DOT HS 811 325 May 2010

Children Injured in 

Motor Vehicle Traffic Crashes
DISCLAIMER

This publication is distributed by the U.S. Department of Transportation, National Highway 

Traffic Safety Administration, in the interest of information exchange. The opinions, findings, 

and conclusions expressed in this publication are those of the authors and not necessarily those 

of the Department of Transportation or the National Highway Traffic Safety Administration. 

The United States Government assumes no liability for its contents or use thereof. If trade names, 

manufacturers’ names, or specific products are mentioned, it is because they are considered essential 

to the object of the publication and should not be construed as an endorsement. The United States 

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i 

Technical Report Documentation Page 

1. Report No. 2. Government Accession No. 3. Recipient’s Catalog No. 

DOT HS 811 325

4. Title and Subtitle 5. Report Date 

Children Injured in Motor Vehicle Traffic Crashes May 2010 

6. Performing Organization Code 

NVS-421 

7. Author: Refaat Hanna 8. Performing Organization Report No. 

9. Performing Organization Name and Address 10. Work Unit No. 

Office of Traffic Records and Analysis 11. Contract of Grant No. 

12. Sponsoring Agency Name and Address 13. Type of Report and Period Covered 

 NHTSA Technical Report 

Office of Traffic Records and Analysis January 1999- December 2008 

National Center for Statistics and Analysis 14. Sponsoring Agency Code National Highway Traffic Safety Administration 

U.S. Department of Transportation 

1200 New Jersey Avenue SE., Washington, DC 20590

15.Supplementary Notes 

16. Abstract 

Objectives: This study analyzes the incidence rates of incapacitating injuries as well as the commonly injured body regions 

among children under 8 years old involved in motor vehicle traffic crashes. 

Method and Data Source: This study provides a statistical analysis of two different databases: the National Automotive 

Sampling System (NASS) General Estimates System (GES) for 1999 to 2008 and the National Trauma Data Bank- National 

Sample Project (NTDB-NSP) for 2003 to 2007.

Results: This analysis indicates that use of child safety seats is effective in reducing the incidence rates of incapacitating 

injuries for the three age groups and in any crash type. The analysis indicates that children involved in rollover crashes had the 

highest incidence rates of incapacitating injuries. In rollover crashes, the estimated incidence rate of incapacitating injuries 

among unrestrained children was almost three times that for restrained children. In near-side impacts, unrestrained children 

were eight times more likely to sustain incapacitating injuries than children restrained in child safety seats. 

Head injuries were the most common injuries sustained by children in motor vehicle crashes. Children under 1 year old had 

higher incidence rates of head injuries than the other two age groups. Similar to head injuries, children under 1 had higher 

incidence rates of thoracic injuries than the other two age groups. 

Cerebrum injuries (contusions or lacerations) were the most common type of head injuries among all children included in the 

analysis. Concussion and unconsciousness were more common among children under 1 year old than the other two age groups. 

Skull base fractures were more common among children 1 to 3 and 4 to 7 years old than children under 1. 

Children under 1 were more likely to sustain rib fractures than the other two age groups. On the other hand, lung injuries 

(contusions or lacerations) were more common among older children than children under 1 year old. 

17. Key Words: AIS, Children, Child Safety Seat, Head Injury, Incapacitating Injuries, Initial 18. Distribution Statement 

Point of Impact, Rollover 

Document is available to the public from the National 

Technical Information Service www.ntis.gov 

19. Security Classif. (of this report) 20. Security Classif. (of this page) 21. No of Pages 22. Price 

Unclassified Unclassified 27 

 Form DOT F1700.7 (8-72) Reproduction of completed page authorized
ii 

TABLE OF CONTENTS 

 Executive Summary ................................................................................................................................... 1

Objective..................................................................................................................................................... 2

Introduction ................................................................................................................................................ 2

Data and Methodology ............................................................................................................................... 2

Results ........................................................................................................................................................ 4

Analysis of Police-Reported Crashes (NASS-GES) ................................................................................... 4

Seating Position of Children in Vehicles .................................................................................................... 4

Injury Severity ............................................................................................................................................ 6

