New York State child agricultural injuries: How often is maturity a potential contributing factor?

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE SUPPLEMENT 2:36–42 (2002)

New York State Child Agricultural Injuries: HowOften is Maturity a Potential Contributing Factor?

Christine Mason, BA� and Giulia Earle-Richardson, MPH

Background Children living or working on New York farms face unique hazards andexperience on-farm injuries related to these. The New York Community Partners forHealthy Farming (CPHF) surveillance provided a unique source of information foranalyses of risk factors—particularly age—for these events.Methods Agricultural injuries recorded by the state’s agricultural nurse surveillance(CPHF) program over a 6-year period were analyzed. Injuries were classified by type,severity, and possible contributing factors, including whether the age of the victim wasbelow the ‘‘job appropriate age limits’’ designated by the investigators using materialsfrom the North American Guidelines for Children’s Agricultural Tasks (NAGCAT).Results Of the 164 recorded injuries to persons aged 1–18 years, 29 were fatalities, 18were disabling, and 55% occurred while working. Leading injury types were tractor run-over (12) and overturns (11). Of those injured while working, 35% were under the ‘‘jobappropriate age limits.’’ Tasks of loading hay (square bales) (100%, 3), fieldwork withtrailed implements (100%, 3), and feeding calves (100%, 2) most frequently involved veryyoung victims. Grouped by injury source, injuries involving non-powered wagons had thehighest frequency of under-age victims (82%, 9).Conclusion The frequency of problems with job appropriate ages suggests that somechildren on NY farms may be developmentally inappropriate for the tasks to which theyare being assigned. The NAGCAT Guidelines are a needed tool for child agriculturalinjury prevention in New York. Am. J. Ind. Med. Suppl. 2:36–42, 2002.� 2002 Wiley-Liss, Inc.

KEY WORDS: child injury; farm injury; agriculture; child fatalities; farm safety;farm fatalities

INTRODUCTION

Agriculture is known to be a dangerous industry

[National Safety Council, 1999], with a fatality rate six

times the rate of all other industries combined. One unique

aspect of farming is that children often work and play on the

farm, exposing them to the dangers of tractors, machinery,

and livestock. Studies of youth agricultural work-related

fatalities have shown high rates (12.2 per 100,000 full-time

equivalent (FTE)) [Castillo et al., 1999], as well as for

injuries of youth 15–17 years old (1.8 per 100 FTE)

[MMWR, 1998]. Debilitating and fatal injuries of this

nature, which are characteristic of injuries to adult victims

of industrial accidents, are typically not seen in children

who are not living in an active war zone [Byard et al., 1999].

Limited data on child agricultural injury currently exist.

The difficulty of determining child rates is demonstrated by

the fact that MMWR data on youth agricultural injuries does

not calculate incidence for youth under 15 years due to the

difficulty of determining actual hours of exposure, since

� 2002Wiley-Liss, Inc.

New York Center for Agricultural Medicine and Health, Northeast Center for Agriculturaland Occupational Health, One Atwell Road, Cooperstown, NewYork

Contract grant sponsor: The National Institute for Occupational Safety and Health;Contract grant number: U07/CCU208020-08.

*Correspondence to: Christine Mason, Northeast Center forAgricultural and OccupationalHealth, One Atwell Road, Cooperstown, NY13326. E-mail: [email protected]

Accepted15 January 2002DOI10.1002/ajim.10062. Published online inWiley InterScience

(www.interscience.wiley.com)

farm children may be exposed at work or play, as well as

when visiting the farm [MMWR, 1998].

What data does exist suggests children make up a

significant proportion of those injured. In Wisconsin, it was

found that of 913 farm injury victims who sought treatment

in a 2-year period, 27% were children. Sixty-eight percent

of these children were working at the time the injury

occurred [Stueland et al., 1996]. A review of data obtained

from the Farm Accident Monitoring System in Alberta,

Canada showed that of the 3,233 reported farm accidents

occurring in a 121-month period, 7% were machinery or

tractor accidents occurring to children. The overall propor-

tion of children 0–18 years involved in farm incidents of all

types was not available [Coury et al., 1999], but would

probably represent a significantly larger proportion.

The current study reviews data on child agricultural

injuries and fatalities gathered by the New York State

Community Partners for Healthy Farming Program, which

employed a novel grass roots reporting network in

combination with the more typical surveillance of death

certificates and newspaper clippings. Recently the National

Children’s Center for Rural Agricultural Health and Safety

has published recommendations for developmental suit-

ability and supervision of certain farm tasks involving

children, the North American Guidelines for Children’s

Agricultural Tasks (NAGCAT) [Lee and Marlenga, 1999].

