Accidents’ Toll on Children Decried
Unintentional childhood injuries claim 250 lives per week and cost the country $14 billion a year in medical care, creating “a steady drumbeat of death and disfigurement” that could largely be prevented, a new report contends.
In a comprehensive review of research on injuries to youngsters, the David and Lucile Packard Foundation found that tens of thousands of children die or are maimed each year because “public outrage is absent” and proven solutions--such as legislation and product modification--go unused or are not enforced.
In California alone, more than 1,100 children died from accidental injuries in 1997, the most recent year studied in the state. By far the most common causes were vehicle and traffic-related incidents, followed by drowning, fires, suffocation, falls and poisoning.
Though unintentional injuries have declined 40% in the past two decades because of safety measures, such incidents remain the leading cause of death among children under 19, according to the Packard report. Accidental injuries kill more youngsters than homicide, suicide, congenital defects, cancer, heart and respiratory illness and HIV combined.
“Despite a plethora of injury-prevention strategies demonstrated to be effective, the implementation of these strategies has lagged far behind their [potential] impact,” according to the foundation report, one of two or three prepared annually by the California-based philanthropy on children’s issues. The national injury statistics in the report are based on 1996 data, the latest available.
Progress is slow because many people in health departments simply are not well-informed or well trained in how to design programs to stem injuries, said Dr. Fred Rivara, the report’s editorial advisor and the former director of the Harbor View Injury Prevention and Research Center at the University of Washington.
“Another factor is just a sense of fatalism,” he said. People “use the word ‘accident,’ as though they are acts of God and can’t be predicted or prevented. . . . There needs to be a mind-shift to thinking of injuries as something that can and should be prevented.”
Dr. David C. Grossman, co-director of the Harbor View Center and a contributor to the report, estimated that up to 31% of childhood deaths could be prevented using technology and other strategies, including the use of car seats, bike helmets and smoke detectors and installing speed bumps on residential streets.
Researchers noted that children in some other developed nations fare far better. For example, the report noted that in 1992, child death rates from unintentional injuries in the United Kingdom were about half those in the United States.
The reason for the disparity, according to the report, is that countries like Britain have made a point of designing safety features into their communities--forcing heavy traffic around residential areas or forcing it to slow down.
Among the more striking findings is that education of parents and children alone is not a particularly effective way to prevent injuries and is “unlikely to lead to major reductions,” even when provided in a doctor’s office.
Researchers said that built-in “passive strategies,” from speed bumps to swimming pools fenced on all sides, often are more appropriate for children because they don’t require repeated, active behavioral changes. Some of the most effective strategies, however, combine an educational message with a passive protection device--wearing a bicycle helmet, for instance.
But the report warns that passive approaches can be ineffective or counterproductive if they are inappropriately tested or used. One of the most dramatic examples is air bags. Although they have substantially reduced adult deaths, they have killed 84 children in the past decade, partly because of inadequate testing with children in mind.
Another common problem is the incorrect use of safety seats. According to the report, a study in Kentucky found that although nearly 80% of children were restrained after a law to that effect was passed, only 20% were restrained properly. The main problems are poor fit, an incompatibility between seat models and vehicles and misunderstanding on the part of users.
A key finding in the Packard report is that legislation and regulations are among the most powerful tools to improve children’s safety. Mandating use of car seats and elevating the drinking age to 21 have saved many lives.
Yet the report notes that many laws are not enforced, have loopholes or are not uniformly adopted in every state. And some people object to high levels of government regulation.
Laws governing car seat use are “a patchwork of different regulations,” and most states do not require proper protection for children between 4 and 8 years old, the report states. Too big for child-safety seats and too small for a regular shoulder-lap belt, these children ought to be restrained in a booster seat, according to the report, but few states require this.
Beyond the human toll in death and injuries, the Packard report noted that the costs in terms of medical treatment and lost productivity are enormous. One researcher concluded that in 1996, the nation spent $14 billion on medical care for injured children and suffered a $66-billion cost in work losses.
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Fatal Childhood Injuries
Thousands of children die each year because proven ways of avoiding accidental injuries go unused or unenforced, according to a new study. Here are some rates of death per 100,000 children in each age group in 1996, the year cited in the study.
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Age Group Causes of Fatal Injury 0-4 5-9 10-14 15-19 Traffic-related: Vehicle occupant 3 2 3 19 Pedestrian 1 1 1 2 Drowning, submersion 3 1 1 2 Residential fire, flames 2 1 1 0.4 Firearm 0.1 0.1 1 1 Suffocation, choking 3 0.3 0.4 0.4 Overall fatal unintentional injury rate 15 8 10 36
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