Incidence of Incapacitating Injuries in Different Crash Scenarios: ............................................................. 6

Injury Severity by Initial Point of Impact (IPI) ........................................................................................... 7

Injury Severity by Restraint Use ............................................................................................................... 10

Injury Severity by Restraint Use and Initial Point of Impact (IPI)............................................................ 12

Analysis of NTDB-NSP Data ................................................................................................................... 15

Injuries by Body Region ........................................................................................................................... 16

Injury Diagnosis ........................................................................................................................................ 18

Head Injuries ............................................................................................................................................. 18

Thoracic Injuries ....................................................................................................................................... 18

Abdominal Injuries ................................................................................................................................... 19

Upper Extremity Injuries .......................................................................................................................... 19

Lower Extremity Injuries .......................................................................................................................... 20

Conclusion ................................................................................................................................................ 21

References ................................................................................................................................................. 22
1 

EXECUTIVE SUMMARY 

Objectives: This study analyzes the incidence rates of incapacitating injuries as well as the 

commonly injured body regions among children under 8 years old involved in motor vehicle 

traffic crashes. 

Method and Data Source: This study provides a statistical analysis of two different databases, 

the National Automotive Sampling System (NASS) General Estimates System (GES) for 1999 to 

2008 and the National Trauma Data Bank-National Sample Project (NTDB-NSP) for 2003 to 

2007.

Results: This analysis indicates that use of child safety seats is effective in reducing the 

incidence rates of incapacitating injuries for the three age groups and in any crash type. The 

analysis indicates that children involved in rollover crashes had the highest incidence rates of 

incapacitating injuries. In rollover crashes, the estimated incidence rate of incapacitating injuries 

among unrestrained children was almost three times that for restrained children. In near-side 

impacts, unrestrained children were eight times more likely to sustain incapacitating injuries than 

children restrained in child safety seats. 

Head injuries were the most common injuries sustained by children in motor vehicle crashes. 

Children under 1 year old had higher incidence rates of head injuries than the other two age 

groups. Similar to head injuries, children under 1 had higher incidence rates of thoracic injuries 

than the other two age groups. 

Cerebrum injuries (contusions or lacerations) were the most common type of head injuries 

among all children included in the analysis. Concussion and unconsciousness were more 

common among children under 1 than the other two age groups. Skull base fractures were more 

common among children 1 to 3 and 4 to 7 years old than children under 1 year old. 

Children under 1 year old were more likely to sustain rib fractures than the other two age groups. 

On the other hand, lung injuries (contusions or lacerations) were more common among older 

children than children under 1 year old. 
2 

1. OBJECTIVE 

Objectives: Analyze the incidence rates of incapacitating injuries as well as the commonly 

injured body regions among children less than 8 years old involved in motor vehicle traffic 

crashes. 

2. INTRODUCTION 

Injuries suffered in a motor vehicle traffic crashes are the leading cause of death among children 

in the United States.5

 Studies have shown that children who are correctly using the appropriate 

restraint for their sizes and ages are at a significantly lower risk of sustaining serious or fatal 

injuries. 

The injury outcome in children can be worse than similar injuries sustained by adults. For 

example, children who suffer traumatic brain injuries can experience lasting or late-appearing 

neuropsychological problems, highlighting the need for careful monitoring of children as they 

grow older.4 For this reason, head injuries are of particular concern when studying children 

injured in motor vehicle traffic crashes. 

In children, some neurological deficits after head trauma may not manifest for many years.2

Frontal lobe functions, for example, develop relatively late in a child's growth, so that injury to 

the frontal lobes may not become apparent until the child reaches adolescence when higher level 

reasoning develops. Since the frontal lobes control social interactions and interpersonal skills, 

early childhood brain damage may not manifest until such frontal lobe skills are called into play 

later in development. Likewise, injury to reading and writing centers in the brain may not 

become apparent until the child reaches school age and shows signs of delayed reading and 

writing skills. 

3. DATA AND METHODOLOGY 

This study provides a statistical analysis of two different databases: 

1- The National Automotive Sampling System (NASS) General Estimates System (GES) for 

1999 to 2008. NASS-GES is a complex probability sample of police-reported traffic crashes that 

occurred in a given year.6

 The NASS-GES data can be weighted to produce national estimates. 

The weights result from the probabilities associated with each stage of selection, reflecting that 

crash's probability of selection. NASS-GES reports injuries with different severity levels. The 

injuries are reported based on the police reports as: no injury (O), possible injury (C), nonincapacitating injury (B), incapacitating injury (A), fatal injury (K), injured - severity unknown, 

died prior to crash, or unknown if injured. NASS-GES is used to identify incidence rates of 

incapacitating injuries in different crash scenarios and estimate effectiveness of child safety seat 

use. Potential misuse scenarios of the child safety seat were not identified in this analysis, which 

could skew some of the data findings toward higher injuries than if the child safety seats or seat 

belts had been properly used.

2- The American College of Surgeons (ACS) was awarded a contract from the National Center 

for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC) 

to develop a nationally-representative sample of the trauma centers that provided data on treated 
3 

trauma patients. This report provides analysis of the National Trauma Data Bank-National 

Sample Program (NTDB-NSP) for 2003 to 2007. NTDB-NSP is a unique database that includes 

clinical and resource information for a nationally representative sample of trauma incidents.1 

NTDB-NSP is a stratified sample based in large part on existing NTDB data. Researchers can 

use the NTDB-NSP to produce national estimates of trauma care. For privacy reasons, the 

NTDB-NSP excludes data elements that could directly or indirectly identify individuals or 

individual trauma centers. 

To establish the NTDB-NSP, a stratified sample design was used, and 100 level I and level II 

hospitals were included. Stratification was based on U.S. Census region (four regions), level of 

trauma care designation (two categories), and NTDB reporting status (two categories). Thus, 

there were 16 total strata: 8 NTDB strata and 8 non-NTDB strata. Of the 100 sample hospitals, 

90 were allocated to the known NTDB-contributing hospitals and 10 to non-NTDB hospitals. 

The sample size of 100 hospitals was chosen on the basis of recent NTDB data that suggested 

that a sample of 100 hospitals would provide estimates having sufficient precision for most 

analyses at the national level. 

In the NTDB-NSP, motor vehicle occupants involved in passenger vehicle crashes were 

identified by using the International Classification of Diseases, External Cause of Injury, Ninth 

Revision (ICD-9 E-Codes) between 810.1 and 819.1. Information on external causes of injury is 

coded and entered into the state’s electronic hospital discharge data system (HDDS) or hospital 

emergency department data system (HEDDS).7

 Although the NTDB-NSP provides detailed 

medical and demographic information about these injured occupants, it lacks the information on 

crash characteristics such as crash direction, crash severity, and manner of collision. Information 

on child seating locations inside the vehicle is not available in NTDB-NSP data. 

Cases not admitted to trauma centers are not included in the NTDB-NSP, including injury 

victims who died before they can be transported to a hospital. 

The analysis of both NASS-GES and NTDB-NSP were run separately without any linkage 

between the two databases. The NTDB-NSP database was used due to the lack of medical 

information in the NASS-GES database. The AIS 2+ injuries in NTDB-NSP are likely coded as 

incapacitating injuries in NASS-GES. 

When analyzing NTDB-NSP, only patients aged 0 through 7 years old with Abbreviated Injury 

Scale (AIS) severity of 2 (moderate) or higher injuries were included3

. Among vehicle occupants 

who sustained AIS 2+ injuries, the injury or injuries with highest AIS for each body region were 

selected for analysis. For example, a child with three head injuries of AIS 2, 3 and 4 and lower 

extremity injuries of AIS 2 and 3, both the head injury with AIS 4 and the lower extremity injury 

with AIS 3 were included in the analysis. 

Injury severity in this study was identified through using the Abbreviated Injury Scale (AIS). 

