Differences in Consumer Products Resulting in Injuries in Children with Autism Spectrum Disorder and Children without Autism Spectrum Disorder

Maneesha Agarwal, MD
Elena Petkovska, MD
Dylan P. Hurley, MPH, MAB, HEC-C
Yin Zhang, MS
Wendy J. Pomerantz, MD, MS

Injuries are the leading cause of morbidity and mortality in children. A child presents to a U.S. emergency department for a consumer product–related injury (PRI) approximately every six seconds. Evidence shows that children with autism spectrum disorder (ASD) experience higher rates of injury-related healthcare visits compared to neurotypical peers. Despite this increased risk, differences in PRIs between children with ASD and those without documented ASD remain poorly understood. The primary objective of this study was to compare PRIs in children with ASD to peers without documented ASD.

This retrospective cohort study used data from the US Consumer Product Safety Commission National Electronic Injury Surveillance System (NEISS). Data were extracted for patients aged 0–21 years from 2005-2024. Variables included demographics, injured body part, diagnosis, disposition, product involved, and narrative text. Cases were classified as ASD if the narrative included terms such as autism, autistic, autism spectrum disorder, ASD, Asperger, pervasive developmental disorder, or PDD. Weighted injury rates per 100,000 children were calculated using ASD prevalence estimates from the CDC and national pediatric population data. Descriptive statistics characterized the populations. Using NEISS, total PRIs with 95% confidence intervals and injury rates were estimated for children with and without documented ASD, including product-specific differences. Comparative analyses were performed.

Over the 20-year study period, 2,174 PRIs were identified in children with ASD, corresponding to an estimated 60, 260 injuries (95% CI 42,908-77,613), compared to 3,597,027 cases in children without documented ASD, representing an estimated 109,850,428 injuries (95% CI 87,019,914-132,680,941) (Table 1). Children with ASD were more likely to be male and injured at home. Children without documented ASD were more likely to be treated and released and injured at a place of recreation or sports. Injury mechanisms differed, with more foreign body related injuries and poisonings in children with ASD. During the study period, PRI rates increased in children with ASD from 23 to 246 cases per 100,000 children with ASD (slope = 7.4, 95% CI 5.7-9.1) while decreasing in children without documented ASD from 192,303 to 165,606 cases per 100,000 children (slope = -2844.4, 95% CI -3777.6 - -1911.1). The most commonly implicated products also differed (Table 2). Elements of the built environment were more frequently associated with injuries in children with ASD whereas sports activities were more common among children without documented ASD.

Children with ASD experience distinct patterns of consumer product-related injuries compared to peers without documented ASD. These findings highlight the need for targeted injury prevention strategies and messaging for children with ASD and their caregivers.

1. Describe differences in the epidemiology of consumer product–related injuries between children with ASD and children without documented ASD.
2. Identify differences in injury mechanisms, injury locations, and consumer products associated with injuries among children with ASD compared with their peers.
3. Consider implications of these differences for developing targeted injury prevention strategies for children with ASD and their caregivers.