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Joining with the adults
  1. Frederick P Rivara, Chair, ISCAIP
  1. Harborview Injury Prevention and Research Center, Box 359960, 325 Ninth Ave, Seattle, WA 91804, USA (Tel: + 1 206 521 1530, fax: +1 206 521 1562, e-mail: fpr{at}

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    It has been more than three months since the decision was made to expand the journal to injuries of all ages. As a pediatrician who spends at least half of his research time focused on injuries in adults, I fully support this decision by the editor, the editorial board, and the BMJ Publishing Group. Change, while never easy, can be a learning experience. What can those of us who work in the child and adolescent injury prevention field learn from our “adult” colleagues and what do they have to learn from us?

    Much of the research and intervention programs discussed in these pages have focused on injuries to children and little, especially relative to its importance, has focused on adolescents. The addition of a readership and authors interested in injuries to adults should enhance the amount of information relevant to adolescents. Many risk factors for injuries in young adults also operate in later adolescence, and many prevention programs will be equally applicable to youth from adolescence to adulthood. For example, most studies that have examined the role of substance abuse in injuries have focused on injuries in adults. Nearly all the studies and trials of brief interventions for substance abuse have also focused on this age group, and have found that such programs can reduce drinking and decrease the risk of injury recidivism.1,2 Injury control programs for adolescents have much to learn from these “adult” interventions.

    Other types of injury problems, while much more common in adults, are nevertheless frequent and serious in children and adolescents. Firearm related injuries are one example; in the US, most deaths due to firearms occur in adults.3 Yet, interventions for these injury problems can potentially affect people of all ages, even if they are focused on a certain age group. Reducing access to guns for teens can potentially reduce the risk of homicide to teens and adults. Personalizing guns so they can be used just by one individual may reduce the risk of gun death to people of all ages. Tracking firearm injuries will benefit all in the community.

    Some injury prevention interventions will simply not be possible unless we team with our adult colleagues. Safer vehicles with better occupant protection, fire safe cigarettes, safer roads for pedestrians, and more widespread use of smoke detectors, will be much slower in coming if individuals concerned with injuries in adults as well as children are not deeply involved.

    The relevance of “adult” programs to children is not limited to those programs targeting young adults. The elderly represent a group that is viewed at least as vulnerable and worthy of protection as are young children. For example, traffic calming interventions to reduce the speed and density of traffic have equal applicability to the very young as to the very old. The addition of the older age groups may make advocacy for such programs more feasible and successful. While children don't vote, the elderly certainly do!

    Community intervention programs may do well to expand their coverage to include adults, and by doing so, enhance their effectiveness for children and adolescents. We all know the importance of adults as role models; this applies to safety behavior as well. For example, in our bicycle helmet campaign we found that among children riding with helmeted adults, more than 95% of the children are helmeted, whereas if the adult is unhelmeted, more than two thirds of the accompanying children will also be unhelmeted.4 Targeting adults may be the easiest way to reach the children.

    We can also teach our “adult” colleagues a great deal. The leading advocates for injury prevention around the world have come from the ranks of individuals seeking to prevent injuries to children, such as people like Hugh Jackson, Ragnar Berfenstam, Bernard Leveque, and Abraham Bergman. These child advocates can serve as role models for the prevention of injuries to other vulnerable groups such as the elderly, the poor, and the foreign born. Far more success stories come from pediatric injury prevention strategies than from those focused exclusively on adults. Poison packaging, flammable fabric safety, pool safety, and tap water burn prevention are all marvelous examples of injury prevention strategies in the pediatric field.

    Most children in the world are cared for by physicians who primarily practice adult medicine, whether they be general practitioners or surgeons. These individuals need to be educated about the risk factors for injuries to children and adolescents, as well as about the interventions which work (and those which don't). What better way to do this than by sharing our work in the same journal?

    Some of the injury problems which we see today might not have occurred if there was more interchange between those concerned with pediatric and those concerned with adult injury prevention. For example, one of the largest nightmares for car manufacturers and the National Highway Safety Administration in the US over the last few years has been children injured or killed by airbags.5 One of the reasons this occurred is that the regulations were written to protect a standard 70 kg male; not enough consideration was given to the potential effects on a much smaller child occupying the front seat. The result has been redesign of airbag systems to take into consideration the size of the front seat occupant, development and testing with a whole new “family” of child size dummies, and a large public education campaign to get the kids in the back.

    Individuals studying child injuries have generally paid much more attention to psychosocial factors which increase the risk of injury as well as those affected by the occurrence of trauma. For example, information on the effects of poverty on injury risk have primarily come from pediatric studies.6,7

    The injury field has much to gain from this decision and I am sure will, through the pages of the journal. At the inaugural meeting for Injury Prevention, Barry Pless called us to be interdisciplinary, not just multidisciplinary. This expansion of our focus is a large step in that direction. At the same time, it further enhances the importance of the International Society for Child and Adolescent Injury Prevention to serve as an advocate for children and to make sure their voice continues to be heard.

    Cars parked in direct sunlight can reach internal temperatures of up to 78°C (172°F) when outside temperatures are between 27°C and 38°C (80°–100°F). The temperature increase usually happens in the first 15 minutes in the sun. The Centers for Disease Control reports that during one month in 1998, no fewer than 11 children died in three separate incidents after being trapped in the boots (trunks) of cars. All were aged 6 years or younger. Denying children access to car keys, keeping cars locked and boots closed, and supervising young children around cars are possible preventive measures (


    When a 5 month old give was ejected from a motor vehicle in a crash, she was apparently uninjured but for a mark on the forehead. Astute clinicians examined the computed tomogram in detail and found a cervical spine fracture which may have been missed had the clue of the forehead abrasion not been followed up (


    Two Canadian boys sustained groin and perineal injuries while sledding on snow racers. Snow racers consist of a sled mounted on two skis steered by a third ski in the front without a protective front panel and may need to be redesigned to avoid similar injuries (


    A 2 year old girl became unwell some hours after a trip to the country, appeared to recover, but died three days later. It was only in retrospect that it became known that during the rural visit she had eaten leaves of unknown origin. Oleandrin was found at autopsy, confirming that the leaves were oleander leaves (


    Maybe chest rubs containing camphor, turpentine oil, menthol, and eucalyptus oil should be packaged in child resistant containers. One 20 month old girl who ingested chest rub suffered a generalised seizure. The parent was unaware the product was toxic and had left the product in an accessible place (


    Using babies' bottles to measure and store methadone is novel, but apparently common in Dublin, particularly in households with children. Doctors prescribing methadone are encouraged to supply alternative measuring devices to avoid children becoming exposed to methadone mistakenly (


    Ceiling fans are popular in tropical climates with over 90% of households in Townsville, Queensland, owning them. Injuries ranging from skull fractures to grazes attributed to ceiling fans were sustained by 50 people, including 22 children under 15 years, in two years. Seven children were injured while on the top of bunk beds. Fans should be guarded, and information provided at point of sale and should include recommendations about the height of fan placement (


    Home roasted chestnuts should be pierced before cooking to allow moisture to escape and avoid the shells causing eye injuries if they explode (


    Some glass fronted gas fireplaces can heat to over 245°C and have the potential to inflict severe contact burns. Guards around the fireplaces, warning labels on the units and ignition switches, and prevention information in the manual are recommended preventive measures (