Accidents to children: Implications for health education

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Accidents to children: Implications for health education

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ACCIDENTS TO CHILDREN: IMPLICATIONS FOR HEALTH EDUCATION

A Thesis Presented to the Faculty of the School of Social Work The University of Southern California

In Partial Fulfillment of the Requirements for the Degree Master of Social Work

by Margaret Mcglasson June 1950

UMI Number: EP66350

All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion.

Dissertation Publishing

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S

'SO

A0 I 4 ^

T h is thesisj w r it t e n u n d e r the d ir e c t io n o f the candidate*s F a c u lt y

Cnm.m.ittee a n d a p p r o v e d

by a l l its m em bers, has been presented to a n d accepted by the F a c u lt y o f the G ra d u a te S c h o o l o f S o c ia l W o r k in p a r t i a l f u l f i l m e n t o f the r e ­ q u ire m e n ts f o r the degree o f

MASTER OF SOCIAL WORK

Dean

Thesis

.MCGLASSON

F a c u lty Com m ittee

C h airm an

TABLE OP CONTENTS CHAPTER

PAGE

I.

THE PROBLEM AND EMPHASIS IN THIS S T U D Y ........

1

II*

LITERATURE AND TRENDS IN ACCIDENT PREVENTION . .

9

Education in the elementary schools, 1919-1930

9

Emphasis on nW o m tB n responsibility, 1930-1940

13

Beginning recognition that the problem belongs to many institutions and many individuals,

III.

1940 to present time • • • • • • • • • • ♦ *

19

.............

32

General findings • • • • • « • • • • • • • * *

32

PRESENTATION OF CASE FINDINGS

Place of occurrence

• . • * • • • • . * • •

«

33

Age of children

38

Significance of multiple accidents • • • • • •

40

Significance of supervision

42

« . . « • « • • •

Excessive concern with supervision

45

Significance of overprotection • • • • • • . *

48

Summary of implications of overprotection and excessive concern with supervision • ♦ » • •

52

Analysis of cases where there was no direct supervision at time of accident

• • « • • •

53 1

Analysis of cases where there was no apparent neglect

58

Analysis of cases where there was parental neglect and accident seemed preventable

• •

59

ii CHAPTER

PAGE Summary of implications relating to supervision. . • • • • • • * • • • • • « • •

IV.

SUMMARY AND CONCLUSIONS

BIBLIOGRAPHY APPENDIX

• • • •...

.......

...........

60 62 69 72

CHAPTER I THE PROBLEM AND EMPHASIS IN THIS STUDY In a typical year accidents kill more children, more young men and women than any disease#

In 1946, according to

figures compiled by the National Safety Council, 99,000 per** sons were killed, 10 million were injured in the United States, and the total cost to our nation was more than five billion d o l l a r s #3*

out of this ten million injured there were approxi­

mately 370,000 permanent impairments#

No one would deny that

here is a grave and menacing problem that must be dealt with in some effective manner# Even more serious, perhaps, are the implications of a study prepared by the Statistical Division of the National Safety Council which reveals that accidents are the leading cause of death in children over one year of age***

Each year

some 20,000 children in the Uhited States die from accidental deaths#

The tremendous figure for additional ones who are

seriously maimed or disfigured for life, if available, would make this a more staggering figure#

One of the tragic elements

1 Herbert Yahraes, Make Your Town Safe! Public Affairs Pamphlet #133 (Chicago; Public Affairs Committee, Inc#, 1947), p# 3#

2 National Safety Council, Accident Facts (Chicago; National Safety Council, 1949), p# 4#

2 in this is that it is estimated that approximately 70 to 80$ of these accidents are preventable*^

Many believe also that

parents are accomplices in these accidents, and it is through parents that prevention must be accomplished* This problem of accident prevention for children has been of concern to the public for many years*

Three main

trends can be seen in the programs and methods that have been employed in such prevention*

The first planned safety work

began in 19T9 under the auspices of the National Safety Coun­ cil in cooperation with the schools*

Most of the responsibi­

lity for prevention of accidents was delegated to the schools* About 1930 there was a swing from an emphasis on the school vs part in this program to the part that mothers played*

Chtll

sometime in the 1940 fs f,mom,s,t responsibility for the child overshadowed that delegated to the school; it was her "fault *•, her negligence, that was the root of any and all accidents to the child*

The present trend is away from stressing the part

that any one person or institution plays in this total pro­ blem*

Accident prevention is being recognized as a complex

problem*

The responsibility for its solution must be shared

by many organizations and individuals interested in the wel­ fare of the child*

3 Etta C* Jeancon, 11Accidental Injuries in Children, " Annals of Western Medicine and Surgery* June, 1949, p* 226*

3 The Children’s Hospital, Los Angeles, provided the setting for a group of studies on accident prevention for children.

It is the belief of the administration of the hos­

pital that many accidents are preventable.

Four students from

the University of Southern California, School of Social Work, were given the opportunity to study all accident cases requir­ ing hospitalization from November 1, 1949 to December 12, 1949 with a view toward determining the validity of this premise, to ascertain factors in the accident causation, and to sug­ gest ways of reducing the number of these accidents.

The hos­

pital has been and is still intensely interested in research in this area.

Several leading magazines in this country, in­

terested in presenting material based on faets and research, have also indicated a desire for such research. The four students who undertook this study were doing their field work in either a medical or a psychiatric place­ ment,

They were interested in the several problems presented

by the hospital authorities and, while the objectives of their studies varied, alX pointed to one use - more under standing of the factors leading to accidents.

One student studied the

specific constellation of factors in the accident itself, or actually "what happened;19 she thought it might be possible to find a definite correlation between certain external environ^ mental factors and the accident phenomena.

Such findings, if

valid, definitely could be utilized in accident prevention.

These would he concrete, easily Illustrated facts that the public could readily see and accept If presented authentically* A second student believed there was much in the parent-child relationship that could be highlighted in a dynamic way toward health education in accident prevention*

She examined the ma­

terial available with the idea of discovering, if possible, "what goes on behind all this**'

It was her premise that the

child actually is led to have many accidents by reason of un­ healthy relationships with the parent, but that these are often on an unconscious level*

The parent is not an ogre; he

or she will accept health education in this direction if it can be presented logically without too much emphasis on the guilt of the parent in respect to these accidents, and if the material is based on facts that the public readily can assi­ milate and digest*

A third student was interested in the im­

plications for casework services or "what can be done now?" This thesis is not being written concurrently with the other three but will be done after the others have been completed* The present study centers around the kind of publicity currently being used in accident prevention, and the trends that have been followed in attempting to solve this problem*

Both

the literature and the publicity on accident prevention were examined and studied to learn what was of positive value and what was of negative value*

The writer, like the hospital

authorities, is familiar with the trauma of guilt feelings and

the havoc such feelings bring about in the behavior of an in­ dividual*

She questioned, therefore, the trends in publicity

that increasingly emphasized guilt of a parent In allowing these accidents*

She believes that the accident Is traumatic

enough without overemphasis of the natural guilt that any parent feels when his or her child is maimed, disfigured, or cruelly hurt*

She was interested in examining the overpro-

tectiveness of children as related to the accident phenomena; the amount and kind of responsibility that should be delegated to other institutions such as the school, and the amount and kind of supervision needed*

What could be done beyond remov­

ing the physical cause of the accident?

What were the more

common types of accidents and where did these accidents occur? Were there any vital child-parent areas that were being neg­ lected?

In reference to current health education and accident

prevention publicity, did this study point up possible changes that would result in a more positive approach? people like, this accident population? rigid all their lives? them?

What were these

Had they been fairly

If so, what would fixing guilt do to

Would it be found that the problem was Indeed one of

health,9 but also ...that it was concerned with mental health? nt The writer realized that she did not know what was "normal,* but she did have some idea as to what is implied in the terms overprotectiveness, rejection, guilt reactions, and rigidity* Could this knowledge be utilized in accident prevention?

Was

it applicable?

Basic to this study, therefore, was the ques­

tion of the effectiveness of the type of publicity currently used in health education and accident prevention#

There was

no question but that it was effective, but was the effect a healthy, constructive one?

Since it was the writer’s premise

that over-sensationalized publicity, resulting in over emphasis of guilt feelings on the part of the parent, only added to the trauma of the accident, she looked at the cases used to see what came out of them and to see how this material could be related to accident prevention publicity and to health edu­ cation# The study was made at the Children’s Hospital, Los togeles, as has been stated#

There was a total of forty inter­

views; the material from each was available to all four of the students#

Seven of these interviews were done by a social

worker regularly employed in the hospital as the child’s hos­ pitalization was of such a duration that the students were un­ able to see the parent while the child was actually in the hospital#

The four students divided the remainder between

them, each one being responsible for approximately eight interviev/s with a parent figure#

Seven other cases were omitted

as the hospitalization was of such short duration that no one was able to see the parents while the child was in the hospi­ tal#

The type of study used in the research was the casework

Interview with the support of schedules^ for the recording of the material gathered*

Several statistical tables based on ^

the material thus gained were prepared for the hospitalvs use# These tables indicated# among other things# place of occurrence time of accident# age of child# whether or not there was super* vision at time of the accident# what medical aid was sought# and time lapse between the accident and seeking and securing medical aid*

The study itself was limited# both in its setting

and the number of cases used*

The students were aware that

the study might prove to be only a focal point for further studies of this kind*

Therefore# it was made# hopefully# with

the purpose of finding material to present for a more con* structive# healthful kind of health education*

The students

recognized that the findings were not all inclusive# and that these findings might or might not indicate that a different approach to the problem should be made* The material for this study, of the series was obtained from three primary sources: (1) the casework interview with the parent or other responsible relative; (2) publicity by the hos* pltal# national magazines# and newspapers; (3) psychiatric and casework literature* parts*

The study is divided into three major

The first part deals with the motivation and planning

4 Sample of these schedules included in Appendix*

8 behind the study, facts about the study itself, and a discus­ sion of the literature, publicity, and thinking regarding ac­ cident prevention#

The main body of the study presents ma­

terial gained from the forty cases#

The four or five most

interesting and significant facts that were revealed are dis­ cussed in detail#

The relatedness of such material to the ac­

cident phenomena and to the current trends in accident pre­ vention is shown, and the implications of these findings are presented from the writer’s viewpoint#

The latter part of

the study is devoted to a summary of the writer’s general conclusions based on her analysis and evaluation of present publicity in the field, literature on this subject, and ma­ terial from the forty cases#

CHAPTER II LITERATURE AND TRENDS IN ACCIDENT PREVENTION EDUCATION IN THE ELEMENTARY SCHOOLS* 1919-1930 The literature on accident prevention in the early years was in line with the general conception of the school in all education*

