Paediatricians, in common with all clinicians, rightly regard patient care as their prime responsibility. At the same time, all doctors have an opportunity and indeed obligation1 to prevent disease and promote health wherever and whenever possible. This paper summarises the scale and nature of the public health challenge posed by unintentional injuries in children, outlines the key preventive approaches, indicates the wide range of available evidence based countermeasures, and suggests ways in which paediatricians can contribute to injury prevention both in the course of their routine clinical duties and in partnership with others.

INJURY IS A GLOBAL AND GROWING PUBLIC HEALTH CHALLENGE

In most developed countries, injuries are the largest single cause of death in children and young people (numerically comparable to malignancy) and a major cause of morbidity2 as reflected by hospitalisation, emergency department attendance, primary care visits and long term disability. The direct costs of injury to the National Health Service in the UK are around £2 billion per annum, with global costs to society perhaps 10 times that figure.3 The costs of child injury care at accident and emergency (A&E) departments in the UK have been estimated at £146 million annually.4

Two related reports published by the World Health Organization recently highlighted the continuing importance of unintentional injuries in children from a European5 and a world perspective.6 In the UK, unintentional injury mortality (though not necessarily incidence) has declined over the past 20 years for reasons that are not entirely clear. Declining mortality may reflect improved trauma care and survival rather than declining incidence,7 although specific injury prevention measures are assumed to have contributed to this trend. By contrast, intentional injury mortality (violence, suicide) has increased and may overtake unintentional injury rates within a few years. Globally, injury mortality is expected to rise up the burden of disease league …