ORIGINAL RESEARCH

Kite flying: Ancient tradition or death trap?Suvir SINGH,1 Nitin James PETERS,2 Clarence SAMUEL,3 William BHATTI1 and Dhruv Nath GHOSH1

1Department of Pediatric Surgery, Christian Medical College and Hospital, Ludhiana, India, 2Department of Surgery, Christian Medical Collegeand Hospital, Ludhiana, India, and 3Department of Community Medicine, Christian Medical College and Hospital, Ludhiana, India

AbstractBackground: Kite flying has beenpopular in India since ancient times,especially during harvest festivals ofLohri, Basant and Makar Sankranti.It often takes form of a competitivesport and in recent times has been as-sociated with multiple, sometimes fatalinjuries. This prognostic study wasconducted to try and understand theepidemiology and factors associatedwith kite flying injuries in the state ofPunjab, India.Methods: Case reports of patients whopresented to the ED with trauma as aresult of kite flying were reviewed. Thestudy included patients reporting to theChristian Medical College, Ludhiana,between January 2005 and January2010. Details of the type and mode ofinjury, and outcomes were recorded.Results: The highest incidence of in-juries occurred during months of thekite flying festivals. The most commonmode of injury was fall from heights,associated with traumatic brain injury.The mortality rate in this series was6.25%.Conclusions: This study highlights theimportance of kite flying injuries as acommon mode of injury in childrenand adolescents. It is an easily pre-ventable mode of injury with simplesafety regulations and possibly strong-er legislation.

Key words: children, injury, kites,prevention.

IntroductionKite flying has been a popular sportin India since ancient times. It is be-lieved to be introduced by Chinesetravellers, Fa Hien and Hiuen Tsangin 600 AD. Kite flying as a traditionhas evolved and modified a lot sincethen. The royals of Lucknow arefamed for flying kites with a goldenthread attached, as an incentive forpeople to cut them. Kites have evolvedfrom fancy cloth toys for the royaltyto a national pastime made from tissuepaper and bamboo; from a celebra-tory event to an intensely competi-tive sport. Children are often foundrunning after kites, running over roof-tops, and trying to frantically ‘cut’ eachother’s kites with the use of sharpglass-covered abrasive thread calledmanja. It is a sport as common as anyother, which often marks a number oflocal festivals and the end of winter inmany parts of this country.

However, kite flying is being recog-nised as a significant mode of injuryamong young children. Apart from theinevitable minor falls and cuts, it is in-creasingly being found to cause manyserious and often fatal injuries. Theseinjuries cover a wide range, from elec-trical accidents, head injuries, blunt ab-dominal trauma and incised woundscaused by manja. Children who flykites and bystanders are equally af-fected. Tiwari and Sharma in 1999looked at burn injuries in children,over 50% of the subjects had kite

flying as the common denominator inurban India.1

Due to the widespread popularity ofthis sport in India, paediatric traumadue to kite flying is a problem ofsignificant proportions. Recently,over 48 lives were lost within 24 hduring Makar Sakranti in Ahmedabad,many of which involved innocentbystanders.2

We conducted this study to evalu-ate the morbidity and mortality asso-ciated with paediatric kite flyinginjuries received in a tertiary care hos-pital in Punjab, India. We attemptedto evaluate the factors associated withcausation, severity and determinantsof outcome, if any. At the outset, thisstudy was meant to be an eye openerto the significance of this mode ofinjury, so that larger, prospective,population-based surveys might becarried out.

MethodsThe study was conducted in the ED ofthe Christian Medical College andHospital, Ludhiana, India. All paedi-atric trauma records from June 2005to July 2010 were analysed after in-stitutional review board approval.

A total of 64 trauma cases had in-juries directly associated with kiteflying. These were further described interms of age group, mode, type and se-verity of injury, treatment given andsequelae.

