Background Stairs and steps have in some countries become the leading source of brain injury, with children and working age adults as the main populations at risk. Risk factors and trends were assessed for hospitalizations of children and youth ≤19 years in Canada.

Methods Non-nominal hospital admission data were obtained from the Canadian Institute of Health Information for the years 1994–2009. Hospitalisations of children and youth 0–19 years of age due to falls on stairs and steps were extracted using appropriate ICD 9 and 10 codes. Trends by age group were analysed and hospitalizations cross classified using external cause and nature of injury codes. Statistical evaluation included χ² for univariate and bivariate analysis and Poisson or negative binomial regression for trend analysis of hospitalizations and injuries.

Results There were 13,500 hospitalisations from falls on stairs and steps among 0–19 year olds. Rate of hospitalisation decreased by 55% over the study period from 16.8/100,000 to 7.5/100,000. Infants less than <1 year old had the highest rate at 33.2/100,000, and the greatest improvement correlating in time with banning of baby walkers. Males represented 55% of patients. The home was the site of 60% of incidents, with 60% of falls resulting in a fracture and 30% in intracranial injury. For infants <1 year, 50% of stair falls resulted in an intracranial injury. Income quintiles were highly correlated (p < 0.001), especially for lowest, at 25% of total, versus highest 16%.

Conclusions Home stairs present serious hazards, especially for infants and children. While rates of stair falls have declined in the last two decades, much work remains to make stairs safer and prevent injuries, especially of the brain. Home stairs can be made less steep by adopting the 7–11 configuration widely adopted for public places, and other building code measures to correct frequent design and constuction hazards.