July 2014

  1. How common are child passenger deaths?

    Motor vehicle crashes remain a leading cause of death for children. A total of 952 children younger than age 13 died in motor vehicle crashes in 2012; more than 65 percent of these deaths were children riding in passenger vehicles.

    The number of child passenger deaths has declined by half since 1975. The rate of child passenger deaths per million children also has fallen dramatically to 12 deaths per million children in 2012, a 60 percent reduction from 1975.

    Proper restraint use can help reduce deaths even more. The proportion of fatally injured children who were restrained rose from 15 percent in 1985 to 54 percent in 2012. Still, more than 200 fatally injured child occupants were unrestrained in 2012, and others were improperly restrained.

  2. Are children safer in the rear seats?

    Yes, rear seats are safer for infants and children. Placing children in back instead of the front reduces injury risk by 64 percent for newborns to 8 year-olds and reduces the risk by 31 percent for 9 to 12 year-olds. Arbogast, K.B.; Kallan, M.J.; and Durbin, D.R. 2009. Front versus rear seat injury risk for child passengers: evaluation of newer model year vehicles. Traffic Injury Prevention 10:297-301. Children younger than 13 in the front seat, particularly infants in rear-facing child restraints, may be at risk of injury or death from an inflating front airbag. Thirteen states require children to sit in the rear whether or not the vehicle has a front passenger airbag, and four states require them to be in the rear unless the front passenger airbag is deactivated.

    Largely because of these state laws and publicity campaigns, many more children now ride in back seats. Observation surveys conducted in 2011 found that 97 percent of infants, 99 percent of children ages 1 to 3 and 92 percent of children ages 4 to 7 rode in back seats. Pickrell, T.M. and Ye, T.J. 2013. Occupant restraint use in 2011: results from the National Occupant Protection Use Survey Controlled Intersection Study. Report no. DOT HS-811-697. Washington, DC: U.S. Department of Transportation.

  3. How do safety belt laws apply to children?

    All 50 states and the District of Columbia have child safety seat laws requiring children under a certain age to travel in federally approved child restraint devices. The age at which belts can be used instead of child restraints differs by state. Young children usually are covered by child safety seat laws, while safety belt laws cover older children and adults.

    Ideally, all infants and children in all motor vehicles should be covered by safety belt laws, child safety seat laws or both. But differences in the wording of state laws mean some children aren't being covered by either law. Lawmakers are eliminating these gaps by amending child safety seat and safety belt laws. All children younger than 16 in 45 states and the District of Columbia are covered by one, or both laws.

  4. How effective are safety belts and child safety seats for children?

    Any restraint is better than none at all, but an appropriate child safety seat provides the best protection in a crash until children are large enough for adult safety belts to fit properly, usually when a child is about 4 feet 9 inches tall and 80 pounds. The federal government estimates that adult safety belts reduce the risk of death in a crash among 1-4 year-olds by 36 percent. Among rear seat occupants 5 and older, lap and shoulder belts reduce the risk of death in a crash by 44-73 percent compared with no restraint. National Highway Traffic Safety Administration. 2009. Lives Saved FAQs. Report no. DOT HS-811-105. Washington, DC: U.S. Department of Transportation. 

    Appropriate child safety seats provide significantly more protection in a crash than safety belts alone. Harness-based child restraints reduce fatal injuries by 58-71 percent for infants (younger than 1 year old) and by 54-59 percent for 1-4 year olds compared with no restraint. National Highway Traffic Safety Administration. 2009. Lives Saved FAQs. Report no. DOT HS-811-105. Washington, DC: U.S. Department of Transportation.  Children 2-6 years old in child safety seats (including child restraints and belt-positioning booster seats) are about 28 percent less likely to be fatally injured than those using safety belts alone. Elliott, M.R.; Kallan, M.J.; Durbin, D.R.; and Winston, E.K. 2006. Effectiveness of child safety seats vs. seat belts in reducing risk for death in children in passenger vehicle crashes. Archives of Pediatric and Adolescent Medicine 160:617-21. Children ages 4 to 8 using belt-positioning boosters are 45 percent less likely to be injured than children using belts alone. Arbogast, K.B.; Jermakian, J.S.; Kallan, M.J.; and Durbin, D.R. 2009. Effectiveness of belt positioning booster seats: an updated assessment. Pediatrics 124:1281-86. 

    The National Highway Traffic Safety Administration (NHTSA) estimates that restraint use saved the lives of 284 children younger than 5 riding in passenger vehicles in 2012. National Highway Traffic Safety Administration. 2013. Lives saved in 2012 by restraint use and minimum drinking age laws. Report no. DOT HS-811-851. Washington, DC: U.S. Department of Transportation.

  5. Which type of child safety seat should I use for my child?

    The best seat for your child depends on your child's height, weight and age. All children younger than 13 should ride in the rear seat.

    Infants and toddlers: All children should ride rear-facing in back seats until they are 2 years of age or until they reach the height and weight limit of their child restraints.

    Infant seats are rear-facing seats with a handle for easy carrying. Most snap into a base that is attached to the vehicle. Convertible seats can typically be used rear-facing for infants and young toddlers and then forward-facing when children are ready. Three-in-one seats typically are designed to be used rear-facing, forward-facing and as boosters as children grow.

