Arch Dis Child: first published as 10.1136/adc.53.10.807 on 1 October 1978. Downloaded from Archives of Disease in Childhood, 1978, 53, 807-813 Current topics Hazards to children in traffic A paediatrician looks at road accidents R. H. JACKSON From the Royal Victoria Infirmary, Newcastle upon Tyne SUMMARY An overall view is presented of the hazards to children in traffic. The importance of the developmental aspects of childhood accidents is stressed, and a plea is made for doctors working with children to recognise the part they could play in reducing the number of road accidents to children by their understanding of child development and behaviour. It is an aspect of preventive paediatrics that is largely neglected at present. Whether they are measured in terms of mortality or Table 1 Total and accidental deaths by age groups morbidity, accidents are one of the most important and years problems of child health today. The facts are clear Age group Deaths 1951 1966 1971 1974 and incontrovertible: they are the commonest single copyright. 1-4 Total 4133 2662 2204 1922 cause of death between ages 1 and 15, account for Accident 583 605 617 447 one-fifth of all hospital admissions in that age group, (%) 14.1 22.7 27.9 22-25 result in about one-third of all attendances at 5-9 Total 1771 1320 1484 1225 Accident 565 473 552 442 accident and emergency departments, and bring one (%) 31.9 33.1 37.2 36.1 in 6 of all the children in our cities to their local 10-14 Total 1328 1186 1109 1091 Accident 323 364 439 468 accident and emergency department in any single (%) 24-3 30-7 39-5 42-8 year. Yet doctors, whether they are working in the fields of primary care, community medicine, or From The Registrar General. http://adc.bmj.com/ hospital-based paediatrics, take little notice of accidents, and I believe those who deal with children and proportion of deaths caused by accidents has could do more in the preventive field than is being risen. The decrease in the proportion of accidental done at present. Because of the large energy forces deaths in the 1-4 age group is associated with more in a moving vehicle, road accidents cause the greatest accurate certification of the cause of death: certain problem in terms of the severity of injuries, and this children previously categorised as dying from suffocation, etc. are now more properly included in paper aims to give an account of the problem in on September 30, 2021 by guest. Protected terms of mortality and morbidity, and then to the sudden infant death syndrome. analyse the factors from the viewpoints of child In a similar way the proportion of deaths caused growth, development, and behaviour. by road accidents has risen slightly in the last few years, although the total number has fallen, as has Statistics the death rate per 100 000 population (Table 2). This reduction in total numbers should not make Mortality. Table 1 shows the total number of deaths us complacent. In the 7 years, 1968-74, 5354 and the proportion of accidental deaths in 3 different children were killed on the roads: 3756 as pedestrians, age groups during 4 separate years. In the last few 745 as passengers, and 710 as cyclists. Not all these years the total number of deaths from all causes and deaths were due to actual collisions, but children from accidental deaths has fallen in the younger knocked down by cars accounted for 3675 out of age groups, but in the 10-14 group the total number the 3756 pedestrians, collisions between vehicles for 545 out of the 745 passenger deaths, and vehicles Received 15 June 1978 hitting cyclists for 634 out of the 710 cycle deaths. 807 Arch Dis Child: first published as 10.1136/adc.53.10.807 on 1 October 1978. Downloaded from 808 R. H. Jackson Table 2 Total deaths from accidents, and road Table 4 Statistics on road accidents to children in accident deaths by years, in children England and Wales 1976 1967 1976 Killed Seriously Slightly injured injured Total no. Of accident deaths 2194 1306 Pedestrians 405 7461 21072 Of road accident deaths 812 557 Cyclists 102 2022 7937 Percentage of accidental deaths 37 42 Passengers in vehicles 100 1759 10209 due to road accidents Driver or passenger on 2 94 266 Road accident deaths/100 000 population 7-25 5*0 motor bicycle, etc. From Office of Population Censuses and Surveys, 1977. From Royal Society for the Prevention of Accidents, 1978. The suggestion of improvement in the figures is most pronounced in the younger age group, the study of all traffic accidents attending the Battle numbers of deaths in the 