Correspondence: Dr Nitin James Peters, Department of Surgery, Christian Medical Collegeand Hospital, Ludhiana 141008, India. Email: nitinjamespeters@yahoo.com

Suvir Singh, MBBS, House Surgeon; Nitin James Peters, MBBS, MS, Assistant Profes-sor; Clarence Samuel, MBBS, MD, Assistant Professor; William Bhatti, MBBS, MS, MCh,Professor and Head; Dhruv Nath Ghosh, MBBS, MS, MCh, Associate Professor.

Accepted 4 July 2014

Key findings• Significant incidence of injuries

related to kite flying in children.• Unsupervised sport and un-

planned urbanization key factor.• High mortality of 6.25% asso-

ciated with the sport.

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Emergency Medicine Australasia (2014) 26, 478–480 doi: 10.1111/1742-6723.12270

© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine

The records were also studied for in-vestigations done, surgical procedurescarried out, and the cost and length ofhospital stay. The relation of thevarious factors noted above was evalu-ated with the type and severity ofinjuries.

The data were analysed using de-scriptive statistical methods.

ResultsSixty-four cases were enrolled in thestudy. They were classified accordingto age, gender and mode of injury. Theinjuries were further characterised ac-cording to mode and type.

The demographic data of the pa-tients is listed in Table 1. The major-ity of subjects (87.5%) were male, andmost of the subjects were from urbanareas (85.9%). The most common agegroup affected by kite flying injurieswas in the 5–10 year age group, com-prising of 59% (n = 38) patients. Theincidents were highest in January co-inciding with various festivals. Thirty-eight (59%) patients requiredadmission to the hospital. Fourteen(21%) had minor injuries and wereprescribed from the emergency room,seven (10.9%) patients did not agreefor further treatment and left againstmedical advice. The mortality rate inthe admitted patients was 7.8% (n =5), one patient had succumbed tosevere burn injury (Fig. 1), whereas therest succumbed to severe traumaticbrain injury. The most common modeof injury was fall from heights (89%).Neurological injuries were the largestgroup (64.1%) followed by head andneck injuries (15.6%), which includ-

ed lacerations, soft tissue injuries withthe manja, and maxillo-facial inju-ries and did not have a component ofneurological injury. Limb injuries con-stituted 20.3% of the injuries and theremaining 14% had more than onesystem involved. These included fivepatients of neurological injuries andlimb injuries combined. Three pa-tients had abdominal and limb injury

and one had neurological and abdomi-nal injury (Table 2).

Surgical intervention was requiredin 18 patients, of whom three under-went craniotomy, five fracture fixa-tion and 10 patients required suturingof lacerated wounds. Analysis of thehospitalisation costs included a meanexpenditure of INR 10 174.5/-.The younger children in the age group

Figure 1. Third degree electric contact burns on chest and upper abdomen.

TABLE 1. Demographic profileof patients

Gender n (64)Male 56 (87.5%)Female 8 (12.5%)

Age group (years) n (64)1–5 14 (21.8%)5–10 38 (59.3%)>10 12 (18.7%)

Month n (64)January 39 (60.9%)December 13 (20.3%)Others 12 (18.7%)

TABLE 2. Mode, type and outcome of injury

Mode of injury n (64)Fall <3 meters 33 (51.5%)>3 meters 24 (37.5%) Total fall injuries (89%)Manjha 2 (3.1%)Assault 2 (3.1%)Electric 3 (4.6%)

Type of injury n (64)Neurological 41 (64.1%)Head and Neck 10 (15.6%)Limb 13 (20.3%)Multiple 9 (14%)

Outcome n (64)Admitted 38 (59.3%)LAMA† 7 (10.9%)Prescribed from ED 14 (21.8%)Mortality 5 (7.8%)

†Left against medical advice.

INJURIES DURING KITE FLYING 479

© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine

1–5 years acquired higher bills com-mensurate with the prolonged hospi-tal stay and greater requirement ofhospitalisation.

DiscussionKite flying injuries are a common modeof seasonal injuries in the paediatricage group in our country. They are as-sociated with significant morbidity andmortality, more so with the wide-spread popularity of this sport in India,which spans all economic, social andcultural groups.

