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Work-Related Injuries and Illnesses Associated With Child Labor -- United States, 1993

During 1993, an estimated 2.1 million persons aged 16-17 years in the United States were employed * (1). Although many children aged less than 16 years work, employment data are neither routinely collected nor reported for this age group, and there are no reliable estimates of the number of children in this age group who work. During summer months, when most children are not in school, employment and hours worked by children aged less than 18 years increase substantially. To characterize workplace-related health and safety hazards for children, CDC's National Institute for Occupational Safety and Health (NIOSH) analyzed 1993 data for workers aged less than 18 years from the Survey of Occupational Injuries and Illnesses (SOII), a survey administered by the Bureau of Labor Statistics (BLS), U.S. Department of Labor. ** This report summarizes the results of this analysis and indicates that substantial numbers of persons aged less than 18 years sustain work-related injuries and illnesses each year.

The SOII is a collaborative federal/state program administered by BLS and is based on employer reports from approximately 250,000 private industries in the United States (2); the sampling frame is representative at the national level and at the state level for most states (data for 1993 were the most recent available). *** Employers identify injuries and illnesses that meet recordkeeping requirements **** of the Occupational Safety and Health Administration (OSHA); based on these data, BLS estimates the national incidence of work-related injuries and illnesses. For those injuries and illnesses resulting in lost work days, employers provide demographic information and data about the nature and circumstances of injuries and illnesses. Because employment data provided by employers were not stratified by age, injury and illness rates could not be calculated for specific age groups. National Estimates

In 1993, persons aged less than 18 years incurred an estimated 21,620 injuries and illnesses involving lost work days. Of these, 24% involved 1 lost work day; 43%, 2-5 days; 13%, 6-10 days; 13%, 11-30 days; and 8%, greater than or equal to 31 days (median: 3 days). Most (96%) injuries and illnesses occurred among persons aged 16-17 years, and males accounted for 59% of cases. Sprains/strains were the most commonly reported problem (31%), followed by cuts/lacerations (17%), contusions/abrasions (13%), heat burns (8%), and fractures/dislocations (5%).

Injured and ill persons were employed most frequently by eating and drinking establishments (39%), followed by grocery stores (14%), nursing and personal-care facilities (6%), and department stores (5%). The most common occupations were food preparation and service workers (i.e., waiters and waitresses, cooks, and food counter and kitchen workers) (37%), followed by cashier (10%), stock handler or bagger (9%), health or nursing aide (7%), and janitor and cleaner (5%).

Common events resulting in injury included falls on the same level (i.e., falls to floors and falls onto or against objects) (21%), overexertion (i.e., from lifting, pulling, pushing, turning, wielding, holding, carrying, or throwing objects) (17%), striking against objects (i.e., bumping into, stepping on, kicking, and being pushed or thrown into or against objects) (10%), contact with hot objects or substances (9%), being struck by falling objects (7%), and being struck by a slipping hand-held object (e.g., knife, razor, or tool) (6%). State-Specific Variations

In general, national patterns were reflected at the state level, although there were state-specific variations. Median number of lost work days ranged from 1 day (Nebraska and Vermont) to 6 days (Alabama, Arkansas, New York, and Wyoming) (Table_1). The most common worksites were eating and drinking establishments and grocery stores. However, in Alaska, laundry, cleaning, and garment services and the manufacture of specific food products each accounted for 16%-17% of cases. In California, worksites providing social and rehabilitation services accounted for 24% of cases. In Florida, Nevada, and South Carolina, 12%-15% of incidents occurred in worksites providing amusement and recreation services. In Hawaii, nearly one fourth (24%) of incidents occurred in construction/special trade worksites (e.g., carpentry and painting). Hotels and motels were the most common site of work-related injuries and illnesses in Vermont (27%) and second most common in Utah (11%).

The types of events and exposures resulting in injuries and illnesses varied from national patterns in some states. Exposures to caustic, noxious, or allergenic substances accounted for 11%-23% of cases in Alaska, Montana, Nebraska, Nevada, New Mexico, and Wyoming. Exposure to sun accounted for 22% of cases in Vermont, and falls through roofs accounted for 28% of injuries in Wyoming.

Reported by: Div of Safety Research, National Institute for Occupational Safety and Health, CDC.

Editorial Note

Editorial Note: The findings in this report are the first to provide comparable state-specific data for work-related injuries and illnesses among persons aged less than 18 years; however, the inability to calculate state-specific rates limits comparisons between states. Although many state-specific patterns of injuries and illnesses reflected national patterns, the variations identified are important for targeting prevention efforts at the state level. Workers' compensation data can provide supplemental information to assist state-specific intervention efforts (3-7).

The approximately 22,000 injuries and illnesses involving lost work days among children aged less than 18 years in 1993 is probably an underestimate because SOII excludes some categories (e.g., self-employed workers, farms with less than 11 employees, private households, and government employees) (2); employment data suggest that at least 11% of working children aged less than 18 years are not represented by the SOII (1). These estimates exclude injuries and illnesses that did not result in lost work days or in death. During 1992, an estimated 64,000 children aged less than 18 years were treated in emergency departments for work-related injuries; approximately 70 die from work-related injuries each year (8).

Safety and health regulations, such as those promulgated and enforced by OSHA, apply to workers of all ages. In addition, children aged less than 18 years are protected by provisions of child labor laws. For example, federal child labor laws specifically prohibit cooking and baking by persons aged 14-15 years (9); however, in this analysis, one third of cases among children aged 14-15 years occurred among persons identified as cooks. During 1983-1990, 1475 serious injuries among persons aged less than 18 years were associated with violations of federal child labor laws (10), and studies during the 1980s suggest that 38%-86% of work-related deaths among children were associated with activities prohibited by federal child labor laws (8).

