Singapore, 14 September 2017 – A study1 on road traffic related injuries in infants and children, conducted by KK Women's and Children's Hospital (KKH) researchers draws attention to the need for greater awareness and adherence to safety measures for children as car passengers and road users in Singapore.

Published in Elsevier's Accident Analysis and Prevention journal earlier this year, the study "Road traffic injuries among children and adolescents in Singapore – Who is at greatest risk?" presents a review of road traffic related injuries that were attended to at the only two paediatric tertiary care hospitals in Singapore, KKH and National University Hospital. The data comprised a total of 2,468 infants and children up to 16 years old, who were seen at the emergency facilities of the two hospitals within 24 hours of injury, from January 2012 and April 2016; these included infants and children involved in a motor vehicle crash as well as pedestrians, bicyclists, or motorcyclists involved in a crash with a motor vehicle.

KKH researchers found that 60.1 per cent of 2,468 children with road traffic injuries were motor vehicle occupants. Among the 1,483 motor vehicle occupants, 51.1 per cent (758 children) were not restrained at the time of the incident. Non-compliance with the use of child car restraints was found to be the highest among infants under a year of age. Data showed that as high as 65.7 per cent of infants in this age group were unrestrained at the time of the incident. Children aged between one and two years were next, with 61.5 per cent of those within this group being unrestrained at the time of the incident. Among children two years and older, this proportion was around 48 per cent to 49 per cent.

Out of 350 children who were on a bicycle or motorcycle at the time of the incident, 245 (70 per cent) were not restrained. Among these, 105 out of the 119 children younger than 10 years were found not to be using appropriate restraints, such as bicycle seats or helmets.

Dr Chong Shu-Ling, Staff Physician, Department of Emergency Medicine, KKH and lead researcher for the study, observed that compared to other advanced countries, compliance with the use of appropriate child seats and restraints for motor vehicles and two-wheelers was found to be substantially wanting in Singapore. "What's even more worrisome, is that the disregard for safety recommendations is seen beginning from early infancy," she said.

The study found that 590 children with road traffic injuries required hospitalisation – a small proportion of these (5.4 per cent) were brought to the hospital in critical condition, requiring cardio-pulmonary resuscitation or surgical intervention with the attendance of a multidisciplinary team. While majority of the other children (67.1 per cent) sustained soft tissue injuries, 17.8 per cent (105 children) suffered injuries to extremities, 17.6 per cent (104 children) suffered injuries to the head or face; the other sites of injury included chest (25 children; 4.2 per cent), abdomen (22 children; 3.7 per cent) and spine (7 children; 1.2 per cent). Six children succumbed to their injuries, 51 children (8.6 per cent) required care in the intensive care unit and 45 children (7.6 per cent) received critical care in the step-down unit. According to the data, a fifth of the children hospitalised had required subsequent surgery – while most required orthopaedic surgery for limb injuries, a small number needed neurosurgical intervention to manage intracranial injuries.  

Another paediatric trauma surveillance study2, jointly conducted by KKH and National University Health System (NUHS), revealed that from January 2011 to March 2015, vehicle and bicycle incidents were a leading cause of severe paediatric head injuries resulting in death, neurological and physical deficits or poor quality of life. An analysis of data from 1,049 children under 16 years, found that 45 per cent of these children with head injuries were vehicle or bicycle passengers, three-quarters of whom were not using child car restraints or helmets.

Dr Chong Shu-Ling said: "Children are fragile. The risk of death and long-term disability is real. The importance of adhering to road safety measures for children, especially the use of age-appropriate child seats and restraints, as well as helmets for bicycle users, cannot be overemphasised."

Dr Chong added that these findings point to the need for greater awareness about best practices that improve road safety for children, and the risk of injury when these are not followed. "We are hopeful that with a better understanding, parents and caregivers will be more conscientious and committed to adherence to safety measures, reducing the incidence of preventable and serious injuries in children locally."

Dr Arif Tyebally, Deputy Head and Senior Consultant of the Department of Emergency Medicine, KKH said: "Improving safety for children is an absolute priority for us. Towards this end, our hospital works in partnership with government agencies and industry bodies to spread awareness about the risks of childhood injury and measures to prevent them. In addition to road safety, awareness about toy safety, and education about the risk of submersion and drowning incidents involving children are among the more recent efforts undertaken by KKH."

1S.-L. Chong et al. Road traffic injuries among children and adolescents in Singapore – Who is at greatest risk? Accident Analysis and Prevention 100 (2017) 59–64;

2Chong SL, Chew SY, Feng JXY, et al. A prospective surveillance of paediatric head injuries in Singapore: a dual-centre study. BMJ Open 2016; 6: e010618. doi:10.1136/bmjopen-2015-010618