The danger of air bags for children in the front seat.

In this issue of the American Journal of Neuroradiology, Marshall et al report the patterns of injury found in children suffering severe or fatal air bag trauma during low-velocity motor vehicle accidents (page 1599). Their results suggest that head trauma is the most important mechanism of injury in infants in rear-facing seats, and that craniofacial and cervical spine injuries are most significant in older children. These results make explicit the widely reported risk of air bag inflation to infants and small children. The authors have provided radiologists with valuable information on the patterns of trauma found in these children. This report will help guide radiologic evaluation and raise awareness of the type of injuries most likely to occur. The workup may be further tailored if details of the accident (eg, velocity of the vehicle, whether the child was restrained or unrestrained) are known. This article reinforces the warning that children should ride in the back seat, properly restrained. It is striking that the major risk to children who are in the front seat of air bag–equipped cars is to those who are not properly restrained in front-facing car seats or lap-and-shoulder belts. Practical considerations largely limited this study to severe or fatal injuries; thus, it is impossible to know what proportion of low-velocity accidents with air bag inflation is represented by the severe injuries Marshall and colleagues report. Although 128 excess child deaths have been estimated as a result of widespread use of passengerside air bags, the reliability of this figure is unclear. This report also does not address the potential value of full-power air bags for children who are not properly restrained but riding in the front seat, or whether, considering accidents at all velocities, restrained children in the front seat are safer with a deactivated or an active air bag. It is well known that children are at substantially lower risk for death and injury in automobile accidents than are adults (1). As is often the case, the authors are chasing a moving target. The coming improvements in auto safety and air-bag design Marshall et al cite most likely will alter the pattern and severity of injuries found in the future. Depowering of air bags may save the lives of children who might otherwise have died as