While these Guidelines are based on cognitive and physical

capabilities as assessed by farm parents, the developers

utilized general age range assumptions in analyzing farm

tasks and noted these for use by farm safety professionals

(see NAGCAT Professional Manual, Job Hazard Analysis).

Clearly it is the intention of the NAGCAT to avoid the use of

arbitrary ages for assigning farm tasks, however these age

ranges provide us with a means to generally assess how

large a role age-inappropriate tasks play in child injury. It

would be impossible to determine how much potential exists

to prevent child farm injury with the NAGCAT without first

understanding how often age or developmental level play a

role in injury. In the research presented here, all child

injuries are assessed in terms of whether age inappropriate-

ness may have played a role. This is done with the re-

cognition that use of age alone as an indicator can lead to

inappropriate assumptions regarding a specific child’s

developmental readiness for agricultural tasks. Neverthe-

less, this type of analysis can help inform health and safety

professionals as to how much emphasis on age appropriate

tasks should be placed in New York State child agricultural

injury prevention programs.

Until recently, New York enjoyed the advantage of a

unique source of data derived from the state’s active

surveillance of agricultural injury through the New York

Community Partners for Healthy Farming (CPHF). This

surveillance was based in the state Department of Health

and consisted of a team of nurses throughout the state

performing on-site injury investigations and building

extensive rural reporting networks. Supplementing this

surveillance, the Department of Health used traditional sur-

veillance methods of news clippings and death certificates.

The purpose of this study was to describe patterns of

childhood injury in this unique dataset and to explore the

extent to which inappropriate age/developmental stage may

contribute to these injury events.

METHODS

In response to frequent reports of farm fatalities and

injuries in New York, the CPHF program was implemented

in 1992. This project was supported by the National Institute

of Occupational Safety and Health (NIOSH) and adminis-

tered by the New York State Department of Health (DOH).

New York State was divided into three regions (western,

central, and eastern), with each region under the surveillance

of an agricultural health nurse. Each nurse established a

network of information to enable prompt notification of an

agricultural injury incident. The network included, but was

not limited to, emergency services personnel, emergency

room staff, medical records personnel, coroners, local law

enforcement, and newspaper clipping services. This infor-

mation was supplemented with death certificate surveillance

by the New York State Department of Health. Upon re-

ceiving notification of an incident, the nurse contacted the

victim or the victim’s family and arranged a farm visit. The

purpose of the visit was to observe the accident scene, obtain

personal interviews, assist victims and families, and

collaborate with agricultural safety engineers to understand

what factors were involved. A comprehensive report was

then prepared and submitted to DOH, where it was analyzed

by a DOH epidemiologist. Excerpts of this report were sent

to the New York Center for Agricultural Medicine and

Health (NYCAMH) for this study.

From these reports researchers extracted and classified

information pertaining to the different aspects of each

incident. Injury events were classified as to demographics,

source, event, severity, activity, victim type, working, and

work task. Classifications are defined as follows:

Work: any non-recreational activity occurring on the farm

Source: physical agent on the farm that was involved in the

injury, i.e., tractor

Event: action that occurred at the exact moment of injury;

for example, rollover

Severity: level of severity of injury

Activity: what victim was doing in the moments leading up

to the injury

Victim: role of child at the time of injury, for example,

operator, worker, or bystander

NAGCAT work task: work task victim was performing,

according the Guidelines classification of tasks.

New York State Child Agricultural Injuries 37

Utilizing the ages noted in the NAGCAT Job Hazard

Analysis grid (NAGCAT Professional Resource Manual)

[Lee and Marlenga, 1999] the investigators arbitrarily

designated the lowest age limits as the study’s ‘‘job

appropriate age limit’’ for specific agricultural tasks. This

job appropriate age was used in analyses of age and injury

occurrence in our data set.

For each excerpt, targeted information was identified,

classified, and coded, then entered into an Access database

and analyzed in SAS.

RESULTS

Demographics

The majority of subjects (n¼ 164) were male (80%).

Subjects ranged in age from 1 to 18. The median age was 12.

Subjects were mainly Caucasian of European decent, which

reflects the demographics of the agricultural community in

New York State.

Injury Events

Of the 164 injuries reported in New York between

October 1992 and September 1998, 19% involved tractors.

This is consistent with Rivera’s [1997] finding of tractors

contributing to 21% of farm injuries at the national level.

Figure 1 shows the frequencies of injuries by injury source.

Within the tractor category, tractor run-overs (includes

falling off, then being run over) were the most frequently

occurring combination. The other leading injury sources

were animals (14%, n¼ 23), non-powered wagons (12%,

n¼ 19), and stationary farmstead machines, (11%, n¼ 18).

