Child Passenger Safety: Fact Sheet

Motor vehicle injuries are the leading cause of death among children in the United States.¹ But many of these deaths can be prevented. Placing children in age- and size-appropriate car seats and booster seats reduces serious and fatal injuries by more than half.²

How big is the problem?

• In the United States during 2008, 968 children ages 14 years and younger died as occupants in motor vehicle crashes, and approximately 168,000 were injured. ²

What are the risk factors?

• Fifteen percent of occupant deaths among children ages 0 to 14 years involved a drinking driver.³
• More than two-thirds of fatally injured children were killed while riding with a drinking driver.⁴
• Restraint use among young children often depends upon the driver’s seat belt use. Almost 40% of children riding with unbelted drivers were themselves unrestrained.⁵
• Child restraint systems are often used incorrectly. One study found that 72% of nearly 3,500 observed car and booster seats were misused in a way that could be expected to increase a child’s risk of injury during a crash.⁶

How can injuries to children in motor vehicles be prevented?

• Child safety seats reduce the risk of death in passenger cars by 71% for infants, and by 54% for toddlers ages 1 to 4 years.²
• There is strong evidence that child safety seat laws, safety seat distribution and education programs, community-wide education and enforcement campaigns, and incentive-plus-education programs are effective in increasing child safety seat use.⁷
• The National Highway Traffic Safety Administration recommends booster seats for children until they are at least 8 years of age or 4'9" tall.⁸
• According to researchers at the Children's Hospital of Philadelphia, for children 4 to 7 years, booster seats reduce injury risk by 59% compared to seat belts alone.⁹
• All children ages 12 years and younger should ride in the back seat. Riding in the back seat is associated with a 40% reduction in the risk of serious injury for children ages 16 and younger.¹⁰ Putting children in the back seat eliminates the injury risk of deployed front passenger-side airbags and places children in the safest part of the vehicle in the event of a crash.  Adults should avoid placing children in front of airbags.
• Overall, for children less than 16 years, riding in the back seat is associated with a 40% reduction in the risk of serious injury.¹⁰ To learn more about effective interventions to increase child safety seat use, visit CDC's Motor Vehicle Occupant Safety page.

What are CDC’s research and program activities in this area?

Child passenger restraint use and emergency department-reported injuries: A special study using the National Electronic Injury Surveillance System-All Injury Program, 2004
CDC’s Injury Center conducted a special study of the NEISS-All Injury Program for 635 injured children aged 12 years or under treated at 15 hospital emergency departments (ED) in 2004. These children all sustained injuries in motor-vehicle crashes. Multiple injury diagnoses were collected and parents of children were interviewed about motor-vehicle crash circumstances. The study found that nine percent of the children were unrestrained and 36% were inappropriately restrained.¹¹Â 

ICARIS 2 Child Counseling Study
CDC's Injury Center researchers conducted a cross-sectional, list-assisted random-digit-dial telephone survey of randomly selected children in English or Spanish-speaking households in all 50 states and the District of Columbia. The main outcome measures were respondents’ reports that they or their children received injury-prevention counseling from their child’s health care provider in the 12 months preceding the interview, children’s practices of safety behaviors (including behaviors related to transportation safety), and the association of injury-prevention counseling and such behaviors. Findings suggest that, although the prevalence of pediatric injury-prevention counseling remains low, such counseling was associated with safer behaviors among children, including use of bicycle helmets while biking and use of car seats and seat belts while riding in motor vehicles .¹²Â 

ICARIS 2 Child Restraint Study (in progress)
CDC’s Injury Center funded the Second Injury Control and Risk Survey, a nationally representative cross-sectional telephone survey conducted in all 50 states. Respondents were asked about their children’s restraint practices (ages 0-12 years) during the past 30 days. While there have been several observational studies that record restraint use at one point in time, this study is investigating whether parents are always using correct restraints or whether children are sometimes inappropriately restrained during a one-month period.

Identifying risk factors and examining outcomes for older children involved in motor vehicle crashes
CDC’s Injury Center is supporting the Children’s Hospital of Philadelphia to examine risk factors and outcomes for children younger than 16 years of age who were involved in motor vehicle crashes. Researchers interviewed parents to learn about their typical use of child restraints and the particular restraint in use at the time of the crash. Interview questions also assessed the parent’s understanding of child restraint laws in their state and explored how the motor vehicle crash had affected the child's daily life. This surveillance system was part of a collaborative effort between researchers at the Children’s Hospital of Philadelphia and State Farm Insurance.  The study found that 3.3% of children had one or more physical limitations after the crash.  Parents were more likely to report physical limitations among older children than younger children.  While less than 1% of children under 3 years had physical limitations after the injury, 7.6% of adolescents were reported to have physical limitations.  Among children with serious to severe injuries (Abbreviated Injury Scale 2 or greater), the percent of children with physical limitations ranged from 58% to 91%.  Although most parents of children with minor injuries did not report physical limitations, 47% of children with whiplash injuries were reported to have physical limitations after their injury.  Sub-optimally restrained children were nearly twice as likely to have physical limitations than optimally restrained children.¹³Â 

ICARIS 2 Alcohol-Impaired Driving and Children in the Household
The Second Injury Control and Risk Survey is a nationally representative cross-sectional, list-assisted random-digit-dial telephone survey that was funded by CDC’s National Injury Center.  This study examined the national prevalence of alcohol-impaired driving and riding with an alcohol-impaired driver and the association of these behaviors to having at least one child in the household.  An estimated 2.5 million adult drivers with children living in their households reported that they had been a recent alcohol-impaired driver.  Evidence–based approaches, including mass media campaigns and sobriety checkpoints, continue to be critically important public health activities.¹⁴ 

ICARIS 2 Modes of Travel to School
CDC’s Injury Center’s researchers conducted a nationally representative, random-digit-dialed telephone survey among English and Spanish-speaking adults (>18). Respondents with at least one child (5-14 years) living in the household were asked about the child’s mode of travel to school  Respondents who reported that the child walked to school less than 4 days per week were asked to identify the primary barrier to walking more often.  The most common mode of travel to school was the family car (46.3%), followed by school bus (39.6%), and walking (14%).  Among those who did not usually walk to school, distance (70.7%) was the most common barrier, followed by traffic danger (9.2%).  Children in the South were less likely to walk to school than children in other regions (Northeast, North Central, West). Distance to school was more commonly cited as a barrier to walking for older children than younger children.  Efforts to promote walking to school may achieve better near-term success if focused on students who already live close to school.¹⁵