An Evaluation of Parent and Child Perceptions About Pediatric Pedestrian Safety Skills.

BACKGROUND: Pediatric pedestrian injury is a major public health concern. Children's perceived abilities correlate with behavior across many pediatric behavioral health contexts, but this association is untested regarding pedestrian safety. OBJECTIVE: If children's perceptions relate to behavior in pedestrian settings, there are implications for targeted intervention. We evaluated associations between parent and child perceptions of children's street-crossing ability with actual abilities within a virtual reality (VR) pedestrian platform. METHODS: As part of a larger clinical trial, 497 children aged 7-8 years participated in baseline pedestrian skill assessments and subsequent virtual reality training sessions. Training terminated when children achieved adult competency. Outcomes included baseline unsafe crossings and number of visits to reach adult competency. Baseline perceptions of children's ability were assessed via parent and child self-report. Linear regression models were completed for each outcome, with parent perception, child perception, child age, and child sex as predictors. RESULTS: The first linear regression demonstrated significant associations between baseline unsafe crossings and both parent perception of real-world crossings (β=-0.10771, p<.05) and child age (β=-0.18288, p<.01). A second linear regression examining the number of training visits required to achieve adult competency also identified significant associations between parent perception of real-world crossings (β=-0.13499, p<.01) and child age (β=-0.13927, p<.01). CONCLUSIONS: Parents' perceptions of children's abilities are significantly associated with children's pedestrian skills, whereas children's own perceptions show less consistent and non-significant associations. Prioritizing youth voices alongside educating parents about pedestrian safety risks may offer complementary and effective strategies to support children to become safe, active pedestrians. CLINICAL TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov, Identifier NCT02948400.