    When children reach the height and weight limits of their infant seats, they should be moved to convertible seats, but should continue to ride rear-facing for as long as possible. Some convertible seats have rear-facing weight limits of 40 pounds or more.

    Infant seatConvertible seat3-in-1
    Infant seat
    (rear-facing only)
    Convertible seat
    (rear-facing and forward-facing)
    Three-in-one
    (rear-facing, forward-facing and booster)

    When children reach the rear-facing height and weight limit of their child restraint, they should be turned forward-facing in a convertible or another forward-facing child restraint. They should remain in forward-facing child restraints in back seats for as long as possible. Some forward-facing seats have weight limits only up to 40 pounds, but many forward-facing seats now go up to 65 and even 85 pounds.

    Convertible seats or 3-in-1 seats can be used forward-facing. Combination seats typically are designed for use as forward-facing restraints and then as belt-positioning boosters once children have reached the weight limit of the harness.

    Convertible seatCombination seat3-in-1
    Convertible seat
    (rear-facing and forward-facing)
    Combination seat
    (forward-facing and booster)
    Three-in-one
    (rear-facing, forward-facing and booster)

    Children 4-8 years old: Children should ride in harness-equipped child restraints as long as possible, up to the height and weight limit of the seats. When they have outgrown child restraints, children should use belt-positioning booster seats until adult seat belts fit properly. Boosters elevate children to improve the fit of the vehicle's three-point safety belts, which are designed for adults and not children.

    There are highback boosters, backless boosters and built-in boosters. Highbacks have guides to route shoulder belts and lap belts and can offer some head support in vehicles without head restraints in the rear seat. Backless have lap belt guides but may need a plastic clip to properly position shoulder belts in many vehicles. Some highbacks convert to backless by removing their backs. These are known as dual-use boosters.

    Combination and 3-in-1 seats are designed to be used as boosters as children grow. In booster mode, parents remove the built-in harness and use the vehicle lap and shoulder belts to restrain their child. Some manufacturers have built-in booster seats in their vehicles.

    Highback boosterBackless boosterBuilt-in booster
    Highback boosterBackless boosterBuilt-in booster

    Tweens: Children should use boosters until adult seat belts fit properly. The lap belt should rest across the upper thighs, and the shoulder belt should fit snugly across the center of the shoulder. Children should be able to sit against the seatback with their knees bent at the edge of the seat. The shoulder belt should never be tucked under a child's arm or behind the back.

  6. My vehicle has lap belts but not shoulder belts in the rear seats.
    Should I use a belt-positioning booster seat for my booster-age child?

    Yes. Research by the Institute and the Children's Hospital of Philadelphia suggests lower injury risk among children restrained in belt-positioning booster seats with lap belts compared with children restrained in lap belts alone. Kirley, B.B.; Teoh, E.R.; Lund, A.K.; Arbogast, K.B.; Kallan, M.J.; and Durbin, D.R. 2009. Making the most of the worst-case scenario: should belt-positioning booster seats be used in lap-belt-only seating positions? Traffic Injury Prevention 10:580-83. The safest way for children to travel is in a booster seat restrained with a lap belt and a shoulder belt. If possible, child restraints with built-in harnesses should be used in seating positions with only lap belts. However, faced with the need to restrain a booster-age child in a lap belt-only seating position, real-world crash data from two large crash databases suggest that it is safer to place the child in a booster secured with the lap belt rather than using the lap belt alone.

  7. Do most children ride restrained?

    National observation surveys indicate that 91 percent of child passengers younger than age 13 were restrained in 2013. Ninety-eight percent of children from birth to 12 months were restrained, compared with 95 percent of children ages 1 to 3 and 91 percent of children ages 4 to 7. National Highway Traffic Safety Administration. 2014. The 2013 national survey of the use of booster seats. Report no. DOT HS-812-037. Washington, DC: U.S. Department of Transportation.

    While most child passengers are restrained, they aren't always in the proper restraint for their age and size. In 2013, 90 percent of children younger than 1, who should have been in rear-facing restraints, actually were; most of the others were prematurely placed in forward-facing child restraints. National Highway Traffic Safety Administration. 2014. The 2013 national survey of the use of booster seats. Report no. DOT HS-812-037. Washington, DC: U.S. Department of Transportation. Children should ride rear-facing until at least age 2. Among 1- to 3-year-old children, 10 percent were still in rear-facing seats, while 73 percent were in forward-facing child restraints. The others were in booster seats (9 percent), were using safety belts only (3 percent) or were unrestrained (5 percent).  Premature graduation to safety belts was common among older children. Among 4-7 year-olds, 24 percent were using belts only, rather than booster seats, in 2013. An additional 9 percent were unrestrained.

  8. Is it safe to purchase a used child safety seat?

    A new child safety seat is likely better. Used or hand-me-down seats may have been recalled or damaged in a crash. If you must use a pre-owned seat, make sure it has a manufacturer label so you can check for recalls. Most manufacturers recommend that their seats not be used if they are more than 6 years old. Check with the manufacturer.

    Don't purchase or use a seat with cracks in the frame or missing parts.

