Road traffic accidents are the leading cause of death and disability in children throughout Europe. They are among the main causes of death among children 5–19 years old in Europe, despite the fact that improvements in traffic safety have been reported in many countries. A recent report shows a substantial decrease of mortality rate both for pedestrians and car occupants in children 0–14 years old in European countries [2]. However, the overall mortality rate (all ages) still ranges from 2.7 per 100,000 inhabitants per year in Sweden to for instance 3.4 in the Netherlands, 6.2 in the Czech Republic and 8.7 in Poland.

Children may be injured as pedestrians (walking to school or playing in the street), as bicyclists, as motorcyclists or as passengers in cars. Most of the deaths in children aged 0–14 years in Europe occur to pedestrians (48%), followed by car occupants (32%), cyclists (9%) and motorcyclists (6%) [3]. In contrast, adolescents (15–17 years old) are more likely to die in car or motorcycle accidents than as pedestrians and bicyclists. Road traffic accidents kill more than 16,000 children each year in Europe [4].

The United Nations has declared the decade 2011–2020 as the “Decade of Action for Road Safety”, and it is urgent that radical steps are taken to reduce child deaths in traffic accidents.

The European Academy of Paediatrics (EAP) strives to prevent morbidity and death in children. We urge policymakers to actively work for a “vision zero”, where no child is killed in traffic. To become operational, such a policy must be widely accepted by all actors in society, and cooperation on all levels is needed. EAP is willing to play a significant role in this work.

To eliminate all child deaths in traffic will take time, and long-term objectives need to be complemented by short-term objectives that are followed up regularly in all participating countries. While manufacturers of cars and bicycles have a responsibility to ensure safe transport of passengers or users, the EAP suggests a number of simple measures to reduce child deaths in the traffic.

  1. 1.

    Secure transport for children between home and school.

    Access to education is a human right and with this should come the right to a secure transportation between a child’s home and his/her school. Where children walk or travel by bike, separate lanes for walking/cycling should be set up so that children need not share the traffic space with cars.

  2. 2.

    Speed limits as well as road bumps should be encouraged on roads near day cares and schools to force drivers to slow down.

    Children play and their behavior is often unpredictable which means that they may run out in the street to fetch a football or for other reason end up in the traffic. In an area with high-speed traffic, this will invariably lead to accidents, but in traffic spaces with low speed, accidents can often be prevented.

  3. 3.

    Children below the age of 12 years should be encouraged to wear bike helmets.

    Bike helmets reduce the consequences of head trauma and can be the thin line between life and death in an accident.

  4. 4.

    Children going by car should wear seat belts.

    A recent meta-analysis suggests that using safety belts reduces fatality risk by more than 40% also for rear-seat passengers [1].

  5. 5.

    Small children should also use child restraints, as recommended by the WHO.

    This will decrease fatality even further. Rear-facing child restraints have the highest degree of protection.

  6. 6.

    Enforcement of legislation on road safety could save lives.

    Governments need to ensure that comprehensive laws are in place for drink-driving, use of helmets, seat belts, child car restraints and road bumps. Enforcement of such legislation needs to be improved.