Table I shows the four leading sources of injury with a more

detailed analysis of their corresponding injury events.

In terms of age, older teens (14–18 years) were most

frequently injured (38.4%, n¼ 63), followed by pre-teens

(8–13 years), (36%, n¼ 59) and younger children (7 and

younger), (25.6%, n¼ 42). However, younger children were

more frequently killed (31%, n¼ 13), followed by older

teens (14%, n¼ 9) and pre-teens (12%, n¼ 7).

Severity of Injury

Table II shows the level of severity of injury, listed by

most severe (fatal) to least severe (minor). Cases with

multiple outcomes were classified according to the most

severe outcome experienced. The majority of incidents

reported in this study involved serious consequences to the

victim, with 95% of injuries falling into the more serious

classifications. However, it should be noted that the

proportionately large number of severe injuries is indicative

of the tendency of minor injuries not to be reported. It is

likely that the surveillance system used to gather this data is

relatively successful at capturing fatalities and disabling

injuries, but less successful at identifying more minor

injuries which are not widely reported in the press, to

hospitals, or to law enforcement.

FIGURE1. Child agricultural injuries in NewYork State by source of injury, October,1992^September,1998.

38 Mason and Earle-Richardson

Fatalities

Of the 164 reported injuries, 29 resulted in death (18%).

Younger children accounted for 45% (n¼ 13) of the

fatalities. Older teens represented 31% of the fatalities

(n¼ 9) while pre-teens represented 24% (n¼ 7). Tractors

were the main farm implement involved in fatal accidents

(24%, n¼ 7) followed by non-powered wagons (14%,

n¼ 4), and then by animals, motor vehicles, and powered

wagons, all at 10% (n¼ 3).

Victim Type

Operators were the most frequently injured victim type

(26%, n¼ 43), followed by workers (20%, n¼ 32) and

bystanders (18%, n¼ 29). Extra riders and operators were

the most frequently killed (each at 21%, n¼ 6). Older teen

victims were most frequently the operator (49%, n¼ 32),

pre-teens were nearly equally split between worker and

operator (22 and 19% respectively), whereas young children

were most frequently injured when they were bystanders

(43%, n¼ 18).

Work

A slight majority of injuries in this group occurred

while children were working (56.8%, n¼ 92). Older teens

represented 55.4% of this workforce, while 35.8% of pre-

teens and 8.6% of younger children were working at the

time of injury. Tractors were the leading cause of injury to

working children (65%, n¼ 20), and of those 20, 13 were

doing NAGCAT classified tasks. Among the other most

common work-related injury sources. non-powered wagons

accounted for 78% (14) of the injuries, stationary machines

72% (13) and animals 57% (13).

In examining work tasks, 72 of 92 could be categorized

as specific NAGCAT work tasks (Table III). Thirty-five

percent of the 72 working children performing these tasks

TABLE I. Most Frequently Reported Child Agricultural Injury Events in NewYork State by Injury Source, October,1992^September,1998

Injury source/event Total frequency Breakdown Percent

Tractors 31 19Runover 12Overturn 12Struck/Pinned 6Falls 1

Animals 23 14Struck/Pinned 10Crushed 5Falls 4Runover 1Cut 1Bit 1Other 1

Non-poweredwagons 18 11Runover 7Falls 4Struck/Pinned 3Crushed 2Overturn 1Cut 1

Stationarymachines 18 11Entanglement 10Struck/Pinned 3Cut 3Crushed 1Strangulation 1

TABLE II. Child Agricultural Injuries in NewYork State by Severity, October,1992^September,1998

Injury severity Percent Frequency

Fatal 18 29Permanent impairment 11 18Hospitalized 31 50Emergency room 35 56Outpatient 2.5 4Minor/unknown 2.5 4

n¼161

TABLE III. Most Frequently Occurring New York State Child AgriculturalInjuries byAssociated NAGCAT Task,October1992^September1998

Task %Child injuries n

Workingwith large animals 11 10Driving farm tractor 9 8Unloading hay 8 7Trailed implements (hitch/unhitch) 4 4Unloading silage 4 4Farmstead equipment (barn cleaner, unloader) 3 3Feeding hay to cows 3 3Trailed implements (fieldwork)-Horses 3 3Loading square bales ontowagon 3 3Milking cows (pipeline) 3 3Workingwith PTO-powered implements (field) 3 3Spreading solidmanure 3 3Feeding calves 2 2Trailed implements (fieldwork)-Tractors 2 2All other NAGCAT tasks (n< 2) 15 14Non-classifiablework tasks 22 20

n¼ 92


fell below our ‘‘job appropriate age limits’’. Table IV shows

the proportion of children who were under the ‘‘job

appropriate age’’ while working around some of the most

common injury sources. The greatest discrepancy occurred

with non-powered wagons where 82% (n¼ 9) of children

injured were under our ‘‘job appropriate age limits’’. Table V

shows the proportion of children injured while working on

certain specific NAGCAT tasks who proved to be under the

‘‘job appropriate age’’.

