Motor-vehicle collisions are the leading cause of unintentional injury and death in children in many parts of the world, including Europe, North America and Australia. The number of fatal collisions has decreased considerably in countries where safety measures such as child restraints, seat belts and air bags have been introduced, providing protection for children within vehicles, although it is recognised that there have been concomitant improvements in emergency responses and techniques, and in hospital treatments. Helmets and changes in external vehicle designs have been implemented to protect paediatric pedestrians and cyclists. However, despite the development of safety guidelines and technologies, injuries still occur. This paper provides an overview of the role of motor-vehicle collisions in paediatric morbidity and mortality to analyse the nature and aetiology of common fatal and non-fatal injuries in children that may present for forensic assessment as passengers, pedestrians or cyclists.

A certain number of single-vehicle crashes into stationary roadside objects such as trees are thought to be occult suicides. However, is it possible that some cases of multiple deaths within a family in similar crashes are due to unrecognized familial murder-suicides? A 39-year-old woman and her 11-year-old daughter are reported who died of injuries following a vehicle impact with a tree. Unusual behavior of the mother leading up to the crash, and assessment at the scene, raised the possibility of this being a nonaccidental event. However, difficulties in retrospectively determining the intent of a driver in a vehicle crash, and the nonrecording of, or lack of separate coding for murder-suicides on registers, make determination of the incidence of these types of events extremely difficult. It may be that this is a subcategory of murder-suicide that is underdiagnosed and so is not being registered on central motor vehicle crash databases.