  9. Do child restraints need to be replaced after a crash?

    It depends on the severity of the crash. Child restraints should be replaced any time there's damage such as cracked plastic, bent metal parts, or stretched or elongated belts, but damage like this doesn't occur in most crashes. There is almost never any reason to replace a child restraint after a crash of minor or even moderate severity. Potential damage should be a concern only in more serious crashes. After a crash, a child restraint should be inspected carefully, and if there's no damage, its performance in subsequent crashes shouldn't be affected.

    When the Institute subjected child restraints to successive crash tests at high speeds, most of the restraints kept their structural integrity despite minor damage. Investigations of restraint durability by the Insurance Corporation of British Columbia found no visible damage to child restraints after 50 consecutive low-speed tests; X-rays revealed no hidden damage lurking beyond the scope of visual inspection. Insurance Institute for Highway Safety. 2000. Child restraints take their punches in repeated crash tests at high speed. Status Report 35(4):1-6.

  10. What is LATCH?

    LATCH, which stands for Lower Anchors and Tethers for Children, is a system designed to make it easier to attach child restraints to vehicles securely. Child restraints have lower attachments that can be connected to anchors in the seat, replacing the vehicle safety belt as the primary attachment to the vehicle. Lower anchors can be used until your child reaches the maximum weight that can be accomodated by your child restraint and vehicle. Check your child restraint manual and vehicle owner's manual for more information. In general, the vehicle safety belt should be used for installation if together your child and child restraint weigh more than 65 pounds combined.

    Top tethers attach to anchors on the vehicle's rear shelf, the seatback, floor or other location. Although the top tether is considered a component of LATCH, it should be used whenever a child restraint is installed forward-facing, whether it’s installed using the safety belt or with the lower anchors. The top tether provides an additional attachment to the vehicle seat and prevents the child from moving too far forward in a crash. LATCH has been required in passenger vehicles since model year 2003 and on child restraints manufactured beginning in 2002. In most vehicles, two rear seating positions must have lower anchors, and three must have a tether anchor.

  11. Is LATCH easy to use?

    Not always. Only 21 of the 98 top-selling 2010-11 model passenger vehicles evaluated in a 2012 Institute study had LATCH designs that were easy to use. A common problem is that safety belt buckles, plastic housing or vehicle seats obscure or interfere with lower anchors. In some vehicles, lower anchors are buried deep within the back seats, so parents have to dig around in the cushions to find them. Some LATCH systems require excessive force to attach the lower connectors. Klinich, K.D.; Flannagan, C.A.C.; Jermakian, J.S.; McCartt, A.T.; Manary, M.A.; Moore, J.L.; and Wells, J.K. 2013. Vehicle LATCH system features associated with correct child restraint installations. Traffic Injury Prevention 14(5):520-31. In some vehicles, the tether anchors may be hard to see or access, causing parents to forego using the tether or have difficulty attaching it correctly. Cicchino, J.B. and Jermakian, J.S. 2014. Vehicle characteristics associated with LATCH use and correct use in real-world child restraint installations. Arlington, VA: Insurance Institute for Highway Safety. Jermakian, J.S.; Klinich, K.D.; Orton, N.R.; Flannagan, C.A.C.; Manary, M.A.; Malik, L.A.; Narayanaswamy, P. 2014. Vehicle factors affecting tether use and correct use. Arlington, VA: Insurance Institute for Highway Safety.

    Few vehicles have lower anchors in the center of the second row, even though that is the safest place for children to travel. Some minivans and SUVs don't have any lower anchors in the third row. Klinich, K.D.; Flannagan, C.A.C.; Jermakian, J.S.; McCartt, A.T.; Manary, M.A.; Moore, J.L.; and Wells, J.K. 2013. Vehicle LATCH system features associated with correct child restraint installations. Traffic Injury Prevention 14(5):520-31.

    If you're struggling to use LATCH, first check the vehicle and child restraint owners' manuals for directions. If you still have problems, try securing your child restraint with a safety belt plus top tether.

    Consider taking your vehicle to a child safety seat inspection station to have a certified technician look at your child restraint to make sure it's been installed correctly.

    When shopping for a new vehicle, take along your child restraint to see how it fits. Pay attention to the location of lower anchors and top tether anchors and consider where you would install a child restraint. Don't forget to plan for times when you might carpool and need to use multiple child restraints.

  12. How can I find out how to properly install my child safety seat in my vehicle?

    Consult the manual that came with your child seat and also your vehicle owner's manual for instructions on proper installation. Child restraints for infants and toddlers need to be secured to vehicle seats using either safety belts or the LATCH system. If done correctly, either type of installation will keep your child safe. Check your vehicle owner's manual to see if your vehicle has LATCH. If your vehicle or seating position is not equipped with LATCH, use the vehicle safety belts to secure the child restraint. Many vehicles have some seating positions with top tether anchors but not lower anchors. If this is the case, use the top tether plus safety belts to secure the child restraint.

    Check for a secure installation by pushing and pulling the restraint where the safety belt or LATCH webbing passes through. The child restraint should not move more than 1 inch side-to-side or back-and-forth.

    Finally, you can take your vehicle to a child safety seat inspection station to have a certified technician look at it to make sure it's been installed correctly.

    Most booster seats don't attach to the vehicle seat, but people may route the safety belt incorrectly or make other mistakes. Child safety seat inspectors can make sure boosters are being used correctly and can evaluate them for proper fit.