DISCUSSION

Among the cases in these data, children falling off

tractors or other machinery and then being fatally struck or

run over stand out as all too common tragedies. Older

children operating tractors and then being involved in a fatal

overturn are also common events. These two scenarios

account for 24% (n¼ 7) of all fatalities in this sample. This

suggests that many lives might be saved with further

research into whether these agents might be designed

differently to carry riders, withstand bumps and hills, or

whether child work and supervision practices could be

changed.

Another frequent injury type was being struck or pinned

by an animal (14%, n¼ 23). Fifty-seven percent (n¼ 13) of

those injured by animals were working, and of those, a third

were found to be younger than our ‘‘job appropriate age

limits’’. This suggests that animal handling tasks are an

important area where the NAGCAT should be promoted in

New York.

Non-powered wagons such as hay wagons were the

third largest injury source. Children were often riding or

hitching wagons when they were injured, and 37% (n¼ 7) of

these children were run over. Of the children injured by a

non-powered wagon, 78% (n¼ 14) were working at the time

of injury, and 9 of the 11 (82%) children working on tasks

included in the NAGCAT were under our ‘‘job appropriate

age’’ limits.

To be more specific, Table V shows the leading tasks for

which a substantial proportion of injuries are occurring to

victims younger than the ‘‘job appropriate age limits’’ for

that task: loading hay (square bales) (100%, 3), fieldwork

with trailed implements (100%, 3), and feeding calves

(100%, 2). These are clearly areas where promotion of age-

appropriateness offers the most promise of reducing injury

among New York farm children.

The main question that this research sought to answer

is: how large a role do age inappropriate tasks play in child

agricultural injury in New York State? The finding that

roughly a third of the child injuries in these data were at

considerable likelihood of having been affected by physical,

cognitive, and emotional development issues is significant,

and confirms the need for promotion of developmentally-

based information on agricultural tasks to parents and

employers in New York’s farm community. While this

analysis, by necessity, uses arbitrarily set ages as markers of

developmental capabilities, it must be emphasized that the

NAGCAT are not intended to be used by farm families in

this manner. Rather, the NAGCAT provide farm parents

with the tools they need to conduct their own developmental

analysis of their children’s readiness for certain tasks.

This research suggests that age appropriateness may be

an important contributing factor to child agricultural injury

in New York. It is important to keep in mind, however, that

age is only one among a number of contributing factors.

These data suggest that the practice of allowing extra riders,

poor supervision of small children playing, inadequately

shielded equipment, poorly restrained animals, and gen-

erally unsafe practices passed down from adults are also

major hazards to children on New York farms.

While most of the attention placed on the NAGCAT

relates to assessing whether a child is developmentally

ready to undertake a given task, the NAGCAT also contain

TABLE IV. NAGCATWorkTasks: ChildAgricultural Injuries inNewYorkStateby Source and Proportion of Victims Below ‘‘Job Appropriate Age Limits’’,October1992^September1998

Injury source

#of Childrenperforming NAGCAT

tasks

#Working injuriesin children underappropriate age

Tractors 13 1 (8%)Animals 12 4 (33%)Non-poweredwagons 11 9 (82%)Stationarymachines 11 3 (27%)

TABLE V. Child Agricultural Injuries in New York State by NAGCAT Tasksand Proportion Below ‘‘Job Appropriate Age’’, October, 1992^September,1998

TaskNumber

performing taskNumberbelow age

Loading square bales ontowagon 3 3 (100%)Trailed implements (fieldwork) 3 3 (100%)Feeding calves 2 2 (100%)Trailed implements (hitch/unhitch) 4 2 (50%)Unloading silage 4 2 (50%)Unloadinghay 7 2 (29%)Workingwith large animals 10 3 (33%)Workingwith PTO-poweredimplements (field)

3 1 (33%)

Spreading solidmanure 3 1 (33%)


other useful safety education tools. Each guideline has a

corresponding job hazard analysis that illustrates the safe

performance of the farm task, the potential hazards, and

important points related to worker supervision. Safety

educators might take advantage of these materials for

educating children (and their parents) on proper technique,

quite independent from the issue of developmental readi-

ness. In addition, the NAGCAT also contain a list of

potential hazards associated with each task, which could

be developed into a safety audit checklist for parents or

used as a tool for identifying priority areas for prevention

education.

