Child safety, absolute risk, and the prevention paradox.

July-August 2012 Imagine you fly home from vacation with your one-and-ahalf-year-old son who is traveling for free as a “lap child.” In the airport parking lot, you put him into his forwardfacing car seat, where he sits much more contentedly than he did in the rear-facing one that was mandatory until his first birthday. After he falls asleep on the way home, you transfer him to his crib without waking him, lowering the side rail so you can lift him in more easily. Many parts of this idyllic parenting picture are deemed unacceptably risky according to recent child safety proposals. First, the National Transportation Safety Board has recommended that children under two years old should be required to have their own plane ticket and ride in a car seat. Second, the American Academy of Pediatrics and the National Highway Traffic Safety Administration have recommended that children should travel in rear-facing car seats until age two, rather than changing to a front-facing car seat at their first birthday. Finally, the Consumer Product Safety Commission has banned drop-side cribs. While these proposals all aim to improve child safety, their possible impact is unclear because there has been little discussion of the absolute risk and risk reduction involved in each. And while precise figures are lacking, rough estimates indicate that the magnitudes are quite small. I will argue that these risk and benefit data raise important questions about the proposals, including whether parents might reasonably believe that the small absolute risk reduction offered by the proposed changes does not justify the attendant burdens. Child Safety, Absolute Risk, and the Prevention Paradox