Is your child accident prone?
It's not always through chance that some children have more accidents than others.Their personalities and home life can be a factor.Here's how parents can recongnize and attack childhood's greatest menace
Since a Viennese psychologist named Alexander Adler proclaimed twenty years ago that “some unknown factor in the human personality causes certain people to have repeated accidents,” the existence of accident proneness has become fairly well accepted. A little has even been learned about the “unknown factor.”
Police, doctors, employers and insurance companies suspect that tense, neurotic, worried, frustrated and aggressive people are more likely than their well-adjusted, placid fellows to drive cars into each other, to fall down stairs, to get caught in machinery. One investigator decided that a tendency to have repeated accidents was a disease, and named it accidentitis.
Children were rather ignored in these early studies. True, they get into even more accidents
than adults, but that was assumed to be because they were not well equipped physically and mentally to cope with danger. Certainly, it was thought, a child could scarcely acquire the tensions and pressures that appeared to cause accidentitis in adults.
Recently, though, a few psychiatrists and pediatricians in Canada, the United States and Britain have been exploring more deeply the whole dimly understood subject of accident proneness.
Can children be accident prone? If so. at what age can the condition begin? How can parents recognize the symptoms? What can parents do to protect or cure an accident-prone child? To what extent may parents themselves be responsible for accident proneness in their children?
The answer to the last question is undoubtedly the most startling. At least two major studies conducted in recent years indicate that parents’ behavior and attitudes can be directly responsible
for infecting their children with accidcntitis.
Long before it had a name or became a branch of psychiatry, accident proneness was familiar to non-professionals. Many a mother, for example, has known the pang of terror that comes when she hears a scream from children at play, because "It's usually my Bobby who gets hurt.” Recently the hospitals of Ottawa took a look at the childhood-accident problem on a mass scale. Of a thousand home-accident cases treated in six
months, two hundred were repeaters and sixty were third-time casualties or worse — including one durable youngster who had survived an average of two major injuries and assorted lesser hurts every year so far in his short perilous lifetime.
l'he number of accident-prone children is ditficult to guess. Lhere are. of course, many accidents in which accidcntitis plays little or no part —a child injured while riding in a car involved in an accident, for example. In the Ottawa survey twentv-five of the thousand injuries could be attributed to such physical defects as paralysis, poor eyesight or deafness, but Dr. F. H. Lossing and Dr. Roger B. Goyette. of the Department of National Health and Welfare, who analyzed the accidents, decided three out of four were “preventable.” In a U. S. study of fifty thousand cases. physical defects accounted for three percent of injuries, mental unfitness one percent, and eight percent of the injured were hurt while trying to do something beyond their ability. Dr. Flanders Dunbar, of Columbia University, who coined the term "accidentitis" and is one of the world's leading authorities in psychosomatic medicine, found accident proneness in as many as eighty percent of fracture patients she examined, especially in the younger age groups.
Whatever the prevalence of accident proneness among children, it is part of the greatest hazard to young people in existence today. Parents who fear they may have reason to ask. "Is my child accident prone?" face these unpleasant facts:
Accidents have become by far the largest single cause of death among Canadian children who survive the hazardous first year of life. In a single generation deaths from all causes ot children aged one to fifteen years have been cut by a dramatic seventy percent. Only one cause has increased—accidents. As a result, the two thousand children of that age who die from injuries in a typical year are as many or more than die of all diseases combined.
Indeed, in one group comprising nearly a million Canadians, accidents just about monopolize the mortality figures. Boys between ten and fourteen are twelve times more likely to die ot misadventure than of the most frequently fatal illness of their age. cancer.
In addition, an estimated one hundred and twenty-five thousand children are injured in accidents in a typical year, injuries ranging in severity from hurts requiring twenty-four hours in bed up to total permanent disability . In other words, the figures above represent the toll that can be reduced—to what extent nobody knows for sure —if the cause and cure of accident proneness can be found and applied.
In the search for cause and cure, findings so far point an accusing finger at parents. Mothers and fathers, already found guilty by many social scientists of their children's delinquencies and other deficiencies, are now to be told that they may also be responsible for their children's accidents. in more ways than one.
First, says Dr. Neil Duncan, an Edmonton pediatrician, in the careless acts by which a grownup helps a child harm himself: Who put candy-coated pills on the bottom shelf of the medicine cabinet? Who left a loaded gun in the den?
