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Injury: The Number One Killer of Children

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By Dr. John K. Petty

Maybe you’ve heard this before, but it’s worth hearing again. Trauma is the leading cause of death in children.

The Centers for Disease Control keeps figures on fatal injuries, and each one tells a tragic story. We worry a lot about childhood cancer in this country, and we should. Cancer causes 9 percent of deaths among children. But listen to this. Unintended injury – in car accidents, boating disasters, fires, ATV accidents and more – accounts for 43 percent of all deaths in children.

And then there’s a topic few of us want to imagine, the intended injuries that result from physical abuse, street violence and suicide. Homicide accounts for 9 percent of deaths in children and suicide 6 percent.

Taken together, these figures mean that injury causes 58 percent of deaths among children – more than all other causes combined.

The pattern holds in North Carolina. In 2007, unintended injury was by far the leading cause of death, claiming 236 children under the age of 15. Homicide was the third leading cause of death among children ages 10 to 14, accounting for 10 deaths. That year, six children in that age group committed suicide. As children become teenagers and young adults, homicide and suicide ranks second and third as the leading causes of death.

I wish I knew more about preventing these tragedies. But I do know something about treating the injuries.

I’m a pediatric surgeon at Brenner Children’s Hospital, part of Wake Forest Baptist Medical Center's pediatric services.  Brenner is certified as North Carolina's first Level I pediatric trauma center. When children are seriously injured they need the kind of specialized care provided by a pediatric trauma center.

We know from experience and studies that children respond differently to traumatic injury than adults, which means they need to be treated differently. To start with, children who are bleeding do not show signs of shock in the same way that adults do.  Their bodies adjust to early blood loss quite well, but this can give a false sense of security if the bleeding becomes severe.  In addition, because their bones aren’t as calcified, the forces of a trauma can be directly absorbed by their internal organs, often without obvious signs of injury on the outside.  Children are resilient and can survive injuries in their bodies that might be fatal to an adult.   In one area, however-- head injury-- children are particularly vulnerable.  Head injury is the greatest risk of death or devastating disability in an injured child.   In our pediatric trauma center, we know to focus on head injury. That expertise gives injured children the best chance at survival and recovery.

That’s not all. Children also respond differently to medicines and procedures than adults. The supplies we use – from catheters to tracheal tubes– come in smaller sizes. Our anesthesiologists are specially trained to manage a child’s vital signs under anesthesia.  We rely on pediatric pharmacists who understand how doses differ for children. I work with two other pediatric surgeons and one of us is always within 15 minutes of the emergency room. We also have pediatric neurosurgeons on call at all times. And we always make room for mom and dad.

I know from experience how important it is to have people trained in pediatric trauma care for injured children. I can say this without worrying about offending any of the fine hospitals and dedicated medical workers in the region. We’re not competing with community hospitals. Quite the opposite: it’s part of our duty as a pediatric trauma center to reach out to other hospitals and serve them and their patients.

I’m glad we’re always here to care for those who need us, though I wish we weren’t needed so often. Most of the serious injuries I see are preventable. There will always be freak accidents, but so many can be prevented with common sense and a little caution. Children are safer now when they ride in cars. And I, for one, am glad that the state requires that children stay in a booster seat until they are 8-years-old.

These days most parents insist that their children wear helmets when they ride bikes. Coaches in youth sports are learning to take head injuries seriously. And gun injuries are down. But I can’t see any good reason why a child needs to ride an all terrain vehicle. I’ve seen too many mangled bodies and head injuries to make the fun outweigh the risk.

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Sadly, we also care for children who receive their injuries at the hand of someone they trust.  Children who are abused are often twice hurt, first by the injury itself and second by the delay that follows before the injury is brought for medical help.  They are three times hurt when you consider the emotional pain. 

With all these injuries, unintended and intended, I’ve come to think of a pediatric trauma center as a central part of a strong community. Like good schools, libraries and parks, a pediatric trauma center adds value to our communities, a service that’s there should we need it.

Learn more about Wake Forest Baptist Health's pediatric services at Brenner Children's Hospital.

Petty John KDr. John K. Petty is an assistant professor of surgery at Brenner Children’s Hospital at Wake Forest Baptist Medical Center. 

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