Aims A child was observed sustaining an injury on an escalator. It prompted us to review the incidence, types and severity of such injuries.

Methods An EMBASE and MEDLINE search using the terms “escalator” or “escalator and related” and “injury” or “injuries” and “child*” or “paediatric” yielded 9 papers – 5 relating to children.

Results In the United States there are approximately 2000 escalator related injuries among children aged 0–19 years /year (rate = 2.6/100,000 population year). Injuries are most likely to occur in rail, bus or subway stations (80%). These injuries are more common in the under 5’s and are more common in boys (53.4%).

The most common mechanism of injury for all age groups is a fall, accounting for 51% of injuries, with a consistent increase in the proportion of injuries that are attributed to a fall with age. Entrapment leads to 29% injuries and causes a higher proportion of injuries in children <5 years (37%).

Of 17 children sustaining injuries presenting to a children’s hospital in Singapore, 13 were wearing rubber clogs. 9 sustained severe injuries requiring emergency surgery.

A laceration is the most frequent type of injury, accounting for 47% of injuries. Amputations and avulsions are uncommon, with a high proportion (71%) occurring in children <5 years old, mostly due to entrapment (86%) and affecting the hand (over 90%).

The leg is the most commonly injured area in all ages (28%), except in children < 5 years old, where the hand is the most common injury site (41%), usually due to entrapment (72% of these injuries). With increasing age, the proportion of leg injuries increases and the proportion of hand and head injuries decreases.

97% of patients were treated and discharged from the Emergency Department; those requiring admission most commonly had a fracture (34%), amputation/avulsion (27%) or laceration (20%).

With childhood escalator trauma, particularly involving entrapment/ physical injury, the chance of developing serious PTSD symptoms is substantial.

Conclusion Escalator related injuries may be serious requiring surgery and leading to long term sequelae. Strategies should be developed to reduce the risk of injuries.