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Nationwide: on kids' side

While millions were enjoying the Super Bowl, many viewers became significantly uncomfortable when a Nationwide Insurance commercial ended with the child who would "never learn" to do a variety of things because he "died in an accident." The ad has been panned almost universally by the populous, with Entertainment Tonight's website announcing "Everyone thinks Nationwide's commercial with the dead kid ruined the Super Bowl." Fortunately, Nationwide is standing by its "Make Safe Happen" campaign and advocating for more action to prevent unintentional injuries and deaths in children.

Outside of public health and medical communities, there is little awareness of the profound impact of injuries on children. Although a few traumatic cases receive media attention, the vast majority of the more than 8,000 child injury deaths each year do not; thousands of children's deaths — an average of 22 each day — go unnoticed in this country. These tragedies affect one family at a time, often with the complicated grief associated with knowing the child's death was preventable.

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Other families are burdened by unintentional injuries. Each year in this country, over 9 million children are treated in Emergency Departments for fractures, burns, lacerations, concussions, poisoning, smoke inhalation, suffocation and spinal cord injuries. Many of these injuries lead to long-term disability. The personal, social and emotional toll of injuries is enormous. So too are the financial costs: $87 billion just to treat the children, according to the Centers for Disease Control and Prevention.

The key message in the controversial commercial and from the public health community is that childhood injuries are almost always preventable. As you might have noticed, we have not used the word "accident" in this op-ed. The reason is that "accident" implies an injury occurred by happenstance, which is clearly not the case for most children injured in our adult-centric environment. We know that children are always at risk for injury, but not because they are "behaving badly." Children fall off monkey bars or bicycles, cross the street without looking, walk into swimming pools and pick up small objects to put in their mouths. Exploring the environment is a natural and important part of child development; it should not lead to injury or death. On occasion, children are injured simply because they are present: in motor vehicle crashes or house fires.

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The good news, missed by those who found the commercial disturbing, is that we can largely keep children safe — and not by over-protecting them. Specific environmental interventions or behavior modifications by caregivers can change these common occurrences into a non-injury event. Specifically, the playground with a soft landing surface will lead to a bruised elbow in an 8 year old who falls off the jungle gym instead of a fractured elbow from contact with asphalt. The swimming pool with a fence around it will prevent the 4 year old from wandering into the pool, whereas no fence can result in a tragic drowning. Parents who have set their water heater temperature to 120 degrees don't have to worry about burning the 18 month old who turns the nozzle to high — unlike those who have a water heater set at 140 degrees, which will cause a large second degree burn after 3 seconds. A child in an appropriate car seat may not have a single injury from a crash, while the improperly restrained child may be ejected from the car and suffer fatal or near fatal injuries. Even healthy babies are susceptible to unintentional suffocation when put to sleep in an unsafe sleep environment. For every 100,000 children born, 25 infants will die in the first year of life as a result of suffocation. By placing an infant alone, on their back and in a crib without soft mattresses, pillows, comforters or other people, the risk of death decreases substantially.

All children have the right to live, learn and play in a safe environment. Children learn by doing and exploring. What they need to be able to do is learn without becoming an injury or death statistic. Nationwide Insurance used its money to shock viewers with the reality of preventable childhood injuries. Despite the outrage, we can only congratulate them and hope they have opened people's eyes to what can and must be done to raise safe, healthy and happy children. Preventing even one child's death and a family's endless grief is worth the momentary discomfort of a 45-second Super Bowl commercial.

Dr. Scott D Krugman is chairman of the Department of Pediatrics at MedStar Franklin Square Medical Center; his email is Scott.krugman@medstar.net. Carolyn J. Cumpsty-Fowler is an assistant professor at Johns Hopkins University School of Nursing and a faculty member at Johns Hopkins Center for Injury Research and Policy; her email is Cfowler1@jhu.edu.

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