INTRODUCTION
Injuries are the leading cause of death for children
over age 1. In 2000, unintentional injuries caused
the deaths of 4,658 children between the ages of 1
and 14 and 6,573 adolescents between 15 and 19. The
leading cause of injury death in all age groups is
motor vehicle crashes, which account for 19 percent
of deaths of children and 38 percent of deaths of
adolescents. Among young children, the second and
third leading causes of injury deaths are drowning
and fires and burns; for 5- to 14-year-olds, firearms
and drowning are the major causes of injury deaths
after motor vehicles. Among adolescents, intentional
injury deaths—homicide and suicide—represent
the second and third leading causes of injury death,
accounting for 27 percent of deaths among 15- to 19-year-olds.
In addition to these deaths are the long-term effects
on children who survive their injuries, many of which
result in lifelong disabilities and special health
care needs.
The prevention of injuries among children is a multifaceted
problem, requiring significant efforts on the part
of parents, schools, policymakers, and society as
a whole. For example, the use of seat belts has contributed
greatly to reductions in motor vehicle injuries and
deaths of children over the past decades, and many
states require restraints for toddlers and older children
as well as infants. Thirteen states and the District
of Columbia require the use of seat belts by all occupants
of a motor vehicle, and an additional 36 states require
all front-seat passengers to wear seat belts. However,
adolescents may flout these laws; in 2001, 14 percent
of high school students reported that they rarely
or never wore seat belts when they were passengers
in a car. Furthermore, nearly 31 percent had ridden
with a driver who had been drinking at least once
in the past month, putting themselves at great risk
for injury or death.
Child abuse is another source of injury to children.
In 2000, an estimated 879,000 children in the U.S.
were victims of abuse or neglect, a rate of 12.2 per
1,000 children under 18. While the majority of victims
suffered neglect, 19 percent of cases were of physical
abuse. Rates of abuse were highest among the youngest
children: among children under age 4, the rate of
child abuse was 15.7 cases per 1,000 children, compared
to 5.7 cases per 1,000 adolescents aged 16 to 17.
Reducing violence among adolescents is another approach
to reducing the rate of death and disability due to
injury. In this area, we are making significant progress;
between 1993 and 2001, the percent of high school
students carrying weapons declined 21 percent and
the percent bringing weapons to school declined 46
percent. However, violence among teens remains a problem:
nearly 9 percent of students report being threatened
or injured with a weapon on school property in 2001,
and this rate has increased 22 percent since 1993.
Injury prevention is but one measure we can take
to assure the health of America's children. Child
health begins before birth, with adequate and high-quality
prenatal care during pregnancy. In 2000, over 83 percent
of pregnant women began prenatal care in the first
trimester, reflecting a significant increase in the
use of early prenatal care over the past ten years.
However, this percentage is significantly lower for
minority women; only 74 percent of African American
and Hispanic mothers received early care. African
American and Hispanic women are also more likely to
begin care late in pregnancy or to deliver with no
prenatal care at all.
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