Child Pedestrian Injuries Report 2007 - 2008 Increased pedestrian numbers actually heighten driver awareness, which results in slower rates of speed and fewer child pedestrian injuries.
Safe Kids Canada Child Pedestrian Injuries 2 About Safe Kids Canada Why focus on child pedestrian injuries? Safe Kids Canada is the national injury prevention program Walking is usually a child’s first means of independent of The Hospital for Sick Children.As a national leader, transportation, which makes children particularly vulnerable Safe Kids Canada promotes effective strategies to prevent to pedestrian injuries.The level of danger posed by traffic unintentional injuries, the leading cause of death among exceeds children’s overall cognitive, physical, sensory and children in Canada. By building partnerships and using auditory development.This danger is exacerbated by their a comprehensive approach, we advance safety and reduce small stature, lower eye level and the need to look up and the physical, financial and emotional burden of injuries over vehicles. Obstructions also limit children’s field of on Canada’s children and their families. Our strength vision, decreasing their perception and ability to deal with is that of knowledge broker, turning research into action, oncoming traffic. by providing credible programs and messages. A neighbourhood’s environment and traffic flow contribute Safe Kids Canada works with more than 2,300 partners greatly to the frequency and severity of pedestrian-related across the country to conduct research, raise awareness, crashes. Children are more likely to be struck by a car in educate families and advocate for safer environments areas with heavy traffic volumes, a high density of parked to protect children from injury. Safe Kids Canada is also cars, higher speed limits, and limited choices for play, such part of Safe Kids Worldwide, a global movement to as available green space. prevent childhood injury. Despite the fact that during the past decade the number of 180 Dundas Street West,Suite 2105 child pedestrian deaths and injuries has declined, Toronto, Ontario M5G 1Z8 international research indicates that a major factor for this reduction is that children are walking less.1 Children are www.safekidscanada.ca still considered to be at greater risk of pedestrian injuries 1-888-SAFE-TIP (1-888-723-3847) due to the increased speed and volume of traffic, coupled with their developing cognitive abilities. Report methodology This report is based on an extensive literature review of Many Canadian communities are taking an interest in active national and international academic sources, in addition living to promote good health, in addition to supporting to data from Transport Canada, Statistics Canada and the the environment by leaving the car in the driveway more Canadian Institute for Health Information. often.This may subsequently lead to a renewed family enthusiasm for walking to school. It is vital to encourage parents and caregivers to talk to children about pedestrian safety during these walks, and it is equally important to create more walkable communities that promote safe, pedestrian-friendly environments. Increased pedestrian numbers actually heighten driver awareness, which results in slower rates of speed and fewer child pedestrian injuries.
3 Child Pedestrian Injuries Safe Kids Canada Key facts and statistics Figure 2. Transport Canada: 2000-2004 Average annual • Child pedestrian injuries are a leading cause of injury- pedestrian injuries by age related death for Canadian children aged 14 years or younger. 1400
• Pedestrian-related injuries contribute almost 15 per cent 1200 of all injury-related deaths of children younger than 14 years.2 1000 • On average, 30 child pedestrians younger than 14 years 800 are killed and 2,412 are injured every year.3,4
• Children aged 10 to 14 years have the highest risk Injuries 600 of pedestrian injuries and deaths.5,6 400
Figure 1. Transport Canada: 2000-2004 Average annual 200 pedestrian fatalities by age 0 14 0-4 5-9 10-14 Age group (years) 12
10
8
6 Average
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0 0-4 5-9 10-14 Children are more likely to be struck by a car in Age group (years) areas with heavy traffic volumes, a high density of parked cars, higher speed limits, and limited choices for play, such as available green space.
