Background Reports of injury burden related to residential fires affecting children in Canada are outdated.

Objective To explore the association between rates of injury and death among children ≤19 years old in Canada and the presence or absence of residential smoke alarms and sprinklers.

Methods Using the National Fire Information Database (NFID), 2005 to 2015, a retrospective analysis was conducted to describe the relationship between residential fire protection features, and injury and death rates among children ≤19 years old within the Canadian provinces of British Columbia, Alberta, Saskatchewan, Manitoba, and Ontario. Rates of injury and death per 10,000 fires were calculated and compared.

Results Structures with a working smoke alarm were associated with lower death rates and higher injury rates, compared to those with no smoke alarms (7.2 vs 12.9, and 87.5 vs 34.5, respectively). Inactive smoke alarms were associated with the highest rates of death and injury (19.8 and 94.2, respectively). Structures with sprinkler protection were associated with no deaths and few injuries.

Discussion The presence of activated smoke alarms and sprinklers were associated with low rates of death among children. While sprinklers appeared to be particularly effective, the presence of smoke alarms – activated or not – was associated with higher rates of injuries when compared with no smoke alarms. Smoke alarms reduced the risk of death, however their effectiveness has been debated in the literature, as children do not consistently respond appropriately to an activated smoke alarm. Sprinklers do not require children to respond; therefore, a combination of smoke alarms and sprinklers may offer the most protection for children. Maintenance of smoke alarms through regular testing, mandating sprinklers in new buildings, as well as promoting child knowledge in fire prevention and fire safety, may help to address the burden of fire-related injury and death among Canadian children.