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Safety first
  1. I D Wacogne
  1. Ian Wacogne is a consultant in general paediatrics at Birmingham Children’s Hospital, UK; ian.wacogne{at}

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We arrived in Ayutthaya, about 60 km north of Bangkok in Thailand at the start of the festival Loi Krathong. Celebrated on the full moon day of the twelfth lunar month the event involves, at its simplest and most benign, the floating of little plate sized islands of flowers and candles down the river. At the other extreme it degenerates into the utterly uncontrolled release of fireworks in the street by adults and children alike. For a few pence you can buy a handful of fireworks and contribute to the mayhem. Or, you can buy a large sausage shaped bin bag with fuel source. This, held inverted with the fuel lit, becomes a little hot air balloon. After several moments of anxiety that the whole thing is about to catch fire, it soars up into the warm night air. After a while it winks out of existence—either too far away to see, or burning out, to be discovered in someone’s garden the next day like the sticks of rockets I’d search for on the 6th of November as a boy.

It’s preposterous of course. Dangerous beyond belief, and must result in as many casualties as the British 5th of November bonfire nights of old. Amidst the chaos you’ll see the familiar Thai spectacle of entire families of five crammed onto the one motor scooter—of course none wearing any sort of head protection. At other times and in other countries you’ll see children diving into rivers thick with effluent, and coming up laughing, looking as healthy as any child I’ve seen in the UK or Australia. You’ll see children balance with bare feet on needle sharp coral reefs before executing a beautiful, exuberant 1½12 somersault into barely a puddle of water. In still other parts of the world you can see children behind windows of houses or cars, motionless except for the fingers and thumbs which are intent on making Lara Croft execute a similar 1½12 somersault, in between conveying high fat, high sugar snacks into their mouths.

This is a jaded, cynical, and somewhat sarcastic comparison, and I’m almost ashamed to write it—but only almost. Risk, and risk taking, is such an essential feature of childhood and growing up—starting right from the peek-a-boo game where the child “risks” losing their playmate—that we’d be foolish to dismiss the essential role of risk in normal development. Being in dangerous—or apparently dangerous—situations teaches us a tremendous amount

about how to handle them. However, this can put us, and those around us, at terrible risk of harm, injury, maiming, or even death. If we were to foolishly expose young middle class British children to Loi Krathong, in some sort of misguided attempt to toughen them up, they would do appallingly, and only those that survived would gain anything from the experience. Even as an adult I feared for my safety in a way that those around me must have found amusing. Learning by your mistakes as a useful educational tool only when the stakes are low—like a few bruises or a bump to the ego—but an entirely different matter when life and limb—your own, those around you, or those of your patients—are actually at stake.

As a boy of 10 I’d cycle near our house and further afield, unsupervised, mostly on quiet roads. If now, I saw an equivalent of myself, knocked off my bicycle and in an emergency department, would I have to fight the urge to scold my mother? Was the fact that I never ended up in an emergency room based on luck, or was it some superior ability to cope with my environment? I would say that I’m glad that I was never given fireworks to play with. I’m glad too that many children seem to wear cycle helmets. I feel less happy about some of the bubble wrapped children we see; who can rarely if ever play out in the street, and who are ferried in four-wheel drive cars to friends’ houses because the traffic is too dangerous—on account of all the four-wheel drive cars on the roads.

A few winters ago, a light fall of snow was taken by dozens of children as a cue to launch themselves down hills on poorly designs sleds, and, ultimately, into the emergency department where I was working. What struck me was our disapproval as we patched up these broken limbed children. Yes, I’d have preferred it if they’d worn a helmet, and maybe a face guard, and perhaps even done the simple calculation that they weren’t going to stop before getting to the trees at the bottom. But this has to be better than sitting at home and watching Lara Croft living their lives for them, doesn’t it?

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