Safe Kids Canada Child Pedestrian Injuries 4 Figure 3. Canadian Institute for Health Information (CIHI): Diagnoses of pedestrian injuries by injury type
3500
3000
2500
2000
1500
1000
500
0 Other Crush sprains Internal Fracture Strains & superficial Dislocation Contusion/ Unspecified Open wound Injury type (includes deaths and injuries)
• A child pedestrian is most likely to suffer injuries to When children are struck by vehicles, their injuries are the lower extremities from hip to toe (34 per cent), often life threatening or cause permanent physical damage. a traumatic brain injury (25 per cent) and injuries to Children of different ages are at risk for different types of the torso (10 per cent).7 injuries because of the child’s physical stature. In children • Fracture is the most common type of injury and the between 10 to 14 years of age, serious injuries occur most common body area injured is from hip to toe. because the body’s center of gravity tends to be above the bumper of the vehicle.The collisions cause three distinct • Internal damage (injury to lungs, liver and spleen) is impacts: the first point of contact is with the leg on the the most common cause of death. bumper, the second point of contact is between the thigh • Traumatic injury to the brain is the most common on the edge of the hood and the third contact is with the body region injured that caused death. head and shoulders on the hood and windshield.As the • Overall, lower extremity injuries occur more frequently vehicle’s speed increases, so does the force of these than upper extremity injuries.8 impacts.At high speeds, the increased momentum forces • More than half of all child pedestrian deaths and most the legs to rotate above the head before falling back onto injuries (95 per cent) happen in urban areas.9* the hood, and at even greater speeds, the child somersaults into the windshield or roof.10
* Note: Transport Canada defines urban as: (a) metropolitan roads and streets and other urban areas, or (b) a speed limit at the collision site of 60 km/hr or less Rural includes: (a) primary or secondary highways, as well as local roads, or (b) a speed limit at the collision site exceeding 60 km/hr. Note that in Alberta and Saskatchewan, urban includes any area within the corporate boundaries of a city,town, village or hamlet. Rural includes any area outside of what is defined as “urban”.
5 Child Pedestrian Injuries Safe Kids Canada In children nine years of age and younger, the centre of Table 2. Transport Canada: Percentage of pedestrian fatalities gravity is often below the bumper, so that the child’s chest by striking vehicle or head is the first point of contact with the bumper, rather than the legs.The child is then vaulted away from Vehicle Percentage of fatalities the vehicle, which results in a second impact as the Passenger cars 57 child hits the ground.At slightly slower speeds, it is more Light trucks & vans 25 likely that the child will not fall far from the vehicle, Heavy trucks 10 which increases the risk of the child being run over.11 Bus 3 Table 1. Transport Canada: 1995-2004 Pedestrian fatalities Other 5 by pedestrian action Passenger vehicles are most often the type of vehicle that injures or kills child pedestrians, followed by light trucks Pedestrian action Age 0-14 (including SUVs) and vans.13 In addition, the highest Intersection 114 number of child pedestrian injuries and deaths occur in Walk with traffic 23 areas where the posted speed limit is 50 km/hr.14 Running into road 59 Safety zone 8 Table 3. Transport Canada: 2004 Pedestrian injury rate Between intersections 6 of children age 0-19 years by province Walk against traffic 7 Play/work on roadway 37 Province Injury rate (/100,000) From behind parked cars 21 Quebec 48.2 Other actions 71 British Columbia 46.5 Unknown 35 Yukon 44.9 Total 381 Manitoba 39.1 Nunavut 37.2 Twenty-nine per cent of child pedestrians younger than Alberta 37.1 14 years of age were killed crossing at intersections Ontario 36.4 with no traffic control, 15 per cent were running on to Nova Scotia 28.9 the road and 10 per cent were playing on the road. Saskatchewan 28.3 The most frequently reported child pedestrian action NWT 25.7 that led to injury or death is crossing at an intersection Newfoundland 24.0 followed by running onto the road.12 New Brunswick 19.3 P.E.I. 17.4
In 2004, Quebec had the highest child pedestrian injury rate for children younger than 19 years of age, followed by British Columbia and the Yukon. In Canada the overall child pedestrian injury rate was 39.5/100,000.
