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Editor,—As part of his useful review on head injuries Dr Beattie briefly discussed aetiology and prevention.1 The role of road traffic accidents (RTAs) as a major cause of serious or fatal head injury is highlighted and ‘preventative measures’ such as cycle helmets, seat belts, and pedestrian education are mentioned. This summary misses the point that it is motor vehicles and their drivers that cause RTAs; more specifically, too many vehicles being driven too fast and parked inappropriately.2 Traffic calming, 20 mph speed limits, reduction of through traffic, and parking restrictions have a major, primary, preventive role in making our streets safer for children. Countries that have acted to control traffic speed and flow have reduced their child RTA mortality to a much greater extent than countries, such as the UK, that rely on education programmes of unproved and limited benefit.3 Education and secondary preventive measures such as cycle helmets do have a role but it is important not to blame victims for failing to protect themselves from injuries caused by vehicles.
Currently RTAs kill more children than leukaemia and asthma combined. Paediatricians have a major part to play, both locally and nationally, in supporting active road safety measures.
Dr Beattie comments:
Thank you for giving me the opportunity to reply to Dr Ball and Dr Williams. As someone who has published extensively on injury prevention I fully endorse their views with regard to the role of primary injury prevention, secondary injury prevention, and education with regard to safety. The general thrust of the article was to discuss head injuries briefly and the lack of space meant that, by default, not every aspect of injury prevention could be discussed.
In my experience, however, a substantial number of significant head and brain injuries could be avoided were the simple measures alluded to implemented more widely. They take little more than education to achieve, together with some peer pressure to ensure that children do continue to use their helmets, and parents continue to restrain their children appropriately in rear seats.
The other measures may well be more effective in the long run but they will take a substantial change in society to achieve. Recently there has been cence in the general press and national news media regarding a solicitor who is objecting to sleeping policemen in his road. As long as attitudes like these prevail then other measures will have to be introduced.
Finally I did not mean to give the impression that children are responsible for their own injuries. As someone who has both children of his own and who sees 90 children a day in the accident and emergency department, I realise how little children are to blame for the injuries they sustain.