Bcause home accidents account for 15,000,000 children's visits to doctors' offices or hospitals annually, it has always surprised me that so few pediatricians, both in academic medicine and in private practice, are actively engaged in accident prevention research. This situation probably results from inadequate teaching of the subject in most of the nation's medical schools, as was documented by Dr. Roger Meyer several years ago.1 Dr. Meyer has worked for over two decades in the field of accident prevention, or injury control, as he prefers to call it, and he is certainly the doyen of this field.
How does a doctor with a full-time practice find the time to do anything significant about accident prevention? Like others in the field, my first study was the result of a traffic accident. One of my patients was instantly killed when a motorist backed his car out of a driveway not knowing the child was playing behind the car.
My colleagues and I collected nine similar cases in the suburbs of Chicago. I reported these findings to the officials of the National Safety Council, who aided and encouraged me to write a paper on them.2
We reported two types of car driveway accidents. In the first type, siblings or playmates shifted a parked car into neutral allowing the car to roll down the driveway over a second child playing behind the vehicle. In the second, a motorist backed his car out of a driveway striking a child playing behind the car. One of our recommendations for preventing the first type was to have a gear shift locking mechanism. After a number of years and a tremendous effort by Ralph Nader, in 1970 all the cars sold in the United States had locks on the gear shift.
Encouraged by the help of the National Safety Council, I decided to study the problem of accidental falls in the first year of life. Again, my interest was stimulated by a tragic event when two infants in one day fell from changing tables, each sustaining a skull fracture.
My colleagues and I surveyed all infants in our suburban practice for one calendar year for falls from cribs, infant seats, changing tables, high chairs and adult beds. We were amazed to find 101 first falls reported in 320 infants (30 per cent) in our suburban practice. 3Infants in the inner city clinics of Children's Memorial Hospital, Chicago, 111., had 154 falls (77 per cent). These figures have led us to estimate that 1,750,000 infants sustain at least one accidental fall during the first year of life.
We were fortunate in obtaining detailed data on the type of furniture from which each infant fell. As the result of our studies and additional studies by the National Commission on Product Safety, it was clearly demonstrated that manufacturers were making infant furniture without adequate regard for the safety of infants and children.
After the final report of the National Commission on Product Safety, which was authorized by Congress in 1968 during President Johnson's administration, the FDA forced manufacturers to put guards on the spring mechanism of infant walkers and jumpers to prevent infants' fingers from being cut or amputated. But, safer cribs, changing tables, high chairs, infant seats, etc., have not been marketed because of the government's long delay in establishing safety standards for the entire industry. My own contact with one large manufacturer of infant furniture leads me to believe that they are willing to market improved and safer models. However, their market surveys indicate that if they made safer furniture and the smaller manufacturer made cheaper, but unsafe products, the consumer would continue to buy the cheaper products, placing the large manufacturer at a competitive disadvantage.
Ideally, pediatricians in private practice could do a great deal in supplying important information on the frequency of accidents if they collaborated and pooled their data. My experience with investigating bicycle spoke injuries is a perfect example. I had talked with many pediatricians in practice, and each reported seeing three to six bicycle spoke injuries in his practice every summer. I tried to get several pediatricians to collect such cases from their practice, but I could not get any documented case reports. To circumvent the problem, I instituted a collection of all bicycle spoke injuries in two suburban hospitals - Lutheran General Hospital, Park Ridge, 111., and Skokie Valley Hospital, Skokie, 111. - during the summer of 1971.
Sixty-four cases were reported.4 We noted fractures of the toes, tibia and fibula in almost ten per cent of our cases. Forty-five bicycle spoke injuries occurred when a second rider sitting on a cross bar, handlebars, a banana seat or a carrier had his foot caught in the bicycle spokes. We were surprised to find that 21 of the 64 cases of bicycle spoke injury occurred with only one rider. In 12 of 21 cases, the child stated that his foot slipped off the pedal. Twenty-three of the children in our study were riding bicycles barefoot.
With the increased popularity of bicycle riding, there has been a sharp increase in all types of bicycle injuries. The National Safety Council has just initiated an extensive study of bicycle injuries. This study will undoubtedly obtain better statistics on the types of bicycle injuries and, hopefully, will result in safer bicycles and fewer accidents.
I believe that most of us in accident prevention have gone through only the initial phase of our work. Namely, we have identified the types of injuries and the products associated with accidents. The National Commission on Product Safety and the National Electronics Injury Survey System have done a tremendous service in identifying the many products that are dangerous and poorly designed, and have caused accidents.
Another important aspect of the problem is why certain children and families have a much higher accident rate than others. Studies have shown that home accidents are due not only to unsafe products, but also to the ignorance, emotional problems and mental illness of parents. Some parents and children seem to lack the proper conditioning to anticipate or ward off accidents. We know that certain teenagers have fantasies of immunity and exemption from injury which impels them to take reckless chances with automobiles or other high energy equipment. The American Academy of Pediatrics Subcommittee on Psychological Aspects of Childhood Accidents has begun a study to identify those "hard-core" families who have high accident rates.
Finally, we need federal legislation to provide money to develop and disseminate educational programs in our schools and on the job.
To carry out a full program of accident prevention, I am convinced that all of the recommendations of the final report of the Product Safety Commission should be adopted. The most important recommendation was that an independent Consumer Product Safety Commission be established by Congress. At this writing I am pleased to report that Congress has passed and President Nixon has signed a bill on October 27, 1972, establishing an independent Consumer Product Safety Agency.
The agency is authorized to carry out the following:
1. Maintain an injury information clearing house.
2. Conduct studies and investigations resulting from accidents.
3. Conduct studies on improving the safety of products.
4. Test consumer products.
5. Develop product safety test methods and testing devices.
6. Develop and promulgate product safety standards.
7. Declare a product a banned hazardous product.
8. Inspect factories and warehouses that produce consumer products.
9. Require manufacturers to establish and maintain records regarding product safety.
1 Meyer. R Childhood injury and pediatric education: a critique. Pediatrics 44 (1969). 865.
2 Kravitz. H and Korach. A Death in suburbia Clin. Ped. 5 (1966), 266
3. Kravitz, H : Dnessen, G .. Gomberg, R and Korach. A Accidental falls from elevated surfaces in infants from birth to one year of age Pediatrics 44 (1969). 869
4. Kravitz. H Bicycle spoke injuries- a report of 64 cases. Ill Med J 141 (1972). 464