The data presented here suggest that there are two

groups affected by farm injury: small children playing on

the farm, and older children working on the farm. While

there are some cases of relatively younger children working

on the farm, (under 10 years old, n¼ 15), for the most part,

these are two distinct groups with different safety needs.

Children are being injured at both work and play, and

prevention programs should be designed to address both.

Clearly, parental supervision is an issue for both groups, but

the needs of parents, both in terms of education and

resources for promoting safety, are different.

LIMITATIONS

The major limitation of this research is that the

denominator consisting of the number of children living,

working, or visiting New York farms is unknown. Therefore,

incidence rates could not be estimated. In addition, these

data certainly under-represent New York child farm injuries

as a whole, and more minor injuries in particular, since cases

of farm injuries reported to the CPHF agricultural nurse

surveillance program were likely to be the more serious

cases, where nurse follow-up and support was requested.

RECOMMENDATIONS

In light of the study findings, the authors make the

following recommendations for improving the farm safety

of children. While these apply specifically to farming in

New York State, we suspect that these recommendations

will be beneficial to children living and working on farms

throughout the United States.

* Further research into child task assignment and age with

New York farmers. In particular, researchers should look at

the tasks of: loading hay, fieldwork with trailed implements,

and feeding calves.

* Further research into the issue of unsupervised young

children playing in the farm environment. This group is

distinct from working children. Particular attention should

be paid to identifying social and economic factors that

underlie the problem.

* Greater emphasis on tractor safety in child farm safety

education. This appears to be the biggest hazard to farm

children. Current child farm safety programs in this region

tend to cover a wide range of farm hazards, thereby

diminishing the emphasis on the major killers. It appears

that greater emphasis on tractors and animal handling

may be more effective in preventing serious injuries and

death.

* Prevention education that uses a supportive approach to

parents. Educators need to understand the challenges facing

farm families and to assist them in creative problem solving

for both younger non-working children and older working

children. The unique strength of the NAGCAT is its sup-

portive and empowering orientation for child agricultural

task assignment. The guidelines are an ideal tool for

prevention activities among parents and employers of farm

children and youth.

CONCLUSIONS

This research is preliminary; more aggressive surveil-

lance and determination of injury incidence rates are needed

to move injury prevention forward. Children who live or

work on the farm enjoy a unique experience. They grow up

integrated into the family enterprise, and can make an

important contribution to it by working with the family.

However, as these data show, the farm can be a hazardous

environment as well, and special consideration for the safety

needs of children must be made to assure a positive farm

experience.

ACKNOWLEDGMENTS

The authors thank the following for providing the child

injury case reports for this study: Susan Ackerman, R.N.,

B.S.N., New York Center for Agricultural Medicine and

Health, Northeast Center for Agricultural and Occupational

Health; Jane Boyd, R.N., B.S., C.O.H.N., Finger Lakes

Occupational Health Services; Kitty H. Gelberg, Ph.D.,

M.P.H., New York State Department of Health; Susan

Roerig, R.N., Eastern New York Occupational Health

Program.

REFERENCES

Byard RW, Gilbert J, James R, Lipsett J. 1999. Pathological features offarm and tractor-related fatalities in children. Am J Forensic MedPathol 20(1):73–77.

Castillo DN, Adekoya N, Myers J. 1999. Fatal work-relatedinjuries in the agricultural production and services sectorsamong youth in the United States, 1992–1996. J Agromed 6(3):27–41.


Coury HJC, Kumar S, Jones E. 1999. Farm related injuries andfatalities in Alberta. Int J Ind Ergonomics (23):539–547.

Lee B, Marlenga B. 1999. Professional resource manual: northamerican guidelines for children’s agricultural tasks. Marshfield, WI:Marshfield Clinic.

Morbidity and Mortality Weekly Report. 1998. Youth agriculturalwork-related injuries treated in emergency departments—UnitedStates, October 1995—September 1997. September 11, 1998. MMWR47(35):773–777.

National Safety Council. 1999. Injury Facts 1999 edition. Itasca, IL.North American Guidelines for Children’s Agricultural Tasks. website:www.nagcat.com.

Rivera P. 1997. Fatal and non-fatal farm injuries to childrenand adolescents in the United States, 1990–1993. Inj Prev 3:190–194.

Stueland DT, Lee BC, Nordstrom DL, Layde PM, Wittman LM. 1996.A population based case–control study of agricultural injuries inchildren. Inj Prev 2(3):192–196.


New York State child agricultural injuries: How often is maturity a potential contributing factor?

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