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Both boys fell but only one was injured. Behind the incident the doctor found a scolding father
The other indictment is deeper and, in many cases, more damning. According to some experts, a child's relationship with his parents—particularly the child's ability to communicate with, to “get through to" his parents -— has a direct bearing on whether that child will become involved in accidents or not.
The most recent and striking study in support of this has been carried out by Flanders Dunbar. In her large New York psychiatric practice Dr. Dunbar has had a unique opportunity to study a large group of children, starting when they were in nursery school under three years o' age. then picking up their careers e;ght years later and examining their personal and family lives into their middle teens. She found that:
One third of the children had no record of accidents. They belonged to families that remained intact, in which the father and mother got along harmoniously and in which the children were encouraged to talk out their problems with their parents.
Two thirds of the children had accident records, ranging from a minimum of one major anti several minor injuries up to the point where accidents became virtually chronie. (One youth, named Wallace, in seemingly endless succession broke his right wrist, then his left wrist, the fingers of one hand then the other, followed by fractures of an arm, a leg and his nose.)
These children had parents suffering from some form of marital difficulties— mutual dislike, quarrels, divorces, separations, lights involving throwing things at each other—which prevented their children from "communicating" with them.
The lack of contact between child and parent was not always the parent s fault. T he death or even illness of a parent could put a child into the accident-prone category. For example, a twelve-year-old boy fell off his bicycle and broke a wrist on his way to visit his mother who was in hospital for a major operation. A
thirteen-year-old girl broke her foot at play soon after her mother had been seriously injured in an accident. Dr. Dunbar blames these children's mishaps on the interruption of their accustomed relationships with their mothers.
Usually, though. Dr. Dunbar's accident-prone children lived in a broken or unhappy home. A typical example is a girl listed in the case records as Caroline. When she was eight her mother and father were divorced. Caroline went with her mother, and the other child, an older brother, with the father. From an early age both children had been exposed to scenes of violence between her parents. Caroline had many minor accidents, usually at a time when she was under a strain or was making a supreme effort to keep her temper. The accidents have increased in frequency and seriousness up to the present.
How do accidents happen?
Dr. Dunbar has not been content to establish a cause and effect between children's accidents and children's relationship with their parents. She has searched for the actual physical mechanism that causes accidents to happen.
She found, in two ten-year-old boys identified as Tom and Alex, examples of children who were similar in background. but who. under different home influences, w'ere vastly different in their ability to avoid accidental injury.
Tom and Alex played hockey for the same boys’ club. Tom was an enthusiastic but awkward and not very good player. Alex was the star of the team, a swift and graceful skater and a daring attacker. On a recent day both boys rushed to the arena exit after a winning game. Tom stumbled heavily against the gate, went down in a tangled heap of skates, stick and pads, picked himself up. grinned, and clattered pell-mell on his way.
Alex, just behind him. put out a hand to steady the swinging gate, felt his forearm twist under the slight impact, heard a snap, winced at a sharp pain—and landed in the rink's first-aid room with a broken bone in his forearm.
The two stories behind that small and not particularly dramatic scene at the gate of the rink were of a kind that could be unearthed only by tin understanding doctor with the help only ol great patience and sharp intuition:
Tom, in a hurry to get home to tell his loved and loving father the big news ("Today 1 nearly scored a goal! ) had not hurt himself in the least by his tumble through the gate. At most he had added a slight bruise to the many he had acquired through numerous falls during the game, all part of the fun to be shared with his father.
Alex, whose skill had earned him two goals during the game, lost his co-ordination with the final whistle. Part of him was eager to go home and tell his parents of his triumph, hut part remembered the chill of his father's words the day before: "That boy's getting altogether too cocky. Next time he comes home boasting of how many goals he scored I’m going to take him down a peg or two for his own good.”
“Tom wasn't under stress,” summed up Dr. Dunbar. “Alex was. Perhaps the extensor and flexor muscles of his arm worked against each other and multiplied the strain on the bone when there was a small sudden pressure-—quite enough to crack a bone. It could be as simple as that ...”
