American Academy of Pediatrics Lays Out Steps for Improving Child Pedestrian Safety

In the United States, 16% of children killed in traffic crashes are pedestrians. Communities can create safe and walkable environments for pedestrians and reduce injuries and fatalities.

Walking is good for the health of children, families and the environment, and yet it can be challenging to safely travel on foot where roads, intersections or vehicles aren’t designed with pedestrian safety in mind.

The American Academy of Pediatrics, in its first policy statement on child pedestrian safety since 2009, calls for communities to adopt and promote policies, programs and legislation that result in a safer environment for pedestrians. The policy statement, “Child Pedestrian Safety,” and an accompanying technical report, “Epidemiology and Prevention of Child Pedestrian Injury,” will be published in the July 2023 Pediatrics (published online June 20).

Policy statements created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics.

“The reminder to ‘Look both ways before you cross the street,’ is good advice, but just part of the equation,” said Sadiqa A. I. Kendi, MD, MPH, FAAP, CPST, co-author of the policy statement, written by the AAP Council on Injury, Violence, and Poison Prevention. “Research tells us that an even more effective way to consistently improve safety is when communities take intentional steps to create pedestrian-safe environments. We live in a busy, distracted world, and when local leaders create walkable spaces, they also enhance the appeal and vibrance of their communities.”

Despite an overall decline in pedestrian deaths over the past 30 years, child pedestrian deaths have risen 11% since 2013, affecting more children ages 10-14 and teens ages 15-19. Black and American Indian youth ages 19 and younger are 1.8 times more likely to die in pedestrian incidents than white children. The risk of death to
Hispanic children is 1.2 times the risk to non-Hispanic children. Studies indicate that these inequities are due to the pervasive impacts of poverty, economic disparities in access to public transportation, individual and systemic racism, and disparities in the investment of transportation safety measures, such as sidewalks, to separate pedestrians from vehicles.

The AAP also notes that the hours of 6:00–9:00 p.m. are the riskiest times of day for child pedestrians, as 64%. percent of deaths occur in daylight hours or at dusk. The risk of child pedestrian death is greater in rural areas, and boys are at higher risk of injury, as are children with disabilities.

While encouraging children to walk and bike outdoors, the AAP also notes that it is unsafe for children to play in driveways and adjacent unfenced yards.

“Drivers may not see small children when backing up their vehicles in a driveway or lot,” Dr. Kendi said. “Newer and self-driving vehicles are increasingly equipped with safety features and technology to detect pedestrians and avoid crashes, but they’re often more likely to detect adults and may not be able to account for the less predictable movements of a small child.”

The AAP advocates for a “Vision Zero” approach focused on the reduction of traffic fatalities and severe injuries. Vision Zero, which is being implemented in more than 45 U.S. cities, is built on the premise that traffic injuries are a public health problem in which human error is assumed and accepted, according to the policy statement. The effort shifts the focus away from individual behavior and toward system-wide change that, in Sweden, resulted in a 50% reduction in pedestrian fatalities.

AAP recommends that pediatricians:

  • Advocate for legislation that addresses environmental and urban design factors that impact pedestrian safety. Work with local, state and federal officials on adopting policies and programs to educate pedestrians and drivers.
  • Support legislation to reduce speed limits in urban areas, including area-wide 20 mph zones, and to permit photo speed limit enforcement in critical areas, including school zones.
  • Develop laws that encourage or require adoption of safety technology in new vehicles, including self-driving cars. Examples are pedestrian detection systems and automatic braking in new vehicles.
  • Support developing safe routes to school.
  • Promote walking as an alternative to motorized transportation.
  • Advocate for pedestrian infrastructure when communities consider how to repurpose urban space and roadway lanes.
  • Support research to further understand and test interventions for pedestrian education. For instance, drivers and pedestrians can be distracted while using cell phones, and changing individual behaviors is one factor in reducing injuries and death.
  • Develop robust surveillance systems to collect data to identify high-risk locations for child pedestrian injury.
  • Provide individual guidance to families that includes:
    • Remind parents of the complexity of the traffic environment. Children at various stages of development may not have the cognitive, perceptual or behavior capability to navigate challenging walking routes.
    • Advise parents of young children that driveways and adjacent, unfenced yards are unsafe play areas.
    • Recommend that adults accompany most children under 10 and provide ongoing, active instruction on pedestrian safety.
    • Counsel patients of all ages about the risk of distracted walking, including text messaging, talking on or looking at the mobile phone, and listening to music.

“We know that active transportation, like walking or biking, is good for kids and it’s good for the environment,” said Brian D. Johnston, MD, MPH, FAAP, co-author of the report. “As children grow older, they will be able to be more independent. Each of us can help keep children safe by paying attention to the people around us and by promoting safer environments that benefit all of us.”