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Fall from loft bed is a frequent mechanism of injury in children

Märzheuser S, Fischer B, Grauel F, Degenhardt

Department of Paediatric Surgery, Charité University Hospital Berlin, Germany



Dr. med S Märzheuser,
Department of Paediatric Surgery,
Charité University Hospital Berlin,
Campus Virchow Clinic,
Augustenburger Platz 1, 13353
Berlin, Germany
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Tel: +49 30 450666639
Fax: +49 30 450 566905



Introduction: Loft beds are a frequent choice for families with many children and have been introduced in response to space saving needs in crowded urban dwellings. In contrast to bunk beds, loft beds are located on a high rise platform with a clear height of 2 meters and more. The objective of this study was to identify the risk of fall from loft bed in children.

Material and Methods: Data from the paediatric emergency room of the Charité University Hospital of Berlin. Cases were defined as children aged 0–16 years treated for a traumatic head injury related to a fall from loft bed.

Results: During one year a total of 1637 patients were diagnosed having traumatic head injury attributable to falls. One of the most frequent accidental injuries in all age groups was fall from loft bed with a total of 132 cases (10%). Falls from loft bed are spread over all age groups.

Conclusions: The high incidence of traumatic head injury in all age groups caused by fall from loft bed gives an important target for regional prevention campaigns.



Falls are a common source of pediatric traumatic head injury (THI) [1]. As the main factors related to the extent of the injury in a fall are distance, the landing surface, and striking something, falling from a loft bed is of primary concern.

In a loft bed, the bed is elevated on a high rise platform with space left underneath for living, working, or playing. Bunk beds work on the same principal, but with another bed underneath the top bunk. Loft beds are a frequent choice for families with many children and have been introduced in response to space saving needs in crowded urban dwellings.

Consideration of physical laws indicates that loft beds should impose an excess injury risk in children and a number of case series on bunk beds have helped to document that such a risk actually exists

Based on clinical encounters it seemed that fall from loft bed resulted in head injuries not only in young children but also in a higher proportion of children older than six years as previously shown. Fall from loft bed has not been studied yet as a separate mechanism of injury. The aim of this study was to try to confirm these suspicions and to suggest ways of reducing the morbidity associated with falls from loft beds.

Material and methods

A retrospective research was undertaken during twelve months in the emergency room of the Pediatric Surgical Unit of the Charité Hospital in Berlin. Within this period of time 27763 new injuries of children aged 0 to 16 were seen.

Case narratives were analyzed using a precoded questionnaire that contained information on sociodemographic characteristics, the mechanism and the objects or products most directly involved in the injury (for example, home furniture and height in case of fall), type of injury, diagnosis, medical evaluation of the child, and type of treatment. The collection of data was approved by the ethics committee of the participating hospital. All information was recorded and coded in a computerised database.

According to the operational definition used in this study, all injuries attributable to falls from different heights, against objects, and from beds, diaper changing tables, cribs or cots were included.

Loft bed falls were considered only those that occurred from the upper bed or the ladder. In every instance, the diagnosis „fall from loft bed“ was confirmed by the available free text description of the emergency room documentation. A total of 1637 children diagnosed with traumatic head injury after fall were included in the study. Information was gathered on age, sex, mechanism of injury, ambulatory treatment and hospital days. Injured children were divided into four age groups: infants 0 – 12 month old, toddlers 1 – 4 year old, pupils 5 – 9 year old, adolescents 10 – 16 year old.

Traumatic head injury was diagnosed, if the child had significant symptoms: loss of consciousness, vomiting or drowsiness. The remainder had no neurological symptoms and were classed as having sustained a minor head injury. Skull fracture, epidural and intracranial bleeding were diagnosed by computed tomography scan.


During a twelve month period a total of 1637 injuries attributable to falls were diagnosed having traumatic head injury. The mean age of the patients was 3,8 years, 58 % of the patients were male and 42 % female.

A minor head injury was diagnosed in 1045 patients, traumatic head injury with significant symptoms was found in 538 patients, a scull fracture in 72 patients, epidural bleeding in 11, subdural bleeding in 8 and intracranial bleeding in 12 patients.

1232 patients (75 %) were treated on an ambulatory basis, 63 children with mild symptoms of traumatic head injury had to be hospitalized for 24 hours, 230 children with traumatic head injury without bleeding or fracture stayed for 2 hospital days, 40 children stayed in hospital for 3 days, 45 children between 4 and 10 days. A hospital stay of 11-20 days was found in 17 children and 10 children were in hospital for 21- 42 days.

