Injuries resulting from motor vehicle crashes are the leading cause of death for children 1-14 years old.1 In 1998, they accounted for 46% of all unintentional injury-related deaths in this age group.1
	Since 1975, the motor vehicle-related death rate for children between 0-12 years has decreased 49%. Death rates for pedestrians and bicyclists declined about 70%, while death rates among child passengers in motor vehicles decreased 13%.2
	In 1998, 2,027 children 12 years old and younger were killed in motor vehicle crashes. Of those who died, 65% were passengers in vehicles, 23% were pedestrians, and 7% were pedalcyclists.2 Top of Page

What is the role of alcohol in child passenger injuries and fatalities?

	Nearly 24% of children 0-14 years old who died in motor vehicle crashes in 1985-1996 were killed in alcohol-related crashes.3
	Results from the same study showed that 64% of all child passengers who died in motor vehicle crashes involving a drinking driver with a BAC > 0.10 g/dL were riding in the impaired driver's car.3 Top of Page

What can be done to improve child passenger safety?

Occupant Restraints

	When properly installed in passenger cars, child safety seats reduce fatal injury by 71% for infants (younger than one year old), and by 54% for toddlers (between 1 and 4 years of age).4
	In 1998, about 57% of motor vehicle occupants 0-15 years old who were killed in fatal crashes were unrestrained.4

What percent of children wear occupant restraints in the United States?

	A 1996 survey found that 85% of infants, 60% of children aged 1-4 years, and 65% of youths aged 5-15 years were restrained.5
	Restraint use by young children varies by driver restraint use. Only one of four children between 1-4 years old who rides with an unrestrained driver is restrained (see graph).5
	Many children ride in child safety seats that are not properly secured. A survey of nearly 6,000 children found that only 21% of children in safety seats were properly restrained.6

When should rear-facing child safety seats be used?

	The Academy of Pediatrics recommends that infants ride in rear-facing safety seats until they are at least 20 pounds and 1 year old.7 When used properly, these seats reduce the risk of neck injury to infants.
	Infants riding in rear-facing child safety seats should never be placed in the front seat of a vehicle with a passenger-side air bag.7

When should children switch from rear to forward-facing child safety seats?

Children older than 1 year who weigh between 20 and 40 pounds should ride in forward facing child safety seats as long as they fit (i.e., ears should be below the top of the back of the seat, with shoulders below the seat strap slots).7

How should children be restrained when they have outgrown their child safety seat?

Regardless of age, children who have outgrown their child safety seat (e.g., weigh more than 40 pounds or stand taller than 40 inches) should use a belt-positioning booster seat. Lap/shoulder belts usually do not fit properly until a child is 4’10" tall and weighs 80 lbs. Most children under 10 should use a booster seat to ride safely.8

Are air bags dangerous for children?

	Yes. Currently air bags inflate at speeds of up to 200 mph. This blast of energy can severely hurt or kill passengers who are too close to the air bag. Children are more likely than adults to be too close to an air bag when it deploys.9
	Until passenger vehicles are equipped with air bags that are safe and effective for children, those who are 12 years old and younger should not ride in a front passenger seat that is equipped with an air bag.10

Recommendations for preventing injuries to infants and children (including those associated with air bags)

	All children 12 years old or younger should be properly secured in the back seat whenever possible – this reduces their risk of fatal injury by 36%.11 Air bag-related injuries that have occurred to children would have been prevented if the children had been riding in the back seat. Regardless of whether the vehicle has an air bag, the rear seat is the safest seating position.
	Infants in rear-facing child safety seats should never ride in the front seat of a vehicle equipped with a passenger air bag. Infants in rear-facing child safety seats must always ride in the back seat facing the rear of the car.
	All children should be placed in the restraint device that offers the maximum protection for their size and age.
	Children who have outgrown child safety seats and booster seats must wear seat belts. Shoulder belts should never be placed behind the passenger’s back or under an arm.

What is being done to promote child passenger safety?

National, state, and community organizations collaborate on a wide range of programs aimed at decreasing the prevalence of impaired driving. For information on impaired driving, refer to NCIPC’s Impaired Driving Fact Sheet.

National, state, and local organizations are working to promote the proper use of child safety seats. Recent efforts have emphasized the use of booster seats for children older than 4 years, who weigh more than 40 pounds and have outgrown their child safety seats.

	All 50 states and the District of Columbia have primary child restraint laws that allow police officers to stop vehicles solely for violations of child restraint laws.
	As of November 1999, 27 states had child-endangerment laws that create special sanctions for cases of driving under the influence of alcohol with a child in the car.12

Where can I learn more about child passenger safety?

Insurance Institute for Highway Safety

National Highway Traffic Safety Administration

Safe Ride News

The National SAFE KIDS Campaign

For more tips on how to select a child safety seat and prevent air bag-related injuries, refer to the SafeUSA fact sheet on child passenger safety.

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References

1. National Center for Health Statistics (NCHS) Vital Statistics System. National Mortality Data, 1998. Hyattsville (MD): NCHS 2000.
2. Insurance Institute for Highway Safety. Facts, 1998 Fatalities: Children. Arlington, VA: IIHS, 1999. Available at: www.iihs.org/safety_facts/fatality_facts/children.htm.
3. Quinlan KP, Brewer RD, Sleet DA, Dellinger AM. Characteristics of child passenger deaths and injuries involving drinking drivers. JAMA 2000;283(17):2249-252.
4. National Highway Traffic Safety Administration. Traffic Safety Facts, 1998-Children.. Washington, DC: NHTSA, 1999.
5. National Highway Traffic Safety Administration. National occupant protection use survey-1996. Research Note, Aug 1997. Washington, DC: NHTSA, 1997.
6. National Highway Traffic Safety Administration. Observed patterns of misuse of child safety seats. Traffic Tech, Sept 1996. Washington, DC: NHTSA, 1996.
7. American Academy of Pediatrics, Committee on Injury and Poison Prevention. Selecting and using the most appropriate car safety seats for growing children: guidelines for counseling parents. Pediatrics 1996; 97:761-2.
8. Centers for Disease Control and Prevention. National Child Passenger Safety Week – February 14-20, 1999. MMWR 1999;48:83-4.
9. 9. Centers for Disease Control. Update: Fatal Air Bag–Related Injuries to Children —United States, 1993–1996. MMWR 1996; 45:1073-6.
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This page last reviewed November 13, 2000

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