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More American children die from violence than from natural causes

By Robert D. Sege, M.D., Ph.D.

Special to Reminder Publications

Here's a fact to think long and hard about: More American children die from violence than from natural causes, like pneumonia, infections, or cancer. What, then, can parents do to keep children safe?

Start with imagining how children, as young adults, will respond to events around them. Several years ago, the day after the senseless shooting of a 17-year-old in a Boston housing development, one of my teen patients let's call him Paul came to see me with his mother. His cousin was the young man who died, and Paul was so upset that his school principal was worried he might become suicidal. Paul and I spoke at length. He was grieving his lost cousin, but was also worried that old gang wars would renew.

I next saw Paul about five days later. This time, he was raising money for a peace retreat, organized by local teens with the help of a neighborhood organization. The teens themselves had broken the cycle of revenge plaguing their neighborhood.

What steps can parents take to help their children become like Paul and his friends young adults who choose to avoid violence, even when provocation appears to be extreme? Here's what the research shows on key topics.

Natural aggression peaks in children when they turn about 18 months old. The parents' job at this tender age is to curb this aggression without crushing their natural spirits. The best way to do this is to help your child learn, positively, what you expect. Try to catch them being good and pay attention to their good behavior. A smile, words of praise ("I love to see you play so nicely with your sister!), or a pat on the head goes a long way to showing young children they're appreciated and loved. When they misbehave, it's time for a "time-out" a simple explanation like "No hitting!" followed by one to two minutes in a corner. These two tips praise for good behavior, time-out for misbehavior replace spanking and teach a child good behavior.

Media violence (movies, television) profoundly affects children, and recent evidence suggests video games do the same. Violence in electronic media is sanitized, as the pain and suffering of real-world violence has been erased. By the time children reach high school, they are likely to have witnessed thousands of murders with virtually no tears. Besides de-sensitizing youngsters to violence, media and electronic games also take time away from play with other children. Playtime is when children figure out how to handle the minor conflicts of everyday life. These play experiences come in handy later, when the stakes are much higher.

Firearms lead to many senseless child deaths, as well as injuries. Parents should protect their children by preventing access to handguns. The safest home is one without guns. If that's impossible, guns should be stored locked and unloaded with ammunition locked separately. And find out if your children's friends have guns in their homes.

Bullying at school affects children throughout the world, in all social classes. Fortunately, years of research have led to effective anti-bullying programs. In the long run, bullies face bigger obstacles growing up than do victims, and school systems can help both groups by developing anti-bullying programs. The key to these programs lies in the vast majority of children who are bystanders. These young people, by refusing to be intimidated and by befriending the victims, literally turn schools around. School programs make bystanders safe in stepping up to stop bullying.

Dating violence must not become part of romantic and dating relationships. Parents can help their teens by talking with their teenage children and ensuring they understand that violence and coercion have no part in romance and love. Victims should understand that they don't deserve bad treatment physical or verbal -- and be encouraged to safely end abusive relationships. Aggressors must be taught to respect their partners and learn that threats and physical harm are just plain wrong.

Pediatricians and family physicians, through our care for children, can be a resource for help. Many parents find advice about childrearing, and connections to community programs, ranging from volunteer opportunities to psychological counseling, from physicians and other health care providers. The Mass. Medical Society's Parent Education Cards on Youth Violence can give you a good start. There's no reason to go it alone. Communities can help us raise our children so that they grow up to be like Paul young people who to organize peace retreats rather than plot revenge.

Robert D. Sege, M.D., Ph.D., a member of the Mass. Medical Society's Committee on Violence, is Chief, Division of General Pediatrics and Adolescent Medicine at The Floating Hospital for Children, Boston. Physician Focus is a public service of the Mass. Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Comments are welcome at For a set of Parent Education Cards on Youth Violence, write to the Medical Society at, call 1-800-322-2303, Ext. 7373, or visit