One of the most frequent accidental injuries in all age groups was fall from loft bed with a total of 132 cases (10%). 1348 children (82%) sustained an injury after fall from different heights and against objects. Infants less than one year experienced accidental injuries at home. One hundred sixty-three injuries (47 %) were a result of a fall from diaper changing table. This was the most common mechanism of injury in babies. There were 7 falls from loft bed (2%) in this small age group (fig. 1).

Figure 1. Causes of traumatic head injury in infants


Home and leisure injuries dominated amongst toddlers (1-4 years), with falls from minor height (less than 50cm) being the leading cause. A total of 54 children (8%) sustained head injury after fall from loft bed (fig. 2).

Figure 2. Causes of traumatic head injury in toddlers


In pupils’ ages 5-9 years fall from loft bed and fall against objects were the most frequent causes of traumatic head injury (fig. 3). The most common type of fall in older children 10 to 16 years leading to THI was a fall during sport at school or leisure time (58%), fall from loft bed was found in 22 children (11%), (fig. 4).

Figure 3. Causes of traumatic head injury in pupils


Figure 4. Causes of traumatic head injury in adolescents


Table 1 depicts the distribution of the 132 childhood traumatic head injuries attributable to fall from loft bed by age, activity and circumstances of fall. On the basis of the data in table 1 it can be estimated that 57 % (76) of all the 74% (98) leisure time related loft bed injuries in all age groups could have been avoided if simply the ladder had been taken away during the day. Among children aged 10 and over the 13 (59%) sleep related injuries might have been prevented with the use of specially designed rails around the loft bed .

Table I: Distribution of the 132 childhood (0–16 years) traumatic head injuries attributable to loft bed falls by age, activity, and circumstances of fall









Fall from up- per bed

Fall from ladder




0 - 1


6 (85%)


1 (15%)




1 (15%)


6 (85%)




1 - 4


44 (82%)


10 (18%)




19 (25%)


35 (65%)




5 - 9


39 (79%)


10 (21%)




20 (41%)


29 (59%)




10 - 16


9 (41%)


13 (59%)




16 (73%)


6 (27%)






98 (74%)


34 (26%)




56 (42%)


76 (57%)




Accurate analysis of data on accidental injury helps to identify age related injury patterns and regional key aspects. This knowledge is essential to develop effective prevention strategies. Fall from loft bed is a preventable unintentional childhood injury. Preventability implies a potential for the reduction of incidence. There are recommendations for loft beds in Germany.

In these recommendations parents are advised, that children under 6 years of age should not be using loft beds while children older than 6 years can sleep safely in loft beds (DIN EN 747-1 from year 1993). Looking at our data, this recommendation is not safe as at least in Berlin a considerable amount of children older than 6 years also experienced trauma falling from loft bed. We consider fall from loft bed a problem of Berlin and other cities with apartments with high ceilings (3-4 metres).

We agree with other investigators [2, 3] who were unable to conclude that children under the age of 6 years are more likely to fall out of bunk beds, for the large numbers of older children sleeping in loft bed who fell out and injured themselves in our study. However, other studies described a higher incidence for children under the age of 6 years to fall out of upper bunks in bunk beds [4].

Previous studies [2,4-6] have pointed out the inherent risks of bunk bed falls and this investigation documents that injuries from loft bed falls are considerably more often than those after falls from conventional beds. Falls from conventional beds are concentrated among children less than 5 years old and decline with advancing age [6]. The decline with advancing age is also evident among falls from bunk beds but it is much milder [1-3,7].

Falls from loft beds are evenly spread over all age groups, possibly because of an increasing trend in the frequency of loft bed use with increasing age. A limitation of this investigation, which is shared by earlier ones on bunk beds, is that, denominator figures were not available, a fact that highlights the importance of collecting population data on exposures in the course of injury surveillance.

Overall, 25 % of the children treated for injuries related to loft beds required hospitalization, which is dramatically higher than other published work [2-6,8]. This may be due to the fact, that loft beds are of greater height than bunk beds and therefore the risk of injury following the fall is higher. Injury resulting from a loft bed fall is a function of the risk of fall and the risk of injury following the fall. Reducing the risk of fall should focus on microenvironmental characteristics such as use of protective rails and removal of the ladder during the day.

Lastly, increased parental awareness on provision of effective supervision during times when children play inside home would contribute to the reduction of the risk associated with the availability of these products.


The high incidence of traumatic head injury in all age groups caused by fall from loft bed gives an important target for regional prevention campaigns. In an attempt to make parents more aware of the risks it is recommended that these dangers should be brought to public attention. Efforts are being made to alter recommendations, re-design beds and educate parents and caregivers concerning the danger of this product for children





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