The AIS is an anatomical scoring system first introduced in 1969.3

 AIS has been revised and 

updated against survival to provide and accurate measure of injury severity ranking. Injuries are 

ranked on a scale of 1 to 6, with 1 being minor, 5 severe, and 6 an unsurvivable injury. 
4 

Examples of injury AIS coding:

Skin contusion = AIS-1; Minor contusion of liver = AIS-2; Fractured femur = AIS-3 

Flail chest= AIS-4; Complex rupture spleen =AIS-5 

Children in this analysis were grouped into three age groups (less than one year, 1 to 3 years and 

4 to 7 years) according to the age-appropriate type of child safety seat. The analysis is limited to 

children involved in crashes involving passenger cars, minivans and light trucks. To account for 

the sample design and its associated standard errors, the Statistical Analysis System (SAS) 

version 9.1 Complex Sample Surveys was used to measure the confidence interval (CI) when 

applicable. 

Both NASS-GES and NTDB-NSP estimates are based on a national probability samples. 

4. RESULTS 

4.1. ANALYSIS OF POLICE-REPORTED CRASHES FROM NASS-GES 

Seating Position of Children in Vehicles 

Seating positions were grouped as first row and second row and rearward. Second row and 

rearward refers to children who were seated in the second or third rows inside the vehicle (e.g. 

minivans and some SUVs). 

There was a noticeable variation on the seating positions inside the vehicle across the three age 

groups. As shown in Table 1 and Figure 1, 31 percent (95% CI 28%-33%) of the children less 

than 1 year old were seated on the center seat of the second row and rearward. Conversely, only 

20 percent (95% CI 19%-22%) and 14 percent (95% CI 13%-15%) of children 1 to 3 and 4 to 7 

years old were seated in the center seat of the second row and rearward, respectively. A higher 

percentage (14%) of children 4 to 7 years old were seated on the front right seat, compared to the 

other two age groups. 
5 

Table 1: Estimated Distribution of Seating Position in Vehicles for Child Passengers 

 Involved in Motor Vehicle Crashes 

< 1 Year 1 to 3 Years 4 to 7 Years 

Seating Position 

Estimated 

Count (%) 

Estimated 

Count (%) 

Estimated 

Count (%) 

First row/center seat 13,233 2% 

CI (1.5%-2.7%) 37,556 1% CI (1%-2%) 61,013 2% CI (2%-3%)

First row/right 38,988 6% 

CI (5.1%-7.3%) 151,339 6% CI (5%-7%) 426,486 14% CI (13%-15%)

First row/unknown 2,265 <1% 

CI (0.2%-0.6%) 14,484 <1% CI (0.4%-0.7%) 13,856 <1% CI (0.3%-0.6%)

Second row & 

rearward/left 149,277 24% 

CI (22%-25%) 802,078 31% CI (30%-32%) 978,895 32% CI (31%-34%)

Second row & 

rearward/center seat 194,695 31% 

CI (28%-33%) 534,264 20% CI (19%-22%) 427,188 14% CI (13%-15%)

Second row and 

rearward/right 200,053 32% 

CI (30%-34%) 933,744 36% CI (34%-37%) 970,208 32% CI (30%-33%)

Second row & 

rearward/unknown 11,288 2% 

CI (1.2%-2.4%) 57,621 2% CI (1%-3%) 82,461 3% CI (2%-4%)

Unknown 21,019 3% 

CI (2.5%-4.1%) 83,121 3% CI (2%-4%) 94,546 3% CI (2.5%-4%)

Total 630,819 100% 2,614,206 100% 3,054,653 100% 

Source: NASS-GES 1999-2008 
6 

Injury Severity 

The vast majority of the children included in NASS-GES between 1999 and 2008 sustained no or 

minor injuries. As seen in Table 2, only 1 percent of the children under 1 year old, 1 percent of 

the children 1 to 3 years old, and 2 percent of children 4 to 7 years old sustained incapacitating 

injuries. 