This pattern of emotional stress acting on the body to make accidents possible —even to invite them—is. in fact, the summarized finding of Dr. Dunbar’s re-
cent study of accident-prone and nonaccident-prone children. She concludes that accidents to accident-prone children are the result of “ill-considered activity” carried out to relieve tension and restore physical and emotional balance when such added problems as a difficult home life or rejecting parents are added to the inevitable strains of growing up.
What can be done about it? The doctor offers two measures. Psychiatric treatment, especially if started early enough, can put a child back on an even keel. “Sometimes,” she said re-
cently, “a child can be made to understand that a parent’s problems are big, too. Children have even been persuaded to feel sorry for the grownups and help to straighten them out.”
It takes professional psychiatric techniques to teach such help-your-parents programs, however, and parents can get faster results if they simply take steps to remove the cause of their children's accident proneness—by getting close to their children and staying there.
It is interesting to note that the skillfid, co-ordinated Alex was the accidcnt-
prone child and awkward Tom was accident-free. This is an apparent contradiction on which most of the studies of accident proneness agree: graceful people are just as susceptible to accident proneness as awkward ones. “Some deft, seemingly well-balanced individuals turn up repeatedly in the accident wards of our hospitals,” says Dr. Dunbar. “They think they are the victims of pure bad luck or divine punishment. In reality, they have been struck down by their own emotional conflicts.”
Children tend to have more accidents than grownups, she believes, partly because in their immaturity they are less able to cope with the problems that predispose them to accidents, and partly for a grimmer reason: the ranks of adult accident repeaters are thinned by fatalities, and by total-disability accidents that keep adult victims out of further trouble.
Other investigators have agreed with Dr. Dunbar’s findings that accident proneness and disturbed family life are connected. At New York's Bellevue Hospital Dr. A. A. Fabian and Dr. Lauretta Bender analyzed sixty-five children with severe head injuries and with histories of two or more previous major accidents each. In their reports on man\ of the children there is frequent men tion of “body covered with numerous scars.” Probing into the background of these children, the two doctors found that eighty percent of them had parents who, via alcoholism, mental deficiency, instability and other physical or personality defects, “created an atmosphere in the home charged with hate, rejection and violence.” Dr. William Langford and a medical group at Columbia University found, in a test-group study, that a majority of the mothers of injuryridden children worked outside their homes, while none of the mothers of the uninjured group did.
Accidents ran in the family
Gradually research workers are building up a picture of the factors that go into making up an accident-prone child. Langford found, for example, that one characteristic of children with a history of accidents is a circle of relatives who arc themselves usually liable to acciden tal death or injury.
One boy had an uncle killed in a fall out of a window at the age of three; a grandfather killed in an elevator crash: an aunt killed by a car; an uncle who still bore the scars of a vat of boiling water he pulled over himself as a child: a cousin killed when people dancing in the apartment overhead loosened a lampshade which fell on the boy's head as he did his homework; another cousin who choked to death on something another child gave him; a father who had had a milk can embedded in his head when it was thrown at him, and who later was injured playing baseball.
As a rule accident-prone children do not know they are afflicted. But occasionally doctors find a child in whom accidentitis is so acutely developed that the victim goes more than halfway to meet his painful fate. Such a child was one who, before his first birthday, broke his nose in a fall. At fifteen months he threw himself from a chair and cut his face. He bites his fingers to the bone and holds onto stoves and steam pipes until his skin blisters—yet he does not cry. If he is left alone or denied his slightest wish he sways to and fro and suddenly dives to the floor. Taken to hospital after one such dive, he had to be provided with a sort of football helmet to protect his head when it landed on the hard floor.
One doctor who examined the boy declared, “His head feels like a bag of bones.” When his mother visited him in hospital, he promptly crushed one hand in a door. His broken nose was deformed and somewhere in his violent career he had picked up a cauliflower ear along with a body covering of scars, so that before he was four years old he looked like a battered pugilist of forty.
Yet tests showed he was of potentially normal intelligence. The doctors who imestigated the boy’s case were not surprised to find a particularly unhappy family background: “R.M. is illegitimate. His mother is an alcoholic and lives with three sisters, two married to alcoholics. There are numerous quarrels and fights in the house and his mother spanks him daily as a matter of routine habit.”