Safe Kids Canada Child Pedestrian Injuries 6 Risk Factors Before 11 years of age, children also have a difficult time Children judging vehicle speed18 or even their own walking speed. Children are particularly vulnerable to pedestrian injuries Pre-school children may say,“I’m as fast as a jet” and really because they are exposed to traffic threats that exceed their believe it. Children younger than eight years of age also cognitive, physical, sensory and auditory development, tend to think that smaller cars travel faster than larger cars. and generally, boys are statistically more at risk than girls To judge speed, children need to be able to classify and for all injuries.15 judge a vehicle’s size relative to other objects.19 Detecting traffic requires a search strategy and this is not a reliable When crossing the street, children have to undertake skill until children reach approximately 11 years of age.20 complex behaviours that put them at risk for injury. To compound this lack of judgement, both pre-school and Crossing involves planning the route, detecting traffic, school-aged children are egocentric and as a result, they making assessments about the speed and distance of traffic, find it hard to believe that a driver would not be aware and deciding when to cross. Crossing skills involve both of them.21 motor skills and continuous feedback about decisions.16 In addition, young children can struggle with recognizing a safe gap in traffic in order to cross the street. Several studies have illustrated that children younger than six years of age Reducing vehicle speed has been proven to be make errors both in identifying too short a gap and in missing appropriate opportunities for crossing.22 One study effective in preventing crashes and reducing the demonstrated that five-year-olds missed more chances to severity of injuries. cross than adults when they had a comparable number of short gaps.23 The ability to scan is poorly developed in children younger than six years of age, however, children between six and seven years of age can begin to learn Children under 11 years of age planned systematic searches. Nevertheless, it is important to Children in this age range have vision and hearing that is note that this function is not well developed until not yet fully developed. Even though visual acuity is well approximately 11 years of age.24 developed by six months of age, young children often have As a result of all of these factors, a five-year-old child will tunnel vision and their short stature and lower eye level take twice as long as an adult to make a crossing decision.25 further limit their view. Children between three and six And for any young child decisions are based on distorted years of age may be able to match colours but not perceptions, and incomplete cognitive tools as a result of the necessarily identify them properly and this may be an child’s developmental level. important consideration when teaching young children about traffic signals. In addition, six-year-olds are Children aged 11 to 14 years substantially less able to detect the direction of traffic.17 By the time children reach 11 years of age, they are Young children in general often favour the most direct beginning to utilize abstract thought, which means that route available, rather than seeking the safest place they have the ability to combine a number of ideas to form to cross.As a result, they will cross in the middle of the a new concept.This ability is used when one set of rules block, at right angles to the curb, or diagonally across is applied to multiple and varied situations. It is not obvious an intersection. to children younger than 11 years of age that the pedestrian In order to cross a street independently AND safely, children safety rules used on one street corner can be applied to need three important skills that are typically NOT acquired all street corners, but older children are capable of until between 9 and 11 years of age: understanding and applying this concept. However, it is 1 The ability to determine and use a safe crossing not unusual for pre-teens and teens to harbour exaggerated pathway beliefs about their abilities and embrace an attitude of 2 The capability to realistically assess a vehicle’s speed invincibility, which can lead to increased risk-taking. For 3 The cognitive means to judge safe gaps in traffic these children, an unhappy ending to their personal story is inconceivable.26