From approximately 1920 to 1935 the total

safety education program* the responsibility and blame, was laid squarely at the schoolhouse door*

Safety work began

formally in 1919 with the work of the National Safety Council in cooperation with the schools*

George E* Payne summarized

the trend of thought of educators in the field in his book Education in Accident Prevention#5

He believed that accident

prevention education could be a part of the curriculum with­ out addition of any subjects*

In the elementary grades habits

of safety in home* in school* and on the streets were stressed through the channels of language* arithmetic* and drawing* In the upper grades there was more emphasis upon use of com­ mittees of pupils to study safety problems and to pass such instruction on to other children*

The channels here were

dramatizations * demonstrations* essays* excursions * and dis­ cussion groups*

Literature of 1924* 1926, and 1928 followed

5 E* George Payne* Education in Accident Prevention (Chicago* Lyons and Caruaham, I91§-T?fe6)* 192 pp#

10 the theme of Payne’s work*

Local happenings were utilized to

bring home lessons in safety*

Outlines of procedures for dif­

ferent grades which represented actual classroom practices in particular schools were drawn up, but no attempt was made to compare them with other methods in relation to effectiveness*® Vaughn, in 1928, supported this trend of safety edu­ cation, but stated additionally that the pupils must under­ stand why they were to study s a f e t y H e found that verbal instructions unsupported by other forms of stimulation were relatively ineffective, especially with children*

A more ef­

fective method was to provide actual experience of the ill effects of wrong reactions*

A demonstration of the manner in

which injuries might take place was more effective than mere negative and positive instructions* This era, which may be thought of as the initial one of ’’accident prevention through education in the elementary school,” was characterized by the belief of educators that the cause of accidents was Inherent in the victims and that this was especially true of children*

”Inherited tendencies,

6 Guy Montrose Whipple, editor, ’’The Present Status of Safety Education,” Twenty-fifth Yearbook of the National Society for the Study of Education* Part II (Bloomington* Illinois t Public School Publishing Company, 1926), pp* 245-80* 7 James Vaughn, Positive Versus Negative Instruction (New York: National Bureau of Casualty and Surety Underwriters, 1928), pp* 160-68*

. 11 bad habits, and ignorance have been the cause of thousands of accidents yearly*11®

Since the tendency to play is inherent*

controls must be built up in the child with the objective of preventing accidents*

Causing many accidents were bad habits,

such as crossing the street at the wrong place#

These might

be the result of the wrong influence, poor training, bad en­ vironment, or a constellation of these factors*

Ignorance,

which came as the result of a complex society, must be over­ come by instruction in safety, correlated with sound teaching methods and the right use of psychology#

Glimmers of a more

positive, sounder approach to the problem were found, in a pamphlet prepared by the National Safety Councils The teaching of safety has its serious dangers# If safety is taught negatively, if emphasis is laid on the horror of accidents, or if it is treated in a morbid way, the teaching will do more harm than good, for it will build up a fear complex in the child#® Those interested in the problem were beginning to see that all dangers could not be eliminated from the life of the child# Teaching safety in a positive way could give to the child a philosophy of life upon which to base a decision as to ?/hen and how danger could or should be avoided and when and how it

8 Patrick P# Shea, Accident Prevention (New Yorks D* C* Heath and Company, 1928), p# 1# "

9 Ibid#, p# 2#

12 was to be faced*

The safety patrol was utilized, as was a

knowledge of safety laws*

Other specific devices frequently

used were safety slogans, songs, and accident data and statis­ tics, both local and national*

In the formal curriculum safety

material was presented through penmanship, drawing, end arith­ metic* These methods did have value, as was demonstrated by the figures on deaths and serious injuries prepared by the National Safety Council*

It was estimated that through these

accident prevention programs, death and injuries were reduced anywhere from 50 to 90$ from 1922 to 1928*^

It was generally

agreed that the school was the plaee to build the desired con­ trols in the child as he was then in a plastic period of growth*

This acquisition of knowledge was also valuable as

the child could carry it into the home and reach the adult* It was also generally agreed that accidents were preventable, that the remedy was adequate education and that the school could play the most fundamental role in the elimination of ac­ cidents*

The problem was the choice of a method which would

be most effective in school instruction*

Iducators believed

there would be an attendant result of such instruction, but they did not anticipate the part that home and parents would

10 Ibid** p* 1*

13 play In all this program*

They considered It from what they

believed was a "much larger point of view” than that of merely saving human lives*

This point of view was that it affected

the development of the child's interest in school work, the child's development of civic ideals, and that it brought about the reduction of accidents*

The entire emphasis and energy

of the educators was thus directed toward the child going to and from school with little thought as to the problem of the whole child population away from school influences* EMPHASIS OH "MOM'S RESPONSIBILITY, 1930-1940 There was a hopeful note in the literature of the 1930's in connection with the White House Conference on Child Health and Protection called by President Herbert Hoover*

In

the range of objectives outlined, not only was the dependent child or child in special need of protection to be considered, "but all children, in their total aspects, including those social and environmental factors which are influencing modern childhood*11^

in President Hoover's opening address there

was a plea for understanding and help of the parent in rear­ ing the child which did not bear much result at the time*

He

held the premise that mothers, as a rule, were competent, but

11 White House Conference on Child Health and Protection, White House Conference* 1950* Addresses and Abstracts of Com** Sit tee Reports (Hew Yorks The Century Company, 1931), pp* vi-vii*

14 they could not hear the entire burden and responsibility for the child who would not be under their complete jurisdiction twenty-four hours daily*

This plea is quite eloquent:

Our country has a vast majority of competent mothers •**»But what we are concerned with here are things that are beyond her power* That is what Susie and John take on when from under her watchful eye*«**She cannot indi­ vidually control the instructions of our schools and the setting up of community-wide remedy for the deficient and handicapped child* But she can insist upon officials who hold up standards of protection and service to her children— and one of your jobs is to define these stand­ ards and tell her what they are* She can be trusted to put public officials to the acid test of the infant mor­ tality and service to children in the town— when you set standards for her to go by* These standards of child health and protection are a complicated problem requiring much learning and much action* ***Let no one believe that these are questions which should not stir a nation; that they are below the dignity of statesmen or governments* If we could have one generation of properly born, trained, edu­ cated, and healthy children, a thousand other problems would vanish*12 It appeared during the next decade that educators, legislatures, safety directors, psychiatrists, and others in­ terested in the field of child safety education took Hoover9s admonition most literally*

By the middle of the 309s a sur­

vey of accident facts showed, that many accidents continued to occur in which children below school age were involved and that all such accidents did not occur on school grounds*

A

new culprit was needed; it inevitably followed that "Mom’1 was the logical successor*

12

Ibldt, p ♦ 7 •

Since then mother has continued to be

15 admonished, reprimanded, and blamed until she found the re­ sponsibility of rearing a child almost too much for her !ffeeble intellectual powers*n and when to do*”

Mother was told Mwhat to do, how to do,

Emphasis was placed on safety in the home,

on the constant and almost Mvlgilanten supervision by the mother* There was a beginning of awareness that the school was not alone in solving this problem; others were Interested and responsible* the times*

However, this awareness was a little ahead of It is true that there was a movement In this di­

rection, but it was a very literal one*

It concentrated on

mother, so the shift in emphasis from the school's to mother's responsibility took place*

Educators continued to campaign

for safety education as a part of the school curriculum but reported that schools were not adequately emphasizing the most effective methods of teaching*

It was generally agreed by all

that the value of direct experience and learning was good; the emotional appeal of dramatizations and self-direction by the pupil was recognized*

However, as MacMillan stated in his

study of this subjects •••all teachers cannot and do not use the same methods for the same end* Much must be left to the initiative of the individual teacher or to the whole needs of a parti­ cular community 13 !,3afety Education Thru Schools,M Research Bulletin of the National Education Association* Vol* XVI, No* 5, November, T§38, p* 255, citing Robert MacMillan, Safety Education in the Public Schools of the Halted States*(Doctor's dissertation, Temple tibiversity, Philadelphia, 1936), p* 107*

16 The White House Conference of 1930 also pointed up mental hygiene aspects in the schools*

With this emphasis

there developed new concepts as to accident causes and pre­ vention*

The amount and kind of discipline which was thought

to be needed was changed materially*

Discipline became a dif­

ferent concept with the development of a health approach to behavior problems*

It was brought out publicly, although this

fact already had become increasingly apparent to many, that the school was not alone in this responsibility for the child's safety*

Children have their roots in the home situation and

In the constellation of factors that make up the child fs home environment*

Many school difficulties were found to arise

from personality difficulties bred at home. A tthealth education curriculum" began to be born*

There

was a concentrated effort to interrelate this instruction closely with the child's experiences in the school, home, and community*

Such a curriculum must be continuous, growing and

flexible to meet life situations, interests, and specific needs*

"Consider the whole child" was to be the guiding prin­

ciple at all times*

Sound thinking characterized this mental

hygiene or health education approach*

The child must learn

to understand himself as a human organism*

He must be given

instruction that would help him to understand the principles basic to healthful living*

He must build up health ideals and

a sense of individual responsibility for the health of the

17 individual and the race*

Education for health behavior was

considered as a way of personal and social living, in its physical, mental, and emotional aspects*

To achieve this it

must grow out of all child experience in the home, school, and community* It was discovered that the field of health and the field of safety were not sharply separated* and is a necessary ingredient in life*

Adventure was

Safety not only in­

volved being safe from something but being safe for something* Safety education should, therefore, be a training that would enable the child to be selective about the choice of adventure, to act intelligently and bravely in the presence of actual or threatened danger, to avoid the poor adventure*

The committee

concerned with the school child at the White House Conference on Child Health and Protection pointed up four ways in which this education could be demonstrated* (1) in the formation of an attitude of mind which would successfully discriminate be­ tween dangers that are to be avoided and dangers that are to pe faced and which will lead the child to take the appropriate

action in each case; (2) in the formation of habits of safety; (3) in the acquisition of certain learnings with regard to dangers and the way either to avoid them or to face them; (4) in the acquiring of the appropriate skills to put these

18 learnings into u s e , ^ Thus, in solving the practical problems of life, the child was also building up the structure for a health rela­ tionship to life.

The educational value to the child, since

such education was almost entirely self-centered, must be judged on two grounds: (1) did it have to do with matters to which the child was emotionalized? matters that were of important human

(2) did it have to do with concern?^

The committee

also en$>hasized the outstanding characteristic of the world of today as being the physical mastery that an individual was able to exercise over it. haphazard world.

Since this was so, it was not a

Learning how to control it and himself made

up most of the substance of the individuals education.