  13. I'm using the vehicle safety belt to install a child restraint. Do I still need to use the top tether?

    Top tethers should be used whenever a child restraint is installed forward-facing. Attaching the top tether achieves a more secure installation and prevents your child from moving too far forward in a crash. It is important to use the tether whether installing the child restraint with LATCH or the vehicle safety belt. Some child restraint manufacturers also may encourage the tether when rear-facing, so it is important to review the instructions in the child restraint owner's manual.

    Since 2001, all passenger vehicles are required to have tether anchors. They are typically located on the rear shelf in passenger cars or on the seatback, floor, cargo area or ceiling in minivans and SUVs. If you have an older vehicle and there is no tether anchor available, check with your dealer — tether anchors can be retrofitted in many vehicles.

  14. What is the correct position of the harness in a child restraint?

    Rear-facing seats: The harness should be routed through the slots that are at or below your child’s shoulders. The harness should be snug, and the locking chest clip should be at chest/armpit level.

    Rear-facing seat

    Harness below shoulders and chest clip at chest/armpit level


    Forward-facing seats: The harness should be routed through the slots that are at or above your child's shoulders. The harness needs to be snug, and the locking chest clip needs to be at the chest/armpit level.

    Forward-facing seat

    Harness above shoulders and clip at chest/armpit level



  15. How do I know if my booster seat fits my child correctly?

    Boosters are supposed to improve the fit of safety belts designed for adults so that the belts are properly positioned to protect children in crashes. However, not all boosters provide good belt fit.

    The lap belt should fit low across the upper thighs, not across the child's soft abdomen. The shoulder belt should cross snugly over the center of the shoulder.

    Good lap belt fit
    Poor lap belt fit

    Good lap belt fit
    outline = arm rest removed to show belt position


    Poor lap belt fit
    outline = arm rest removed to show belt position


    Good shoulder belt fit
    Poor shoulder belt fit
    Poor shoulder belt fit

    Good shoulder belt fit


    Poor shoulder belt fit


    Poor shoulder belt fit


    The Institute evaluates boosters sold in the United States to see whether they provide good lap and shoulder belt fit. In November 2013 the Institute published belt fit ratings for 106 booster seat models. Fifty-eight seats were recommended as Best Bets. These boosters should provide good belt fit for a typical 4-8 year-old in almost any passenger vehicle. Five boosters were Good Bets and would provide good belt fit in almost as many passenger vehicles. The 41 boosters in the Check Fit category may provide good fit for some children in some vehicles, but not as many as a Best Bet or Good Bet. Two boosters were not recommended because they do not provide good belt fit.

  16. Are child safety seats commonly misused?

    Child safety seats reduce child deaths and injuries, but they can be difficult to install and are commonly misused. In 2002-03, NHTSA observed more than 5,000 children riding in vehicles and found more than 70 percent of the children were riding in child safety seats that were being critically misused — defined as a misuse that could increase the risk of injury in a crash. The most common types of misuse were loose safety belts attaching the seat to the vehicle and loose harness straps. National Highway Traffic Safety Administration. 2004. Misuse of child restraints. Report no. DOT HS-809-671. Washington, DC: U.S. Department of Transportation. An earlier observational study in 1997-98 by SAFE KIDS found similar results. Taft, C.H.; Mickalide, A.D.; and Taft, A.R. 1999. Child passengers at risk in America: A National study of car seat misuse. Washington, DC: National SAFE KIDS campaign.

    Top tethers are recommended for use with all forward-facing child restraints but many parents do not use them. In an Institute observational study conducted in 2010, top tethers were used in only 43 percent of forward-facing restraints. Top tether use was particularly low for older vehicles and pickups. Jermakian, J.S. and Wells, J.K. 2011. Observed use of tethers in forward-facing child restraint systems. Injury Prevention 17: 371-74.  Top tether use was higher, 56 percent, in an Institute observational survey conducted in 2012. Parents who were not using the top tether most often did not know the tether was on the child restraint (22 percent) or did not know how to use it (15 percent). Ten percent were unsure of where to attach it in the vehicle. Eichelberger, A.H.; Decina, L.E.; Jermakian, J.S.; and McCartt, A.T. 2014. Use of top tethers with forward-facing child restraints: observations and driver interviews. Journal of Safety Research 48:71-6.  According to two 2014 Institute studies, parents are more likely to use the top tether if the tether anchor in the vehicle is easy to find, such as on the rear shelf of passenger cars or the middle of the seatback in SUVs and minivans, and if there is no other hardware that could be confused with a tether anchor. Cicchino, J.B. and Jermakian, J.S. 2014. Vehicle characteristics associated with LATCH use and correct use in real-world child restraint installations. Arlington, VA: Insurance Institute for Highway Safety. Jermakian, J.S.; Klinich, K.D.; Orton, N.R.; Flannagan, C.A.C.; Manary, M.A.; Malik, L.A.; Narayanaswamy, P. 2014. Vehicle factors affecting tether use and correct use. Arlington, VA: Insurance Institute for Highway Safety.  