The profile of the patient most likelyto be affected, as described by ourstudy is a male, 5–10 years old, pre-senting with a fall from heights. Thisis probably because children less than5 years of age are usually supervisedby parents, and more than 10 years aremore aware of dangers involved. Notmany studies have been performed spe-cifically describing these injuries, butlarge surveys of paediatric trauma ingeneral have been published, whichhelp to draw parallel with kite flyinginjuries. In a large retrospective studyby Tandon et al. in 1993, over 14%of paediatric admissions were foundto be due to trauma. The mostcommon mode of injury reported wasfall from heights.3

The alarming factor was that over50% of cases had poorly protectedroofs (23%), poor lighting, bad stateof roads and houses opening directlyon the streets, which contributed to theoccurrence of injuries. Falls were alsothe most common mode of injury inanother study conducted by Sehgalet al. in 2004, ranging from 50% inrural households to 80% in urban.More than 60% of the households hadno protection on the stairs and roofs.4

Similar factors could be present incase of kite flying injuries, the major-ity of which consist of falls fromheights, as described in our study. Thisis significant because 80% of thedeaths in our study were caused dueto head injuries from falls.

There were slight differences in thecost of hospitalisation and duration of

stay when the mode of injury wascompared among groups. None ofthese differences were statistically sig-nificant, but a difference of 1–2 daysof admission seemed to have greatersocial and economic impact on the lifeof an affected family.

This highlights the importance ofeducation and prevention in injuriesduring childhood. The awareness ofparents regarding various preventivemethods has been shown to be vari-able and dependent on the parents’education and profession. The aware-ness level was shown to range 10–25%.4

The use of protected roofs, guardrails on stairs, well-insulated electri-cal wiring and parental supervisionduring play would help to mitigate therisk factors described above. Recog-nising this, a campaign was initiatedby the Indian Academy of Paediat-rics, calling for injury prevention inchildren and adolescents through edu-cation and parental involvement.5

Attempts towards legislation weretried in Pakistan in 2003, followingover a dozen cut throat wounds as aresult of sharp thread (manja) used inkite flying. It culminated in a ban, withpossible homicide charges against theoffenders. In 2006, over 500 peoplewere detained for not complying withthe ban.6

Recognising the underlying factorsand implementation of strong preven-tive measures such as specific areas andguidelines for kite flying would go along way in reducing morbidity andpreventing childhood mortality fromthis ancient tradition. The aim of thisstudy is not to unequivocally show sig-nificance of factors associated with kiteflying injuries in children. A more im-portant message is to highlight thismode of injury as a hitherto unrecog-nised form of danger to young chil-dren. Sporadic efforts have been madetowards attempts to reduce the mor-tality and morbidity associated withthese injuries, and such reports shouldhelp to draw attention towards kiteflying as a preventable source of child-hood injuries.

Author contributions

SS: definition of intellectual content,literature search, clinical study, data ac-quisition, data analysis, manuscriptpreparation; NJP: concepts, defini-tion of intellectual content, literaturesearch, clinical study, data acquisi-tion, data analysis, manuscript prepa-ration, manuscript editing, manuscriptreview, guarantor; CS: design, defini-tion of intellectual content, data analy-sis, statistical analysis, manuscriptediting, manuscript review; WB: con-cepts, data acquisition, manuscriptediting, manuscript review; DNG: con-cepts, design, definition of intellec-tual content, data analysis, manuscriptpreparation, manuscript editing, manu-script review.

Competing interests

None declared.

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3. Tandon JN, Kalra A, Kalra K, SahuSC, Nigam CB, Qureshi GU. Profile ofaccidents in children. Indian Pediatr.1993; 30: 765–9.

4. Sehgal A, Jain S, Jyothi MC. Paren-tal awareness regarding childhoodinjuries. Indian J. Pediatr. 2004; 71:125–8.

5. Adhikari KM, Vishwanath G. The kiteof joy and the plight of a boy: whencelebration ends up in amputation.Indian Pediatr. 2009; 46: 445.

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