Then,

”An accident is only the outward evidence of an inability to exercise such control; the study of safety is in reality a study in effective control,l|16

Safety education was con­

sidered by this committee as primarily a problem of controlling behavior by encouraging safety habits and attitudes.

Some of

the specific ways such education was to be carried out was

14 White House Conference on Child Health and Pro­ tection, The School Health Program (Hew York: The Century Company, 1*932), pp, 176-7^, 15 Ibid,, p. 178, 16

Ibid,, p, 179,

19 through organized play, through safety education work among children in the school and playground and also among motorists, hy providing adequate neighborhood play space and play leader­ ship, by a teaching of play skills and attitudes that would create a structure for the right relationship to life* BEGINNING RECOGNITION THAT THE PROBLEM BELONGS TO MANY INSTITUTIONS AND MANY INDIVIDUALS, 1940-present time The Committee on Safety Education in Schools subscribed to this same philosophy*

Although admitting that safety edu­

cation had its technical side, this Committee stated that in its deeper sense safety education was the acquiring of an at­ titude toward life* The safety habit when established has a practical pro­ tective effect, but still more important is the effect upon character that is produced, and that can be produced only while such a habit is being formed*^ Again, there was recognition that accident prevention was a complex problem, belonging specifically to no one individual* This Committee recognized that many organizations and agencies contributed to the program for protecting child life*

Shar­

ing such responsibility were the school, police department, building inspectors, and many others*

This view was advanced

17 White House Conference on Child Health and Pro­ tection, Safety Education in Schools (New York: The Century Company, 153277 P« 5*

20 also by Esther Richards during this 1930 White House Conference* She stated that the mental health of childhood should be the active concern of and to the intelligent interest of doctor* teacher* parent, social worker* and of all constructive forces that came in contact with the welfare of children**-®

she pre­

sented a viewpoint ahead of the times* and one that is being more and more accepted by those psychiatrists and educators inter­ ested in this problem today* Mental hygiene is an aspect of hygiene that takes a genetic Interest in the behavior of an individual* deal­ ing with assets and liabilities of life which may or may not develop into pathological behavior* It must concern itself with every factor contributing to the growth* de­ velopment and personal welfare of a human being functions ing as an Integrated personality* and not as an organism functioning in segments of mind and body**-® Richards also pointed up* in her discussion of this problem in 1932* a fact which somehow became mislaid until re­ cently* when it has become the cause of concern to many in the field of child health and protection*

This fact was the trend

to concentrate on one individual as responsible for this pro­ tection of the child*

As Kubltchek so descriptively stated

its

18 Esther Lor ing Richards, "Extracts from Discussion*" White House Conference on Child Health and Protection* Psycho­ logy and Psychiatry in Pediatrics: The Problem (Hew Yorks The {Jentury Company* 1932T* pp* 44-47*

19 Ibid** p* 45*

21 The avalanche of popularized literature on psychology, psychiatry, mental hygiene and child welfare has left many an intelligent parent with mental Indigestion and in a state of confusion as to what they should do#20 Thus, even in the 30*s when ’’mom’s” responsibility was the prevailing theme of those interested in accident preven­ tion for children, there were those who eould see that respon­ sibility could not be delegated to one person or institution* However, these glimmers of a different approach were, not high­ lighted until a decade later*

In the 1940’s this theory of

’’mom’s” responsibility was beginning to appear in disrepute* Educators began to draw others into the solution of this pro­ blem, and as they did so, the parents’ responsibility began to be seen in a new light*

In 1947 this accident prevention

campaign was picked up by the Children’s Hospital of Los Angeles with the cooperation of the Los Angeles newspapers* For approximately two years, monthly articles appeared stress­ ing positive safety factors*

Miss Rhea Ackerman, assistant to

the administrator of the Children’s Hospital, was largely in­ strumental in this series of articles*

Her purpose was to pro­

mote a sound program of accident prevention*

Besides enlist­

ing the aid of the newspapers, Miss Ackerman found support in

20 Paul Edward Kubitchek, ’’Extracts from Discussion,19 White House Conference on Child Health and Protection, Psycho­ logy and Psychiatry In Pediatric a t The Problem (New York: The Century Company, 19357* p* 59*

22 the police department, in educators, in young people who had special talents and hobbies such as photography*

Believing

firmly that adult education was basic to any program such as hers, she compiled and had published many salient facts con­ cerning substances, objects, and situations that resulted in accidents*

With the assistance of Dr* Sidney Lasell, who was

then chief resident physician at the hospital, Miss Ackerman instituted a spot check to determine the actual percentage of auto accidents and home accidents*

It was her purpose to call

to public attention the causes of most accidents to children and to impress upon the public the need for adequate supervi­ sion of children at play*

It was Miss Ackermanfs belief that

most accidents could be prevented by proper supervision and adequate precaution in removing hazards where possible*

More­

over, she maintained that parents alone were not to blame, that many accidents occurred at neighbors9 and relatives1 homes where the adults were not accustomed to having young children around* Borne splendid articles were presented on the dangers of cer­ tain foreign bodies, many of which parents had heretofore con­ sidered of little danger to their child*

Valuable and life-

saving articles for preventing the strangulation of babies in bed were pointed up graphically by the doctors*

The child's

interest in motion was highlighted so as to bring home to par­ ents the inherent dangers in leaving a child unsupervised around a fan, a wringer, or other whirling household appliances*

23 Dr# Etta C# Jeancon, attending physician on Opthalmology Ser­ vice for Children’s Hospital, contributed some very worthwhile material to the subject of accident prevention which appeared in the Los Angeles Times» April 3, 1949#

21

In it she made this

statement indicating the awakened interests of many in her field in accident preventions Hospitals are through with the negative attitude of the past generation of doctors who believe a certain number of children have to be hurt and there is not much one can do to reduce the average##• Dr# Harry F# Dietrich, prominent Los Angeles pediatrician, presented an excellent paper at the Tenth Annual Western Safe­ ty Conference, June, 1948, which gave a little different theory of safety education#^

ge pointed up the need for adequate

supervision while the child was yet an infant and at the com­ plete mercy of others, but he advocated the use of education as a gradual and desirable substitute for such supervision as the child grows older#

He reemphasized the point made much

earlier by others interested in this problem that the child must be prepared for, not protected from, the ordinary risks of living#

21

Etta C# Jeancon, "Parents Can Prevent Accidents to Child,11 Los Angeles Times. April 3, 1949, Part III, p# 2# 22 Harry F# Dietrich, "Will Your Children Have Chil­ dren?w Paper presented at the Tenth Annual Western Safety Conference, Los Angeles, June 17* 1948, pp# 1-4#

24 The need for and the value of this campaign was de­ monstrated graphically by the decreased number of accidents to children from certain types of injuries during the two year period*

Dr* Dietrich's statement that he believed, "time,

thought, and well-directed effort on the part of parents will prevent this accidental slaughter and mutilation of their chil­ dren”*^ seemed to be borne out*

No one would deny that these

articles had their positive values*

Yet, underneath the cam­

paign, there seemed to be an underlying theme that could pos­ sibly have had negative effects* of the guilt of the parent*

This was the overstressing

They, the parents, were warned

against the purchase of sharp toys which often caused eye in­ juries wdue to improper supervision and thoughtless selection of such playthings by parents.1124

Articles giving feasible

ideas for preventing child accidents concluded with statements and phrases as Children are a great deal of bother, but most people think they are worth it*”25

Or, wIt is the negative

23 Ibid*, p* 3* 24 Sidney Las ell, "Parents Warned on Sharp Toys for Children,” Los Angeles Times* January 5, 1948, Part II, p* 1* 25 "Careless Parents Blamed for Children's Accidents,w Editorial, in the Los Angeles Times* October 3, -1948, Part II, p* 4*

25 attitude of the parent that often does the mischief#^®

4

leading magazine published an article in December, 1948 with the threatening caption, "Safe at Home-Thatfs What You Think!"27 Guilt and improper parental supervision were inevitably em­ phasized#

"Do this but donft do that” and "supervise, super­

vise, supervise!" became a thread that tied all these articles together*

It could not be too much of an assumption to say

that thoughtful parents were becoming so burdened with the terri­ fic responsibility that was theirs, that the trauma of an ac­ cident was almost more than they could handle# At present, there is a trend to examine what the dev­ astating effect of such constant supervision, such rigidity on the part of the mother, has been on the child and on the mother, and to seek a new approach to the problem of accident prevention and safety education#

Psychiatrists and other

leaders interested in this problem are increasingly emphasiz­ ing the fact that the mental health of childhood belongs to many groups, each of which can be a constructive force toward the welfare of children If each can be brought to see the re­ spective part it can play In this opportunity#

There is a

26 Jeancon, op# cit#, Los Angeles Times» April 3, 1949, Part III, p# 2# 27 Harry B# Logan, Jr#, "Safe At Home-That*s What You Think!" Better Homes and Gardens* December, 1948, pp# 140-145#

26 breaking away from the idea that the parent is or can be re­ sponsible totally* and an Increasing recognition that the many factors contributing to the growth, development, and personal welfare of the child cannot possibly be controlled by "Mom* alone*

Rigidity is not to be sought since the effects it has

on the parent and the child alike are contrary to the prin­ ciples of mental hygiene*

In accident prevention for children,

F

these leaders believe the education must go on continually from the child's birth to maturity*

If this education is misdi­

rected, as placing the blame on one institution as the school, or upon one individual, as the parent, it cannot be effective* The child must be helped to develop his own skills and controls so that when it does become necessary for him to act in a situa­ tion that implies physical danger, these controls will allow him to do what must be done* The National Safety Council In 1949 outlined an ap­ proach that it believed to be sound*

It is the Council's be­

lief that practically all of the 98,000 deaths due to acci­ dents In 1948 could have been prevented*

The methods sug­

gested by which this prevention might be effected weret (l) the education or control of potential victims; (2) the eli­ mination of harmful agents from the environment, or their isolation In such a way as to render them harmless; and (3) the development of new ways to render environments safe and

27 persons less suspectible to accidents*28

While each of these

methods have merit and doubtless will help to decrease accidents, there is yet theremnant of the old

philosophy of ac­

cident prevention which does not take into

consideration the

recognition that there is much in human relationships, one to the other, that can create or can solve a problem*

It is this

fact that the psychiatrists of today are beginning to bring to the publicfs attention; It illustrates, perhaps, that a new approach to the problem

is indicated*

These leaders are in­

creasingly bringing to the public view facts and principles that, while closely allied to the Council's three methods, gives recognition to the importance of the healthy parent-child relationship*

It is recognized that the child must have a way

to express himself; if such expression is to be allowed to grow, parents and educators cannot maintain a rigid and in­ flexible standard for the child*

True, there is need to help

the child with his own adjustment of what he can and cannot do, and to help him gain the greatest efficiency within such adjustment*

Under the leadership of many farseeing authorities

in the field of child health and welfare, series of readers and other educational material are being given to the teacher*29

28 National Safety Council,

0 £*

clt*. p* 2*

29 Cf*, Clifford Lee Brownell and Jesse Feiring Williams, editors. Health Of Our Nation (New York: American Book Company* 1943)*

28 The main theme of these series is the training and condition­ ing of the child for life, and the recognition that healthful, positive attitudes must be formed on the childfs part if his is to be a satisfactory life#

This precludes the possibility

that the parent is totally responsible for the child1s safety, but it also implies that the parent*s relationships with the child are of the utmost importance in forming such healthy attidues# Benjamin Spook1s book, Baby and Child Care, which was awarded the 20th Annual Parentfs Magazine Award, is a guide that is illustrative of the present thinking in respect to the care and training of the child from birth to adolescence*

In

the very beginning of his book, Dr. Spock points up the signi­ ficant fact that educators and psychiatrists do not know all the answers yet* Our ideas about how to treat a child have changed a lot in the past and will certainly change in the future* This book only tries to give you sensible present-day ideas of the care of a child, taking into account his physical and emotional needs# It *s not infallible*30 Clearly, from the way in which Dr. Spock*s presentations are made, he is not ,fagainstn the parent and does not advance the thinking that diligence and supervision can prevent all acci­ dents to children*

In a discussion of the way of handling the

30 Benjamin Spock, Baby and Child Care (New Yorks Pocket Books, Inc., 1946), p* 2*

29 on© year old, there Is found some sensible, factual material that is not in any way conducive to emphasizing the responsi­ bility of the parent beyond its limits, or to over-empha si zing the guilt of the parent if an accident states itr "Parents cannot prevent

does occur#

all accidents#

As he If theywere

careful enough or worrisome enough to try, they would only make a child timid and dependent#"3^* From this he goes on to outline the ways in which some of the more serious accidents can be prevented if the parent knows "where the common dangers lie and are sensible in avoiding them#"32

This approach is

positive; it puts the parent in the mood to be sensible and avoid accidents, and at the same time it avoids the implica­ tions that are present in much of the sensationalized publi­ city that has been the rule during

the last few years#

In Washington, making plans

for the Mid-Century

White

House Conference on children and youth, Dr# Helen Witmer com­ mented on this publicity and made some very succient state­ ments that were in line with those principles advocated by Dr# Spock in the preceding paragraph#

Under the by-line of Dorothy

B# McCardle, a Washington reporter, an interview with Dr#

31 Ibid#, p# 204# 32

Ibid#, p. 204#

30 Witmer was presented to the public through a newspaper article#^3 Concern was expressed over the fact that when an accident did occur, the parent had often in the past been made to feel bur­ dened with his guilt for allowing the accident*

In this inter­

view, Dr* Witmer recognized that psychiatrists have been in­ terested in doing all they possibly could to help parents, but she expressed the belief that in many instances they had cre­ ated a traumatic situation for these same parents by emphasiz­ ing this guilt*

She agreed that parents were often at fault

when these accidents occurred, but to constantly blame parents and to give them no credit was not a positive approach to the problem*

Rather, it only resulted in parents being afraid of

the job that Is theirs#

Parents are people § they need to have

some recognition of the job they are doing and help with what they cannot do alone#

To help them to feel more adequate, not

less, is the desired goal*

There is no doubt that psychiatrists,

psychologists, pediatricians, sociologists, social workers, and all hospital personnel and others interested in the youth of the country are eager to do all In their power to further the child1s welfare*

Dr* Witmer, being aware of this, hoped

to enlist the,lr aid In an over-all approach to the problem,

33 Dorothy Bartlett McCardle, "You*re Okay, Mom--Psychiatrists Are The Ones Who Are Wrong,” Washington, D* C# news­ paper, publication facts not available#

31 one that will give mom only her just share of the blame*

Her

closing words in this interview summarize clearly the present trend in accident prevention? We want the country to get rid of the feeling that parents are a threat to the mental stability of their children and ought to be hangedl What we need more than anything else in this country are parents who feel needed# They have to feel that way if they are to help their chil­ dren to feel that way*34 It is in accord with the sentiment and purpose ex­ pressed by Dr* Witmer that the writer has proceeded with this thesis*

It would be well to look Into some of the well-known

psychiatric principles of the parent-child relationship, of the growth and development of the child, and into the growing concept of mental health for all In order to gain a little more insight into the trauma that can be the parent fs when guilt is constantly fixed at his or her door*

Perhaps those Interested

in this problem can begin to see what might be done and that the cooperation of all is needed to bring about mental health as It Is thought of by those devoted to such a concept*

34 Loc* cit*

CHAPTER III PRESENTATION OF CASE FINDINGS GENERAL FINDINGS Some interesting and possibly significant facts came to light when the forty cases were studied and analyzed with a view toward securing health education implications for acci­ dent prevention*

Fifteen or three-eighths of the accidents

were ones In which the child received a fracture of some kind; ingestion accounted for one-fifth of the accidents*

Other ac­

cidents were of various types with few cases in each category* In looking at the fractures it was found that the majority of them were just a matter of falling down or of the child's hit­ ting himself against an object*

The accident itself was not

particularly serious, and there seemed nothing in particular that could have been done to have prevented it*

An illustra­

tion of this type of accident was Mary, who was hospitalized for osteomyelitis*

One month prior to this accident she had

sprained her ankle when running at school*

This accident oc­

curred when she was skipping down the aisle of a movie theatre and struck the same ankle on the steel rim at the base of a chair*

The resulting bruise necessitated hospitalization*

A

second example was seen in John, Jr*, who, walking home from a playmate's house after school, tripped and fell*

It was not

known whether he tripped on a shoelace or a crack in the

S3 sidewalk#

He fell with his weight on the palm of his hand,

his arm held stiff, so that a break in the elbow joint occurred# Both accidents might have occurred had a parent been present# On the surface it does not seem that the public could do any­ thing about publicity in respect to such accidents#

Some of

the accidents in which the child swallowed a harmful object or substance indicated neglect or carelessness; others came in the same category as the majority of the falls#

These find­

ings are in line with Dr* Dietrich’s conclusions on accidents# The particular hazards of this age are the street and driveway, electrical outlets and appliances, fire and heat, machinery, and poisons, and points and pellets*##The wise parent lets his run-about child fall from a chair and drink vinegar from a bottle, but locks the upstairs screen and puts the bottle of lye under lock and key# The wise par­ ent’s children learn in painful but not lethal situations *55 PLACE OP OCCURRENCE A significant fact in these forty cases studied was the place where the accident occurred#

Nineteen or almost half of

the accidents happened in the home, either inside or on the premises#

An additional six happened in the homes or on the

premises of the neighbors#

Nine occurred on the street#

The

writer does not intend to convey here the idea that the home is the most dangerous place for the child to be*

35 Dietrich, op# cit»* p# 4#

Rather, the

implication is that the presence of an adult does not neces­ sarily mean supervision#

Due to this fact, it would seem to

he indicated that health education directed to similar situa­ tions would he appropriate#

Only three of the forty accidents

occurred on the playground and one in a camp#

This might he

directly related to the tremendous part the school has played in teaching accident prevention#

From 1919 when school pro­

grams in accident prevention began until recently, the source of this instruction was in the schools#

Evidently, they have

done a splendid job, hut is it not safe to draw the conclusion that this education is not the responsibility of the school alone?

Is it not indicated that since accidents in large num­

bers persist, it is imperative that the areas in which these occur he located and education toward prevention he directed thusly? Reexamining the various types of accidents that occurred in the home and on the home premises, it was clear that publi­ city and adult education are needed to point up some everyday dangers the little child faces# hazards in the home#

Many accidents are due to

One child is burned; another is poisoned#

Still another child is crushed In the driveway by a backing car; a fourth is found choking on foods it should not have had access to at the time#

The pamphlet compiled and published

by the Children^ Hospital entitled "Safety Your Child*8 Heritage” effectively pointed, up many of these common dangers

for the young child#

36

There was much of positive in this

pamphlet as compared with some of the more lurid kind which intensifies the parent*s guilt*

In the cases studied for this

thesis, startling neglect was found; it was not difficult to recognize the thinking of those who write publicity directed to make the parent more conscious of just such accidents*

Many

accidents occurred due to failure of the parent to take a simple precaution such as setting a firescreen in place*

The horror

of a child being needlessly burned or maimed for life because it was left unsupervised, and seized upon such an opportunity to examine a wringer in motion is great enough to supply moti­ vation for many articles establishing the parent*s guilt#

This

is the kind of situation that can easily be demonstrated in ac­ cident prevention publicity and backed up with the exhibited evidence of tragic facts that many accidents are due to a par­ ent fs carelessness or ignorance# Yet, in a careful survey of the forty cases upon which this thesis is based, two facts stood out very vividly*

In

those cases where there was little or no neglect the accident often would have occurred regardless of anything the parent could have done*

family relationships were, on the whole,

36 “Safety Your Child*s Heritage,“ pamphlet published by The Children’s Hospital, Los Angeles, California#

wholesome in most of these cases*

In some of the cases in­

volving neglect, there were reactions on the parentfs part which made the interviewer question the desirability of publi­ city that, while pointing up positive facts that the parent could utilize in protecting her child and insuring his future, also carried a strong implication of her guilt if she permitted such an accident actually to happen to her child* dents particularly illustrated this point*

Two acci­

In one instance

parents with their one and a half year old child were visiting close relatives*

The childfs father and uncle were in the

dining room where the child was playing while the mother and aunt were in the kitchen*

The child ate some ant paste from

an open can which was on the floor in a corner of the room* There is no question but that there was neglect here*

The can

should have been removed while the child was in the room, but there was no actual neglect on the part of the parents*

They

could not have known the ant paste was there, and the father was actually in the same room with the child*

It is question­

able that fixing the ^blame11 for the accident or establishing the guilt of the parents for such would have positive gains# Rather it would appear that some publicity pointed to awareness on the part of all adults of possible hazards to the child would be more life-saving for the child and less traumatic for the parent*

In another Instance a child was put to bed*

Later he

awakened and reached for some nosedrops which were on a nearby

37 dresser*

Ee swallowed some* and it was necessary that he be

hospitalized* defensive*

Mother, when interviewed, was quite abrupt and

There was no doubt that she had great guilt feel­

ings at a time when her concern over an ill child was enough of a burden for her to carry*

These reactions were repeated

many times in these home accidents* Of the nine accidents occurring on the streets, three or one-third showed neglect*

One child, struck by a car while

crossing the street, was clearly too young to be in traffic alone as she was*

In two instances the child was playing in

a driveway and was struck by a neighborfs car*

There was neg­

lect on the part of the parent for allowing the child to play where such a tragedy could occur*

Yet, the adult in the car

also had some responsibility for that child1s safety*

Again,

it would appear that this matter of accident prevention for the youth of the country Is a matter that is of concern to all adults and which can only be accomplished by the united efforts of all adults*

Since traffic accidents are usually more seri­

ous, direct publicity would appear to be appropriate here* Parents have to be told about many hazards which are minimized simply because they are so frequent*

They, perhaps, need more

Illustrations, more elaboration, to be effective*

There is a

question that fixing the guilt for such accidents would lessen them without some grave trauma to the adult involved*

Many

cases are known where an adult who had maimed or killed a child

58 in an accident has the greatest difficulty in continuing to live a normal life*

This person often refuses to touch a car

again and is so burdened with guilt that he is unable to func­ tion as a worthwhile, useful citizen#

This is no more desir­

able than is the wanton destruction of children*

To be de­

sired is a healthy attitude of mind, a frame of reference as it were, for all those adults interested in the safety and well being of the dependent child# AGE OF CHILDREN Another highly interesting fact, and one related to this delegating of responsibility to other institutions or places, was the age of the children involved in the forty accidents studied*

Twenty-one or half of the children were under six

years of age#

Eight were between the ages of six and eight#

Thus, practically three-fourths of the children were below eight years of age*

(The writer was aware that Children,s

Hospital limits their service to children under fourteen#

How­

ever, she felt that the age of the children whose hospitaliza­ tion was Included In this study may prove to be of some In­ terest to readers#)

There would seem to be an indication here

for more health education of children of preschool levels and in the first two years of school#

From these facts it can be

easily seen why educators, physicians, psychiatrists, and teachers have become convinced that parents are to blame for

39 accidents and have directed their teaching, publicity, and edu­ cation to that end, l#e#, to bring home to the parent his part in this unnecessary yearly total of accidents to children# They have attempted to fix guilt in an effort to prevent such wanton destruction of the children of the land#

Publicity

given accident prevention over a period of some two years which appeared in the Los Angeles Times, and has previously been al­ luded to, was provided in all good faith by doctors and in­ terested participators of the Children^ Hospital; it stressed supervision and parental guilt#

Typical of the negative in

such articles in this series was the following which appeared as an editorial in the Times during this campaigns Careless Parents Blamed for Children*s Accidents One-fourth of all admissions to Children*s Hospital are accident cases directly resulting from parental neglect, statistics of that institution show# Ant poison, gasoline, paint thinner, and other lethal drinkables and eatables are left open within the reach of baby hands; and if the result is not always tragic, that does not justify par­ ental carelessness# Children are notoriously finto everything* and parents can hardly be unaware of this characteristic# The only safeguard is to lock everything up that can harm the child# These precautions are troublesome but less so than the difficulties caused by lack of them# At best, children are a good deal of bother, but most people think they are worth it#s?

37 Editorial in Los Angeles Times# op# cit#, Part II,

p# 4#

40 As the study of these cases progressed, the justifica­ tion of such an article has necessarily been questioned*

There

was no quarrel with the fact that the two year publicity had been instrumental in a decrease in accidents*

Parents had be­

come aware of many situations, previously not thought of as dangerous or threatening, that meant death or crippling to a child*

They had learned much of caution in the use of lyes,

poisons, of the perils of open fireplaces, pots, and pans with handles that could be reached by a curious tot, of unsupervised play* tinued*

There was no doubt that this education should be con­ Some things must constantly be before the public eye

or the implications do not register* The remainder of this section is devoted to several quite significant findings with the implications that they pointed up to the writer in line with what has currently been done in the field of accident prevention and the current think­ ing on the same subject* SIGNIFICANCE OF MULTIPLE ACCIDENTS A significant finding in this group of accidents was that there was a definite correlation between parent*s rigi­ dity, overpossessiveness, or rejection of the child to the num­ ber of accidents that happened to that particular child*

On

pages 32 and 33 two Illustrations of fractures were given* In each case, as was stated, there appeared to be no neglect

41 involved and no way in which accident prevention publicity could be directed to prevent these accidents*

Analyzing the

cases further, it was found that in the case of Mary, the re­ lationship of mother and child left much to be desired, with each other and with other persons*

Mother showed definite

hostility to father, definite rigidity in her supervision of the children*

She always wanted to know exactly where the

children were at all times and often specified the nature of the children’s activity* ful and often disobedient*

Mary, herself, was found to be wil­ She was interested only in her

dramatic ability of which mother is also quite proud; she got along well with those children whom she could dominate in play* In the other example of John, Jr*, a similar situation was seen*

John fell often; he was awkward and clumsy*

In the

hospital he was very upset; he feared that he was deserted and alone*

In his relationships with other children much inse­

curity was demonstrated* vision over her children*

Mother maintained constant super­ She could not understand, since this

was so, why John repeatedly had minor accidents*

It was indi­

cative that father was the person interviewed regarding John’s accident* viewer*

Mother was too upset and nervous to see the inter­ Father believed that mother was too rigid and too

strict In her rearing of the children; he expressed the hope that she would f,go easierfr after this accident*

It would ap­

pear that there is need for health education which, while

42 protecting the child, would strengthen and encourage good, wholesome attitudes and relationships between parent and child# ^Telling parents1* does not seem to be adequate; a factual kind of publicity does not reach the parents in these situations# This appears to be a complex thing, concerned with more than appears on the surface#

It would seem to be indicated that

mental health education may help in the troublesome parentchild relationships that seem to breed painful situations, and which accident prevention publicity seem not to reach in a helpful manner# SIGNIFICANCE OF SUPERVISION In looking at the cases in more detail it was seen that more than one-third of them occurred where there was no adult supervision#

This would seem to reinforce the constant super­

vision that some educators advocated#

This matter of super- .

vision will be taken up In more detail later in this study so the reader is asked to hold that point in abeyance until then# Two points, however, need to be emphasized here#

First, If

more than one-third of these accidents occurred when there was no adult supervision, then almost two-thirds of them occurred when there was total or partial supervision#

This would in­

dicate that it is not enough to have an adult present, and that one-third might have happened in some instances had there been supervisionl

The other point to be made here Is the result

43 of laboring the point of constant supervision. it having on the child?

What effect is

What is fixing the guilt on the par­

ent, when such excessive supervision is not given, doing to the parent-child relationship?

In other words, are there other

facets to this health education program that have been over­ looked?

Is there a more positive approach that can be made?

It is the belief of those interested in mental health planning for children that there is a more positive approach that can be made, but there is emphasis on the part that social and poli­ tical institutions play in the success of such a plan.

Ibis

is well presented in a recent article by Herschel Alt*^®

Mr#

Alt stresses the tie between human behavior and social insti­ tutions, one of which is the family#

It is his belief that

there must be first an understanding of how the individual grows and develops before there can be any Idea of how great the influence of social forces and organizations really is on that individual*

It is his thesis that certain kinds of social

patterns, especially those having to do with the parent-child relationship, are of the utmost importance in the determination of the behavior of the child*

MThe Interconnections between

human behavior, social institutions, and their resistance to

38 Herschel Alt, ttMental Health Planning for Children,” Social Casework, February, 1950, pp* 47-54*

44 change lead us to a perplexing dilemma *w39

He believes that

the kind of social institutions will determine in large meas­ ure the personality and behavior of the child; conversely, the attitudes of human beings are responsible for the form these institutions take*

To him this means that:

We need to work simultaneously on both aspects of the problem— on the modification of social institutions and on strengthening the mental and emotional integrity of the individuals who make up our social group*4u This article appears to stress the thesis that has been the writer*s in this study, that health education and mental plan­ ning must be done with both the childfs and the parents1 at­ titudes and personalities clearly in mind*

Only by consider­

ing the effect that any phase of such education may have upon all the family members can it be made positive and of benefit to all* Horror tales and countless newspaper exposes have not been particularly effective*

Human reactions being such as

they are, it is safe to assume that there would be a turning away from the whole question when it is presented in this man­ ner*

The schools have done a marvelous job under the auspices

of the national Safety Council, but they cannot do the job

39 Ibid*, p* 43* 40 Loo* cit*

45 alone*

The realization that the matter is not one that can he

delegated to one person or institution has heen brought home with remarkable clarity by the simple fact that accidents per­ sist*

The individual crusade11 campaign is not broad enough*

After this approach, as was pointed up in a preceding chapter, a ,,scapegoat,f was sought and l,momft was elected! too, has been short-sighted*

This approach,

Today, there is increasing aware­

ness that wholesome, effective results will come about only by the organized, persistent efforts of all those interested in this campaign of accident prevention***and that includes prac­ tically everyone*

It is hoped that the case findings of this

study along with the facts and implications gleaned from them will give food for thought to those who have and are so un­ selfishly pursuing this campaign which should be a matter of concern and cooperation to all* EXCESSIVE CONCERN WITH SUPERVISION Another major area of interest in these cases studied was the excessive concern with supervision of the child that was frequently exhibited and which, apparently, encouraged multiple accidents to the same child*

Mothers, usually, were

so determined to isolate the child, to keep him on his own grounds, to supervise him twenty-four hours of the day, that the entire family life centered around the carrying out of such drastic supervision*

Measures taken to Insure constant

46 supervision almost took on a sense of the ridiculous in one case*

Buddy R# was hospitalized for an abrasion of the lower

left leg#

He had incurred this injury while pushing his bi­

cycle across an intersection, almost in sight of both parents* In the interview with the mother certain significant factors in the parent-child relationship bore out the statements made above#

Mother had repeatedly been told by the family doctor

that she was too protective of patient, that she could not supervise him twenty-four hours a day# most literally tried this#

In the past she had al­

Only recently, the parents sold a

lovely home in the valley because they feared the child would be injured in the swimming pool#

The child was an excellent

swimmer, a definite out-of-doors type#

Mother described his

way of escaping from some of this constant supervision when she said, "he always dives from the highest boards; he always climbs the highest tree#"

Yet, his need to get freedom some­

how evidently had not been called to her attention until at the time of this recent accident#

Mother was accepting of the

physician's advice as to a lessening of her supervision over the patient, but she verbalized her possible inability to do so in a short period of time#

She felt that too much supervision

could actually cause the child- to be involved in accidents and hoped, with reservations, to be able to avoid more traumatic incidents#

She had some ideas that previous minor casuallties

might have been avoided had she^ not been so overly protective

47 and possessive* In a second case, Sally, aged ten, was hospitalized for a fractured arm*

In the interview with the mother, it was

brought out that mother was ambivalent about supervision*

She

watched the child quite closely, yet she expressed the opinion that she still believed she must allow the child some freedom* Sally was a child by a former marriage of mother's; there were children by the present marriage In the household*

Mother

plainly identified with this child; she was quite Indulgent and possessive of her*

Sally was allowed to go every place

with mother; she was permitted to be quite demanding of motherfs time and attention*

Harmonious relationships existed in the

home as long as patient received more attention from mother than did the others*

She had to be assured of this*

Mother

had to be careful of the way she handled the other children as the patient was somewhat jealous and resentful of attention to the others if she thought that she was not getting just a little more of mother's time than they were*

She felt she should come

first and determinedly set about to see that she came first* Mother was vaguely aware that her relationship with patient was a little Intense and not quite healthy; she also recognized that patient's relationships and attitudes towards her siblings left much to be desired*

Yet, her concern with the need for super­

vision and her own part In doing those things that would pre­ vent child accidents made her almost oblivious to these

significant facts•

The accident itself appeared to be a com­

pletely unavoidable one where more supervision by the mother would not have prevented it*

These two cases further illustrate

the effects of rigidity, previously discussed, in causing mul­ tiple accidents to the child* SIGNIFICANCE OF OVERPROTECTION Overprotectiveness was another area of much interest to the writer in her analysis of these cases*

What is there in

the overprotection of children that is related to the accident phenomena? freedom? theory*

Doesn1t the child have to find some way to get The above illustrations would seem to support this

What are these mothers doing who are determined to be

such "good" parents?

This, too, has been illustrated by the

examples already given in this chapter*

In studies of human

behavior, of the growth and development of the Individual, much has been learned of the Influence parental attitudes have upon the child*s growth*

These attitudes form the groundwork for

the child *s ego formation*

There is a constant conflict for

the child In his need to satisfy his early drives and impulses and his need to control them*

The parent provides the "brake11

for him; the parent is a much needed mediator*

Whether the

parental attitudes are wholesome or not will determine whether or not the child Is able to meet the pressures and situations of the environment in which he finds himself*

If he is exposed

49 to harsh intimidation, there is a good chance that he will have a weak, intimidated, anxious approach to whatever comes up; if he is given no discipline at all, he will have no inner securi­ ty upon which to draw at a time when he must depend upon his own judgments in avoiding or meeting danger#

By the time the

child is five the superego, too, is quite well formed#

Most

children want to please their parents or other adults with whom they identify#

If these adults are too strict, too harsh, too

concerned with constant supervision, the child is likely to he caught between what they want him to do and his own aggressive drives#

Parents must he realistic ahout the problems and feel­

ings of the child#

They must realize that the child has to find

out certain things for himself#

He should not be made to feel

guilty over repressed aggressive feelings which are perfectly normal in a young child#

If he is constantly aware of the too-

high standards that parental domination sets for him, he may become too anxious and tense, or he may develop defense patterns which result in behavior problems# This last point was illustrated by a case in this study where the child literally ran the other way when the mother called#

Mary, aged 9, has been reacting negatively to mother

for several years#

Mother, being aware of this, usually tries

to manage a situation by taking this Into consideration, so no harm will befall the child#

At the time this accident occurred,

Mary was running down the alley behind the family*s house#

&

50 sister and a dog were close behind her*

When mother called,

Mary’s Immediate reaction was to turn around* she tripped over the dog and fell*

In doing so,

The step-father’s reaction

to the accident was quite significants ”What can you expect of a child who can’t keep still a minute?”

The child apparently

adores this step-father, in spite of the contraindication that may be seen in the above statement*

Her relations with her own

father, who was described as being extremely abusive, were not sound*

Mary has great difficulty in expressing or receiving

affection from anyone* The little child needs a lot of help and understanding in these early years to develop an ego and a superego that will permit him to grow up into an emotionally mature adult with full confidence in himself or the ability to ask for help when it is needed*

Such self-security is developed only through

actual experiences in which the child has been given some guid­ ing principles, and in which he has been permitted to appraise for himself the nature of the diverse problems with which he is confronted day by day, knowing all the while that he has the love and confidence of those who figure largely in his world, i*e*, the parents or parental figures*

Unhealthy or faulty

parental relationships do not give'the child such a sound basis for his development Into a secure adult*

Two factors in the

learning situation can well be highlighted here*

When there

is great or constant conflict, when there is too much domination

51 or deprivation, no learning takes place*

Conversely, when there

are positive relationships between learner and teacher, when there is good motivation for acquiring learning, the pupil has gained half the battle#

The child, as the pupil, wants to

learn, wants to please the parent in most instances#

The

teacher, who in this case is the parent or parent figure, must supply the positive emotional relationship that will help the child do so# Benjamin Spock points up this ambivalence in the young child, this need to have freedom, to try to be on one’s own, yet to cling to the parental love and care#

The child likes

to be with his mother, but at the same time he must try things for himself# At one time you see his urge for independence getting the upper hand, at another the need for security# He sat­ isfies each in turn# As the months go by, he becomes more bold and daring in his experiments and explorations# He still needs his mother but not so often# He is building his own independence, but part of the courage comes from knowing he can get security when he feels the need#41 This child specialist makes it quite clear that independence comes from security, as has been brought out in preceding para­ graphs#

Given a chance, h e ’ll learn and become more independent,

more out-going, more self-reliant#

If he is given the opposite

treatment, if he is watched every minute, no such independence

41 Spock, op* cit#, p# 201#

52 is encouraged*

He is apt to become just the opposite; he will

become the timid, introverted, fearful child described in the first of this section*

As Dr* Dietrich pointed out, ttComplete

and prolonged protection of children is worse than total neg­ lect *f,42 SUMMARY OP IMPLICATIONS OP OVERPROTECTION AND EXCESSIVE CONCERN WITH SUPERVISION To summarize the facts and implications of overprotection and excessive supervision as they may be related to accidents in children, it is readily seen that the child fares badly when these two attitudes are part of the parental figure’s makeup* The child needs protection and supervision, but at the same time he needs to be encouraged to be independent and to make his own decisions*

He must learn to rely on his own judgments, to be

able to size up a situation for himself* tudes are most important here*

The parents’ atti­

They must allow the child to

try his own judgment, to be independent, and at the same time make him feel secure in their love and confidence in him which­ ever way things go*

The child who is made to feel tense, anx­

ious, and fearful of his own instincts and drives will be much more likely to have accidents, to get into situations with which he cannot cope*

It is necessary that protection and supervision

42 Dietrich, op* cit*. p* 4*

53 be given, but always to be given with the intention of encourag­ ing independence and responsibility#

Some parents look upon

each separation, each giving up of their domination over the child as a little bit of the final separation which is death* They, thus, are reluctant to bring such separation, i*e*, such independence, about#

Other parents are more realistic; they

try to teach values and meanings which are related to the child’s world, and values which will encourage the child to develop into a secure, confident adult# mental health is apt here#

One of Preston’s rules for

nRemember that if you train a child

properly, you should lose him*

Then your job is done, and

done well*”43 ANALYSIS OF CASES WHERE THERE WAS NO DIRECT SUPERVISION AT TIME OF ACCIDENT The question of supervision was of much concern to the writer#

In analyzing the cases, she looked to see what the

statistical data of these cases showed regarding supervision# In a tally of the cases, it was found that in fifteen of the forty accidents there was no supervision at the time of the accident#

When more than one-third of the accidents occurred

when no adult supervision was being offered, it is readily seen how those advocating more supervision would feel their solution

43 George H# Preston, The Stabstance of Mental Health (New Yorks Rinehart and Company, Inc*, 19437, p* 147#

54 to the problem highly pertinent.

It might be helpful to look

at some of these fifteen cases. In one instance, William, eleven and a half, was play­ ing football with a friend in the sand before his parents* beach home.

While catching a pass, patient fell against the

board fence which encloses his home. spleen.

He received a ruptured

William was considered to be a wnatural athlete. 11

He had excellent coordination and was of an easy, outgoing per­ sonality.

Apparently, there was no neglect as this boy was of

an age where it can be assumed that he could have some judg­ ment regarding danger.

There is no indication that the acci­

dent would not have happened had the parents been present.

In

other words, the accident did not appear to be preventable. In a second case, previously referred to, John, Jr., aged eight, was walking home from a playmate fs house after school when he tripped and fell.

He may have tripped on a

shoelace, or he may have stumbled because of a crack in the sidewalk; the exact cause of the fall is not known.

At any

rate, he fell with his weight on the palm of his hand and hold­ ing his arm stiff. joint.

The result was that he broke his elbow

As In the case quoted above, there Is no apparent neg­

lect, and the accident did not appear to be preventable. In a third case, Carol, aged six, stepped into a cross­ walk on a busy street, preparatory to boarding a street car. The signal changed just as she did so; she was struck by a car

55 and was knocked to the pavement* factors pointing to neglect*

Here there are two possible

In the first place, the child was

too young to be in such traffic solely under the supervision, If It can be termed such, of an eight year old brother*

Secondly,

the driver of the car was at fault by not having good brakes and by not making sure that the intersection was clear of pe­ destrians when the light changed* These three cases seem to point up the factors that are significant in the accidents where there was no direct super­ vision by parents or other adults*

In the first one, the ac­

cident did not appear to be preventable and no neglect was seen* It would, no doubt, have happened had the parent been present* In the second case, again the accident did not seem preventable, and neglect was not apparent*

It, too, would possibly have

happened had the parent been present* ly and was very awkward*

The child fell constant­

Yet, In looking at the family picture,

there we^e certainly family attitudes and relationships that played a part in the way this child reacted to any situation* Mother was seen as an extremely rigid person*

She seldom was

away from home, and she had few social engagements*

At the

time the accident occurred, she was attending a bridge party* Mother expressed much guilt over being away from home when the accident occurred5 father feared it would be even more diffi­ cult to persuade mother to meet social engagements*

Mother

had few close friends and appeared interested only in her home

56 and family*

Father appeared to be outgoing and willing to

participate in wider circles than he does*

He had provided

patient with boxing lessons to counteract the child’s tendency to daydream and to live in a world of his own*

Father believed

the child had become a little more secure now that he can nhold his own1^ with children of his own age, but he indicated by account of some of the child’s actions that there were re­ siduals of that insecurity*

In the third case, there was neg­

lect to a considerable degree*

The interviewer characterized

the mother as cordial and cooperative, but very defensive of the children’s independence#

The family appeared to be a very

close unit with mother in the role of a strict disciplinarian* With these three cases as illustrative of the fifteen in which there was no direct supervision, what can be said in a positive or negative way of the immediacy of direct super­ vision?