Table 2: Estimated Distribution of Injury Severity by Child Passenger Age Involved 

in Motor Vehicle Crashes 

< 1 Year 1 to 3 Years 4 to 7 Years 

Injury Severity 

Estimated 

Count 

Estimated 

(%) 

Estimated 

Count 

Estimated 

(%) 

Estimated 

Count 

Estimated 

(%) 

No Injury 545,786 87% 

CI (84%-89%) 

2,249,267 86% 

CI (84%-88%) 2,528,615 

83% 

CI (80%-85%) 

Possible Injury 51,204 8% 

CI (7%-9%) 

215,772 8% 

CI (7%-10%) 313,632 

10% 

CI (9%-12%) 

Non-incapacitating 

Injury 12,177 2% 

CI (1.6%-2.3%) 

84,993 3% 

CI (2.8%-3.7%) 132,210 

4% 

CI (3.8%-5%) 

Incapacitating Injury 7,572 1% 

CI (0.1%-2.3%) 

30,500 1% 

CI (0.1%-2.2%) 47,521 

2% 

CI (0.4%-2.8%) 

Fatal Injury 

979.957 <1% 

CI (0.01%-0.3%) 

1,719 <1% 

CI (0.01%-0.1%) 2,348 

<1% 

CI (0.0%-0.1%) 

Injured, Severity 

Unknown 2,031 <1% 

CI (0.1%-0.5%) 

6,026 <1% 

CI (0.1%-0.3%) 6,960 

<1% 

CI (0.1%-0.3%) 

Unknown if Injured 

11,069 2% 

CI (1.1%-2.4%) 

25,929 1% 

CI (0.7%-1.3%) 23,366 

1% 

CI (0.5%-1.2%) 

Total 630,819 100% 2,614,206 100% 3,054,653 100% 

Source: NASS-GES 1999-2008 

Incidence of Incapacitating Injuries in Different Crash Scenarios: 

This section provides information of incidence rates of incapacitating injuries in relation to the 

initial point of impact (IPI), seating position inside the vehicle and use of child safety seats. To 

examine the incidence of incapacitating injuries in relation to the IPI and seating positions, the 

IPI and seating positions were grouped into nine groups as shown in Table 3. Children who were 

involved in rollovers and were seated in any seating position inside the vehicle were grouped as 

Rollover. Children who were involved in rear impacts were grouped into two groups (1) Rear 

Impact/First Row and (2) Rear Impact/Second Row and rearward. Children who were involved 

in frontal impacts were grouped into two groups (1) Children seated in the first row “Frontal 

Impact/First row” (2) Children seated in the second row and rearward “Frontal Impact/Second 

Row and Rearward.” Children who were involved in side impacts were grouped into three 

groups (1) Near-Side Impact (2) Far-Side Impact (3) Side Impact/Center seat (Table 3). 
7 

Table 3: Seating Position and Initial Direction of the Impact (IPI) 

Initial Direction Of 

Impact (IPI) Seating Position IPI/Seating Position 

Right Right (Any Row) Near-Side Impact 

Left Left (Any Row) Near-Side Impact 

Right Left (Any Row) Far-Side Impact 

Left Right (Any Row) Far-Side Impact 

Frontal First Row Frontal Impact/First Row 

Frontal Second Row + Frontal Impact/Second Row & Rearward 

Rear First Row Rear Impact/First Row 

Rear Second Row + Rear Impact/Second Row& Rearward 

Side Impact Center seat (Any Row) Side Impact/Center Seat 

Rollover Any Seating Position Rollover 

Injury Severity by Initial Point of Impact (IPI) 

Overall, vehicle’s front, rear and side were the most common IPI in all crashes involving 

children 0 through 7 years old. Rollovers comprised only 2 percent of the crashes involving 

children under 1 year old, 1 to 3 years old, and 4 to 7 year old, respectively (Table 4a). However, 

rollovers had the highest incidence rates of incapacitating injuries with no significant difference 

between the three age groups. An estimated 11 percent (95% CI 3% - 19%), 9.6 percent (95% CI 

1% - 18%), and 15 percent (95% CI 6% - 24%) of children less than 1 year old, 1 to 3 years old, 

and 4 to 7 years old who were involved in rollover crashes sustained incapacitating injuries, 

respectively (Table 4b and Figure 2). 

Children who were involved in frontal impacts and were seated in the front seats were twice as 

likely to sustain incapacitating injuries as children who were seated in the second row and 

rearward (Table 4b and Figure 2). 