Not all studies of accident-prone children are based on the theory of family dislocation, however. Dr. Elizabeth Fuller, of Minnesota’s Institute of Child Welfare, has chosen to approach the accident problem from the viewpoint of the child’s appearance, attitude and behavior, in relation to the number of its mishaps, regardless of the situation at home. Her survey of a school term's experience with thirty boys and thirty girls in one class may be of particular interest to parents who prefer to look for clues of accident proneness in their children rather than in themselves. The survey showed that the boys had more accidents than the girls—an average of six injuries to each boy and five to each girl. Other surveys agree that boys are more vulnerable, as much as three times more subject to injury than girls. In Canada twice as many boys as girls die accidentally between the ages of one year and fifteen.
In Dr. Fuller’s test group all the boys had some accidents, but eight of them were particularly accident prone and accounted for as many visits to the infirmary as all the other twenty-two boys combined. Some of the girls, on the other hand, didn’t get a scratch all term, but a group of four practically lived in splints and bandages. They accounted for half the thirty girls’ total accidents, with as many as fifteen injuries each.
One interesting discovery was that even accidents that could be attributed to pure chance, like a cinder in the eye or a splinter in the seat, were more likely to happen to accident-prone children, along with such predictable hurts as cuts from fighting or burns from playing with matches.
This led Dr. Fuller to comment that accident proneness “is the habit of getting into certain injury-laden situations, which the non-prone child would avoid.”
Some clues as to how accident-prone
and non-accident-prone children can be identified by behavior and attitude are contained in a list (see below) drawn up by Dr. Fuller for parents who ask themselves, "Is my child accident prone?”
When these clues were applied to individual children they matched neatly the personality sketches of two of the children studied. Kaye was one of the few who had no accidents; Frank had more than average.
Kaye is a pretty girl, with blue eyes and blond hair. She is very neat and pleasant looking and seems to enjoy quiet activities more than boisterous ones. Stories and music interest her particularly. Her co-ordination is no better than average, but her routine habits are wellestablished and she carries them out rapidly. She’s a small eater but not “picky" and always tries to finish her meal. She likes other children and is liked by them, is co-operative and easy to please. Although she enjoys being with other children she prefers to play alone most of the time. She is a quiet child, perhaps even a little retiring.
“A bridge over the chasm”
Frank is a rugged awkward youngster of the type fathers like to describe as “all boy.” He is often rowdy in behavior and almost overwhelms other children with his strength and self-assurance. He is alert, has various interests and plenty of "drive.” He is more realistic than fanciful. He develops extreme likes and dislikes. Probably his greatest handicap is his terrific stubbornness. He takes on a defensive attitude immediately at any kind of suggestion or pressure. He likes to be the centre of attention, which is easy because he’s skillful at reading poetry and story-telling. He speaks with an extra-loud voice and assumes a rather dramatic manner during these recitals. He knows how to “use" other children to his advantage and likes to be boss, although he often follows up what others start.
The story of accidentitis to date makes it clear that not much is known of this new human problem and not much help is available to the parent who would like to learn more of the cause and something of the possibility of curing the “accident disease.” What knowledge there is belongs to psychiatrists and pediatricians. The doctor who probably knows most about accident proneness, Flanders Dunbar, says, “A start has been made toward building a bridge over the swampy chasm that separates the physical from the psychic. When it is completed we may be able to deal with the fundamental causes of accidentitis as we now deal with the fundamental causes of malaria—by draining the swamps.”
Children who had repeated accidents:
Persistent, even obstinate Impatient, hot-headed, explosive Easily aroused, ranging to hysterical and high-strung
Impulsive, act on spur of moment Stronger than average, ranging to exceptionally strong
Self-confident, ranging to cold and
insensitive of social feeling
Rarely show fatigue, even unusually
vigorous and robust
Energetic, vivacious, even overactive
Resolute to daredevil
Sometimes unmannerly and saucy,
even rude, insulting, insolent
Assertive, insistent, obstinate
Involve others in their injuries
Children who did not have accidents:
Give up before adequate trial, or quit in the face of obstacles Tolerant, ranging to very submissive Apathetic, with emotions slowly aroused
Deliberate, ranging to very cautious or calculating
Some physical difficulties, ranging to weak
Self-conscious on occasion Endure fatigue only satisfactorily Move with no more than required speed
Become timid, maybe even fearful Courteous, gracious, elegant Hold their own, but yield when necessary
Seldom cause others to be injured. -R