Current controversies in child accident prevention. An analysis of some areas of dispute in the prevention of child trauma.

The rate of serious child trauma has not been significantly reduced in the last two decades. During this time, both infant mortality rates and the total child death rate have fallen by 30%. Child trauma, as a relative contributor to child mortality in general, continues to increase. Effective prevention depends on a detailed understanding of causes, an appraisal of options, and cost-benefit audit of intervention programmes. Controversial themes are common in accident prevention work; controversies relating to child safety result from both an absence of data about detailed causes, and from philosophical conflicts about whose responsibility it is to prevent child trauma, and who will bear the cost. Five controversial areas have been selected and are discussed to illustrate these current problems. These are the inevitability of accidents, the loss of personal freedom that occurs in the regulation of a safe environment, "drownproofing" of infants, questions of sporting injuries involving children and the progressive upgrading of rules to make sports safer, and problems relating to the assessment of true exposure risks.