The risks for work-related injuries and illnesses among workers of all ages can be reduced through adherence to routine precautions such as prescribed housekeeping practices; training and safe work procedures; use of proper shoes, gloves, and protective clothing; and maintenance and use of equipment with safety features. In addition, workers aged less than 18 years should not be required to lift objects weighing greater than 15 pounds more often than once per minute or ever to lift objects greater than 30 pounds; tasks involving continuous lifting should never last more than 2 hours (8). Children aged less than 18 years should not participate in work requiring routine use of respirators (a means of protecting workers from inhaling hazardous substances) (8). Employers should be knowledgeable about and comply with child labor laws, and school guidance counselors and physicians who sign work permits for children also should be familiar with child labor laws and ensure that the work they approve does not involve prohibited activities.

Most persons aged less than 18 years enter the workplace with minimal prior experience for a job. During the summer of 1992, more than half (54%) of persons aged 14-16 years treated in emergency departments for work injuries reported that they had received no training in prevention of the injury they sustained and that a supervisor was present at the time of injury in only approximately 20% of the cases (8). Differences in maturity and developmental level regarding learning styles, judgement, and behavior should be considered when providing training for youth in occupational safety and health.

Additional state-specific data and information about prevention of work-related injuries can be obtained from NIOSH, telephone (800) 356-4674 or (513) 533-8328.


  1. Bureau of Labor Statistics. Employment and earnings, vol 41, no.

    1. Washington, DC: US Department of Labor, January, 1994.

  2. Bureau of Labor Statistics. Occupational injuries and illnesses: counts, rates, and characteristics, 1992. Washington, DC: US Department of Labor, April, 1995; bulletin 2455.

  3. Brooks DR, Davis LK. Work-related injuries to Massachusetts teens, 1987-1990. Am J Ind Med 1996;29:153-60.

  4. Miller M. Occupational injuries among adolescents in Washington state, 1988-1991: a review of workers' compensation data. Olympia, Washington: Safety and Health Assessment and Research for Prevention, Washington Department of Labor and Industries, 1995; technical report no. 35-1-1995.

  5. Parker Dl, Carl WR, French LR, Martin F. Characteristics of adolescent work injuries reported to the Minnesota Department of Labor and Industry. Am J Public Health 1994;84:606-11.

  6. Belville R, Pollack S, Godbold JH, Landrigan PJ. Occupational injuries among working adolescents in New York state. JAMA 1993;269:2754-9.

  7. Banco L, Lapidus G, Braddock M. Work-related injury among Connecticut minors. Pediatrics 1992;89:957-60.

  8. NIOSH. Request for assistance in preventing deaths and injuries of adolescent workers. Cincinnati, Ohio: U.S. Department of Health and Human Services, Public Health Service, CDC, 1995; DHHS publication no. (NIOSH)95-125.

  9. Wage and Hour Division, Employment Standards Administration. Child labor requirements in nonagricultural occupations under the Fair Labor Standards Act. Washington DC: US Department of Labor, Employment Standards Administration, August 1990 (WH-1330).

  10. General Accounting Office. Child labor: characteristics of working children. Washington, DC: General Accounting Office, 1990;(GAO)/HRD-90-116.

* Wage and salary workers (including domestic and other private household workers), self-employed persons, and unpaid workers who work greater than or equal to 15 hours a week in family-operated businesses.

** For persons aged less than 20 years, BLS publication of SOII data used the standard age groups of less than 14 years, 14-15 years, and 16-19 years.

*** The base sample for SOII is designed to produce national estimates. However, each year, approximately 40 states participate in a federal/state cooperative program through which, in these states, the base sample is augmented to generate state-specific estimates that meet the individual needs of participating states. In 1993, 42 states participated in this program.

**** OSHA requires employers to record information on every occupational illness and injury that involves one or more of the following: loss of consciousness, restriction of work or motion, transfer to another job, or medical treatment (other than first aid). Employers who are selected for the SOII sample but who are not usually required to keep these records are provided with a copy of instructions and recordkeeping forms for the survey.

Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

TABLE 1. Estimated number of injuries and illnesses and median number of lost work days among
persons aged <18 years, by state *, 1993
                   No.                                            No.
              injuries and       Median no.                  injuries and      Median no.
State           illnesses      lost work days   State          illnesses     lost work days
Alabama             330               6         Missouri           615             5
Alaska               86               3         Montana             84             4
Arizona             592               2         Nebraska           440             1
Arkansas            238               6         Nevada             159             5
California         1418               2         New Jersey         248             3
Connecticut         220               4         New Mexico         231             2
Delaware             39               5         New York          1060             6
Florida            1527               3         North Carolina     947             3
Georgia             499               3         Oklahoma           383             4
Hawaii              141               4         Oregon             410             2
Indiana             706               3         Pennsylvania       719             3
Iowa                340               3         Rhode Island       158             2
Kansas              225               3         South Carolina     234             2
Kentucky            490               3         Tennessee          859             4
Louisiana           175               4         Texas              992             3
Maine                93               4         Utah               303             3
Maryland            425               2         Vermont             24             1
Massachusetts       519               4         Virginia           686             3
Michigan            544               4         Washington         361             2
Minnesota           336               4         Wisconsin          435             4
Mississippi         227               3         Wyoming             43             6
* Data not available from Colorado, District of Columbia, Idaho, Illinois, New Hampshire,
  North Dakota, Ohio, South Dakota, and West Virginia because the sample design in these
  states could not generate state-specific estimates.

Source: Survey of Occupational Injuries and Illnesses, Bureau of Labor Statistics,
U.S. Department of Labor.

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