We thank Dr Harrell for his comments on our article.1 He is correct in emphasizing our theme of shopping cart redesign as the strategy most likely to result in a significant decrease in shopping cart–related injuries to children. He states that his opinion differs from our comments about the role of the narrow wheel base in these injuries. Dr Harrell's remarks focus narrowly on wheel stance and miss the main thrust of the discussion in the article.
The 2 most common mechanisms of shopping cart–related injury, in order of frequency, are a fall from the cart and cart tip-over. In our study of 62 children treated in the emergency department of Columbus Children's Hospital for shopping cart–related injuries,2 58% of injuries resulted from falls. Twenty-six percent of the children were injured when carts tipped over, and tip-overs accounted for 38% of cart-related injuries to children