Report numberRA-2005-52
TitleInjuries, exposure and risk factors for children as weak road user (cyclist or pedestrian)
AuthorsPascal Lammar
Published byPolicy Research Centre for Traffic Safety 2002-2006
Number of pages92
Document languageDutch
Work packageOther: Knowledge traffic unsafety

Children, as vulnerable road users, have a significant higher risk than adults to be killed or injured in a traffic accident. Moreover, traffic injuries are the leading cause of death for children. According to the international literature, children from 5 to 14 years old are especially vulnerable as a pedestrian or cyclist. Although the international literature mainly indicates that children from 5 to 9 years are especially vulnerable to pedestrian accidents, and the children from 10 to 14 years for bicycle accidents, these findings are not entirely supported by the Belgian traffic accident statistics. Among the child pedestrians, there is almost no difference anymore in accident involvement between the age categories 5 to 9 years old and 10 to 14 years old. Among child cyclists, the peak in the age category 10 to 14 years old is also found in Flanders/Belgium, when using hospital figures. The peak among the 10 to 14 years old is less pronounced, when the traffic accident statistics are used. This difference may be explained by the underregistration of cyclists under the age of 14.


The evolution of the number of victims during the last 5 years, based on the Belgian traffic accident statistics, shows that there is only a slight decrease in the number of pedestrian victims between 5 and 14 years old. Moreover, an increase may be noticed in 2001 compared to 2000. The decrease in the number of bicycle victims between 5 and 14 years old is more pronounced. This is especially the case for the number of deaths and serious injured people, less so for the number of slightly injured people. 


This high accident involvement among children results most often in injuries. Head injuries and injuries of the lower extremities are the most common among child pedestrians and child cyclists. An important difference between child pedestrians and child cyclists concerns the injuries of the upper extremities, which are much more frequent among cyclists than pedestrians. Hospitalized child pedestrians often have femur fractures due to the bumper impact. Concussions are very frequent among young pedestrians and cyclists, in particular among the children between 5 and 9 years old. The higher injury severity among pedestrians explains the difference in length of hospital stay. The average hospital stay is 5-6 days for child pedestrians, compared to 2-3 days for child cyclists.


Flemish children often use the bicycle to go to school. This is especially the case for children going to secondary school. Primary school children more often go on foot. The evolution of the exposure data indicates that the share of secondary school children who use the bicycle to go to school is still increasing. However, the share of children going on foot to school strongly decreases, especially among the primary school children. The bicycle is more often used during school days, while walking trips are more frequent during weekends and holidays. The children between 13 and 15 years old are responsible for the most trips and the most bicycle kilometers.


The decreasing number of bicycle victims may be called successful, taking into account the increase of bicycle use for school trips. The non-significant decrease in the number of child pedestrian victims, however, is reason for concern, taking into account the strong decrease in exposure, especially during school trips. The lack of information concerning the exposure during playing outdoor, however, is a weakness when interpreting the evolution of the number of victims. To fill this gap, it is recommended to develop a methodology for measuring the exposure of children when playing in or next to the street.


Several risk factors are mentioned in the international literature in connection with accidents or injuries among child pedestrians and child cyclists. The main risk factors from the literature are divided into different categories in this report, i.e.: personal risk factors, time-related risk factors, developmental risk factors, behavioural risk factors, socioeconomic risk factors, environmental risk factors, driver-related risk factors and other risk factors.


The personal, time-related, developmental and socioeconomic risk factors are not immediately modifiable. Knowledge of these factors is, however, important, for instance, for organising prevention campaigns. The behavioural, environmental and driver-related risk factors can be influenced more directly. 


In literature, there is no consensus about the most important risk factors. Several authors, however, stress the importance of the environmental risk factors.


The most important personal risk factors are age and sex. Young pedestrians between 5 and 14 years and young bicyclists between 10 and 14 years are the most vulnerable age categories, respectively, in Belgium. Boys are more likely than girls to be injured, both as a pedestrian and as a cyclist. This may be due to differences in exposure to traffic, in combination with risk-taking behaviour.


According to the time-related risk factors most accidents occur in the period after the winter. Pedestrians seem especially accident-prone in the period between March and June; for cyclists the period between May and October is important. Most accidents occur in the late afternoon or early evening, mostly between 15 and 19 h, as well on schooldays as on non-schooldays.  


The developmental characteristics of young children put them at increased risk for injuries when moving in a traffic environment, especially during the first 9 or 10 lifeyears. It is not until an age of 14 years that a child is able to move quite reliably in traffic, as the cognitive and motor developmental process is almost completely finished. Some developmental processes, such as the speed of information processing and insight into complex situations, however, continue till an age of 15-16 years old.  


The main behavioural risk factors are risk-taking behaviour (during play), inadequate crossing behaviour, inadequate behaviour during cycling, cycling on the footpath, impulsive behaviour and inattention, the presence of friends during walking or cycling or during playing outdoor, and the lack of protective behaviour, e.g. wearing a cycle helmet.


Major socioeconomic risk factors are a low socioeconomic status (lower family income, low parental educational level, more unemployment and a larger proportion of families below the poverty line), household crowding (a high number of people per household), high child population density, lone parenthood (children of single mothers), high density of housing units and higher proportion of ‘non-white’ children. These interactions seem stronger for young pedestrians than for young cyclists.


Typical characteristics of areas with high frequencies of child accidents (environmental risk factors) are: high level of through traffic, long and straight streets, the presence of one-way streets, presence of visual obstacles such as parked cars, lack of play areas and/or open space, presence of crossroads, presence of crossing facilities, abscence of separate bicycle lanes and abscence of divided highways.  


Other important risk factors include the traffic volume, in combination with vehicle speed. More accidents are also observed on multilane roads, on local roads in residential area and in urban area (speed limit 50 km/u).


Driver-related risk factors include, among others, the age and sex of the driver, driver fatigue, use of alcohol, speeding, insufficient attention to children in or near the roadway.


Other risk factors are, among others, the trip to and from school, and vehicle speed. Besides these risk factors there are also some specific risk factors for child pedestrians and cyclists. Specific risk factors for child pedestrians are the number of pedestrians and the presence or abscence of supervision. Specific risk factors for child cyclists are cycling speed, using a bicycle that is not the right size for the child, and insufficient maintenance of the bicycle. Moreover, many of the accidents with young cyclists occur during driving straight ahead at an intersection and when turning left in front of an oncoming car.


In the next report an overview will be presented of the preventive measures. These preventive measures will be evaluated, based on the risk factors, mentioned in this report. The objective is to suggest possible improvements and/or identify possible gaps in the current preventive measures in Belgium. 

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The Policy Research Centre for Traffic Safety carries out policy relevant scientific research under the authority of the Flemish Government. The Centre is the result of a

cooperation between Hasselt University, KU Leuven and VITO, the Flemish Institute for Technological Research.


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