TABLE 1
SOURCE: Kristen Kucera.
reveal higher rates for minority youth, with Native
Americans experiencing the highest rates of uninten-
tional injury and suicide while African Americans’
rates for homicide exceed those of other ethnic
groups. Some of this difference is attributable to envi-
ronmental conditions associated with poverty (Afri-
can Americans and Native Americans) and/or living
in rural areas (Native Americans) where risks are high
and rapid access to medical care is less readily avail-
able.
Injury patterns differ by both age and type of
event, as demonstrated in Tables 1 and 3. For all age
groups, motor vehicle crashes were a significant cause
of fatalities in 1998. The youngest children (infants)
are most likely to be fatally injured as a result of suffo-
cation, motor vehicle traffic, and drowning/
submersion. For toddlers, the leading causes of injury
death are motor vehicle traffic, drowning/
submersion, and homicide, while for those in the five
to fourteen age group (elementary and middle-school
age), most fatal injuries result from motor vehicle
traffic, homicide, and drowning/submersion. In con-
trast, teenagers are fatally injured as a result of motor
vehicle crashes, homicide, and suicide.
As shown in Table 3, various causes of injury fatal-
ity exhibit differing patterns depending on age. In
part, this is a function of different developmental fac-
tors that impinge on children’s abilities to avoid inju-
ry events (e.g., being able to walk without falling,
being able to make judgments about avoiding risks,
testing authority, having transient depression, acting
impulsively). In addition, children have greater or
lesser exposures to different risky situations (e.g.,
crossing streets without a parent, playing sports, rid-
ing a tricycle near traffic, being a teenage driver, own-
ing or carrying firearms, working on a construction
crew) based on the practices of their parents (e.g.,
level of supervision provided, drinking and smoking
behaviors, disciplinary practices); or because of social,
economic, or cultural factors (e.g., access to afford-
able, high-quality child care; well-constructed homes
that are equipped with fire safety devices such as
smoke detectors; practices of riding in the back of
pickup trucks; use of hazardous products such as fire-
arms, baby walkers, in-line skates, or trampolines.Morbidity
Morbidity (i.e., nonfatal injury) is both much
more common than mortality and presents different
patterns of injury. In 1997, 213,000 hospitalizations
of children ages zero to fifteen in the United States
resulted from injuries, while in 1996 alone an estimat-
ed 8.71 million in this age group were treated and re-
leased from emergency care. Using 1990s data from
North Carolina on unintentional injury for children
under age fifteen, Table 4 lists the differences in inju-
ry patterns by age group for the leading causes of
death, of nonfatal, hospitalized injuries, and estimat-
ed incidence of injuries treated in outpatient settings.
This demonstrates the importance of considering the
range of injury outcomes in establishing priorities
and devising preventive strategies.
Furthermore, several child and adolescent injury
problems are not easily recognized in the health care
system at all, yet have profound effects on injury oc-
currence and developmental outcomes. One type of
event is child abuse and neglect. Reporting through
social services systems and national surveys indicates
that as many as 1.5 million children a year experience
physical or sexual abuse at the hands of an adult care-
taker. Likewise, children and adolescents may be sex-
ually assaulted or raped by strangers or experience
injuries in dating relationships, similar to domestic vi-
olence experienced by adults. National estimates in-
dicate that as many as 1.4 million persons under age
eighteen experience sexual assault or rape each year.
In addition, it is estimated that 8.8 percent of adoles-
cents may experience violence in their dating rela-
tionships, including incidents of hitting, slapping, or
being physically hurt.
Other types of circumstances that put teenagers
at risk of nonfatal injuries are sports participation and
employment. Together, these two categories of injury
result in more emergency care for teenagers than any
other categories. Sports and occupational injury are
the two most common categories. National data sug-
gest that as many as 3.5 million youth under age 14
are injured in sports and recreational activities annu-212 INJURIES