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A consideration of severity is sufficient to focus our prevention efforts
  1. John Langley,
  2. Colin Cryer
  1. Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
  1. Correspondence to Professor John Langley, Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand; john.langley{at}otago.ac.nz

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Molcho and Pickett1 suggest that it is unrealistic and counterproductive to try and prevent all childhood injury. We agree, welcome this contribution and support the intent of their article to facilitate debate and discussion around the issue.

We agree with their view that the dominant paradigm in injury control is that all childhood injuries, irrespective of their origins, are unacceptable. We would argue this paradigm extends to all age groups. Taken to its extreme, this position does not, however, stand up to scrutiny. Are the proponents seriously suggesting we seek to prevent even the mildest of injuries? For example, a child tripping over and sustaining a barely visible abrasion to her arm but nevertheless is crying as a result. We believe most parents would probably briefly console the child and once the crying had abated encourage them to continue playing and then completely forget about the incident.

There clearly are unstated thresholds that guide which injuries we should pay attention to, which vary depending on circumstances. Nevertheless, it is likely that many in the injury control field are challenged by the idea that, for example, some medically treated sports injuries may be acceptable if the benefits are seen significantly to outweigh the costs.

In this commentary we critically appraise the criteria proposed by Molcho and Pickett1 to classify the occurrence of childhood injuries into acceptable or non-acceptable.

Molcho and Pickett criteria

Molcho and Pickett1 propose that the following are deemed unacceptable: ‘(1) intentional injuries; (2) severe, fatal, or disabling injuries; (3) injuries occurring while involved in unhealthy, unnecessary, or abnormally risky behaviours; and (4) injuries that occurred while ignoring known preventive measures. However, injuries that are unintentional, occurring during a necessary or health generating activity, and that do not …

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