For those in the first group, i*e*, where there was

no apparent parental neglect and where the accident was evi­ dently not preventable, it was fairly safe to assume that some accidents did

11Just

happen*11

As Dr* Dietrich so aptly stated

in the address previously quoted! I am not an idealist* I am a pediatrician and a father •••And so I will unflinchingly accept a number of broken bones, split lips, burnt fingers, chipped teeth, black eyes, and bloody toes as normal wear and tear* I am, In fact, a little worried about children who do not get at least some of them*^

44 Dietrich, og* cit*> p* 2*

57 William, the first patient mentioned in this section* is grow­ ing up in a healthy* wholesome atmosphere*

He has the love of

his parents and enjoys the security that love gives him# he also enjoys his parents1 confidence in him#

Yet*

They have taught

him the nsafety rules,w provided him with the inner security that gives him the courage to attempt to carry on his life with an increasing amount of independence as he grows older#

William

has had no previous major accidents, hut he has had the usual number of cutsand bruises that loving, active boy#

are to be expected of a fun-

Mother and father

both are anxious and

concerned over the accident but in a positive way#

They see

no guilt that they must attach to themselves, and they do not propose to change their present way of supervising their chil­ dren#

It would not appear that there is any need to do so#

Trying to make themfeel ^guilty1* over perhaps have damaging results#

such an accident would

Again quoting Dr# Dietrichs

l£rom the age of three on, education supplants protection# Protection must still be supplied for incomprehensible and as yet unlearned dangers# Yet from this age on the more the child has to rely on protection rather than instruc­ tion, the weaker is his position# Safe self-conduct is a form of behavior, and like any other behavior manifestation its pattern is largely set by the time the age of three is Reached* thereafter, it is subject to growth* but little change in fundamental shape# The desirable balance of curiosity and caution, impetuous drive and forethought* cause and probable effect is established in the child only by a carefully thought out program of edueation#45

45 Ibid#* p • 4•

58 Then, it can be assumed that those thoughtfully interested in prevention do not desire to make a seemingly unpreventable ac­ cident into a criminally neglectful act on the part of the par­ ents#

One accident to a child may be the attendant of his

t,growing-up, 11 and it is not necessarily an indication that the parents* way of supervision and instruction is lacking# ANALYSIS OF CASES WHERE THERE WAS NO APPARENT NEGLECT For those in the second group, l#e«, where there was no apparent parental neglect, where the accident did not appear preventable, but where there was definitely unhealthy family relationships, and it could be assumed that although these ac­ cidents, too, might

11just

of health education# their lives?

happen,w there was need for some type

Had these people been fairly rigid all

In a study of the attitudes presented by the

parents of children like John, Jr#, much rigidity is shown# Their pattern of meeting the demands of parenthood have been in the role of strict, rigid disciplinarians#

They already

feel inadequate; they feel that the child must be constantly guarded against the vicissitudes of. life#

Isn*t it logical

to assume that the child will adopt this same pattern of life, that he will meet life feeling almost overwhelmingly afraid and Inadequate, feeling perhaps that life is almost too much of a burden?

For educators in the field of accident prevention

to fix such guilt, to make such accidents more traumatic than

59 they already appear, would only be to continue a vicious circle, a circle in which the problem appearing in the center is never reached#

To make the parents feel it is their failure to as­

sume responsibility, their carelessness and neglect that has resulted in this injury to their child can not be considered positive education in any way# ANALYSIS OF CASES WHERE THERE WAS PARENTAL NEGLECT AND ACCIDENT SEEMED PREVENTABLE For those in the third group, i#e«, where there was de­ finite parental neglect and where the accident did seem pre­ ventable, there were two assumptions that readily came to mind# The parent might have paid no attention to current health edu­ cation and accident prevention material or such material was not pointed up in a way as to give them a positive approach to the matter of child-care and their responsibility in this care# There was a third implication here that might prove to be the most significant one#

In these and similar Instances, what

emotional acceptance had there been on the part of the parents of accident prevention publicity?

The material highlighted in

this chapter seemed to indicate to the writer that this was the keynote for further research in effective publicity of this kind#

Naturally, there was the assumption here that the child-

parent relationship was a fairly wholesome one* but the parent was not as acutely aware of the dangers imminent in a child’s growing-up#

To make them defensive of the patterns in which

60 they have previously set their lives, to make them become the rigid, strict parents that were described in the previous group of accident cases, would be to insert a still more negative ap­ proach to the problem#

Too much emphasis on guilt might make

the parent so rigid and inflexible, so adamant regarding super­ vision, that more accidents will occur#

It would appear that

making accident prevention education more easily accessible, making parents and other adults more aware of the part they play in the child*s ability to grow up would be more desirable# It would be safe to assume that the woman driving the car which struck Carol will never again start up her car and rush through an intersection as soon as the "yellow” fades from the signal# Yet, could this fact have been driven home to her in a less dramatic fashion?

Most drivers doubtless think only of other

cars and other drivers in their race to "beat" another through the Intersection#

Is this a place for some more helpful kind

of accident prevention material on a factual level? SUMMARY OP IMPLICATIONS RELATING TO SUPERVISION To Summarize the facts and implications of these acci­ dents in which there was no direct adult supervision, it was seen that some cases were ones In which neglect was clearly seen, whereas others showed little or no neglect#

Some showed

healthy family relationships while others showed undesirable ones which might directly have contributed to the accident#

It

61 was difficult to Imply that on© particular opinion on super­ vision was true, whether more or less supervision was needed# It was difficult to say that parents were to blame because of rigid or lax disciplines#

However* the problem is there#

Hospital has considered it to be one of health#

The

The writer ad­

vances the thesis that it may be concerned with mental health#

CHAPTER IV SUMMARY AND CONCLUSIONS This study was undertaken in an attempt to learn what there has been of positive and negative value in the accident prevention education campaign that has been employed, and with the intent of highlighting anything of particular significance In this direction that came out of the forty cases studied# It was the writerfs purpose to examine her own belief that cur­ rent publicity and literature with its too great emphasis on guilt would make the parent so rigid and Inflexible, so ada­ mant regarding supervision, that more accidents would occur# ' The research was limitedprimarily to the analysis of the cur­ rent publicity, literature, and thinking of experts in the field and to the analysis of the forty cases available for i

study#

In the final analysis of these cases in respect to their

meaning in the matter of accident prevention and the present publicity that has been presented, there are few, If any, de­ finite conclusions that can be drawn#

However, as the reader

has seen by the material that has come to light, there are many points that do have significance for those Interested in a further pursual of this subject# The analysis was threefold# school training program were traced#

First, the effects of the It was definitely es­

tablished that this program has been of immense value in re­ ducing the number of accidents to children#

It was established

63 that one institution, the school for example, can not be given the entire responsibility for such a program*

One very valid

reason for this is that a good proportion of child accidents occur to children of preschool age*

Secondly, the parentfs

responsibility and the emphasis on his or her guilt, if such accidents occurred, was considered#

It was not possible to

determine a conclusion in this matter due to the brief contact with the parent figure and due to the limited number of cases Included in this study#

However, from the material gathered,

It is the writerfs opinion that too much emphasis on guilt does make the parent rigid and Inflexible; this leads to insistence on excessive supervision that, In turn, leads to more accidents as the child struggles to show and maintain some independence# In an examination of the literature that has been presented, it would appear that there is much of positive value as well as much of negative value#

There seems to be no question but

that publicity as the pamphlet entitled, f,Safety Your Child fs Heritage” is not only positive but necessary#

Concrete facts

such as reminders that toys do have sharp edges, ant paste can be mistaken for candy and eaten by the child, electrical ap­ pliances in motion are objects of fascination for the child, are certainly vital-and life-saving#

During the year there are

certain danger spots, seasonal in nature, that should be called V

to a neglectful public*s eye and ear; precautions should be en­ couraged at these times#

Traffic hazards are always present,

64 and the campaign to decrease these for children should be car­ ried out faithfully throughout the entire year# However, the horror and guilt-emphasis, that many arti­ cles embodying these precautions do carry, is to be questioned# This matter of guilt must be given careful consideration be­ fore it is so widely emphasized and brought home to a parent# The over-emphasis on guilt does not seem to make the child get along any better; in fact, it appears to make the child unable to get along#

A constantly frightened child is not a secure

child; over-guilty parents cannot engender wholesome attitudes to children looking to them for a healthy way of meeting lifefs problems#

The lurid has been tried in publicity; it has not

been found to lead to a constructive attitude on the part of adults responsible for the children of the land# It has been seen that the simple removal of the physical cause of an accident will not, in many instances, prevent an accident#

It also has been seen that the same constellation

of factors that produce an accident for one child will not pro­ duce an accident for another#

This would seem to support the

premise of the writer that many accidents are the attendant of certain parent-child relationships which seem to be the root of many of the child* s difficulties#

It would appear that those

people who have been fairly rigid all their lives become more so when they are constantly confronted with their guilt in situa­ tions which involve the safety of their child#

The writer is

65 of the opinion from her study of these cases that rejection, guilt reactions, overprotection, and excessive concern with supervision are some of the vital areas that must be dealt with in the matter of accident prevention.

&a has been previously

stated, the findings from the study of the material discussed within this thesis are not inclusive#

They do emphasis, how­

ever, that there is still much that can be done in this field that may be of more positive value than what has come forth# The third point of this analysis was the fact that this pro­ blem is of concern to many, and that it is the responsibility of many institutions and individuals# That safety campaigns are vital and of value has been demonstrated by the safety program that was instituted in the schools.

The tracing of this in Chapter II Illustrates this

point quite graphically.

