Why are our kids still dying in car crashes?

People who work in public health often see the glass as half empty. Troubling health reports remind us where public health strategies have failed to take hold to prevent lost lives or injuries. Grim health statistics often underscore the number of people living with diseases that could have been prevented with early screening, prompt medical care or lifestyle changes, and injuries that could have been prevented with better safety precautions.

But public health has its share of accomplishments. Vaccination campaigns have eradicated smallpox; clean water and sanitation improvements have dramatically reduced infectious diseases like typhoid and cholera; and anti-smoking ad campaigns, smoke-free laws and tobacco taxes have reduced rates of cigarette smoking to their lowest level, saving thousands of lives each year.

And improvements in motor-vehicle safety through engineering of safer cars and highways and successful efforts to change driving and passenger behavior have contributed to large reductions in motor-vehicle-related deaths.

The Centers for Disease Control and Prevention recently reported that child passenger deaths decreased by 43% between 2002 and 2011. The proportion of deaths of children who were not in an age-appropriate child safety seat also decreased. Enforcement of child car safety laws and free or low-cost seats provided with parent education are credited with improving child passenger safety. Media coverage of enforcement campaigns and of strategies such as checkpoints or specially trained enforcement officers reduce the number of children riding in cars unsafely. Car seat give-away programs combined with education about the importance of proper use of the car seat help low-income families in particular.

But more lives could be saved. Proper use of child safety restraints is still too low, especially as children get older, and too many children are put at risk riding in the front seat. One in three children killed in car crashes in 2011 were unbuckled. Lives are not being saved equally across all populations In 2009 and 2010, almost half of black and Hispanic children who died in crashes were unbuckled, compared with 26% of white children. The public health strategies that are saving lives by increasing the proper use of child safety restraints are failing to reach many families, especially within the African American and Hispanic communities.

The reasons for these disparities are not completely understood. But they but may be related to parents' knowledge or sociocultural norms. A strong association between adults who don’t use seat belts and unrestrained child passengers or children sitting in the front seat may be a factor -- a greater number of Hispanic and African American adults don’t use seat bests when traveling with children. The proportions of nonwhite parents who prematurely transitioned their children to booster seats and seat belts were almost triple those of white parents, too.

More research is needed to effectively reach communities where children are not riding in age-appropriate car seats and to reduce the racial and ethnic disparities in child passenger deaths. At a minimum, messages should be culturally sensitive, bilingual, and programs easily accessible. The Buckle Up for Life program, which was created by Cincinnati Children’s and Toyota in 2004, works with local hospitals and churches to increase proper car seat use for children. The six week program has been expanded to 11 American cities including Philadelphia, where it is housed in the Children’s Hospital of Philadelphia. Preliminary results are encouraging.

Motor vehicle injuries are a leading cause of death among children in the United States. Age and size-appropriate child safety seat use reduces the risk for death of infants and children by 45% to 71%, depending on the age of the children. Yet, despite increasing use of child safety seats, many children still die needlessly passengers in car crashes.

Buckle up on every trip every time; keep children under 13 in the back seat; and use the best safety restraint for your child’s size and age. Install and use car seats and booster seats according to the owner's manual or get help installing them from a certified Child Passenger Safety Technician. Set a good example by using seat belts every time you get in a car.

Children's Hospital has tons of information about buying, installing, and using child safety seats for all ages, as well as numerous videos, such as the seven-second simulation, embedded below, of how a six-year-old's body moves in a 35 m.p.h. crash with and without a booster seat. Here are more links, for free car seats, loaned car seats and car-seat inspection programs and child car passenger safety.

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