Accidents, the leading cause of death in children and adolescents, is such an important topic that we selected it for one of the early issues of the magazine.
Every year in the United States, approximately 15,000 children under 15 years of age die in accidents. In addition, an estimated 17,000,000 children, one in three, are injured in accidents, and many of these are crippled or maimed for life.
Formerly disease was the greatest cause of death in this age group, but this is no longer so because of the efforts of the medical world, particularly pediatricians. In the problem of accidents as well, the pediatrician is a primary if not the primary key to the solution.
Twenty-three years ago a group of pediatricians, realizing the exceedingly high accidental death rate in infants and children, organized a committee within the American Academy of Pediatrics to attack the problem. The prime figure in this effort was Dr. George Wheatley, the guest editor of this issue. Dr. Wheatley, who for some years previously had been presenting exhibits on accidents and accident prevention at numerous pediatric meetings and meetings of the American Medical Association, was selected as the first chairman of the Academy's Committee on Accident Prevention.
The titles of some of the committee's early exhibits and brochures are still very poignant. An exhibit in 1951 was titled, "Help Immunize Me Against Accidents." A brochure was entitled, "Are You Using the New Safety Vaccine?"
Although a fair amount of progress has been made with the establishment of poison control centers, the passage of laws controlling the amount of lead in paint and covering the flammability of children's clothing, studies on automobile and bicycle safety, and more recently the passage of a law on the safety of children's products, much more remains to be accomplished.
In actuality almost all accidents can be prevented. A preventive effort should aim at four areas. For accidents to children are either the fault of parents, the fault of the child himself, the fault of others or the child may be accident-prone. Only a few accidents may be considered uncontrollable such as bee stings or a cut foot due to a sharp rock stepped on under water.
How can the practicing pediatrician, who is largely responsible for the health and protection of the child, help eliminate preventable accidents? He realizes from his training and experience that young children are almost constantly in motion, exploring, experimenting, discovering, and that they frequently put things to their mouths and in their mouths. He has undoubtedly seen many children after preventable accidents have occurred. He has probably criticized parents for leaving medicines or poisonous substances around, for leaving young children alone, for not strapping their child in a car, for leaving a staircase unguarded - the list is almost endless. But his critical advice is usually given after an accident has occurred.
The articles in this issue written by pediatricians who have been among the foremost in preventing accidents, give the direction which all physicians caring for children must take if they sincerely wish to protect their young patients.
It is obvious that pediatricians must spend more time instructing parents in child protection, especially during the child's early years. There should be brochures and even signs in the waiting room impressing certain important accident prevention rules on parents and children alike.
Some years ago there was an unsuccessful attempt to have pediatricians report all accident cases that they saw. Most busy practitioners were unable to find the time to keep the necessary records and send them to a central office.
However, when a pediatrician discovers that a product is responsible for an accident, it is his duty to report this finding. High chairs that topple, cribs or playpens in which infants catch their heads between the bars, toy animals with pin eyes that can be removed and swallowed, flammable or electric cars which produce a shock are examples of such products.
Supporting anti-accident legislation is also of vital importance. The interview with Dr. Southard, a practicing pediatrician who became deeply involved in this aspect of prevention, and the articles by Dr. Diamond, Dr. Kravitz and Dr. White show the direction this work has taken.
A further area in which pediatricians can work effectively is by giving lectures on accident prevention to young parent groups, prospective parents, mothers' clubs, parentteachers associations and even to the children themselves in classrooms and elsewhere. Such talks may appear to be difficult for the average pediatrician. But they are a most important, worthwhile and satisfying undertaking.
The many aspects of accident prevention are brought out in the comprehensive article by Dr. Wheatley. He not only views the subject from the aspect of child development but also includes numerous suggestions for pediatricians to give to parents and others. What to do in case of fire, how to prevent drownings, how to judge the safety of ice for skating, how to select nonflammable clothes for children - these are but a few of the many suggestions. He closes with a minimum list of unbreakable rules for parents of infants and preschoolers.
It is our hope that this issue of Pediatric Annals will be read by all pediatricians and will serve as a strong impetus in their efforts to reduce the great number of preventable accidents. For only through a concerted effort can we make appreciable progress with this problem.