Scope of the Problem
Worldwide, approximately one-half of the motor vehicle fatalities
are due to pedestrian-motor vehicle collisions. Children are among the groups at
highest risk of pedestrian injuries, especially when the amount of walking done
by children is taken into consideration. The risk to child pedestrians is very clearly
related to the number of roads they cross.1 The greater the number of roads crossed,
the higher the risk of pedestrian injuries. Poorer children under the age of 9 have
higher rates of pedestrian injuries at least in part because of their increased
exposure to traffic. The reduction in pedestrian fatalities to children in the US,
UK, and other countries in recent years is probably largely due to a reduction in
walking by children, (DiGuiseppi 1997).
Pedestrian injuries are most common among 5-9 year old children,
and in this age group, pedestrian injuries are the most common cause of serious
head trauma. Pedestrian motor vehicle collisions are qualitatively different from
other types of trauma in that very few of the victims escape injury. In contrast,
94% of occupants of vehicles involved in crashes are uninjured. Police data under-report
pedestrian injuries by one-half to two-thirds.
The most common type of action by the child leading to pedestrian
injuries is the midblock dash/dart-out and intersection dash actions. These account
for 60-70% of the total for children under the age of 10. Incidents in which children
are run over by a vehicle backing up are limited primarily to the youngest age grouptoddlers.
Pedestrian injuries are a complex problem, for which
no single intervention will be completely effective. Control will require intervention
at local and regional levels, and involve changes in the host, agent and environment.
The evidence for the effectiveness of interventions at these various levels is highly
variable. In this review, we evaluate these studies in the following areas of potential
prevention strategies for pedestrian injuries to children: