Evolution of the care of the injured child.

Pediatric trauma care has become an art form practiced by pediatric surgeons who regard it as their field of special interest. The emotional and physiologic differences of young patients and the need to cope with pediatric trauma as a syndrome require special techniques and organization best provided by pediatric trauma centers. Improved outcome in trauma centers, both adult and pediatric, has been documented beyond reasonable doubt, and the trauma center movement has matured to the point where legislative and regulatory bodies and insurance carriers are directing seriously injured patients to specialized facilities. We hear so much about rare diseases that it is possible to forget that trauma kills more children than all other diseases combined. Seventy years after Dr. Ladd's vision the day may finally be at hand in which every pediatric hospital and children's service has a pediatric trauma program. The essential ingredient of pediatric trauma care is commitment to the special needs of injured children--personal, institutional, and community commitment. The future belongs to those who understand the past.