Intended for healthcare professionals


Children in cars

BMJ 1997; 314 doi: (Published 08 February 1997) Cite this as: BMJ 1997;314:392

Child restraints should be built in safety features, not optional extras

  1. Ian Roberts, Directora,
  2. Carolyn DiGuiseppi, Senior research fellow in epidemiologya
  1. a Child Health Monitoring Unit, Institute of Child Health, London WC1N 1EH

    Cars are not designed with children in mind. There can be little dispute about that. This will be obvious to any parent obliged to purchase the procession of products necessary for the safe transportation of children. Although children make up nearly 20% of the population, the car industry has yet to design and build cars that afford the same degree of crash protection for children as for adults without the need to buy and install additional safety equipment.

    The issue is not trivial. In 1995 in England and Wales there were 73 child passenger deaths and 1073 serious injuries. The death rate per passenger mile has fallen, but this has been offset by large increases in car travel.1 Between 1985 and 1994, the number of car miles travelled by children increased by 40%, from 2260 to 3160 miles per person per year.2 With children spending more and more time in the car, the safety of child occupants is increasingly important.

    Airbags are nitrogen filled buffers, concealed within the dashboard and steering wheel, that inflate in a crash, preventing potentially fatal injuries to the occupant's head and chest.3 Air bags save lives, but, with their introduction, the safe transportation of children has become even more of a nightmare. A flurry of case reports has raised concern about the use of rear facing child restraints in the front seat of cars fitted with airbags. In a crash, an infant in a rear facing restraint could be killed or seriously injured when the explosive force of the airbag impacts on the back of the restraint.4

    The Society of Motor Manufacturers and Traders has responded with an education campaign urging parents “not to fit a rear facing child restraint in a seat protected by an airbag.” In addition, every car with an airbag on the passenger side is to be fitted with a warning pictogram. It is reassuring that the car industry is taking steps to warn parents, but, as campaigns go, this one does not score highly. Firstly, user testing has shown that the pictogram is poorly understood. Secondly, the campaign poster shows a toddler in a forward facing restraint in the back of a car, an odd choice bearing in mind that the problem concerns infants in rear facing restraints.

    It is recommended that infants use a rear facing restraint until they weigh 9 kg or are 1 year old. So, if a car has a passenger side airbag what should parents do? Fortunately, advice from the Department of Transport is clearer: infants should travel facing rearward in the back of the car. Sound advice perhaps, but it will not receive a warm welcome. Many parents understandably do not like placing infants facing rearward on the back seat. There is, however, a technical fix on the horizon. A “smart air bag” is being developed that deactivates in the presence of a child restraint. In the meantime parents need advice on how to transport infants in cars with airbags. The message should be short and simple, outlining what to do rather than what to avoid.

    The safe restraint of children could be as easy as it is for adults. But the car industry likes to make a profit, and safety and profit are sometimes in conflict. For example, the concept of the airbag was first mooted in the 1940s, but half a century later only a third of new cars have airbags. Despite well documented safety benefits, the introduction of airbags was vigorously opposed by Chrysler chairman Lee Iacocca, Henry Ford II, Richard Nixon, and Ronald Reagan. They feared increased production costs would reduce profits and competitiveness. The delay may have led to thousands of unnecessary deaths in road traffic accidents.5 6 Child restraints, like airbags, should be built in safety features, not optional extras. If children must be condemned to motorised monotony then cars should be designed with them in mind.


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