Children as passengers in automobiles: the neglected minority on the nation's highways.

The federal government is urging states to enact legislation requiring that safety belts be worn. Small children are excluded from this requirement. Following the neonatal period, the motor vehicle poses the greatest single threat to a child's life. Contrary to popular belief, more small children are killed and injured inside the vehicle than outside. The marjority of children now ride in cars unprotected or inadequately protected. Standard safety belts are unsuitable for small children. Special devices capable of distributing collision forces over a large body area should be used. Original children's car "safety" seats were not intended to protect their occupants in a crash. These seats became subject to a government safety standard in April 1971. Shortly after this standard came into effect it was shown to be grossly inadequate in ensuring crash protection. A proposal for revising current safety criteria was issued in March 1974--to be implemented in September 1975. A number of progressive companies have developed crashworthy devices. As public awareness is being awakened, manufacturers are begining to find that "safety" sells. Child crash protection has not escaped the attention of safety experts whose writings are reviewed, but it is shown that lack of parent awareness and concern can be directly related to sparse and often inaccurate and incomplete information available. Many popular child care books ignore the subject entirely. Because correct use of devices is of such critical importance, instructions detailing what parents must do should be prominently displayed on a permanent label attached to the device. Observation of car seats in use confirms that correct installation of the device itself and/or proper securement of the child within the device in the exception rather than the rule. The development of child restraints is of recent date. It is essential to keep abreast of advances made in the field. Earlier recommendations may be superseded by more recent research findings. It has been found that parents are most receptive to new ideas prior to and immediately following the birth of a new baby. In-hospital instruction of expectant and new parents is showing promising results. There is an urgent need for pediatricians to become involved in this vital area of "preventive medicine".