    Misuse of belt-positioning boosters also is common. In 2006-07, Indiana's Riley Hospital for Children found nearly 65 percent of children in boosters had at least one belt misuse. The most common error was the shoulder belt over the booster armrest (36 percent), and about a third of the shoulder belt guides weren't used properly. O'Neil, J.; Daniels, D.M.; Talty, J.L.; and Bull, M.J. 2009. Seat belt misuse among children transported in belt-positioning booster seats. Accident Analysis and Prevention 41:425-29.

  17. How can I tell if my child safety seat has been recalled?

    It is important to register your child safety seat when you purchase it so that the manufacturer can contact you in the event of a recall. In addition, NHTSA records recalls. The list of recalls can be searched on the agency's website.

  18. My vehicle has side airbags in the rear seat; could they injure my child?

    The risk of injury from a side airbag in the rear seats is extremely low for properly restrained and positioned adults and children. Passengers shouldn't lean against doors because the initial deployment force may be harmful.

  19. Can inflatable safety belts be used with child safety seats?

    Inflatable safety belts are designed to better protect rear-seat occupants. When the vehicle senses a collision, the belt's airbag deploys, expanding across the occupant's body. Inflatable safety belts aim to reduce head, neck and chest injuries by deploying over the occupant's torso and shoulder, so that crash forces are distributed to over 5 times more area of the body than conventional safety belts.

    The first inflatable belts were developed by Ford and are available as an option in the second row of certain Ford and Lincoln models. Mercedes-Benz has inflatable belts as standard equipment in its new S-Class.

    Ford has tested the inflatable safety belt with child-sized dummies, belt-positioning boosters and child restraint installations using the belt and believes it is compatible with child seats. Caregivers should consult the vehicle owner's manual and the manufacturer of the child safety seat for guidance on whether an inflatable belt can be used with a particular child safety seat. Some manufacturers explicitly prohibit the use of inflatable belts with their boosters and child restraints, but not all child seat manuals address the issue. If you have any doubt about using a particular seat with an inflatable belt, use the LATCH system instead or move the seat to a seating position that doesn’t have the inflatable belt.

April 2014

  1. What is a backover crash?

    A backover crash occurs when a vehicle backs into a person such as a pedestrian or bicyclist, often when exiting a driveway or parking spot. These crashes typically are at low speeds. Crashes that involve multiple vehicles or vehicles that back into objects aren't considered backover crashes.

  2. How widespread is the backover problem?

    Government databases generally record only crashes on public roads, but most backover crashes occur in driveways and parking lots. Until recently no federal data system collected information on all backover crashes in the United States. An overall picture could be gleaned from a review of crash data from the National Highway Traffic Safety Administration (NHTSA), hospital emergency department records, death certificates, and media sources. Because these sources may not capture all of the deaths and injuries, Congress directed NHTSA to develop a database of injuries and deaths in nontraffic events involving motor vehicles. U.S. House of Representatives. H.R. 1216: Cameron Gulbransen Kids Transportation Safety Act of 2007. Washington, DC: US Congress.

    In 2009, NHTSA launched the Not-in-Traffic Surveillance (NiTS) crash database of nontraffic events resulting in injuries and deaths, which can be used to calculate a national annual estimate. Based on 2007-2011 NiTs data and data about onraod crashes, NHTSA estimates that 267 deaths and about 15,000 injuries occur annually in backover crashes. National Highway Traffic Safety Administration. 2014. Backover Crash Avoidance Technologies FMVSS No. 111: Final Regulatory Impact Anlysis. Washington, DC: U.S. Department of Transportation.  

  3. Who is most likely to be injured or killed in a backover crash?

    Young children and older people are most likely to be killed in a backover crash. Based on 2007-2011 crash data, 84 of the estimated 267 annual deaths in backover crashes in the United States were children younger than 5, and 70 deaths were people 70 and older.s National Highway Traffic Safety Administration. 2014. Backover Crash Avoidance Technologies FMVSS No. 111: Final Regulatory Impact Anlysis. Washington, DC: U.S. Department of Transportation. A Canadian study of backover collisions involving children younger than 13 andoccurring between 1993 and 2004 found that 52 percent of the children were younger than 5. Nhan, C.; Rothman, L.; Slater, M.; Howard, A. 2009. Back-over collisions in child pedestrians from the Canadian hospitals injury reporting and prevention program. Traffic and Injury Prevention 10(4):350-3. An Australian review of deaths of children younger than five in low-speed vehicle run-over crashes, including backovers, found that more than 80 percent were children younger than three. Anthikkat, A.P.; Page, A.; and Barker, R. 2013. Low-speed vehicle run over fatalities in Australian children aged 0-5 years. Journal of Paediatrics and Child Health 49(5):388-93.

    According to a systematic review of international studies of low-speed vehicle incidents involving children, boy are more likely than girls to be injured or killed in backover crashes. Anthikkat, A.P.; Page, A.; and Barker, R. 2013. Risk factors associated with injury and mortality from paediatric low speed vehicle incidents: a systematic review. International Journal of Pediatrics 2013. An Australian study of child pedestrian backover collisions occurring between 1999 and 2009 found that males were involved in two-thirds of backover crashes that resulted in injuries and nearly three-quarters of backover crashes that resulted in fatalities. Griffin, B.R.; Watt, K.; Shields, L.E.; and Kimble, R.M. 2014. Characteristics of low-speed vehicle run-over events in children: an 11-year review. Injury Prevention. Advance online publication doi: 10.1136/injuryprev-2013-040932.

