WSJ: "The Perils of Texting While Parenting" by Ben Worthen

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Some doctors see the growing use of hand-held electronic devices as a plausible explanation for the surprising reversal of a long slide in injury rates for young children. 

One sunny July afternoon in a San Francisco park, tech recruiter Phil Tirapelle was tapping away on his cellphone while walking with his 18-month-old son. As he was texting his wife, his son wandered off in front of a policeman who was breaking up a domestic dispute.

"I was looking down at my mobile, and the police officer was looking forward," and his son "almost got trampled over," he says. "One thing I learned is that multitasking makes you dumber."

Injuries among young children are on the rise as the number of Americans who own a smartphone grows. Many child-health experts see a possible connection between device distraction and increased injuries. WSJ's Linda Blake and Ben Worthen report.

Yet a few minutes after the incident, he still had his phone out. "I'm a hypocrite. I admit it," he says. "We all are."

Is high-tech gadgetry diminishing the ability of adults to give proper supervision to very young children? Faced with an unending litany of newly proclaimed threats to their kids, harried parents might well roll their eyes at this suggestion. But many emergency-room doctors are worried: They see the growing use of hand-held electronic devices as a plausible explanation for the surprising reversal of a long slide in injury rates for young children. There have even been a few extreme cases of death and near drowning.

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Nonfatal injuries to children under age five rose 12% between 2007 and 2010, after falling for much of the prior decade, according to the most recent data from the Centers for Disease Control and Prevention, based on emergency-room records. The number of Americans 13 and older who own a smartphone such as an iPhone or BlackBerry has grown from almost 9 million in mid-2007, when Apple introduced its device, to 63 million at the end of 2010 and 114 million in July 2012, according to research firm comScore.

Child-safety experts say injury rates had been declining since at least the 1970s, thanks to everything from safer playgrounds to baby gates on staircases to fences around backyard swimming pools. "It was something we were always fairly proud of," says Dr. Jeffrey Weiss, a pediatrician at Phoenix Children's Hospital who serves on an American Academy of Pediatrics working group for injury, violence and poison prevention. "The injuries were going down and down and down." The recent uptick, he says, is "pretty striking."

Childhood-injury specialists say there appear to be no formal studies or statistics to establish a connection between so-called device distraction and childhood injury. "What you have is an association," says Dr. Gary Smith, founder and director of the Center for Injury Research and Policy of the Research Institute at Nationwide Children's Hospital. "Being able to prove causality is the issue.... It certainly is a question that begs to be asked."

It is well established that using a smartphone while driving or even crossing a street increases the risk of accident. More than a dozen pediatricians, emergency-room physicians, academic researchers and police interviewed by The Wall Street Journal say that a similar factor could be at play in injuries to young children.

"It's very well understood within the emergency-medicine community that utilizing devices—hand-held devices—while you are assigned to watch your kids—that resulting injuries could very well be because you are utilizing those tools," says Dr. Wally Ghurabi, medical director of the emergency center at the Santa Monica-UCLA Medical Center and Orthopaedic Hospital.

Adds Dr. Rahul Rastogi, an emergency-room physician at Kaiser Permanente in Oregon: "We think we're multitasking and not really feeling like we are truly distracted. But in reality we are."

Representatives for Apple and Research In Motion declined to comment.

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The three-year increase in CDC child-injury numbers could be a statistical anomaly. Child-injury experts say there could be other factors contributing to the increase, including riskier behavior among children or an increasing tendency for parents to drag children to emergency rooms.

Susan Hudson, a professor at Northern Iowa University and education director of the National Program for Playground Safety, says budget cuts by schools and local governments could be a factor. "You're hitting into an economic downturn," she says. "One thing that happens is that you have maintenance going out the window."

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But those explanations, some experts say, don't square with the injury numbers for older children during that period. The rates of increase were smaller for older age brackets, when adult supervision typically tails off. Unintentional injuries among kids ages five to nine increased 5% between 2007 and 2010, and 3% for kids ages 10 to 14, according to the CDC. For 15- to 19-year-olds, injuries decreased 3%.

Young children "have a natural risk to hurt themselves if they are not properly watched by an adult," says David Schwebel, a professor of psychology at the University of Alabama at Birmingham who specializes in injury prevention. "If the adult is distracted, clearly the risk is increased. We know that drivers and pedestrians are distracted and more at risk when they use devices. It's a fairly small leap to suggest that supervisors are distracted."

Statistics from the government's Consumer Product Safety Commission, which tracks injuries by product type, show children are getting hurt more during activities and at ages that would seem to warrant close supervision. Injuries involving playground equipment among children under five jumped 17% between 2007 and 2010, after trending down the previous five years, the commission said. Injuries involving nursery equipment such as changing tables were up 31% among children under five over that period, after declining over five years. Injuries involving swimming pools climbed 36% in that age group after a slight increase over the prior five years.

The kind of data that might be useful for establishing whether there is a direct link between child injury and device use by supervising adults aren't often collected. Doctors say that when they see a child who appears to have a broken arm, for example, they order X-rays and don't ask parents what they were doing at the time of the injury. In the case of serious injuries that involve a police response, subsequent reports usually don't note what a parent was doing during an accident, except in cases of suspected neglect.

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Overall, parents typically don't self-report distraction as a cause for accidents. "Folks are not going to admit to the fact that—look I was doing this, and that's why my kid fell off and broke his arm," says Dr. Ghurabi.

