Three-year-old Ji Yunfei got a small bicycle as a gift this Children's Day. Like many others, Ji's parents did not buy him a helmet to go with it. They did not fully appreciate the dangers he would face while out riding.

In China, accidents remain the top killer of children under 14. There are 200,000 fatalities from accidents in that age bracket each year, accounting for one in every three deaths in the group.

More than one-third of the injuries result from falls. Over 80 percent of such tragedies involving children aged under the age of four occur in the home as they fall out of bed, a window or down steps.

Collisions and traffic accidents are the next most common cause of injury, according to a recent survey conducted by the National Center for Chronic and Noncommunicable Disease Control and Prevention (NCNCD), SAFE KIDS World-China, and Johnson & Johnson.

The mean cost for medical treatment per injured child was 250 yuan (US$30). Shanghai, the most populous city in China, spends an estimated 62.5 million yuan (US$7.5 million) to treat injuries each year.

Nationwide, children's deaths from accidents cause an economic loss of 36.5 billion yuan (US$4.4 billion) each year, accounting for 2 percent of China's gross domestic product.

The year-long survey conducted in Beijing, Shanghai and Guangzhou covered a total of 10,000 respondents.

"This is an important pilot study that measures childhood accidental injury patterns and public awareness. The result can provide data to develop proper preventative measures and related policies," said Doctor Duan Leilei, of the NCNCD.

Despite the number of fatalities, a "safety culture" is still sorely lacking in most of China, even in huge cities like Shanghai.

"All the injuries and deaths could be prevented if proper measures were taken," said Professor Zhang Ling'en, vice chairman of the Chinese Emergency Medicine Society's pediatric division.

The survey showed that fewer than half of parents think their children are at risk and only 16.4 percent had attended child injury and prevention training courses.

Safety in the home should be made a priority: more than 40 percent of injuries occur around the house.

Meanwhile, the social environment is also disadvantageous to children, as they lack the protection that strong laws and regulations would offer.

"This can easily be shown by the limited demand for children's safety equipment here, which leads to high prices for such products," said Heather Paul, executive director of SAFE KIDS Worldwide, an international network dedicated to preventing childhood accidents.

"More than 50 hours of wages are required in China to purchase a quality child safety seat, versus 2.5 hours in the United States," she said.

There are 540 million bikes in China and 16 million cars. Yet bike helmets are rarely used, despite China being a major manufacturer of helmets. Most are exported.

For school-age children, game and sports periods have become the most likely time for children to be injured, according to a research conducted by Sun Hongyan from the China Youth and Children Research Center.

Sun's survey, which covered 5,846 students in 10 different cities, indicated that about 53.6 percent said they often or sometimes got injured while playing games or sports at school.

(China Daily June 1, 2004)