10-14 age group remaining Hospital, Reading in the course of a year Grattan virtually unchanged. The 10-year totals show that et al. (1976), from the Transport and Road Research 1185 children were killed in the age group 0-4, Laboratory (TRRL), found that only 32% of cycle 1861 in the 5-9, and 1384 in the 10-14 age group. accidents at all ages had been reported to the police, As may be expected, more boys than girls are and even more significantly, Craft et al. (1973) in a killed-for example, in 1976, 365 boys were killed study of 400 consecutive bicycle accidents to compared with 189 girls. Figures issued recently children in Newcastle, found that only 11% were from the Office of Population Censuses and Surveys known to the police. It is therefore difficult to know have again drawn attention to the striking social how much reliance to place on reports, such as class differentiation both in accidental deaths from leaflet 395 (Transport and Road Research Labora- all causes and road accident deaths (Table 3). tory, 1974b), which reports a study of pedestrian and cycle accidents to schoolchildren in 6 towns Morbidity. Mortality figures are of course accurate, (total population about 784000) collected over 2 but morbidity figures for the total number of years, during which time only 417 bicycle accidents children injured on the roads must be interpreted in were reported. In contrast, the 400 cases of Craft copyright. the light of the means used to obtain them. They are, et al. (1973) were collected in the space of a few in fact, obtained from the police, who make out a weeks from accident and emergency departments. report (Stats. 19) on road accidents that come to Havard (1974) drew attention to this problem of their notice: the constable filling in the form esti- data collection for pedestrian accidents. In his paper mates the degree ofseverity. This has two drawbacks: he stated, 'The first comment to be made is that the firstly, the police can only report on those accidents epidemiological information on child pedestrian of which they are informed-a child who fractures accidents is very inadequate in relation to the size of his skull after coming off his bicycle when he hits a the problem. .. The question must therefore be http://adc.bmj.com/ stone might well not come to their notice at all- asked if the public health authorities are assigning and, secondly, the constable's estimate of severity the right priorities to childhood accidents, having may well be inaccurate. regard to the fact that children are far more liable Figures published by the Department of the to be killed or disabled by accidents, and especially Environment (Table 4) show that in 1976 over road traffic accidents, than by any other cause'. It 11 000 children were seriously injured, nearly 7000 would seem that the best place to collect such data is as pedestrians, and nearly 40 000 were slightly at the accident and emergency (A and E) department on September 30, 2021 by guest. Protected injured, just over half as pedestrians. of the local hospital: there are not likely to be many The validity of these data is particularly question- road accidents of any degree of severity which do able when they relate to bicycle accidents. In a not come either directly to that department or in- directly via the family doctor. This has been receiving Table 3 Death rates (per 100 000 population) by social attention, and to try to bring greater concordance class in age groups, 1959-63 between police and hospital statistics, revised Age group Accident Social class instructions have been of deaths - issued (Department I lI III IV V Transport, 1977). In due course more reliable 1-4 Total 9-5 12-77 16-87 24-00 44-86 figures may therefore become available. Road 2-85 3.87 7-35 9.25 15-80 5-9 Total 6.28 9.73 12-68 16-10 28-90 The child Road 3-61 5-23 7-00 8.08 14-76 10-14 Total 7.36 8.09 9.70 11-23 15-50 Road 2.91 4.03 5.12 5.35 7.30 However, figures themselves do not tell us every- From Office of Population Censuses and Surveys, 1976. thing about accidents. Road accidents, like other Arch Dis Child: first published as 10.1136/adc.53.10.807 on 1 October 1978. Downloaded from Hazards to children in traffic 809 accidents, can be looked at from 3 different aspects: signs: in no age group did all the children under- the child himself, the 'agent' causing the accident- stand even the best understood signs (pedestrian the car, bus, bicycle, etc., and the circumstances crossing and school). The pedestrian crossing surrounding the accident.