Further complicating the picture, researchers say, is that people tend to underreport the amount of time they spend on their mobile devices. Device users don't consider themselves distracted when checking email, for example, something they put into a different category than watching television or reading newspapers.

Barbara Morrongiello, a psychology professor at the University of Guelph in Canada who has studied the relationship between child-supervision and injury, says that most people don't realize how much they are distracted by devices. If you ask a parent or caregiver who is sending a text message "if they are paying attention, they would say, 'of course,'" she says. People "often underestimate how much time they're taking to do something."

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When a parent is on a device, 'your kid may know that you are there but not paying much attention.'

One afternoon at a swimming pool at a Foxwood Resort Casino hotel in Connecticut, Habibah Abdul-Hakeem was watching a friend's 2-year-old son when another friend texted, asking how her day was going. She texted back that she would send him a photo of herself.

The child sat down on a step in the pool, slipped and began sinking, according to an April 2011 sworn statement by the responding police officer, who said he reconstructed the episode based on security-camera footage and Ms. Abdul-Hakeem's account to police. There was no lifeguard. The boy flailed for about a minute, drifting toward the deep end, then sank. Ms. Abdul-Hakeem, standing beside the pool, was looking at a photo on her smartphone, the police officer said.

About three minutes after she began fiddling with the phone, she dropped it. Only then did she notice the young boy underwater, the officer said. She plunged in and pulled him out. Her calls for help brought a pool attendant who resuscitated the child, who recovered fully.

Ms. Abdul-Hakeem told an emergency technician that she had taken her eyes off the boy for about 20 seconds, according to the police statement. The security-camera footage suggested she didn't look at him for more than three minutes, according to the officer.

The Connecticut state police charged Ms. Abdul-Hakeem, then 35, with reckless endangerment in the second degree and risk of injury to a minor. A clerk in Connecticut state court said that the case is pending and the records are sealed. Ms Abdul-Hakeem didn't respond to requests for comment.

Parents have been collecting their own stories about device distraction. In February, Hope Hughes, a stay-at-home mom, was at a playground near her Chicago home with her daughter, then four, when she heard a thunk—the sound, she says, of a young boy hitting his head on equipment. She says she comforted the boy as his head swelled and he bent over, throwing up.

She says about eight minutes passed before a woman she had seen using a mobile device nearby noticed what was happening and came over. It was the boy's nanny. "She was texting or surfing or something and wasn't paying any attention," Ms. Hughes says.

Ms. Morrongiello, the Canadian psychology professor, says that information she collected from 62 families with two-year-old children revealed that 67% of injuries occurred when a parent wasn't supervising or was only listening intermittently, and only about 10% occurred when a parent was watching. In another study, she found that 7- to 10-year-old children who either were left unsupervised or were supervised indirectly tended to get hurt more.

Cellphone distraction may have played a role in a tragedy that befell one Florida family. On Dec. 14, 2009, Shellie Ross called to her two sons, age 2 and 11, to come see a tortoise in the family's backyard in Merritt Island. At 5:17 p.m., she posted a cellphone photo of the tortoise on Twitter. Records of her tweets show she tweeted four more times over five minutes.

At 5:23, operators took a 911 call from the 11-year-old, police records show: His little brother was at the bottom of the swimming pool, unresponsive. The police report says that Ms. Ross pulled the boy out and performed CPR. Rescue workers rushed him to the hospital, but it was too late.

Ms. Ross told police at the time that she thought the boy was with his older brother. Police ruled the death an accident. Seven months later, the Florida Department of Children and Families concluded that "the death was a direct result" of inadequate supervision. The report noted: "mother twittering at the time the child passed."

Ms. Ross didn't return calls seeking comment.

Ira Hyman, a professor at Western Washington University who specializes in human memory and cognition, contends that mobile devices are more distracting for parents than radio, conversation and other outside-the-home diversions of yesteryear. Scientists aren't exactly sure why, he says, but when a person is using a device, "you can have something pass directly in front of you and your eyes may see it but it doesn't really enter your awareness."

Sociologist Clifford Nass of Stanford University has found that people who stare at a device take a while to refocus. He says that doing so while supervising a child, even if a parent regularly looks up, would make the parent more likely to miss the kind of warning signs that frequently precede a mishap. Playground accidents, for example, often are the result of a sequence of events, such as climbing too high on a jungle gym. "What mobile technologies do is essentially remove you from the situation," he says. "The ability to anticipate problems is much more reduced."

In a 2010 survey by the Pew Research Center, 14% of adults and 22% of adults who send text messages reported being so distracted by their devices that they have physically bumped into an object or person.

Nevertheless, researchers have found, people who complete a task on a device don't report feeling impaired. That may explain why many adults continue to use devices when supervising children.

Psychologist Kathy Hirsh-Pasek of Temple University recently had students observe 30 parents and their children in public places. In almost every case, she says, the parent interrupted an activity with the child to use a device. "In one case a parent let go of her kid's hand in the middle of a big street in Philadelphia in order to check a text message," she says.

Studies have found that children are more likely to take risks when they aren't watched carefully. "It may be that children can perceive the inattention and take more risk," says Dr. Schwebel, the psychologist at the University of Alabama. When a parent is on a device, "your kid may know that you are there but not paying much attention."

Kayla Cory, co-owner of Wonderwild, an indoor play area in Houston, says that she sees it regularly. "People bring their kids in, turn their backs and turn on their phones," she says.

"I go up and ask parents to pay attention to their kids," she says. "We just assume that as long as we're in the same room with them that they're safe. But kids will find a way to hurt themselves."

—Linda Blake contributed to this article.