Automobiles and Children by Mark B. Levin, M.D. The Pediatric Group, P.A., Princeton

This is the twentyseventh article in a series written for Princeton Online. Click here for an archive of other articles.

Automobiles are responsible for more deaths in this country than any natural disease. Car makers are constantly designing automatic safety features such as ignition key locks, gear shift locks, automatic seat belts, air bags, force-absorbing crumpling hoods and trunks, and a safer passenger compartment. Lawmakers are frequently mandating safety measures - mandatory car seat and safety belt use, automatic loss of license for intoxicated drivers. Despite these safety interventions, children continue to be maimed or killed by vehicles. Children are explorative and curious, while adults are sometimes forgetful or distracted. This combination allows a momentary opportunity for potentially lethal mischief.

Some of the more common ways children are injured in and around vehicles are so preventable; yet the minor inconvenience of enforcing safety practices regularly gets the better of us. In many aspects of life, following the rules makes us feel like such a goody-goody. And in a certain respect, when we break the rules for our convenience, we experience a sense of power like we are getting something for nothing. But if we compare this minor victory over society's constraints to the dire consequences of loss of a child's life or limb, we clearly have no excuse for not compulsively instituting and abiding by appropriate safety measures. Let's shed the false bravado of the "it won't happen to my kid" syndrome and take these situations one at a time in an effort to figure out ways to avoid tragedy. Check out the Kids 'n' Cars web site (www.kidsncars.org) for stories from parents who also felt it could never happen to their kids.

The first most obvious risk is children unrestrained in a car or being placed in a dangerous position. Children belong away from dashboards, windshields, airbags, and whatever is found in the front of a car. Infants should be facing rearward in center of the back seat until they reach one year of age AND twenty pounds. Depending on the model, an infant car seat is appropriate for a child up to twenty pounds. At this size, a convertible infant-toddler car seat is desirable until your child reaches a size of about forty pounds. When a child is large enough (seventy pounds and fifty-three inches) to safely be restrained in a 3-point harness in the front seat and old enough (eight to ten years old) not to touch any of the controls and not lean forward in the seat, only then is it safe to permit him or her to sit in the front. The child must be large enough so that the lap belt sits on the pelvic bones, not on the soft part of the abdomen at the waist. After about eight to ten years of age, it is acceptable to put a youngster in a regular three-point harness with a belt-positioning clip. This clip centers the should strap over the center of the collar bone to avoid slipping off the shoulder and to avoid compressing the carotid artery on the side of the neck (brains appreciate continuous blood flow!). Given their imitative nature, children will, of course, be more willing to be restrained if the adults in their lives routinely use seat belts. Likewise, a child riding on an adult's lap is also at risk for grave injury, either by being thrown around the car or by being crushed by the weight of an adult being amplified during a crash by several times the force of gravity. A child should NEVER be transported in an open truck bed. And don't forget that dog. An unrestrained pet in a car is not only a hazardous obstruction to the driver's vision but is also at great risk of injury in an accident. If you have more passengers than seat belts, even though it may be inconvenient, arrange for additional transportation for the additional passengers.

The simple procedure of leaving your home by car can be disastrous. On television or in the movies we have all seen the depiction of a car backing out of the driveway over a child's bicycle. But what if the child runs to retrieve the bike while you are backing out? Inspect the driveway before backing out to be sure it is clear of obstructions. Be sure there are no children in the vicinity. If there are, assign them a spot in front or to the side of the vehicle where you can see them. Auto supply stores carry a replacement back up light that emits warning beeps. This safety device is as easy to install as changing a light bulb. Why not warn anyone inadvertently behind your car while you are in reverse?

When taking your child in the car, whether at home or in a parking lot, always keep the keys in your pocket (to prevent anyone from driving off with your car and your child). If you have a remote keyless entry system, do not activate it until you are within a few feet of your car. Otherwise, someone else could get there before you. Put the child securely in the car and lock the doors before you load the groceries in the trunk or passenger compartment. Keep an eye on your child during the grocery-loading. Although abductions are rare enough to be newsworthy, they happen. These simple precautions are worth taking to prevent your child's picture from being on the television in this context.

