Accidents, the major source of death and disability in the child over age 1, are amenable to prevention. Accidents and their prevention can be better understood if viewed as a coincidence in time of agent, environment, and victim predispositions. One can intervene at any of these three sites using either active or passive modes to prevent the accident. Much of the progress in child safety reviewed in this article is the result of improved government product safety standards which generally result in passive modes of accident prevention by modifying the agent (eg, flame-retardant sleepwear). These regulations are highlighted partly because they provide very tangible efforts and partly because the logical site for primary accident prevention is the manufacture of safe products. Modification of the victim and his environment more often requires individual effort and active modes of prevention. Although sometimes less tangible, this motivating role that the individual clinician must fill should not be minimized. Regulations are not likely to prevent many childhood accident hazards (eg, coffee cups), but physicians can remind parents of the risk. We have seen that physicians can be effective in this motivating role in encouraging the use of automobile restraints for children.
Physician input is needed to recognize the correctable hazards of the environment and lobby for their improvement. A primary goal for the early 1980s should be safe packaging of children for automobile rides. Effective passive restraints for children would be best, but we will also need to work for an intermediate step of child restraint laws in individual states. The physicians "in the trenches" will be needed to help parents recognize the age-appropriate hazards of childhood which regulations cannot prevent. The physicians will also be the ones to recognize and treat stressed families that are at greatest risk of accidental injury.