Child Passenger Safety

Abstract

Child passenger safety has dramatically evolved over the past decade; however, motor vehicle crashes continue to be the leading cause of death of children 4 years and older. This policy statement provides 4 evidence-based recommendations for best practices in the choice of a child restraint system to optimize safety in passenger vehicles for children from birth through adolescence: (1) rearfacing car safety seats for most infants up to 2 years of age; (2) forward-facing car safety seats for most children through 4 years of age; (3) belt-positioning booster seats for most children through 8 years of age; and (4) lap-and-shoulder seat belts for all who have outgrown booster seats. In addition, a fifth evidence-based recommendation is for all children younger than 13 years to ride in the rear seats of vehicles. It is important to note that every transition is associated with some decrease in protection; therefore, parents should be encouraged to delay these transitions for as long as possible. These recommendations are presented in the form of an algorithm that is intended to facilitate implementation of the recommendations by pediatricians to their patients and families and should cover most situations that pediatricians will encounter in practice. The American Academy of Pediatrics urges all pediatricians to know and promote these recommendations as part of child passenger safety anticipatory guidance at every health-supervision visit. Pediatrics 2011;127:788-793Improved vehicle crashworthiness and greater use of child restraint systems have significantly affected the safety of children in automobiles. Major shifts in child restraint use, particularly the use of booster seats among older children, have occurred in response to public education programs and enhancements to child restraint laws in nearly every state. 1-3 In addition, there has been a substantial increase in scientific evidence on which to base recommendations for best practices in child passenger safety. Current estimates of child restraint effectiveness indicate that child safety seats reduce the risk of injury by 71% to 82% 4,5 and reduce the risk of death by 28% when compared with those for children of similar ages in seat belts. 6 Booster seats reduce the risk of nonfatal injury among 4-to 8-year-olds by 45% compared with seat belts. 7 Despite this progress, approximately 1500 children younger than 16 years die in motor vehicle crashes each year in the United States, nearly half of whom were completely unrestrained. 8

An observational survey of child car safety practices in private pre-primary and primary schools in two local government areas of Lagos State, Nigeria

“…The American Academy of Paediatrics updated these guidelines in 2011 21. The major difference in the revised guidelines, as it pertains to the scope of this study, is that rear-facing car safety seats are now recommended for use until 2 years of age, as opposed to 1 year of age in the earlier guidelines.…”

Evaluating a smartphone application to improve child passenger safety and fire safety knowledge and behaviour

“…MVCs are the leading cause of death for children aged 4–7 years in the USA 1. The American Academy of Pediatrics (AAP) recommends that children remain secured in a child passenger restraint such as a car seat or a booster sear until they are 145 cm tall and are between 8 and 12 years old 2. Estimates suggest that 62% of children aged 4–8 years are inappropriately secured in seat belts 3.…”

Comparison of the effectiveness of hands-on versus online education in child passenger safety

“…Child safety seat (CSS) use reduces mortality by 71% in infants and by 54% in toddlers 2. The CDC, American Academy of Pediatrics (AAP) and National Highway and Safety Transportation Agency (NHTSA) recommend using age-appropriate and size-appropriate child restraints 2–4.…”