# Child vehicular heat stroke deaths

Children left in cars can die of heat stroke; when this is the result of a caregiver inadvertently leaving them in the car, this is sometimes termed forgotten baby syndrome.

## Background

Until the 1970s, child passenger safety was not a focus of legislation or a concern for manufacturers. In the 1980s, states began to develop child-safety laws. In the 1990s, the Academy of Pediatrics and the National Highway Institute created child-passenger safety guidelines which included requiring children under a certain age or weight be in a car seat. Most car seats for babies were rear-facing seats that could be strapped into the front passenger seat, which meant a parent or caregiver was constantly aware of the child's presence in the seat. In the mid-1990s, concerns developed about the safety of rear-facing car seats when airbags deployed, and the recommendations changed to placing all car seats into the back seat. For rear-facing car seats in particular, this meant that a parent would see the same thing -- the back of a car seat -- from the driver's seat, whether that car seat had a child in it or not.$^{:76}$
According to Erika Breitfeld, writing in the Berkeley Journal of Criminal Law, "Amplifying the problem, children frequently fall asleep during car rides...Not surprisingly, more than half of the children who die from vehicular heatstroke are under the age of two and in rear-facing car seats." Breitfeld's 2020 analysis concluded that "more children died from hyperthermia than ever died due to front-seat airbags" and that there was a direct correlation between the recommendations to place rear-facing child seats into back seats and children being inadvertently left in cars.$^{:76}$

## Causes

Each year, around the world, dozens of children die of vehicle-related hyperthermia. Because these numbers began to rise after the popularization of air bags$^{:7}$ and rear-facing child safety seats,$^{:76}$ researchers began to suspect that memory may be the culprit. According to Consumer Reports, inadvertently leaving a child in a car could happen to any parent or caregiver.
According to David M. Diamond, a psychology professor at the University of South Florida who has been studying the phenomenon since 2004, the phenomenon is a consequence of tension between the brain's habit-memory and prospective-memory systems, which is resolved when basal ganglia "habit memory" suppresses the "prospective memory" system of the hippocampus and the prefrontal cortex,$^{:78,83}$ resulting in a false memory and what he calls "autopilot". Other psychologists have suggested the phenomenon is functionally similar to forgetting keys in a car or forgetting to post a letter.
Diamond has identified common factors of the phenomenon as "stress, sleep deprivation, and change in routine". Inevitably a child in a rear-facing child seat represents a change in routine, as this is always a child who has changed the routines of its caregivers. It also almost inevitably represents stress and sleep deprivation for the same reasons. Stephen Cowen, a psychology professor at the University of Arizona, has said that stress can render a person "more attentive to the immediate sensory stimuli or threats in your environment but not as attentive to your more distant memory of leaving your children in the car".

## Public reactions

Although according to Diamond, over 25% of parents with children under 3 have lost awareness of the child being present in the car at any point during a drive,$^{:77}$ many people believe they couldn't forget a child in the car with them.
Typical reactions from those hearing about such incidents is condemnation of the parent or caregiver, suspicion of their motives, and a belief that a loving competent parent or caregiver could never forget they had a child in the car with them. Ed Hickling, a clinical psychologist, theorizes that people want to believe bad things don't happen to good people and that the universe or that a just God wouldn't allow such horrific things to happen. According to Breitfeld, "we have a visceral response to blame someone".$^{:92}$

## Prevention efforts

There have been several efforts dating to at least 2008 in the US to address the phenomenon through technology, including back-seat alert systems (which note when a backseat is opened prior to driving), car-seat alarms (which detect whether a child is buckled in), and end-of-trip reminders. In 2019 Italy required all child car seats be equipped with an alarm. By 2021 Israel had enacted laws requiring such safety systems.
In 2001, General Motors announced that by 2004, all models would be equipped with sensors, but by 2020 that had not happened. In 2019, the Association of Global Automakers and the Alliance of Automobile Manufacturers committed to the standardization of rear-seat-occupant alert systems by 2025.
In the US, the Infrastructure Investment and Jobs Act included a mandate for action by the U.S. Department of Transportation to propose rules. The National Highway Traffic Safety Administration has estimated rules will be proposed in April 2025.

## Incidence

In 2018, 52 children died of hyperthermia in cars in the United States. In 2024, 40 children died in the US. More than half of deaths are due to caregivers inadvertently leaving the child is in the car, and around a quarter happen when a child gets into a car without the caregiver's knowledge. The remainder occur when a child is intentionally left in a car due to caregiver neglect or ignorance.

## Notable cases

* Death of Cooper Harris