org/Conference-Events/Backpack-Safety-Awareness-Day/Handouts/Infographic-Injury-Stats.aspx ) *** see note above
This level of severe concern was surprising to me. I am an occupational therapist and I have been treating children for 30 years, and I have never encountered a single incident of strain, sprain, dislocation, or fracture caused by wearing a heavy backpack. That is just anecdote, and I found it confusing, so I set out to learn a little more about the incidence of these injuries in the United States.
I contacted the Consumer Product Safety Commission and learned that their only regulatory jurisdiction in regards to backpack injuries only covers the amount of lead content that may or may not be present in the materials that make up a backpack (in the plastic clips, metal zippers, etc). According to the CPSC, these instances of injuries are virtually non-existent. Certainly, this is not the cause of the alarming statistics provided by the AOTA.
The CPSC operates the National Electronic Injury Surveillance System (NEISS). According to their website, CPSC’s National Electronic Injury Surveillance System (NEISS) is a national probability sample of hospitals in the U.S. and its territories. Patient information is collected from each NEISS hospital for every emergency visit involving an injury associated with consumer products. From this sample, the total number of product-related injuries treated in hospital emergency rooms nationwide can be estimated.
I attempted to query this database in the broadest possible terms and was unable to replicate a result of 22,000 backpack injuries in 2013. Then I decided to get some more updated results and I used the following parameters for a search:
Age: between 5 and 18 years of age (corresponds to student population)
Dates: all reported injuries between 1/1/16 and 12/31/16
NEISS Product Code: 5011 (corresponds to Book Bags or Back Carriers)
The query returned these results:
Dislocation injuries (actual reported): 3
Fracture injuries (actual reported): 18
Strain/Sprain Injuries (actual reported): 59 This category was the only one with a large enough sample to even provide possible weighted estimates - which was given as 1556 for this category.
The NEISS system considers national estimates as potentially unreliable when the reported incidence is very low. It does not calculate extrapolated statistics for dislocations or fractures.
Within each query, you can examine the details of each reported case. The vast majority of injuries associated with backpacks were caused by tripping over backpacks, swinging backpacks at other children and hitting them, and punching backpacks. Very few injuries were actually caused by strain of an overly-heavy backpack. In fact, of the entire dataset, only ten strain/sprain injuries were caused in the 5-10 year old population. Of those ten injuries, four were caused by overly heavy backpacks and six were caused by tripping over backpacks that were left on the floor.
Incidents of strains and sprains were most common with older children (ages 11-18), but even within that population, the majority of injuries were not actually related to wearing a heavy backpack but more often with trips and falls, thrown backpacks, etc.
These findings are consistent with previously published studies that do not support the premise that heavy backpacks are causing injuries in children (Child Health Alert, 2003; Wiersema, Wall, & Foad, 2003).
These findings support my anecdotal observation that injuries from wearing heavy backpacks are rare events.
Wearing heavy backpacks is NOT a significant cause of injury in children. The incidence of these injuries is actually so small that the CPSC is unable to provide statistical estimates about these injuries.
A child may receive an injury from a backpack - but the most likely cause of that injury is tripping over backpacks, swinging backpacks around unsafely, or being hit by a child who has thrown a backpack.
For the rare incident of a heavy backpack causing an orthopedic injury to a child, nearly all reported cases are for middle and high school aged children. If OTs are going to dedicate resources to injury prevention with this population, older children aged 11-18 are the most likely to ever incur a rare injury from wearing a heavy backpack.
Occupational therapists are qualified and trained to provide injury prevention education and programs; they are naturally interested in these topics because of the impact that injuries can have on children's occupational participation. However, the concern about heavy backpacks has been significantly over-inflated. There are many other areas of pediatric injury prevention (concussion/helmet use, bike accidents, trampoline accidents, motor vehicle accidents, playground injuries) that are a much more significant cause of injury and should be considered important targets for prevention efforts.
Child Health Alert (2003). Backpack injuries in children--not what you think. (2003). Child Health Alert, 21, 4.
Wiersema, B., Wall, E., & Foad, S. (2003). Acute backpack injuries in children. Pediatrics, 111(1), 163-166.
note: Thank you to CPSC staff who provided useful guidance based on a simple consumer query.