7 Child Pedestrian Injuries Safe Kids Canada In order to cross a street independently AND 1 The ability to determine and use a safe crossing safely, children need three important skills that pathway are typically NOT acquired until between 9 and 2 The capability to realistically assess a vehicle’s speed 11 years of age: 3 The cognitive means to judge safe gaps in traffic
Safe Kids Canada Child Pedestrian Injuries 8 Socio-economic factors Parents expressed a strong concern about the environment One 2008 study reported that children who live in in which their children walk.38 They identified speeding, neighbourhoods which they view as unsafe, are aware of safe increased volume of traffic, drivers not being aware of traffic behaviours but may not adhere to them because of children playing, children’s risk-taking behaviours, increased the environment.27 Children in such neighbourhoods report crime, and unpleasant walking environments as perceived adopting distinct walking behaviours in order to avoid risks in their neighbourhoods.39,40 Parents also believe that social risks. For example, they reported traveling quickly, children resort to playing in the street due to the lack of avoiding eye contact and crossing streets randomly to accessible and affordable alternatives, and that existing public avoid troubled areas or large groups of people.28 All of these spaces are ill-equipped and poorly maintained.41 behaviours and distractions could leave them more Parents have expressed a willingness to participate in susceptible to pedestrian injuries. strategies to reduce the risk of child pedestrian injuries.42 Another study found that ethnicity and socio-economic If parents perceive a high risk of injury, they are more likely status may factor into route selection, as research to spend time attending a meeting or to volunteer for consistently shows that children both from lower income a safety program.43 Neighbourhood solidarity or feeling a families and ethnic minority backgrounds experience sense of connection to the neighbourhood was the best higher pedestrian injury rates. Growing up in an urban predictor of parents’ willingness to make changes to improve neighbourhood with higher traffic volumes and with few child pedestrian safety.44 safe places to play may result in fewer opportunities to learn safe crossing behaviours.29 Environment Traffic environments contribute greatly to the frequency Parents’ knowledge, attitudes, and behaviours and severity of pedestrian-related crashes. Children are more Many parents view injuries as a natural consequence of likely to be struck by a car in areas with heavy traffic childhood and although most parents do report teaching volumes, a high density of parked cars, higher speed limits, their children pedestrian safety, one study of more and limited choices for play, such as a neighbourhood than 700 parents found that only 16 per cent knew basic park. Lower income neighborhoods, particularly urban ones, pedestrian safety facts.30,31,32,33 have also been shown to present a higher risk for child pedestrian injuries.45,46 Even when parents have the correct knowledge, they do not always use it. For example, approximately 25 per cent Drivers of the parents in high-risk neighbourhoods who knew There is a direct correlation between an increase in vehicle that children younger than 10 years could not safely cross speeds and the increase of the risk of injury. It is estimated the street, allowed them to do so anyway.34 that a pedestrian struck by a car travelling at 50 km/hr is Studies demonstrate that even brief teaching by parents eight times more likely to be killed than a pedestrian struck can improve child pedestrian safety35 and when adults at 30 km/hr.47 Even small reductions in speed can be accompany children to and from school there is a significant. For each 1.6 km reduction in average speed, demonstrated reduction to the risk of injury.36 However, collision frequency is reduced by five per cent.48 Reducing research has shown that parents do not generally take vehicle speed has been proven to be effective in preventing advantage of teaching opportunities when they are crashes and reducing the severity of injuries. crossing the road with their child, and neither parents Speeding is common in Canada.According to the Traffic nor children alter their road crossing behaviour as the child Injury Research Foundation, about 2.7 million Canadians gets older.37 Most parents do not raise the subject of admit to habitually driving well over the speed limit; how to cross streets with increased independence, as might 2 million admit to frequently accelerating to get through be developmentally appropriate. a traffic light; and about 670,000 say they take risks while driving, just for the fun of it.49