  4. Where do most backovers occur and who is the typical driver?

    Most backover incidents don't happen on public roads. NHTSA estimates that 39 percent of backover fatalities occur in residential spaces such as driveways and the parking lots of apartment and townhouse complexes. National Highway Traffic Safety Administration. 2008. Fatalities and injuries in motor vehicle backing crashes: Report to Congress. Washington, DC: U.S. Department of Transportation. Nonresidential parking lots account for only 17 percent of backover fatalities, but 52 percent of backover injuries. 

    Three Australian studies have looked at the circumstances surrounding the deaths of children in low-speed run-over crashes, including cases in which the vehicles were moving forward as well as reversing. A study of deaths of children younger than 5 in 2000-10 found that 37 percent of the deaths occurred in residential driveways and 11 percent occurred on public roads. Anthikkat, A.P.; Page, A.; and Barker, R. 2013. Low-speed vehicle run over fatalities in Australian children aged 0-5 years. Journal of Paediatrics and Child Health 49(5):388-93. A review of child deaths in driveway crashes in 1996-98 showed 86 percent of the drivers were members of the struck child's family or family friends. Nee, T.; Wylie, J.; Attewell, R.; Glase, K.; and Wallace. A. 2002. Driveway deaths: fatalities of young children in Australia as a result of low-speed motor vehicle impacts. Road Safety Report no. CR208. Canberra, ACT: Australian Transport Safety Bureau. A study in Queensland found that parents were driving in 11 of the 15 low-speed run-over fatalities of children that occurred in the state in 2004-08. Griffin, B.; Watt, K.; Wallis, B.; Shields, L.; and Kimble, R. 2011. Paediatric low speed vehicle run-over fatalities in Queensland. Injury Prevention 17(Supplement):i10-3.

  5. What types of vehicles are most often involved?

    An analysis of driveway backovers involving children in Utah in 1998-2003 found that children were more likely to be injured by a pickup truck, minivan or SUV than a car, relative to the number of registered vehicles of each type, although the difference between SUVs and cars was not significant. Pinkney, K.; Smith, A.; Mann, N.; Mower, G.; Davis, A.; and Dean, J. 2006. Risk of pediatric back-over injuries in residential driveways by vehicle type. Pediatric Emergency Care 6:402-407. Larger vehicles like SUVs and pickup trucks typically have bigger blind zones than cars, Mazzae, E.N. and Garrott, W.R. 2008. Light vehicle rear visibility assessment. Report no. DOT HS-810-909. Washington, DC: National Highway Traffic Safety Administration. Mazzae, E.N. and Barickman, F. 2009. Direct rear visibility of passenger cars: Laser-based measurement development and findings for late model vehicles. Report no. DOT HS-811-174. Washington, DC: National Highway Traffic Safety Administration. in large part because they sit higher off the ground, making it more difficult for drivers to see children and smaller objects near the rear of the vehicle.  Consumer Reports measures distances behind the rear of a vehicle that a driver cannot see and has found that a 5-foot-8-inch-tall driver in an average midsize SUV can see up to 18 feet behind the vehicle, compared with 13 feet for an average midsize sedan. Consumer Reports. 2012. Best and worst rear blind zones. Available: http://www.consumerreports.org/cro/2012/03/the-danger-of-blind-zones/index.htm. Accessed: August 4, 2012. NHTSA measurements of rear visibility also have found that blind zones for shorter drivers are typically much bigger.

  6. What technologies are available for detecting people behind a vehicle?

    Of the currently available technologies, rearview video cameras hold the most promise for reducing backover crashes involving passenger vehicles and will essentially be required on all new vehicles under 10,000 pounds by May 2018. Office of the Federal Register. 2014. National Highway Traffic Safety Administration – Final rule. Docket no. NHTSA-2010-0162; 49 CFR Part 571 Federal Motor Vehicle Safety Standards; Rear Visibility. Washington, DC: National Archives and Records Administration. While not specifically requiring cameras, NHTSA has mandated that all light vehicles meet certain rear visibility requirements that currently can only be met by the use of rearview video cameras. The 2002 Infiniti Q45 was the first vehicle to be equipped with a rearview camera. Less than 5 percent of vehicle models for 2005 offered rearview cameras compared with 85 percent for 2014 models. Highway Loss Data Institute. 2013. HLDI facts and figures: 1981-2014 vehicle fleet. Vehicle Information Report VIF-13.

    Another potential avenue for reducing backing crashes is to have vehicles brake automatically when the threat of a collision is detected. Automatic rear braking systems might be as effective or more effective at reducing the risk of backover crashes than cameras or sensors, which require the driver to react appropriately.

    Other types of parking aids that rely on radar or ultrasonic sensors have also been studied for their ability to prevent backovers but are considered less reliable for this purpose. These systems produce audible or visual signals to warn a driver if an object is detected behind a reversing vehicle. The signals may intensify as the distance between the vehicle and the object or person narrows. A NHTSA evaluation conducted in 2006 found that eight sensor-based systems could detect a moving adult when the vehicle was stationary, but all of them performed inconsistently and had areas where children weren't detected. National Highway Traffic Safety Administration. 2006. Vehicle backover avoidance technology study: Report to Congress. Washington, DC: National Highway Traffic Safety Administration. Some newer systems combine cameras with radar or ultrasound sensors.

