The use of car air bags was heralded as an effective means of further reducing the number of automobile-related deaths in both adults and children. Air bags have become standard safety equipment in newer model cars, and federal safety standards require that all new passenger cars and light trucks be equipped with passenger and driver front air bags by 1999. However, a news article appearing in a Salt Lake City, Utah, newspaper in October 1995, profiled the death of a young child who was believed to have been critically harmed by a passenger-side air bag. Further investigation by the National Transportation Safety Board (NTSB) indicated that the deaths of six out of eight children over a period of 13 months pointed to air bags as the cause of death. Two other children suffered serious injuries as a result of air bag misuse. These children sustained head and neck injuries caused by the inflating bags. It was also pointed out and underscored that none of the children involved were wearing seat belts at the time of the air bag deployment (MMWR, 1995).
The National Highway Traffic Safety Administration (NHTSA) is currently studying ways to decrease the incidence of air bag injuries to children and is expected to release further information in September 1996. In the meantime, the NHTSA is recommending that children under the age of 12 not ride in the front passenger seat of vehicles with air bags. The agency reiterates the current American Academy of Pediatrics recommendation that children ride in the back seat, or if absolutely necessary to ride in the front seat, that they be positioned as far back from the air bag as possible (American Academy of Pediatrics, 1996; USA Today, 1996). The NHTSA indicated that passenger seat air bags were known to have caused the deaths of at least 21 children since 1993 (USA Today, 1996).
The American Academy of Pediatrics (1996) recommends that children ride facing the rear of the vehicle until they weigh at least 20 pounds or are 1 year of age to reduce injuries in the event of an accident. Rear-facing seats should not be placed in the front passenger seat of any vehicle with a passenger front air bag. A convertible safety seat may be used for the child older than 1 year or between 20-40 pounds in the semi-upright and forward facing position, as long as the child fits well. Many new cars and vans now advertise built in convertible seats as part of the purchase package to emphasize child safety. A booster seat should be used for the child who has outgrown the convertible safety seat yet is too small for a regular lap/shoulder seat restraint system. The booster seat which uses a combination lap/shoulder belt is preferred to the booster with a small shield which can only be used with a lap belt. As previously indicated, the American Academy of Pediatrics strongly emphasizes that the rear seat of any vehicle is the safest place for children of any age to ride, buckled properly in a weight- and age-appropriate device (American Academy of Pediatrics, 1996).
Nurses in many different pediatric work settings are in an optimal position to educate parents and caregivers regarding air bag and car restraint safety to effectively decrease the number of injuries occurring to children. Parents with small children, particularly newborns and toddlers, may easily be taught to properly restrain their child when riding in a car. This habit, when enforced early in life, does not then become a struggle to enforce as the child grows and develops physically and mentally.
American Academy of Pediatrics, Committee on Injury and Poison Prevention: Selecting and using the most appropriate car safety seats for growing children: guidelines for counseling parents, Pediatrics 97(5):761-763, 1996.
Morbidity and Mortality Weekly Report: Air-bag associated fatal injuries to infants and children riding in front passenger seats - United States, MMWR 44(45):845-847, 1995
USA Today: Air bags unsafe for under-12s, even with belts, USA Today, July 12, 1996.
See Chapters 8, 12, and 14 in Nursing Care of Infants and Children, 5th and 6th editions.
See Chapters 8, 10, and 12 in Essentials of Pediatric Nursing, 5th edition.
March 15, 2002