There was no significant difference in the incidence rates of incapacitating injuries for children 

involved in different seating positions in rear crashes. 
8 

Table 4a: Estimated Distribution of IPI + Seating Position by Child Passengers Age 

Involved in Motor Vehicle Crashes 

Age < 1 Year 1 to 3 Years 4 to 7 Years 

IPI+ Seating Position 

Estimated 

Count 

Estimated 

(%) 

Estimated 

Count 

Estimated 

(%) 

Estimated 

Count 

Estimated 

(%) 

Frontal Impact/First 

Row 25,948 4% 

CI (3.2%-5%) 

94,139 4% 

CI (3.1%-4.1%) 

234,943 8% 

CI (7%-9%) 

Frontal Impact/Second 

Row & Rearward 234,011 37% 

CI (35%-39%) 

1,007,921 39% 

CI (38%-40%) 

1,025,369 34% 

CI (33%-35%) 

Near-Side Impact 61,591 10% 

CI (9%-11%) 

280,626 11% 

CI (10%-11.4%) 

343,830 11% 

CI (10.6%-12%) 

Far-Side Impact 52,657 8% 

CI (7%-10%) 

259,128 10% 

CI (9%-11%) 

328,505 11% 

CI (10%-11.3%) 

Side Impact/Center 

Seat 58,638 9% 

CI (8%-11%) 

145,111 6% 

CI (5%-6.2%) 

149,325 5% 

CI (4.5%-5.3%) 

Rear Impact/First Row 9,016 1% 

CI (1%-2%) 

42,773 1.6% 

CI (1.3%-1.9%) 

104,390 3.4% 

CI (3%-4%) 

Rear Impact/Second 

Row & Rearward 145,601 23% 

CI (21%-25%) 

598,197 23% 

CI (21%-25%) 

649,529 21% 

CI (20%-23%) 

Rollover 12,965 2% 

CI (1.5%-3%) 

49,932 2% 

CI (1.5%-2.3%) 

52,974 2% 

CI (1.4%-2.1%) 

Other/Unknown 

30,392 5% 

CI (4%-6%) 

136,380 5% 

CI (4%-6%) 

165,788 5% 

CI (4%-7%) 

Total 630,819 100% 2,614,206 100% 3,054,653 100% 

Source: NASS-GES 1999-2008 
9 

Table 4b: Estimated Incidence Rates of Incapacitating Injuries by IPI by Child Passengers Age 

Involved in Motor Vehicle Crashes 

< 1 Year 1 to 3 Years 4 to 7 Years 

IPI+ Seating Position 

Estimated 

Count 

Estimated 

(%) 

Estimated 

Count 

Estimated 

(%) 

Estimated 

Count 

Estimated 

(%) 

Frontal Impact/First Row 

 

530 2%

CI (0.3% - 3.8%) 1,904 2% 

CI (1%- 3%) 6,320 2.7% CI (1%-4.5%)

Frontal Impact/Second 

Row & Rearward 

 

2,176 1%

CI (0.1%-1.8%) 9,694 1%CI (0.0%-2%) 12,026 1.2% 

CI (0.1%-2.2%)

Near-Side Impact 

 

914 1.5% 

CI (0.0% - 3.4%) 

3,420 1.2% 

CI (0.1% - 2.3%) 

5,563 1.6% 

CI (0.4% - 2.8%) 

Far-Side Impact 

 

860 1.6% 

CI (0.0%-3.6%) 

3,722 1.4% 

CI (0.0%-2.9%) 

6,743 2% 

CI (0.3%-3.8%) 

Side Impact/Center Seat 

 

552 1% 

CI (0.1% - 1.8%) 

1,763 1.2% 

CI (0.0% - 2.7%) 

2,245 1.5% 

CI (0.1% - 3%) 

Rear Impact/First Row 

 

44 0.5% 

CI (0.0% - 1.4%) 278 0.7%

CI (0.1% - 1.3%) 745 1%CI (0.1% - 1.3%)

Rear Impact/Second Row 

& Rearward 

 

864 0.6% 

CI (0.0% - 1.3%) 2,933 0.5%

CI (0.1% - 1%) 3,434 0.5%CI (0.0% - 1%)