    An Institute study measured the extent to which cameras and sensors improved rear visibility and reduced blind zones for an object with the height of an average 12-15-month-old child in 21 vehicles. Rearview cameras reduced the blind zone by about 90 percent on average. Kidd, D.G. and Brethwaite, A. 2014. Visibility of children behind 2010-2013 model year passenger vehicles using glances, mirrors, and backup cameras and parking sensors. Accident Analysis and Prevention 66:158-67. Parking sensors also reduced blind zones, but not as much. In the eight vehicles that had both technologies, the parking sensors had a small added benefit of 2-3 percentage points beyond the reductions provided by the cameras alone.

    In many vehicles the rear blind zones could be reduced through better vehicle designs that increase the directly viewable area. The Institute supported the rearview camera requirement but also requested that NHTSA consider the feasibility of regulating the size and position of the directly viewable areas behind vehicles in a separate rulemaking action. Insurance Institute for Highway Safety. 2011. Comment to the National Highway Traffic Safety Administration concerning proposed amendments to rearview mirrors safety standard. Docket no. NHTSA-2010-0162. January 31, 2011. Arlington, VA.

    Beyond passenger vehicles, many large trucks are equipped with alarms to alert pedestrians when these vehicles are backing up. All construction vehicles manufactured since 1971 have been required to have back-up alarms.

  7. Will requiring rearview cameras eliminate backover crashes?

    No. NHTSA estimates that 58 to 69 deaths will be prevented each year once every vehicle under 10,000 pounds on the road is equipped with a rear visbility system meeting the requirements. National Highway Traffic Safety Administration. 2014. Backover Crash Avoidance Technologies FMVSS No. 111: Final Regulatory Impact Anlysis. Washington, DC: U.S. Department of Transportation. An Institute study examined the effectiveness of rearview cameras, sensor systems, the two combined, and neither at preventing collisions with a stationary or moving toddler-size object in the path of a reversing vehicle. The object was the size of an average 12-15-month-old child. When it was stationary, the camera alone prevented the most collisions, while the sensor system alone was the least effective. Kidd, D.G.; Hagoski, B.L.; Tucker, T.G.; and Chiang, D.P. 2014. Effects of a rearview camera, parking sensor system, and the technologies combined on preventing a collision with an unexpected stationary or moving object. Arlington, VA: Insurance Institute for Highway Safety. None of the technologies provided a benefit when the object was moving compared to drivers using their mirrors and/or looking over their shoulders.

    The actual effectiveness of cameras depends on how drivers use them in the real world. In the Institute study, shade from a tree hampered detection of the stationary object, and some participants hit it even when they looked at the camera display. Kidd, D.G.; Hagoski, B.L.; Tucker, T.G.; and Chiang, D.P. 2014. Effects of a rearview camera, parking sensor system, and the technologies combined on preventing a collision with an unexpected stationary or moving object. Arlington, VA: Insurance Institute for Highway Safety. Drivers also looked at the camera less when they had both a camera and a sensor system. A review of relevant research indicated that factors such as prior experience with rearview cameras, expectations regarding the likelihood of an obstacle during backing, and the timing of glances at the camera display influence the use and benefits of these systems. Llaneras, R.; Neurauter, M.; and Reen, C. 2011. Factors moderating the effectiveness of rear vision systems: what performance-shaping factors contribute to unexpected in-path obstacles when backing? SAE 2011 World Congress & Exhibition Paper no. 2011-01-0549. Warrendale, PA: Society of Automotive Engineers.

  8. How useful are auxiliary rearview mirrors?

    Two mirror systems NHTSA tested had substantial areas behind the vehicle where people couldn't be seen, and the images were subject to distortion due to the convexity of the mirror. National Highway Traffic Safety Administration. 2006. Vehicle backover avoidance technology study: Report to Congress. Washington, DC: National Highway Traffic Safety Administration. These convex mirrors are generally placed on rear windows or are mounted inside the vehicle near or on the rear pillars.

  9. What else can be done to prevent backover crashes?

    Technology may never be 100 percent effective so drivers will always need to be vigilant. The national "Spot the Tot" campaign, developed by Safe Kids Utah, encourages drivers to walk completely around a vehicle before getting in and to roll down windows to hear what is happening near the vehicle before backing. Intermountain Primary Children's Medical Center. 2014. Spot the tot brochure. Availabile: http://intermountainhealthcare.org/hospitals/primarychildrens/Documents/SPOT_TOT_Info_Card_opt.pdf. Accessed: March 28, 2014. It also suggests teaching children to move away from a vehicle when started and to have them stand in full view of the driver when backing. An Australian review of crashes in which children were run over at low speeds found that more than three-quarters of drivers were unaware that a child was in the immediate vicinity of the vehicle at the time the crash occurred. Anthikkat, A.P.; Page, A.; and Barker, R. 2013. Low-speed vehicle run over fatalities in Australian children aged 0-5 years. Journal of Paediatrics and Child Health 49(5):388-93.

