Seating positions and children's risk of dying in motor vehicle crashes.

OBJECTIVES To determine the effects of seating position, combined with restraint use and airbag status, on children's risk of dying in crashes. METHODS Using 1988-95 data from the United States Fatality Analysis Reporting System, risk of death was compared among front and rear seated passengers aged 12 and younger who were involved in fatal crashes for different categories of restraint use and in vehicles with and without passenger airbags. RESULTS Restrained children in rear seats had the lowest risk of dying in fatal crashes. Among children seated in the rear, risk of death was reduced 35% in vehicles without any airbags, 31% in vehicles equipped only with driver airbags, and 46% in vehicles with passenger airbags. Both restrained and unrestrained children aged 0-12 were at lower risk of dying in rear seats. Rear seats also afforded additional protection to children aged 5-12 restrained only with lap belts compared with lap/shoulder belted children in front seats. Children were about 10-20% less likely to die in rear center than in rear outboard positions. CONCLUSIONS Parents and others who transport children should be strongly encouraged to place infants and children in rear seats whether or not vehicles have airbags. Existing laws requiring restraint use by children should be strengthened and actively enforced.