However, as shown In Chapter III, in

this study It was found that twenty-one or half of the chil­ dren whose hospitalization was studied were under six years of age while eight were below the age of eight#

This means that

practically three-fourths of the children were below preschool level#

It would seem apparent that there is an Indication here

for more health education of children of preschool levels and in the first two years of school#

Therefore, this education

can not be delegated wholly to the school any more than it can be delegated wholly to the parents#

This would Illustrate fur­

ther the premise of the writer that health education Is the

66 concern of all adults and of all social institutions#

It would

appear also that the emphasis should be on what can be done about this situation rather than who is to be blamed for what has not been done# A reexamination of the findings in these cases regard­ ing supervision also gives few conclusive results, but they do give significant material that may be of use in further studies of this kind#

It was seen that more than one-third of the ac­

cidents occurred where there was no adult supervision#

Con­

versely, more than two-thirds of them occurred when there was total or partial supervision#

In studying the one-third In

which there was no adult supervision, it was found that some of these might have occurred had there been supervision#

The

conclusion that can be readily seen is that supervision alone is not enough#

It also was seen that In many of the cases where

adult supervision was present, there was an excessive concern with supervision of the child that frequently led to multiple accidents#

It was seen further that, in some instances, this

constantly-supervised child had accidents and in excess of those in Ti&iich the supervision was a little more relaxed*

Studying

the cases in more detail, it was seen that when these adults were too strict, too harsh, too concerned with constant super­ vision, the child often was caught between what he wanted to do, I#e#, his own aggressive drives, and what his parents wanted him to do#

The effect of such conflicts, If constant,

67 is readily seen, and is an effect that is most certainly not to he desired*

To repeat, parents must he realistic ahout

their child.fs problems and feelings#

Self-security, based on

the childfs experiencing certain situations and learning the guiding principles to he employed in similar situations, is the desired goal for the child#

If there is conflict in ex­

cess, if there is too much domination or deprivation, no such security can he obtained by the child*

Positive relationships

between teacher and pupil are highly desirable; then, there is good motivation for learning and the acquisition of the more positive values and attitudes toward life* In summary, it is seen quite readily that the parents1 attitudes are all important to the child who must be protected and supervised at the same time that he is learning to be In­ dependent and to rely on his own Judgment#

Protection and super­

vision should be given with the intention of encouraging in­ dependence and responsibility*

Only in this way will the child

develop Into a secure, confident adult*

It is difficult to say

that parents are to blame because of rigid or lax disciplines since there are so many other factors that have been seen to be a part of the whole accident constellation*

It also is dif­

ficult to say whether more supervision or less supervision Is the answer*

It Is the writerfs opinion that there is a great

deal to be done in this field as yet, but that it is certainly a matter of presenting more than Just concrete facts and placing

68 the blame at one individual’s or one institution’s door#

It

is the writer’s conclusion that better accident prevention edu­ cation can be accomplished when all the areas of the parentchild relationship are Integrated, and the principles of mental health In their entirety are considered#

Publicity that takes

these points into consideration would be of more positive value, in the writer’s opinion, and it would bring more desirable re­ sults# The thinking of the far-seeing Committee on the Adminis«

tration of the School Health Program, during the White House Conference of 1930, is applicable in summarizing the conclusions of this study#

Their definition of health education, and the

ramifications of this education, point up, In the writer’s opinion, the underlying theme of this study# Health education ’is the sum of experiences In school and elsewhere, whlch.favorably influence habits, attitudes, and knowledge relating to individual, community, and racial health#’ It is also important in this connection to re­ member, as stated in Health Education ’that health educa­ tion can be promoted only by emphasizing all aspects of healths physical, mental, social, moral#’46

46 White House Conference on Child Health and Protection, The Administration of the School Health Program (New York: The Century Company, 1935?), p# 5#

BIBLIOGRAPHY*

70 BIBLIOGRAPHY Alt, Herschel, "Mental Health Planning for Children," Social Casework, 31:47-54, February, 1950* Brownell, Clifford Lee, and Jesse Feiring Williams, editors, Health of Our Nation# New York* American Book Company, 1643# "Careless Parents Blamed for Children1s Accidents," Editorial in Los Angeles Times, October 3, 1948, Part II, p* 4# Dietrich, Harry F#, "Will Your Children Have Children?" A paper presented at the 10th Annual Western Safety Con­ ference, Los Angeles, June 17, 1948* 4 pp# Henig, Max S#, Safety Education in the Vocational School# New York: National Bureau of Casualty and Surety Under­ writers, 1928# 110 pp# Las ell, Sidney, "Parents Warned on Sharp Toys for Children," Los Angeles Times, January 5, 1948, Part II, p, 1# Logan, Harry B#, Jr#, "Safe at Home-That’s What You Think!" Better Homes and Gardens» Decentoer, 1948, pp# 140-145# Jeancon, Etta C#, "Accidental Injuries in Children," Annals of Western Medicine and Surgery, June, 1949, pp# 225-226• ", "Parents Can Prevent Accidents to Child," Los Angeles Times, April 3, 1949, Part III, p# 2# McCardle, Dorothy Bartlett, "You’re Okay, Mom--Psychiatrists Are the Ones Who Are Wrong#" Press Interview, Washington, D#C# newspaper, name and date not available* National Safety Council, Accident Facts, prepared by Statisti­ cal Division# Chicago* National Safety Council, 1949# 96 pp# Payne, E# George, Education In Accident Prevent!on# Chicago: Lyons and Carnaham, 19l9^T9^5# 192 pp# Preston, George H#, The Substance of Mental Health# Rinehart and Company, Inc•, 1932• 147 pp #

New Yorks

"Safety Education Thru Schools," Research Bulletin of the Na­ tional Education Association, Vol# XVI, No# 5, November, 1638, pp# 23r/-296"i "Safety Your Child’s Heritage," pamphlet published by Chil­ dren’s Hospital*

71 Shea, Patrick F*, Accident Prevention# and Company, 1928# 8 6 pp* Spook, Benjamin, Baby and Child Care# Inc*, 1946# 517 pp#

New York* D# C* Heath New Yorks Pocket Books,

Vaughn, James, Positive Versus Negative Instruction# New Yorks National Bureau of Casualty and Surety TJhderwrIters, 1928# 172 pp# Whipple, Guy Montrose, editor, wThe Present Status of Safety Education,n Twenty-fifth Yearbook of the National Society for the Study of Educat ion* Part I# Bloomington, Illinoiss Public School Publishing Company,"“1926• 410 pp# White House Conference on Child Health and Protection* Growth and Development of the Child* Part I, General Considerations» New Yorks The Century Company, 1932T 377 pp# * Parent Education# 35? pp#

New Yorks The Century Company, 1932#

* Psychology and Psychiatry in Pediatrics s The Problem# New Yorks The Century Company, T93&Z 146 pp • * Safety Education in Schools# Company, 1§3^# 61 pp#

New Yorks The Century

______ mP The Administration of the School Health Program# New Yorks The Century Company, 1932# 4l pp# _______ , The School Health Program# Company, 1932# 400 pp#

New Yorks The Century

* White House Conference* 1930* Addresses and Abstracts of Commit Fee Reports# ifew York; The Century Company, 1931"• 7S5$ pp# Yahraes, Herbert, Make Your Town Safe* Public Affairs Pamphlet #133#. Chicagos PubiTc Affairs Committee, Inc*, 1947# 32 pp#

APPENDIX

73 STUDY OP ACCIDENT CASES ADMITTED TO CHILDREN'S HOSPITAL DURING MONTH OP NOVEMBER SCHEDULE IDENTIFYING INFORMATION 1* Study no*

2* Hospital no*

3* S«S * no*

4* S*S*E* clearance 5* Relationship of informant to patient 6

* Interviewer

7* Date of interview 8

* Name of patient

9* Address 10* Birthdate

11* Sex

12* Date, day and hour of accident 13* Date, day and hour of admission to hospital FAMILY COMPOSITION Those living with patient 14* Father

(a) name age occupation *•*

5

15* Mother

(a) maiden name (b) age (c) occupation

16* Brothers

(a) names (b) ages

17* Sisters

(a) names (b) ages

Is* Others

(a) relationship to patient (b) approximate ages

74 FINANCIAL INK>RMATION 19« Income

(a) amount (b) sources

20• Expenditures

(a) amount (b) objects

21* Cost of medical care

(a) rate of hospitalization (b) estimated total cost

CONDITION OF PATIENT 22* Medical diagnosis 23* Source of information

(a) doctor (b) record (c) other - specify

24# Medical prognosis

(a) for life (b) for residual handicap (c) estimated length of conval­ escence (d) plan for further medical care

25* Source of information

(a) doctor (b) record (c) other - specify

26* Emotional condition 27* Source of information

(a) doctor (b) nurse (c) record (d) social worker (e) other - specify

CIRCUMSTANCES OF THE ACCIDENT 28*

Description of the accident

29#

Persons present

30#

Actions of persons present

31#

Relationship to patient of person responsible

32#

Whereabouts of person responsible

33#

If neither parent was present, whereabouts

34*

Description of events immediately following accident

35*

Immediate reactions of patient

75 36•

Immediate reactions of parents

37*

Immediate reactions of others present

38#

Immediate reactions of other members of

the family

MEDICAL CARE 39#

Time interval between accident and seeking of medical aid

40#

Person called

41*

Time interval between accident and securing of medical aid

42*

Kind of medical care given in the interim

43*

Source of referral of patient to the Childrens Hospital

44•

Means of transportation to hospital

45*

Financial situation as a factor in securing immediate medical aid

FAMILY*S PRESENT ATTITUDES 46#

Toward accident

47#

Toward present situation (a) hospitalization, (b) con­ valescence, (c) present and possible impairment of child, (d) permanent effects

48#

Toward accident prevention (a) with regard to present accident, (b) with regard to fkture accidents

49#

Toward interview situation

GENERAL ATTITUDE OF THE INFORMANT 50#

Toward patient

51#

Toward other members of the family

52# ‘ Toward the neighbors 53#

Toward social responsibility

RELATIONSHIPS OP PATIENT 54*

Toward informant

55* Toward other parent 56#

Toward siblings

57#

Toward any other relatives present in the home specify relationship

58•

Toward other children

59•

Toward others • sp ecify

OTHER INFORMATION 60#

Description of previous accidents of patient

61#

Description of accidents of other member of the family

62#

Indications of need for social work treatment (a) Yes (b) No

63#

Referral to Social Service Department (a) Yes

64#

Reaction of the informant to availability of social service

65#

Spontaneous expression of awareness of accident publi­ city or lack of it (a) Yes (b) No

November

8,

(b) No

1949

University of Southern California Project Helen Boardman Div# of Social Service

U h iv ersltv o f S outhern C a lifo to f*

RELATIONSHIPS OF PATIERT 54#

Toward Inf ormant

55*

Toward other parent

56*

Toward siblings

57*

Toward any other relatives present in the home specify relationship

58*

Toward other children

59•

Toward others - specify

OTHER INFORMATION 60*

Description of previous accidents of patient

61*

Description of accidents of other member of the family

62*

Indications of need for social work treatment (a) Yes (b) No

65*

Referral to Social Service Department (a) Yes

64*

Reaction of the informant to availability of social service

65*

Spontaneous expression of awareness of accident publi­ city or lack of it (a) Yes (b) No

(b) No

November 8, 1949 University of Southern California Project Helen Boardman Div* of Social Service