An article in the March 1997 issue of Automotive Engineering entitled "Crash Injuries to
Children" described data from recent studies of injuries sustained by children when
child restraint systems (CRSs) or air bags were in use. Results suggested that while
CRSs have reduced the number of injuries and fatalities, more research is warranted,
particularly research on child safety in air-bag deployment situations.
CHILD RESTRAINT SYSTEMS
Background
A recent study analyzed data on 4,600 children from birth through age 12 who were
involved in automobile crashes reported to the New York Department of Motor Vehicles
(DMV). The data came from western New York State during 1991 and 1992. Of these
children, 3,224 were not injured, and 1,376 sustained a total of 2,318 injuries.
Fourteen percent of the 4,600 crash-involved children were not restrained, 37 percent
were restrained with lap belts, 18 percent were restrained with three-point belts, and 31
percent were in child restraints. The CRSs studied included toddler harness restraints,
toddler booster-shield restraints, toddler booster-adult belt restraints, and rear-facing
infant restraints. Of the 250 CRS injury cases, 29 involved either misuse or failure of
the equipment. The majority of vehicles involved were 1980-1989 models.
Results
Of the six possible seating positions for children in a vehicle (involving restrained or
unrestrained occupants and excluding air bags), results showed that the risk of injury
was highest when a child was in the right-front position. Older children (ages 6 to 12)
accounted for slightly less (45 percent) than half the child occupants and sustained
slightly more (58 percent) than half the injuries. Children ages 3 and 10 were also
subject to "a noticeable increase in the percentage of injury cases." Whether a child
was restrained or unrestrained, the face was the most common injury area, followed by
the head.
For those children (221) who were in a CRS that was not misused or did not experience
failure, 64 percent sustained only one injury. Of the 29 children who were injured in a
CRS that was misused or failed, 48 percent sustained only one injury. In the study as
a whole, the "injury rate for children protected by properly used CRSs was 16%,
compared to 58% for unrestrained children and 30% for those in adult restraints."
Conclusions
An important conclusion from these data was that an increased measure of safety for
children appeared to result from safely securing them in correctly installed and used
CRSs. In addition, "the CRS misuse rate for injured children in this study is only 12%,
a much lower figure than expected from other studies of misuse frequency." The article
recognized that the distribution of restraint systems in the study would reflect the ages
of the vehicles involved in the crashes, since newer vehicles employ more three-point
protection systems.
AIR BAGS
Background
Air bags are a significant development in crash protection, but questions have arisen
about their effectiveness in protecting children. Of particular concern are injuries to
children caused by deploying air bags.
Studies from the Special Crash Investigation (SCI) program have provided in-depth
data to improve safety systems. The latest SCI study "looked at crashes with
passenger-side air bag deployment showing unexpectedly severe injuries to children in
low-impact collisions." Twenty-two of 29 investigations of critical-injury or fatal-injury
crashes where a side air bag caused the injury or fatality involved infants and children
from 1 week to 9 years old. Seven of 11 infants less than one year of age and 17 of 18
older children sustained fatal injuries; no children between the ages of nine months and
three years were fatally injured.
Results
Fifteen of 16 older crash-involved children who received fatal injuries were
unrestrained in the right-front position. In these crashes, braking before a frontal
crash caused the child's body to move forward, restricting the normal deployment of the
air bag. When the air bag module cover flap forcefully opened, the child's head often
struck the windshield, then whipped back, resulting in fatal spine and head injuries.
The infants, all in rear-facing safety seats (most installed without a locking clip), were
typically in the right-front passenger position. The "proximity of the rear of the safety
seat to the air bag module resulted in rearward displacement of the safety seat. . . . The
injury mechanism involved crush, with skull fractures and brain injuries." Fatal injuries
to older children involved primarily top-mounted or ledge-mounted air bags; with
infants, the air bags were most often mid-mounted.
Conclusions
In contrast to these severe injuries sustained by children, when adults are involved in
air bag-associated incidents, injuries are often minor. However, when children are
injured, air-bag effectiveness appears to suffer from the no-news-is-good-news
syndrome: successful air bag deployment goes unheralded, while incidents where air
bags may have caused injury become public knowledge.
Most studies of air-bag injuries have evaluated driver-side air bags; "the
passenger-side air bag fleet continues to be too small for significant evaluations of their
lifesaving benefits." Because the data on passenger-side air bags is insufficient, their
overall effectiveness cannot be evaluated. However, this information is much needed
in the continued effort to provide the best possible protection for children involved in
automobile collisions.