9 Child Pedestrian Injuries Safe Kids Canada In a Transport Canada study on driver behaviours and able to co-exist with relative safety which means that drivers attitudes towards speeding, seven out of 10 drivers admit to have sufficient time to stop for pedestrians, and pedestrians exceeding the speed limit, at least occasionally.The average can make better crossing decisions. Lower traffic volumes can increase over the speed limit was 12 km on highways, 10 km also result in a reduction of pedestrian injuries. on two lane highways and seven km on residential streets. Remind drivers when they are speeding Many people believe that they are not technically speeding at these rates and that they are not endangering themselves or Mechanisms that alert drivers when they are speeding can others.50 It is significant that drivers are unable to accurately be very useful.According to Transport Canada, 72 per cent assess their own speed while they are driving and, as a of Canadian drivers supported the idea of roadside warning 54 consequence, make few adjustments in the presence of signs to tell drivers when they are speeding. children.They continue to drive in excess of posted speed Speed cameras limits.51 Drivers who were involved in a crash with a child Research has demonstrated that using a combination of pedestrian were statistically more likely to be males between speed cameras and fines can enforce speed limits in 52 the ages of 17 to 20 or 31 to 40. residential areas and school zones. One study illustrated that the proportion of vehicles travelling more than 10 km over the speed limit actually dropped by 70 per cent.55 What can be done to make Canada safer for 2 Encourage guided practice to teach children pedestrian safety child pedestrians? Parents and caregivers should use guided practice to instil In order to create safer communities for child pedestrians, safety awareness and safe pedestrian habits in young children. societal attitudes must be changed to embrace a perspective This can be accomplished by talking with children about that acknowledges and respects the rights of pedestrians, pedestrian safety as soon as they start walking with them, strives to make environments safer, and increases the and continuing to do so at least until the early teenage years. knowledge, skills and practices of children and their parents It is crucial that adults create opportunities for discussion and caregivers. by accompanying children on walks, especially since the 1 Reduce driver speed simple presence of parents or caregivers may help reduce 2 Encourage guided practice to teach child the risk of injury.56 pedestrian safety Discussions and demonstrations addressing safe crossing 3 Make communities more walkable behaviours, in a variety of situations, will enable children to make more independent – and correct – decisions about road crossings and safe pedestrian travel in general.
1 Reduce driver speed Many opportunities can arise for discussing pedestrian safety Research on speed limit reductions in countries such as with children. Here are just a few: South Africa, Belgium, Finland, France, Germany, New • When weather conditions change (e.g. snow, fog, Zealand, United Kingdom and the United States, have sleet, rain) demonstrated that when a speed limit was reduced, road • When taking, or deciding on, a new route to school crashes decreased from eight to 40 per cent.53 or the playground Reduce traffic speeds • When visiting a new place At speeds greater than 40 km/hr, both drivers and pedestrians • When moving to a new neighbourhood have an increased potential for making mistakes in judging • When it’s a child’s first time walking with friends the time required to stop or cross the street safely, • When it’s a child’s first time walking alone compounded by a drivers tendency to underestimate their speed.At a speed of 30 km/hr, vehicles and pedestrians are • When witnessing jaywalking or other unsafe pedestrian practices