    Separating children's play areas from driveways also may help. A study in New Zealand in the 1990s found that children in homes without a fence separating the driveway from the play area were 3½ times more likely to be killed or injured in a driveway crash. Roberts, I.; Norton, R.; and Jackson, R. 1995. Driveway-related child pedestrian injuries: a case-control study. Pediatrics 95:405-408.

February 2014

  1. How many people are killed or injured by power windows?

    There is no comprehensive database that tracks power window injuries or deaths. Most of the people who die from power window injuries are children. The National Highway Traffic Safety Administration counted an average of five children 14 and younger killed by power windows each year in 2003-2004. National Highway Traffic Safety Administration. 2009. Not-in-traffic surveillance 2007-Children. Report no. DOT HS-811-116. Washington, DC: U.S. Department of Transportation.  The agency estimated that approximately 2,000 people were injured by power windows in 2008-20010, half of whom were children. National Highway Traffic Safety Administration. 2012. Not-in-traffic surveillance – non-crash injuries. Report no. DOT HS-811-655. Washington, DC: U.S. Department of Transportation.

  2. How do children get caught in power windows and what happens when they do?

    In documented power window cases involving child injury or death, children often were left inside a vehicle without adult supervision. Children put their heads and/or arms outside the window and inadvertently leaned, knelt or stepped on the window switch or in some other way triggered the power window. Office of the Federal Register. 2006. National Highway Traffic Safety Administration – Title 49 Transportation, Part 571 Federal Motor Vehicle Safety Standards, Subpart 118 Power-operated window, partition, and roof panel systems (49 CFR 571.118). Code of Federal Regulations (October 1, 2006 edition), pp. 405-10. Washington, DC: National Archives and Records Administration.  There also have been cases in which an adult unknowingly trapped a child when closing a window. Simmons, G.T. 1992. Death by power car window: an unrecognized hazard. American Journal of Forensic Medicine and Pathology  13(2):112-4.

    Sixty-eight percent of incidents result in fractures or crushed body parts. Other injuries include bruising, dislocation, laceration and strain or sprain. National Highway Traffic Safety Administration. 1997. Injuries associated with hazards involving motor vehicle power windows - research note. Report no. DOT HS-042 417. Washington, DC: U.S. Department of Transportation.  Children have died after their heads, necks or midsections were trapped in the window for five or more minutes and they couldn't be resuscitated. In cases involving multiple children in a car, those who witnessed the injury were more likely to panic and call for help rather than try to open the power window.

  3. Can power window switches be designed so that children won’t trigger them inadvertently?

    Yes, lever switches are considered the safest design. This type of switch is pressed down to open the window and pulled up to close the window. Since Oct. 1, 2010, the federal government has required that all new passenger vehicles with power windows be equipped with lever switches. Office of the Federal Register. 2006. National Highway Traffic Safety Administration – Title 49 Transportation, Part 571 Federal Motor Vehicle Safety Standards, Subpart 118 Power-operated window, partition, and roof panel systems (49 CFR 571.118). Code of Federal Regulations (October 1, 2006 edition), pp. 405-10. Washington, DC: National Archives and Records Administration.

    Rocker switch
    Consumer Reports

    Rocker switches are designed to pivot on a center hinge, effectively operating like a see-saw.

    Toggle switch
    Consumer Reports

    Toggle switches operate using small levers that push back and forth to open and close a window.

    Lever switch
    Carbodydesign.com/Mini

    Lever, or push-down/pull-up, switches are pressed down to open the window and pulled up to close the window.


    Before the regulation went into effect, rocker and toggle switches were also commonly used. Rocker switches are designed to pivot on a center hinge, effectively operating like a see-saw. Toggle switches operate using small knobs that push back and forth to open and close a window.

    With rocker and toggle switches, downward pressure (e.g., a child kneeling or leaning) on the switch can result in windows opening or closing. With lever switches, windows can't be closed due to unintentional pressure.

  4. What are automatic-reverse power windows?

    Like many elevator doors, this type of power window automatically retracts when it contacts an obstruction such as a hand or arm. Child safety advocates support automatic-reverse windows as an added measure to prevent power window-related injuries and deaths. This feature would prevent injuries that lever switches don't address, for example, when a driver is operating the switch and cannot see the rear seat passengers.

    In February 2008, the Cameron Gulbransen Kids Transportation Safety Act of 2007 became law, directing NHTSA to consider amending the federal standard for power windows to require an automatic reverse feature that would be activated if the window's path is obstructed. In February 2011 NHTSA announced it would not pursue such a regulation. Office of the Federal Register. 2011. National Highway Traffic Safety Administration – Withdrawal of notice of proposed rulemaking. Docket no. NHTSA-2011-0027; 49 CFR Part 571 – Federal Motor Vehicle Safety Standards, Subpart 118 Power-operated window, partition, and roof panel systems. Federal Register, vol. 76, no. 41, pp. 11415-7. Washington, DC: National Archives and Records Administration.  The agency said serious and fatal injuries involving power windows already are being addressed by the rule requiring lever switches in all new vehicles. The remaining injuries are mostly minor and hard to quantify, NHTSA said.  "Given our present understanding of the data about the nature, source, and number of power window injuries, we believe that there are very few fatalities or serious injuries that any additional requirements for ARS (automatic reversal systems) could mitigate or prevent. They would instead address primarily 'finger-pinch' type injuries."