Third, we searched our personal libraries. Second, we followed references in those articles. First, we searched both the PscyINFO and Pubmed databases for relevant articles using the following search: AND AND. We conducted the literature review using three steps. These include aspects of the road environment, traffic engineering, vehicle engineering, and the time of day and season of year. In doing so, we acknowledge the importance of other variables that impact pedestrian safety risk and prevention of pedestrian injury. This review focuses on behavioral factors, or those related to human behavior of the pedestrian and others around him or her. Pedestrian injuries are caused by a wide range of factors. In other cases, the incidents are the result of poor judgment by the child he or she believes it to be safe, and enters the street when in fact the situation is not safe. 8 – 11 In some cases, incidents are “dart-out” situations where children enter the street quickly, without thought, to chase a person, toy, or pet, or to meet someone or something on the other side of the street. During this stage of development, most pedestrian injuries occur in mid-block areas, where children enter into the middle of the street and are struck by moving vehicles, or at intersections. 7 This review focuses on children between those two phases, ages 4 through 12. 5, 6 Adolescents are at risk due to walking at night with poor visibility, walking while intoxicated, walking while distracted by phones, and other reasons. Toddlers (ages 1–2) are most likely to be injured in driveways, where drivers moving backward are unable to see them. 1Īs children develop, specific pedestrian injury risks change. 4 Although all children are vulnerable, boys are more often the victim of pedestrian injuries (64% of US fatalities in 2007), as are children who are Caucasian (71% of US fatalities) or African American (26% of US fatalities). 3 Recent economic estimates suggest pediatric pedestrian injuries cost almost $300 million dollars for inpatient hospital treatment alone. 1 This places pedestrian injury as the third-leading cause of injury-related death for both boys and girls aged 5 to 14 in the US. 1, 2 Among children ages 4–12 in the US, 2007 data indicate 17,342 serious injuries and 219 fatalities from pedestrian injury. Pedestrian injury is among the leading causes of pediatric death in the United States and much of the world. We conclude the section on prevention with discussion of community-based interventions. Technology-based training strategies using video, internet, and virtual reality are reviewed. Categorized by mode of presentation, we discuss parent instruction strategies, school-based instruction strategies (including crossing guards), and streetside training techniques. The second section of the review considers child pedestrian injury prevention strategies. We conclude the first section with brief reviews of environmental risks, pedestrian safety among special populations, and the role of sleep and fatigue on pediatric pedestrian safety. The roles of distraction, temperament and personality, and social influences from parents and peers are presented. Cognitive and perceptual development risks are discussed. First, we review the literature on behavioral risk factors for child injury.
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