Safe Kids Canada Child Pedestrian Injuries 10 Child pedestrian education needs to be based on children’s 1 DiGuiseppi C., Roberts I., Li L., Influence of changing travel patterns on child death rates from injury: Trends analysis. BMJ 1997; 314:710-713. development in order to be useful. Because cognitive 2, 3 Statistics Canada. Vital Statistics Registry 2004. abilities and perceptions change dramatically from age seven 4, 5, 9, 12, 13, 14 Transport Canada Road Safety's Traffic Accident Information to 14 years, educational and parental approaches must also Database (TRAID) 2007. 6, 7, 8 Canadian Institute of Health Information 2003. Note: This data excludes the evolve in order to reflect the child’s developmental growth. provinces of Manitoba and Quebec. 10, 11 Chakravarthy B., Vaca F.E., Lotfipour S., Bradley D. Pediatric Pedestrian Injuries, 3 Make communities more walkable Emergency Care Consideration. Pediatric Emergency Care 2007; 23(10):738-744. 15 Safe Kids Canada. Child & Youth Unintentional Injury: 10 Years in Review 1994- Studies have shown that when there are more people 2003, 2006. walking, pedestrian injuries are less likely to occur. It appears 16, 17, 19, 20, 21, 22, 24, 25 Schieber R.A., Thompson N.J. Developmental risk factors for childhood pedestrian injuries. Injury Prevention 1996; (2):228-236. that motorists unconsciously adjust their driving behaviour 18 Hoffmann E.R., Payne A., Prescott S. Children’s estimates of vehicle approach time. in response to increased numbers of pedestrians.57 Human Factors 1980; 22(2):235-224. Walkable neighbourhoods also promote health benefits to 23 Demetre J.D., Kee D.N., Pitcairn T.K., Grieve R., Thomson J.A., Ampofo-Boateng K. Errors in young children’s decisions about traffic gaps: Experiments with roadside the community’s residents, in addition to reducing simulations. British Journal of Psychology 1992; 83:180-202. environmental pollution from vehicles.58 26 Goswami, Usha [editor]. Blackwell Handbook of Childhood Cognitive Development 2004. Since wider roads entice drivers to travel at greater speeds, 27, 28, 31, 38 Safe Kids Worldwide. Walk a Mile in Their Shoes 2006 Oct. changes in how streets are constructed, such as building 29 Barton B.K., Schwebel D.C. The influences of demographics and individual differences on children’s selection of risky pedestrian routes. Journal of Pediatric narrower streets, can support speed reduction.59 Refuge Psychology 2007; 32(3):343-353. islands and medians can assist pedestrians by allowing a 30 Morrongiello B.A., Dayler L. A community-based study of parents’ knowledge, attitudes and beliefs related to childhood injuries. Canadian Journal of Public Health staged crossing and simplifying decision-making. Curb 1996; 87(6):383-388. extensions can also improve pedestrian safety by reducing 32, 33, 34, 40 Gielen A.C., DeFrancesco S., Bishai D., Mahoney P., Ho S., Guyer B. the crossing distance, the area, and the time in which the Children Pedestrians: The role of parental beliefs and practices in promoting safe walking in urban neighborhoods. Journal of Urban Health 2004; 81(4):545-555. pedestrian is at risk.This is helpful for children who often 35 Barton B.K., Schwebel D.C., Morrongiello B.A. Brief Report: Increasing children’s safe have difficulty choosing a safe gap in traffic at a conventional pedestrian behaviors through simple skills training, Journal of Pediatric Psychology crossing point.60 Existing streets have the potential for 2007; 32(4):475-480. 36, 56 Roberts I. Adult accompaniment and the risk of pedestrian injury on the school- modifications that reflect these traffic-calming elements. home journey. Injury Prevention 1995; (1):242-244. 37 Zeedyk M., Kelly L. Behavioural observations of adult-child pairs in pedestrian crossings. Accident Analysis and Prevention 2003; 35:771-776. 39, 41 Christie N., Ward H., Kimberlee R., Towner E., Sleney J. Understanding high traffic injury risk for children in low socioeconomic areas: A qualitative study of parents’ views. Injury Prevention 2007; Oct(13):394-397. It is crucial that adults create opportunities for 42, 43, 44 Bishai D., Mahoney P., Defrancesco, S., Guyer B., Gielen A.C. How willing are parents to improve pedestrian safety in their community? Journal of Epidemiology discussion by accompanying children on walks, and Community Health 2003; 57:951-955. 45 Robert I., Norton R., Jackson R., Dunn R., Hassall I. Effect of environmental factors especially since the simple presence of parents on risk of injury of child pedestrians by motor vehicles: A case-control study. Injury Prevention 1995; Jan 310:91-94. or caregivers may help reduce the risk of injury. 46 Stevenson M.R., Jamrozik K.D., Spittle J. A Case-Control Study of Traffic Risk Factors and Child Pedestrian Injury. International Journal of Epidemiology 1995; Mar Vol 24(5):957-964. 47 Pasanen E., Salminvaara H. Driving Speeds and Pedestrian Safety in the City of Helsinki. Traffic Injury and Control 1993; 34(6):308-310. Canadian communities can create more walkable, 48 UK Department of Road Safety.
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