Motor vehicle crashes remain the leading cause of unintentional injury-related death among children ages 14 and under, despite a nine percent decline in the motor vehicle occupant death rate from 1987 to 1997. During the same time period, the motor vehicle occupant nonfatal injury rate among children has increased by four percent.

Child safety seats and safety belts, when correctly installed and used, can prevent injury and save lives. It is estimated that 71 percent of children ages 4 and under are restrained while riding. Unrestrained children are more likely to be injured, to suffer more severe injuries, and to die in motor vehicle crashes than children who are restrained.

DEATHS AND INJURIES

• In 1997, 1,775 child occupants ages 14 and under died in motor vehicle crashes. Children ages 4 and under accounted for 34 percent of these childhood motor vehicle occupant deaths.
• In 1998, more than 274,000 children ages 14 and under were injured as occupants in motor vehicle-related crashes. Children ages 4 and under accounted for nearly 30 percent of these childhood motor vehicle occupant injuries.
• Motor vehicle injuries can have long-lasting psychological effects. One study showed that 25 percent of children who suffered from traffic injuries and 15 percent of their parents were later diagnosed with posttraumatic stress disorder.
• As of November 1, 1999, 86 children have been killed by passenger air bags. More than 20 percent of these deaths were among infants in rear-facing child safety seats in front of a passenger airbag. More than 89 percent of all children killed by passenger airbags were either unrestrained or improperly restrained at the time of the crash.

WHEN AND WHERE DEATHS AND INJURIES OCCUR

• Seventy-five percent of motor vehicle crashes occur within 25 miles of home. In addition, 60 percent of crashes occur on roads with posted speed limits of 40 mph or less.
• More than one-fifth of all traffic deaths among children ages 14 and under involve alcohol. Almost half of the children killed in alcohol-related crashes are passengers in vehicles with drunken drivers.
• Rural areas have higher motor vehicle crash incidence rates and death rates than urban areas. In addition, crashes in rural areas are more severe.

WHO IS AT RISK

• Riding unrestrained is the greatest risk factor for death and injury among child occupants of motor vehicles. Approximately 29 percent of children ages 4 and under ride unrestrained, placing them at twice the risk of death and injury as those riding restrained.
• Among children ages 14 and under killed as occupants in motor vehicle crashes in 1998, 61 percent were not using safety restraints at the time of the collision.
• Misuse of child safety seats is widespread. It is estimated that approximately 85 percent of children who are placed in child safety seats and booster seats are improperly restrained.
• Driver safety belt use is positively associated with child restraint use. In a study of car crashes, a restrained driver was found to be three times more likely to restrain a child.
• The back seat is the safest place for children to ride. It is estimated that children ages 12 and under are 36 percent less likely to die in a crash if seated in the rear seat of a passenger vehicle.
• It is estimated that one in four children ages 13 and under ride in the front passenger seat, many in front of passenger air bags. Children traveling with unbelted drivers, as the only passenger, and those ages six and over are more likely to be seated in front.
• Recent surveys indicate that children ages 3 to 6 years are increasingly riding unrestrained and improperly restrained in the front passenger seat. Nearly 60 percent of children killed by deploying air bags are in this age group.
• Male children ages 1 to 14 have a motor vehicle fatality rate nearly one and a half times that of female children.
• American Indian and Alaska Native children ages 14 and under have a motor vehicle occupant death rate three times that of white and black children.
• Restraint use is lower in rural areas and low-income communities. Lack of access to affordable child safety seats contributes to a lower usage rate among low-income families. However, 95 percent of low-income families who own a child safety seat use it.

RESTRAINT SYSTEMS

• Child safety seats are extremely effective when correctly installed and used in passenger cars, reducing the risk of death by 71 percent for infants and by 54 percent for children ages 1 to 4, and reducing the need for hospitalization by 69 percent for children ages 4 and under.
• It is estimated that nearly 300 children ages 4 and under were saved as a result of child restraint use in 1998. If all child passengers ages 4 and under were restrained, it is estimated that an additional 173 lives could be saved and 20,000 injuries could be prevented annually.
• Adult safety belts do not adequately protect children ages 4 to 8 (about 40 to 80 pounds) from injury in a crash. Although car booster seats are the best way to protect them, only five percent of booster-age children are properly restrained in car booster seats.
• Safety restraints afford the greatest protection against ejection from a vehicle during a crash. Nearly three-quarters of occupants who are totally ejected from passenger vehicles during fatal crashes are killed.
• Air bags, combined with lap/shoulder safety belts, offer the most effective protection available today for adult passenger vehicle occupants. It is estimated that air bags have saved more than 3,700 lives since they were first introduced in the late 1980s.

CHILD OCCUPANT PROTECTION AND SAFETY BELT USE LAWS

• All 50 states, the District of Columbia and all U.S. territories have child occupant protection laws which vary widely in their age requirements, exemptions, enforcement procedures and penalties. These laws typically cover only children ages 3 and under.
• A total of 49 states (New Hampshire is the exception), the District of Columbia and all U.S. territories have safety belt use laws in effect. Most of these laws cover front-seat occupants only and mandate secondary' enforcement, which means an officer may cite a driver for not wearing a safety belt only if the violator is initially stopped for another violation.
• Only 16 states and the District of Columbia currently have primary (standard) enforcement laws. States with primary laws average 15 percentage points higher in restraint usage rates than those with secondary laws as well as lower fatality and injury rates.
• Child occupant protection and safety belt use laws are proven effective at increasing restraint use. Ninety percent of Americans favor stronger enforcement of laws that require all children to be buckled up.
• In 1999, a new federal standard went into effect resulting in the manufacture of most new child safety seats with a standard top tether that will snap into vehicle anchors on most new passenger cars. The tether system will allow the child seat to be fastened more securely to the vehicle seat.

HEALTH CARE COSTS AND SAVINGS

• The total annual cost of motor vehicle occupant-related death and injury exceeds $25.5 billion for all children ages 14 and under, and is nearly $7.8 billion among children ages 4 and under.
• Every dollar spent on a child safety seat saves this country $32.

PREVENTION TIPS

• Always use child safety seats and/or safety belts correctly every time you ride. Restrain children ages 12 and under in a back seat.
• Infants, until at least 1 year old and at least 20 pounds, should be in rear-facing child safety seats. Never put a rear-facing infant or convertible safety seat in the front passenger seat of a vehicle with an active passenger air bag.
• Children over 1 year old and between 20 and 40 pounds should be in forward-facing child safety seats. In addition, children ages 4 to 8 (about 40 to 80 pounds) should be in a car booster seat and restrained with lap/shoulder belt every time they ride.
• Read your child safety seat instruction manual and your motor vehicle owner's manual for directions on proper installation.
• Call the National Highway Traffic Safety Administration's Auto Safety Hotline, (888) 327-4236, to inquire about any recalls or safety notices on your child safety seat.

12/99 This information was compiled by the National SAFE KIDS Campaign.