When you are running into a store for a brief moment or just picking up a child from school, it is very tempting to leave a young child in the car, especially if (s)he has fallen asleep. Perhaps you might even leave the motor running. Because of the risk of heat injury, suffocation or abduction, no one should ever leave a child (or a pet) alone in a car. A child's imitative behavior can have disastrous consequences if left in a running car. When the child awakens, you can count on him or her to try to operate some of the car's equipment. Park the car in an appropriate spot, turn it off, engage the parking brake and take your child with you. Of course, whether inside the house or in the car, never leave the car keys where an ambulatory child can easily find them. And always lock your car, even in your own garage. This will prevent a toddler from being trapped in the car (or trunk) or an older child from "playing driver" when you are not around.

Other dangerous in-car behaviors that predispose to injury are using a cell phone while driving and a driver taking his or her eyes off the road to tend to a child's needs instead of first pulling off the road safely. Pull off the road safely before using a cell phone or turning around to check on or admonish your child(ren). Prepare for your trip by having something available to occupy the child(ren) during the ride. In this electronic age, inexpensive personal tape- or CD-players can turn a dreaded journey into a peaceful drive. If possible have a vehicle large enough so that children do not have to be seated adjacent to each other.

There has been so much publicity about the adverse legal, moral and physical consequences of driving under the influence of substances that, on the surface, it seems unnecessary to dwell on this topic. Despite these efforts, however, this issue remains at the root of most lethal automobile accidents. Many adults do not realize that, even though a legal level of intoxication may require two or more drinks, even ONE beer (or the equivalent amount of alcohol in a dose of some adult cough/cold medicines) impairs reaction speed, judgment and coordination significantly. As well, we hear all the time of teens having alcoholic beverages at parties. Sometimes, the beverages are even supplied by parents. These poorly informed adults justify their action by averring the teens' need "to learn how to drink". This faulty logic encourages dangerous behavior for the sake of speeding the developing mature judgment. What can they say when one of the party-goers has an accident on the way home? (Look for an upcoming article about safety tips for teen parties and dates) Mind-altering drugs (including marijuana, as well as more potent drugs) have been shown scientifically to have effects on reaction time and judgment similar to those caused by ingestion of alcoholic beverages. The likelihood of these substances, or even sedating cold preparations, causing auto accidents may be just as high as it is for alcohol.

Because a child becomes a teen, a parent need not relinquish parenting authority or responsibility. Here, as well as in the instance of seat belt use, we set an example for our children when we elect to drink or not before driving. When your teen becomes a driver (see our previous article entitled I Passed My Driver's Test!), before handing over the keys, establish cooperatively with your teen a set of rules (as you would for any other activity that he or she participated in during earlier growing years) including guidelines for

driving at night versus during the day;
driving during inclement weather versus in good conditions;
driving alone versus with friends or children;
driving with music on versus with the car quiet;
curfews;
safe routes to follow to a particular destination
filing a pre-travel plan with someone at home, similar to what pilots, vacationers and hikers do).

If you live in a part of the country that experiences adverse winter weather, take your teen practice driving on a vacant parking lot in the ice and snow. Often parents let the new teen driver use the oldest car to minimize the cost of repair in the instance of an accident. It seems wiser to have the teen use the newest vehicle with the most safety devices, since the teen is the most likely to sustain an accident.

Many parents to not realize that sleep deprivation may be a more potent inhibitor of judgment, reaction time and coordination than alcohol! A recent controlled cross-over study performed on a driving course by drivers before and after drinking or being sleep deprived showed a higher rate of accidents for the sleep-deprived group. An accident is not worth the time or money saved by attempting to get to your destination earlier. If you are tired, call to change your arrival time. Get rest. Otherwise, you are putting yourself and your passengers [your child(ren)] at mortal risk.

Having the means to prevent accidents, it is up to us to assure our children's safety in this arena.

Here are useful web addresses for more information and ideas regarding community action aimed at keeping kids safe from motor vehicle accidents:

KIDSNCARS
The Centers for Disease Control and Prevention
The American Academy of Pediatrics
The National Institutes of Health
The National Highway Safety Traffic Administration
The American Medical Association
The American Automobile Association

Dr. Mark B. Levin 

Dr. Levin has been a member of the staff at The Pediatric Group since 1977. Currently an attending Pediatrician at the Medical Center at Princeton, he has been Chairman, Department of Pediatrics, Medical Center at Princeton, 1984 to 1986, 1989 to 1992, and past President, Medical and Dental Staff, Medical Center at Princeton, 1987 to 1988. Dr. Levin has served on numerous Departmental and hospital committees. He has published original articles both while at Upstate Medical Center in Syracuse and at The Pediatric Group. He has a wife and three children. Dr. Levin enjoys alpine skiing, jogging, hiking and camping, travel, computers and racquetball.

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