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Motor vehicle crashes are associated with one of every five deaths among children 1 to 14 years of age in the United States, and pedestrian injuries account for a third of them. Compared with occupant injuries, pedestrian injuries are more severe; death is five times more likely to occur among those injured. In 1999, 533 child pedestrians were killed, and at least 30,000 children were nonfatally injured in traffic. Another 200 were killed in non-traffic areas, including driveways, sidewalks, and parking lots. Traumatic brain injury accounts for more than half the fatalities.
Dr. Schieber noted that the decline in the child pedestrian death rate over the past several decades may be related more to reduced exposure than to a safer environment or better pedestrian skills. Less walking (a major form of exercise for children) may be partly responsible for the obesity epidemic among American children.
How and where a child is struck greatly depends on the child’s gender and age. Boys are more likely than girls to be injured, though this is more likely due to some inherent factor, rather than any difference in exposure to traffic. Overall, children are more likely to be struck in an urban area on a residential street in the late afternoon or early evening. Walking at night or while drunk are risk factors for adult, but not child, pedestrians. Children are at risk when they dart out at midblock, dash across intersections, and alight from buses. Age is a major determinant, since it largely determines their degree of mobility and independence. Accordingly, solutions are also age-dependent. For example, infants (less than one year old) are pedestrians when they are carried in arms or transported in a stroller so their risk is closely related to the caregiver’s, the locus of control. Toddlers (ages 1 to 2 years) sustain the highest overall number of pedestrian injuries. Small size and limited traffic experience appear to be factors. They are the most likely group to be injured in a non-traffic location, especially during driveway back overs. However, fatality statistics that are traffic-based may underreport these events by as much as 50% in this age group, since driveways and parking lots are not classified as traffic areas.
Preschool-age children (ages 3 to 4 years) and younger elementary school children (ages 5 to 9 years) are most often struck as they enter the roadway at midblock, particularly if cars parked along the side of the road shield them from the view of drivers. According to some, they are at higher risk because their knowledge and key perceptual skills concerning traffic are not yet fully developed. As a child’s age increases, he or she becomes more mobile, has less supervision, and travels further from home independently. Play may divert focus from traffic. As children mature into preadolescents and young adolescents (ages 10 to 14 years), they acquire more experience in a traffic environment. Even so, a greater proportion of these children are injured on relatively busy streets, further from home.
All age groups share certain risk factors. Their parents often have unrealistic expectations of their street-crossing ability. Drivers pose risks such as inattention, speed, risky driving habits, and the use of alcohol and illegal drugs. Other risk factors include the time when school ends, the proximity of school to home, family income, highest parental educational level achieved, employment status, crowding, ethnicity, family stress, and the child’s road environment. Among these, high traffic volume, lower income, and younger age are most strongly related to child pedestrian injury.
There are notable gaps in current surveillance systems used to report pedestrian injuries. In some instances, case ascertainment is incomplete, while in others, information about circumstances of a crash is not collected. Although fatal and non-fatal injuries are reported to the U.S. Department of Transportation by the Fatal Analysis Reporting System and the General Estimates System, respectively, neither data set captures children killed in non-traffic areas, such as driveways and parking lots, which account for many such injuries among toddlers and preschoolers. On the other hand, although the National Center for Health Statistics does tally the number of children killed in both non-traffic as well as traffic areas, details concerning the crash event are largely absent, and non-fatal injuries are not reported. No surveillance system currently reports enough details of the crash or environment to suggest road engineering improvements at crash sites. Surveillance information that describes the precise location and circumstances of the crash, the volume, complexity, speed or density of traffic at the time, and the crossing distance attempted for each child injured is sorely needed. Such information could substantially influence decisions concerning local road improvements, including traffic control measures.