Rollover 

 

1,416 11% 

CI (3% - 19%) 

4,791 9.6% 

CI (1% - 18%) 

7,943 15% 

CI (6% - 24%) 

Other/Unknown 

 

213 0.7% 

CI (0.1% - 1.4%) 

1,994 1.50% 

CI (1% - 2%) 

2,502 1.5% 

CI (1% - 2.2%) 

Total 7,569 

1%

CI (0.1%-2.3%) 30,500 

1% 

CI (0.1%-2.2%) 47,521 

2% 

CI (0.4%-2.8%)

Source: NASS-GES 1999-2008
10 

Injury Severity by Restraint Use 

Overall, in this analysis, the rate of child safety seat use in police-reported crashes varied from 

85 percent (95% CI 83%-88%) among children less than 1 year old to only 24 percent (95% CI 

21%-27%) among children 4 to 7 years old. A large proportion of the children 4 to 7 years old 

(48%, 95% CI 43%-52%) were using lap and shoulder belts (Table 5a). 

The incidence rate of incapacitating injuries was lower among children restrained in child safety 

seats. As shown in Table 5b and Figure 3, incapacitating injuries were sustained by 8 percent 

(95% CI 2%-13%), 7 percent (95% CI 2.5%-11%), and 7 percent (95% CI 2.6%-12%) of 

children less than 1 year, 1 to 3 years and 4 to 7 years old who were not in child safety seats and 

did not use lap/shoulder belts, respectively. Conversely, only 1.1 percent (95% CI 0.0%-2.2%) , 1 

percent (95% CI 0.0%-2%), and 1 percent (95% CI 0.2%-2%) of children less than 1 year, 1 to 3 

years and 4 to 7 years old who used child safety seats sustained incapacitating injuries, 

respectively. 

The breakdown percent distribution of the other/unknown category of restraint system use is 

provided in Table 5c. 
11 

Table 5a: Estimated Distribution of the Police-reported Child Safety Seat Use by Child Passengers Age 

 Involved in Motor Vehicle Crashes 

Age < 1 Year 1 to 3 Years 4 to 7 Years 

Restraint 

Systems 

Estimated 

Count (%) 

Estimated 

Count (%) 

Estimated 

Count (%) 

Child Safety Seat 537,142 

85% 

CI (83%-88%) 1,919,191 

73% 

CI (71%-76%) 722,731 CI ( 

24% 

21%-27%) 

Lap and Shoulder 

Belt 28,160 

4% 

CI (3.5%-5.5%) 328,772 

13% 

CI (11%-14%) 1,454,340 CI (43%-52%) 

48% 

None Used 14,239 

2% 

CI (1.8%-2.7%) 84,310 

3% 

CI (2.7%-3.7%) 128,362 

4% 

 CI (3.6%-4.8%)

Other/Unknown* 51,279 

8% 

CI (6%-10%) 281,928 

11% 

CI (9%-13%) 748,954 

25% 

CI (20%-29%) 

Total 630,819 100% 2,614,202 100% 3,054,386 100% 

Source: NASS-GES 1999-2008

Table 5b: Estimated Incidence Rates of Incapacitating Injuries by Police-reported Child Safety Seat Use and Child 

Passengers Age Involved in Motor Vehicle Crashes 

Age < 1 Year 1 to 3 Years 4 to 7 Years 

Restraint Systems 

Estimated 

Count (%) 

Estimated 

Count (%) 

Estimated 

Count (%) 

Child Safety Seat 5,822 

1.1% 

CI (0.0%-2.2%) 17,026 

1% 

CI (0.0%-2%) 7,540 

1% 

CI (0.2%-2%) 

Lap and Shoulder Belt 439 

1.5% 

CI (0.0%-3%) 3,737 

1.1% 

CI (0.3%-2%) 21,120 

1.5% 

CI (0.2%-2.7%) 

None Used 1081 

8% 

CI (2%-13%) 5,768 

7% 

CI (2.5%-11%) 9,199 

7% 

CI (2.6%-12%) 

