Clinical Review

Recent advances in paediatrics: II–childhood and adolescence

BMJ 1997; 314 doi: (Published 12 April 1997) Cite this as: BMJ 1997;314:1099
  1. John Pearn, professora
  1. a Department of Paediatrics and Child Health, Royal Children's Hospital, Brisbane, Queensland 4029, Australia


    Infants die from prematurity, congenital malformations, and infectious diseases; over 90% of those who succumb do so in the less affluent countries of the world. Infection with HIV and malaria are afflicting an increasing number of children and teenagers in tropical countries, and everywhere children who survive infancy become exposed to trauma and neoplasms. Prevention of child trauma,1 2 drug resistant malaria,3 and violence to and exploitation of children4 5 6 remain the topics central to the professional life of all doctors, irrespective of their nationality.

    Child trauma

    Child trauma continues to rank fourth after infections, prematurity, and genetic disease as a major cause of child mortality. After the first year of life, trauma is the leading cause of death until early adulthood.7 The professional world has been slow to accept a medical model for the prevention of child trauma.8

    Reduction in child mortality resulting from injury has been one of the success stories of the past decade. In affluent countries the rate of injury and violent death in children and adolescents has decreased by 20%, and child deaths from accidental poisoning are now rare. In all Western countries the rank of causes of traumatic death remains road trauma, drowning, non-accidental injury, and burns (particularly in children living in relative or absolute poverty).7 9 10 Strategies for preventing road deaths include controlling speeds near schools and compulsory seat restraints and bicycle helmets.11 In all studies of violent child death and injury, male sex, poverty, and underprivilege are risk factors. Rural children are particularly vulnerable to trauma.12

    Bicycle helmets have been shown to reduce road deaths and injuries.


    Such deaths are prevented by increased public awareness of risk, improved safety hardware, and legislation. Most children who die violently do so before reaching hospital; …

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