Children in the United States are increasingly wearing flip flop sandals and Crocs shoes. Do these shoes make our children more at risk for escalator injuries? As a physician and mother, I had to get to the bottom of this question. Flip flop sandals and Crocs shoes have been lumped together as part of the problem, but is this fair? What is the truth regarding escalator injuries and our children? Do the shoes our children wear on escalators matter?

Let's start with a look at the numbers. 245 million peolpe ride an estimated 35,000 escalators every day in the United States. The Consumer Product Safety Commission estimates that about 10,000 people go to the emergency room every year after accidents on escalators and 20 percent of these injuries involve entrapment of feet, hands, or shoes. That's approximately 2,000 emergency room visits per year for such entrapments, which usually involve softer shoes or bare feet. These figures have been fairly constant for the past 15 years, long before the advent of Crocs, so this seems to nullify the idea that Crocs somehow increases the risk of entrapments as compared to other soft footwear. Given the number of kids wearing Crocs today, it only stands to reason that eventually an entrapment would occur, as Crocs are not immune to rider missteps resulting in being grabbed by escalators, any more than flip flops, jelly shoes, sandals or soft running shoes.

What puts our children at risk? The fact that escalators are dangerous to small children has been well known for years. In fact, in 1997, in the Journal of the American Academy of Pediatrics, it was reported by a group of physicians from the Department of Pediatrics, New York University School of Medicine and the Pediatric Emergency Service, "Children are at risk for sustaining severe injuries on escalators. Young age, inadequate adult supervision, improper activity while riding on the escalator, and escalator-related mechanical problems all increase the risk of injury. Escalator-related injuries may be reduced with focused education directed towards parents and the public on the safety issues that lead to these injuries.The average age of the injured children was 6 years old, but the largest group involved was children between 2 and 4 years old (50%). It should also be noted that 60% of children fell prior causing their injury.

The action of stepping off the escalator is associated with an increased risk of injury. Young children may remain standing on the escalator and allow their feet to slide off at the end, instead of actually stepping off. The small size of a child's foot may increase the risk of it slipping into the gap where the last step slides into the comb plate. While stepping off an escalator may seem like a simple and natural task to an adult, the developmental level of young children limits their ability to both anticipate and coordinate this action. In addition to feet becoming entrapped during the process of stepping off, children's small extremities may become lodged between two steps or between a step and the side-rail.

We can continue to ride escalators with our children if we follow some simple safety tips from the Consumer Product Safety Commission:

1. Loose shoelaces, drawstrings, scarves and mittens can become entrapped. Make sure a child's clothing does not put them at risk.

2. Always hold children's hands, just like crossing the street!

3. Do not permit children to sit or play on the steps.

4. Do not carry children in strollers, walkers, or carts. Use the elevator.

5. Hold the handrail and always face forward. If you fall, you put your child at increased risk!

6. Avoid the edges of the steps where entrapment can occur.

7. Always pay attention and alert while riding with your children, note where the emergency shut off is.

Prevention of escalator-related injuries is the key and efforts should be focused in two directions. Safety education for parents should include and give specific guidance regarding injury prevention about riding on escalators. Increased parental supervision should be encouraged, such as hand-holding or even carrying of young children while riding on and especially while stepping off escalators. Children should be taught not to run, play, or sit while riding on an escalator and of course, children should face forward and hold the handrails.

The bottom line about escalator injuries is that no matter what shoes a child is wearing, if the parents are not supervising them closely, injuries can occur. There is no specific correlation between shoes and injuries; they occur even in the best of circumstances usually due to inattention and children's unsafe behavior. Parents need to be diligent about watching their children and following the guidelines to provide a safe ride for all children on escalators.