Children and Collision. Are they Hurt?

Children Collision
Dr. Garreth MacDonald

Crashes happen. We hope they don’t and we prepare ourselves by taking precautions like wearing seatbelts and placing our younger children into car seats or booster seat based on guidelines and age, height and weight considerations. Unfortunately, children are often passive recipients of these collisions, which is the leading cause of reasons to visit an emergency room1-3.

I often hear from parents when they are having themselves checked for injuries, that they took their child to their pediatrician and after a brief cursory examination the child was deemed to be fine and without injury. This may be true for an individual child but the literature does not bear out that EVERY child is NOT injured in a collision.

In fact, Children are injured in collisions, yet often overlooked. Estimates of children injured in collisions range from 29% to 47%4, which seems low and likely underreported as this article will attempt to illuminate reasons why.

What are the injuries sustained in a collision? That depends on the age of the child.5 8-12 years old tend to have cervical and thoracic injuries5 and younger more restrained children usually sustain only cervical injuries6. The reason for these injured areas come from a multitude of factors including the use of car seats with a 5-point harness. These adequately restrain the body and torso of the small child but leave the head exposed to excessive motion. In addition, the ratio proportion of a child’s head to their body is greater than that of an adult, accounting to up to 1/3 of their body mass being their head. That large mass being supported on a small neck and unrestrained is one reason why cervical injury alone occurs exclusively to younger children.

Once children are injured up to 47% have resulted in “physical limitations”, with “suboptimally restrained children nearly twice as likely to have limitations”7. Even 91% of children that were reported to be “properly” restrained reported injuries4. Most children will report the onset of symptoms within the first 24 hours (40%)4.

How do Children report their injuries?

Reporting of pain is a learned behavior. Therefore, younger children do not always have the ability to adequately express how they feel and what exactly is hurting. As parents there are often other clues that can alert one to have a more detailed assessment of the potential for injuries.

These clues often take the form of behavior changes including changes in sleep patterns, changes in eating patterns, changes in social interactions and psychological issues4.

In the next part, I will discuss the myriad of ways children report injuries and the ways parent and health care providers need to pay attention.



1. Cirak B, Ziegfeld S, Knight VM, Chang D, Avellino AM, Paidas CN. Spinal injuries in children. J Pediatr Surg. 2004;39(4):607‐612. doi:10.1016/j.jpedsurg.2003.12.011

2. Lee YY, Fang E, Weng Y, Ganapathy S. Road traffic accidents in children: the ‘what’, ‘how’ and ‘why’. Singapore Med J. 2018;59(4):210‐216. doi:10.11622/smedj.2017114

3. Al-Habib A, Alaqeel A, Marwa I, et al. Causes and patterns of spine trauma in children and adolescents in Saudi Arabia: implications for injury prevention. Ann Saudi Med. 2014;34(1):31‐37. doi:10.5144/0256-4947.2014.31

4. Boyd R, Massey R, Duane L, Yates DW. Whiplash associated disorder in children attending the emergency department. Emerg Med J. 2002;19(4):311-313. doi:10.1136/emj.19.4.311. 5. Mallory A, Stammen J, Zhu M. Cervical and thoracic spine injury in pediatric motor vehicle crash passengers. Traffic Inj Prev. 2019;20(1):84-92. doi: 10.1080/15389588.2018.1529412. Epub 2019 Feb 4.

6. Brown, RL., Brunn, MA., Garcia VF. Cervical spine injuries in children: A review of 103 patients treated consecutively at a level 1 pediatric trauma center. Journal of Pediatric Surgery, Volume 36, Issue 8, 1107 – 1114

7. Olofsson E., Bunketorp O., Andersson A.-L. Children at risk of residual physical problems after public road traffic injuries – A 1-year follow-up study. Injury, Volume 43, 2012

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