Objectives. Despite significant advances in automatic garage door open
er design, automatic garage door openers continue to severely injure o
r kill children. In this investigation, we sought to determine the fre
quency and circumstances of accidents that have caused severe injury o
r death to children. We also tried to develop a means by which homeown
ers can evaluate their door openers. Methods. We present the histories
of three children severely injured or killed by automatic garage door
openers. We reviewed national data of similar accidents primarily pub
lished by the US Product Safety Commission and Underwriters Laboratori
es. Also, we evaluated 50 automatic door openers for safety of operati
on. The reversing mechanisms of door openers were tested using a cardi
opulmonary resuscitation mannequin, a roll of paper towels, and a bloc
k of wood. Results. In the United States, at least 85 children have ha
d permanent brain injury or have died since 1974 as a result of accide
nts involving automatic door openers. A review of circumstances of the
accidents illustrates that accidents are caused both by use of the op
eners by children and by faults in design. Most accidents have occurre
d when children have found access to the activation devices and have b
een entrapped under closing doors that failed to reverse. However, in
one case, an adult activated the opener and left the premises before t
he door completely closed. Our evaluation of 50 garage door openers sh
owed that although 88% percent reversed when encountering a block of w
ood, 40% failed to reverse when coming down on a supine, child-sized c
ardiopulmonary resuscitation mannequin. Conclusions. Automatic garage
door openers pose a serious risk of severe injury or death to children
. It is probable that many doors would not reverse if they came down o
n a young child. Therefore, we have devised a way for homeowners to te
st their door openers that closely mimics our evaluations using the ma
nnequin by using a large roll of paper towels. If the door fails to re
verse using this test, we suggest that homeowners disconnect their ope
ners and operate the doors manually until the openers are serviced or
replace their automatic openers with one that meets the latest Underwr
iters Laboratory standards. We also have other recommendations regardi
ng the safe operation of the doors, including improving the safety sta
ndards for openers in apartment complexes. Compliance with these recom
mendations should reduce the number of injuries to children caused by
garage door openers.