Buckle up and put the children in the back
CMAJ 1997;156:857
© 1997 Canadian Medical Association
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Automobile air bags undoubtedly save lives; in 1996 Transport Canada estimated that air bags had prevented more than 100 deaths in this country.[1] However, the deployment of air bags can cause cuts, bruises and eye injuries, including burns.[2] Children can be killed or seriously injured by the impact of an inflating air bag. Thirty-five children in the US have died as a result of air-bag deployment;[3] in Canada, air bags have been responsible for the death of 1 child and the injury of 2 others.[4] Most children killed by air bags were unrestrained or improperly restrained in the vehicle.[5]
Air bags inflate within 0.05 of a second at more than 300 km/h in response to rapid deceleration in a front-end collision. They can be activated in collisions occurring at speeds of as little as 15 km/h.
A child travelling in the front passenger seat may be dangerously close to the air bag when it inflates.[5] Children are more likely than adults to move around or lean forward and to wear seat belts too loosely or in the wrong position. Because of their stature most children will not be able to brace themselves with their feet against the floor when the vehicle brakes and are more likely than adults to be struck in the head by the air bag. A forward-facing safety seat places the child significantly closer to the inflating air bag than an adult would be, and a rear-facing infant carrier cannot be positioned at a safe distance from the air bag.
The following precautions can prevent air-bag injury to children:[5,6]
- Children under age 12 should ride in the back seat.
- If a child must ride in the front of a vehicle equipped with dual air bags the seat should be positioned as far back as possible.
- Infants in rear-facing carriers should never be placed in the front seat of a vehicle equipped with dual air bags. The safest practice is to place front-facing safety seats in the back as well.
- Infants and children should be restrained with safety devices appropriate for their physical development, height and weight.
A study conducted in 1992 showed that less than 50% of children under age 5 travelling in car seats or safety seats were restrained properly and that roughly 24% were not restrained by any system.[7] Transport Canada advises that infants weighing less than 9 kg should ride in rear-facing infant carriers; children 922 kg should ride in forward-facing child safety seats properly secured by the seat-belt system and a tether strap anchoring the top of the seat. (Infants who weigh more than 9 kg but cannot sit up unaided for long periods should ride in rear-facing infant carriers.) Children who are too tall for their car seat (i.e., when the mid-point of the ears is above the top of the seat) or who weigh more than 18 kg can be seated on booster cushions to achieve correct positioning of lap and shoulder belts. Booster cushions should not be used if they raise the child's head above the level of the seat back.
Air bags should be deactivated only in exceptional circumstances (e.g., for drivers who cannot sit at a safe distance from the steering column) and only after careful consideration of the risks. Transport Canada and the US Department of Transportation are cooperating in the development of "smart" air bags that adjust for variables such as the size and proximity of the occupant and the nature of the collision. North American manufacturers will be installing less aggressive air bags in 1998 model vehicles sold in Canada.[1] -- JH, AMT
References
- Transport minister issues reminder of air bag precautions -- provides action update [news release]. Ottawa: Transport Canada; Dec 19, 1996.
- White JE, McClafferty K, Orton RB, Tokarewicz AC, Nowak ES. Ocular alkali burn associated with automobile air-bag activation. CMAJ 1995;153:933-4.
- Child passenger safety awareness week -- February 915, 1997. MMWR 1997;46:87.
- Air bag safety [backgrounder]. Ottawa: Transport Canada; June 1996.
- Update: fatal air bagrelated injuries to children -- United States, 19931996. MMWR 1996;45:1073-5.
- Bourke GJ. Airbags and fatal injuries to children. Lancet 1996;347:560.
- 1992 observational and telephone survey of restraint use by children in motor vehicles [publ no TP 11943(E)]. Ottawa: Transport Canada; 1992.
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