A Doctor's Journal
Children on the Roads
By MILES HOWARD
IN children who are not injured or deformed at birth, the second commonest cause of death is 'accidents,' and of these road accidents make up by far the most important single type— one-third of the total. Although the 'road-mortality' has fallen in most age groups, these fatal accidents to children now outnumber deaths from TB or whooping-cough by six to one; in 1956, fifteen times as many deaths as polio. However, unlike polio, this threat to our children attracts little notice from the profession or society at large; exploration of the causes and conditions of the fatal accident has been curiously meagre. In a paper on this topic (the first of its kind I can recall), Maurice Hackett, now in the Chair of Social Medicine at Aberdeen, gives the results of a close scrutiny of two matched groups of school- children between five and fourteen : one taken at random from names, provided by the police, of children involved in non-fatal road accidents as pedestrians (A group), and the other from the records of the school health service (C group). The home of each child in the survey was visited by a social worker, who completed, with the aid of the child's mother, a detailed schedule. One important point about the method of study is that data were coded 'blind'—that is, without knowledge of which group any particular child belonged to.
A greater volume of illness classed as 'serious' was found in the families of the A group, where the children were in the lower age range, and thus more directly under parental control. The factor of preoccupation in the mother—with a younger child, a pregnancy, going to work, an elderly relative and the like—was assessed, and here, too, the figure for the A group was higher. The 'vulnerable' family was, in general, more crowded, and it did not provide adequate room to play or even the simplest play facilities. Rather more accidents of the serious kind were noted among the young relatives of the A children— a finding which suggests that, with accidents as with illness, it is the family rather than the indi- vidual who is vulnerable. Of course, these various factors interact in many ways, but from the study as a whole some conclusions may safely he drawn: for instance, that the determinants of a road accident are to be sought, not only in the time and the place, the car and its driver, b in the well-being of the family from which tli child comes. Any illness in the household whether in the mother or other member—ma render an ordinarily healthy child more liable be run down in the Street: presumably becau it reduces the care and attention which the moth can spare. Much evidence can be found to su port the notion that family patterns have :no effect on the younger child; for the causes 'risk-taking' in older children, we have to too outside the family unit. If risk-taking is a patter of behaviour learned early in life—as ma patterns are—then its early diagnosis becomes the more urgent.
A reader asks—'What about teeth? No me (ion of those yet.' Although several papers OP even one or two books have been written—t° America—on the interaction of emotion ad 'dental health.' it is odd how seldom complain about the teeth come up in a patient's story 01 illness. In the last year or so, I can recall ong two instances: the patient's comment was thi: same in both—that a few teeth seemed to 'loosen during a spell of adversity and upheaval. Since pretty well every bodily organ and function tha! we can examine is affected by the 'total reaction to a threatening situation, one might expects '311 principle, that the teeth are too. Sometimes all attack of toothache will begin when the vidual is 'under pressure': more often pain th° seems to be of physical origin at the outset 1.1 maintained and prolonged in this way, and nial: move from one tooth to another. Dental.decay is a disorder that moves 'in sic)! time,' and so is less easy to study : one indireo. but important effect upon this i- the cornpulso' sweet-sucking of the depressed child---the Ind is kept bathed in an acid medium which favoeri caries. In a few people the ministrations of dentist are experienced as a violent attack. 3 , even minor procedures, like a filling. can car, a `catastrophic' response—depression. 'jitters' alv, bad dreams, for all the world like a blitz-reactio% as indeed, in a way, it is. But I am still curiolJa about the rarity of dental symptoms in the r1,1
of illness one sees every day. Perhaps one .1
may be the cycle of 'fashion' in symptoms: PP now, digestive troubles and fatigue are in vog°4 and the teeth get left out.
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