Stopping a decade-long increase in child pedestrian deaths | #childsafety | #kids | #chldern | #parents | #schoolsafey



Healio Interview.

Johnston reports no relevant financial disclosures.

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Key takeaways:

  • Child pedestrian deaths have increased 11% since 2013.
  • The AAP has called for communities to adopt policies or legislation to make pedestrian areas safer.

As summer begins and children spend more time outside, the American Academy of Pediatrics is calling on communities to adopt policies or legislation to improve child pedestrian safety.

According to a policy statement and accompanying report published in Pediatrics this week, 16% of children killed in traffic crashes are pedestrians.

The AAP advocates for a “Vision Zero” approach focused on reducing traffic fatalities and severe injuries, which seeks to shift focus away from individual behavior in vehicular accidents toward system-wide change. It supports “Complete Streets” policies, which promote the development and use of roadways with all forms of transportation and people in mind.

We spoke with Brian D. Johnston, MD, MPH, chief of pediatrics at Harborview Medical Center in Seattle and a member of the AAP Council on Injury, Violence, and Poison Prevention, about the AAP’s first updates to this policy statement since 2009.

Healio: What is new in this edition of the policy statement?

Johnston: This new version was prompted by a decade-long increase in child pedestrian deaths. After declining for 30 years, deaths have increased by 11% since 2013. While some of this was driven by a general drop in road traffic safety during the pandemic, this unfortunate trend in child pedestrian risk was apparent well before coronavirus upended our lives.
The new policy really emphasizes the role of the built environment — streets and urban design — and the planning decisions that communities can make to insure the safety of all pedestrians. Vision Zero and Complete Streets are two policy and planning frameworks that we strongly support. By making streets safer for everyone, we can encourage walking, with its health and environmental benefits, without compromising on child safety.
We also focus on various disparities in the policy statement. Unfortunately, in the U.S. today, Black, Hispanic, and native children are at higher risk for child pedestrian death than white children. This is a disparity driven by the historical fallout of redlining, racialized housing policies, and underinvestment in pedestrian safety infrastructure in poorer communities. The good news, however, is that by targeting pedestrian safety investments toward streets and communities in lower income areas, we can both improve pedestrian safety and reduce disparities in opportunity and outcome.Another disparity of interest is safety for adults versus children. As vehicle automation progresses, the pedestrian detection algorithms that trigger collision avoidance or automatic braking systems may favor adult pedestrians, who are easier to detect and more predictable around traffic. If this happens, we will see improved safety for adult walkers with no benefit for younger pedestrians. We encourage manufacturers to tackle these issues proactively.

Healio: What role does a pediatrician have in this discussion?

Johnston: Pediatricians are uniquely poised to contribute to increasing pedestrian safety.
Individually, we work with children and families and can offer advice and anticipatory guidance to help children grow into safe and competent pedestrians. This includes advice about when and how to teach children pedestrian skills, the unique needs of children with physical disabilities or behavioral health concerns that may impact safety planning around independent mobility, and some threats or concerns that we are seeing more commonly. For example, distracted driving is a risk to pedestrians, but distracted walking is also possible and increasingly contributes to pedestrian injury.
Collectively, as experts in child health, we can influence policy decisions, transportation investments, and urban planning approaches to keep the needs of the youngest, and often most vulnerable, road users in mind.

Healio: What are some misconceptions that parents may have about pedestrian safety for their children?

Johnston: For young children, parents may forget that toddlers or preschoolers can easily wander into driveways or behind vehicles where they are not visible to the driver when reversing. This causes so many tragedies.
Older children may know the answer to, “What do we do before crossing the street?” but this does not mean that they can accurately judge the speed of an approaching car, appreciate the stopping distance required, or understand what drivers can, and cannot, see. Navigating a traffic environment on foot requires complex cognitive, perceptual, and motor skills that most kids do not have until at least age 10 — and many children will take longer to develop. There is no substitute for walking with your children, under a variety of conditions, to really see what they can do safely and where they will still need help or practice.


Johnston BD, et al. Pediatrics. 2023;doi:10.1542/peds.2023-062506.

Johnston BD, et al. Pediatrics. 2023;doi:10.1542/peds.2023-062508.


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