The trouble with pediatricians.

Rarely, as far as I can discern, do the pediatric departments of the six medical schools in Chicago come together to address an issue in health care. There are certainly many issues available: pediatric AIDS, infant mortality, prematurity, access to care, health care finances, funding pediatric education, and probably others. But the Chicago area pediatric department chairmen have come together to deal with violence. In announcing their alliance against violence the chairmen have firmly established their desire to make the children of Chicago safe in their environments. Development of this alliance, its goals, and its eventual products, are relevant to injury prevention advocates, practitioners, and researchers everywhere. Why violence? When I began to work in the area of injury prevention, the hot topics were motor vehicle and other unintentional injuries. We fought the child safety seat and seat belt battles. We reported on product injuries, falls from windows, tricycles, bicycles and child seats on bicycles, pedestrians, tap water burns, and much more. Relatively little attention was paid to intentional injury or violence except for child abuse. Since the mid-1980s violent injuries have garnered more attention, I think not because unintentional injuries have become less important—they remain a major cause of morbidity and mortality—but because we have come to recognize that violent injury is also a major cause of death and disability in childhood. We are surrounded by images of violence, both real and fictional. Violent injury is expensive in both monetary and social terms, and it is seemingly so preventable. Why is this alliance coming together in Chicago? Violent injury is not unique to Chicago, or even to the United States. But Chicago is near the heartland geographically, socially, and politically. There are six medical schools in Chicago and there are even more hospitals with pediatric programs. If you want to start an alliance you need more than one; Chicago has a critical mass if ever there were one. Other American metropolitan areas have several medical schools with pediatric programs, but it is in Chicago that the academic pediatric community has committed itself to counter violence. Chicago has historically been a nidus of medical education and medical innovation— blood banking, infant incubators, and heart surgery for blue babies were pioneered in Chicago. T Duckett Jones first described his criteria for the diagnosis of acute rheumatic fever at a meeting at the Palmer House on 16 June 1944. Subsequently, the nation’s, maybe even the world’s, largest registry of rheumatic fever patients was established in Chicago. There is a child welfare tradition in Chicago from Jane Addams and Hull House to the founding of the nation’s first juvenile justice system in 1899—recognition that children need special consideration. In addition, many people at Chicago universities, medical schools, and hospitals have developed expertise in violence related fields. I see an alliance to stop violence against children as yet another example of the vitality of the medical community of Chicago. But Chicago suVers from an epidemic of violence and violent injury, making this alliance vitally important. Here are a few examples of our problems and a small subset of the questions in need of answers.