Children's Health


The leading cause of death for toddlers in the United States is not poisoning or medical ailments or accidents around the home. By far the biggest killer of children is car crashes. Today in Washington, the National Transportation Safety Board holds a forum on car seat safety. And some of the recommendations could mean wholesale changes in how Americans transport their kids. NPR's Russell Lewis reports.

RUSSELL LEWIS: One morning this week in Birmingham, Alabama, Alexandria Paige pulled her car into a parking garage. She wasn't looking for a spot, but the car seat installation team from Children's Hospital.

MS. JULIE FARMER (Children's Hospital): What we're going to do is get your little sweetpea out, and I'm just going to make sure that we have the harness straps in the car seat in the correct position before we get started.

LEWIS: Paige is here with her nine-month-old son, Peyton, to get a new car seat installed. And she's excited to finally have her son's rear-facing seat flipped around so she can see him.

Ms. ALEXANDRIA PAIGE: I've seen in other cars babies his age. I've seen them front-facing, so I just always thought, OK, once he comes out of the infant seat, he faces front ways.

LEWIS: She must wait a few months though. Alabama, like most states, requires rear-facing car seats be used until toddlers weigh twenty pounds and are at least a year old. But Julie Farmer, of the hospital's Child Passenger Safety Resource Center, tells Paige that's just the minimum.

Ms. FARMER: The best choice is for you to keep your child rear facing as long as possible, not only because of the law, but because, well, of the law of gravity, I guess you could say.

LEWIS: The reason is simple physics. In a head-on collision, a rear-facing car seat spreads the energy of the crash across the toddler's entire back, not just a narrow-portion of a tiny baby. In fact, studies have shown that toddlers in a rear-facing car seat are five times safer than those who face forward. In the U.S., five children a day die on average in car crashes. That's frustrating to pediatricians like Ben Hoffman.

Dr. BEN HOFFMAN (Pediatrician): I think we've become immune to this. I think it happens so frequently and with such regularity that we've lost focus on how important it is. And I think that we're so reliant on cars to get us from point A to point B that we've sort of accepted it as the price of doing business.

LEWIS: Hoffman also teaches at the University of New Mexico and is a member of the American Academy of Pediatrics. For a couple of years, that organization has wrestled with changing requirements to recommend all toddlers sit facing the rear much longer. In Europe, that already happens. Most four-year-olds in Sweden are transported that way.

Ms. ALISA BAER ( Cultural change is very slow. The United States is a society that doesn't like to be told what to do.

LEWIS: That's Alisa Baer of the website For more than 30 years she and her mother have worked to strengthen and expand state car seat laws.

Ms. BAER: I do feel like we're failing the children. Children do not have a voice. We have to be their voice and we have to be their advocates.

LEWIS: At today's National Transportation Safety Board forum, the issue will get a very public airing. Also on tap is a proposal to require babies be buckled into car seats on airplanes rather than being held on their parents' laps. The NTSB has long pushed the FAA to make this change, which allows infants under two to fly for free. NTSB chairwoman Debbie Hersman says it would require parents to buy an extra seat but it would be much safer.

Ms. DEBBIE HERSMAN (NTSB): When you get on an airplane, you're expected to fasten your seatbelt on takeoff and landing and during turbulence. The same should be true for children.

LEWIS: Flying is still the safest mode of travel. Safety experts applaud the call for changes and hope the added cost of flying won't force some families to drive to their destinations rather than fly.

Russell Lewis, NPR News, Birmingham, Alabama.

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