TRENDS
By JOHN P. HUBBARD, M.D., Contributing Editor
Statements appearing in this column do not necessarily reflect the opinion of the editor nor are they to be interpreted as the official opinion of the Academy.
In view of the importance of accidents as the leading cause of death in children, and
in view of the increasing attention which pediatricians are giving to accidents, the
follow-ing contribution
has been submitted by C. Collins-Williams, M.D., Hospital for SickChil-dren, Toronto. This article calls attention to a campaign against accidents in children being
conducted by the Health League of Canada, a voluntary agency whose purpose is the
pro-motion of national health.
ACCIDENTS
IN
CHILDREN
IN
CANADA
CCIDENTS, at the present time, are one of the principal causes of death, particularly
among children. In Canada approximately 1,500 children die each year as the result
of accidents, a mortality greater than that due to the 10 acute infectious diseases of
child-hood combined. During the five year period 1942-46 inclusive, in Canada, accidents stood
in eighth place as a cause of death during the first year of life, in third place during the
second year, and in first place during each year after infancy up to the fifteenth birthday.
During the same period, 21% of the deaths between the first and fifteenth birthdays were
due to accidents.
In this age of preventive medicine when our chief purpose as physicians is the
preven-tion of morbidity and mortality, we, as pediatricians, cannot neglect this extremely
im-portant phase of child care. In any campaign to reduce the number of accidents, there are
three ways in which the physician can play an important part. Firstly, the general public
must be made aware of the seriousness of the situation and must be educated in the ways
in which they, as citizens and parents, can help to reduce accidents. Secondly, the medical
profession, working through its associations and publications, must stimulate all physicians
to a concerted effort to reduce the number of accidents. Finally, and most important, the
physician must concentrate on an educational program for his own private patients. A few
words from the physician who looks after the child will do more to impress parents than
will reams of propaganda published by someone unknown to them.
During the past year an educational program based on these three premises has been
started in Canada. In the field of public education, three articles have been published in
Health Magazine, the official organ of the Health League of Canada. This bimonthly
publication is admirably suited for the purpose because, although its circulation is relatively
small (25,000), it is widely quoted by the press and radio throughout the country. The
first article, ‘‘Protect Your ‘ emphasizes the number of accidental deaths each
year and points out that these represent only a small fraction of the serious accidents
which occur, most of which are nonfatal and therefore nonreportable. The common types
of
accidents which happen to children-poisonings, burns, cuts, falls, wringer injuries,electric shocks, ingestion or inhalation of foreign bodies, wounds due to firearms, traffic
accidents, and drownings-and some practical measures for preventing them are
de-scribed. The second article, ‘‘Save the Ch’2 discusses the same kinds of accidents
TRENDS 649
until a physician can be obtained. The third article, “Poisonings in Children,”3
concen-trates on poisonings, the sixth most common cause of accidental death among children in
Canada, and the one which the alert parent can probably do most to prevent. This artide
deals with the most common poisons, describes ways of preventing children from
ingest-ing them and lists the specific first aid treatment for approximately one hundred of them.
In addition, articles on accidents in children are now being prepared by two of the
best known popular magazines with wide circulation throughout Canada. As these are
being written by the magazines’ own feature writers, their content is not known at the
present time. However, these articles, which will reach a large audience, can be expected
to contribute a great deal to education of the public.
In the second phase of the campaign, namely, bringing the seriousness of the situation
to the attention of the medical profession as a whole, an article has been published in the
Canadian Medical Association Journal.4 This is a statistical review of the causes of death
in children in Canada during the two five year periods 1922-26 and 1942-46, inclusive,
analysed according to cause of death and age at death with a detailed breakdown of the
accidental deaths. Among other things, these statistics show that in the period 1922-26
accidental deaths were in seventh place as a cause of death in children from birth up to the
fifteenth birthday and that in children over the age of one year, 1 1% of the deaths were
due to accidents, whereas, for the period 1942-46 the corresponding figures were fourth
place and 2 1
%
. Study of the tables reveals that this increased relative importance ofacci-dents is due in large part to a decrease in the number of deaths from the acute infectious
diseases of childhood, tuberculosis, the other infectious diseases and diseases of the
res-piratory, circulatory, nervous and digestive systems, rather than to a great increase in the
number of accidental deaths.
When the statistics are adjusted to the increase in population it is found that between
these two five year periods there has been a reduction of 45% in the total death rate,
whereas there has been a corresponding reduction of only 12% in the accidental death
rate. These figures show how our conquest of deaths due to accidents has lagged behind
our success in other fields. A further breakdown of the accidental deaths, corrected for
population changes, for the same two periods reveals a considerable increase in deaths
due to accidents of transportation but large decreases in deaths due to poisonings, burns,
drownings, firearms, falls and crushings.
Emphasis that these deaths represent only a very small part
of
the over-all accidentpicture is given by the admission figures for the Hospital for Sick Children, Toronto,
during the five year period 1943-47. Among those children injured seriously enough
to
be admitted to hospital, the mortality rate was less than 1%.
The two phases of the educational campaign just described are relatively easy to carry
out. They involve only the publication of articles by magazines, newspapers, and medical
journals at intervals frequent enough to keep the subject constantly before the public eye.
The third, and very important, phase is much more difficult to accomplish. Even
phy-sicians who realize the need for educating parents in the prevention
of accidents
find
it650 C. COLLINS-WILLIAMS
able to all physicians for distribution to their patients. If such a booklet were available
so
that the physician could give a copy to each patient it would solve the dilemma of theconscientious physician who cannot find time to do more than urge the mother to read
the booklet. At the same time it would help to solve the mother’s problem since she would
have at hand reliable information on how she could protect her own child against injury
or death and, since this information would come from her own physician, its importance
would be emphasized.
At the present time the Health League of Canada is endeavouring to have such a
book-let printed and made available to physicians either free or at very low cost, for distribution
to
their own patients. Unfortunately it is not known at the present time whether this willbe financially possible. Because of the great value of such a booklet to parents and children
alike, it is to be hoped that it will succeed.
C. COLLINS-WILLIAMS, M.D.,
Hospital for Sick Children, Toronto
REFERENCES 1. Protect Your Children, Health Magazine, Jan-Feb. 195 1.
2. Save the Children, Health Magazine, March-April 1951. 3. Poisonings in Children, Health Magazine, May-June 1951.