Other/Unknown 229 

0.4% 

CI (0.0%-0.5%) 3,968 

1.4% 

CI (0.6%-2.2%) 9,662 

1.3% 

 CI (0.4%-2.0%)

Total 7,569 

1% 

30,500 

1% 

47,521 

2% 

CI (0.1%-2.3%) CI (0.1%-2.2%) CI (0.4%-2.8%) 

Source: NASS-GES 1999-2008

Table 5c: Details of Other/Unknown Category of Restraint System Use

RESTRAINT SYSTEM USE < 1 Year 1 to 3 Year 4 to 7 Year 

Lap Belt 0.5% 3.5% 11% 

Shoulder Belt 0.1% 0.2% 0.5% 

Restraint Used-Specifics 

Unknown or Other 3.4% 3.7% 10% 

Unknown if Used 3.9% 3.2% 4% 

Total 8% 11% 25% 

Source: NASS-GES 1999-2008
12 

Injury Severity by Restraint Use and Initial Point of Impact (IPI) 

The information provided in this section examines the incidence rates of incapacitating injuries 

for the three age groups combined. The use of child safety seats reduced the incidence rates of 

incapacitating injuries for the three age groups and all crash types. As shown in Table 6b and 

Figure 4, children involved in rollover crashes had the highest incidence rates of incapacitating 

injuries. 

Unrestrained children had significantly higher rates of incapacitating injuries regardless of their 

seating position inside the vehicles. As shown in Table 6b, the incidence rates of incapacitating 

injuries were 7 percent (95% CI 2%-12%) and 6.5 percent (95% CI 0.0%-13%) for children 

involved in frontal crashes and were seated in the first row and second row and rearward, 

respectively, compared with 1 percent (95% CI 0.1%- 1.6%) and 1 percent (95% CI 0.0%- 

1.7%) for children restrained children involved in frontal crashes and seated in the first row and 

second row and rearward, respectively. 

In rollover crashes, the estimated incidence rate of incapacitating injuries among unrestrained 

children was 26 percent (95% CI 14%-37%) compared with 9 percent (95% CI 0.4%-18%) 

among children restrained in child safety seats and 10 percent (95% CI 1.1%-19%) among 

children who used lap and shoulder belts. 

Unrestrained children had significantly higher rates of incapacitating injuries in side impacts than 

restrained children. Incidence rates of incapacitating injuries were 8 percent (95% CI 5%-12%), 

6.5 percent (95% CI 1%-12%), and 7 percent (95% CI 2%-13%) for unrestrained children 

involved in near-side impacts, far-side impacts and side impacts/center seat, respectively, 

compared with 1 percent (95% CI 0.1%-2%), 1.3 percent (95% CI 0.0%-2.7%), and 1 percent 
13 

(95% CI 0.0%-2%) for restrained children involved in near-side impacts, far-side impacts and 

side impacts/center seat, respectively. 

Table 6a: Estimated Distribution of IPI by Restraint Systems Use for Child Passengers 

 Involved in Motor Vehicle Crashes 

Restraint 

Systems 

Child Safety Seat Lap & Shoulder None Used Other/Unknown 

IPI+ Seating 

Position 

Estimated 

Count 

Estimated 

(%) 

Estimated 

Count 

Estimated 

 (%) 

Estimated 

Count 

Estimated 

(%) 

Estimated 

Count 

Estimated 

(%) 

Frontal Impact/ 

First Row 77,166 2.5% 

CI (2.1%- 2.8%) 

180,588 10% 

CI (9%-11%) 

27,906 12% 

CI (10%-15%) 

69,366 6% 

CI (5.5%-7%) 

Frontal 

Impact/Second 

Row & Rearward 

1,270,065 

40% 

CI (39%- 41%) 

572,927 

32% 

CI (30%- 33%) 

69,481 

31% 

CI (27%-34%) 

354,823 

33% 

CI (31%-34%) 

Near-Side 

Impact 337,226 11% 

CI (10%- 11.2%) 

239,063 13% 

CI (12%-14%) 

19,046 8% 

CI (7%-10%) 

90,712 8% 

CI (7%-10%) 

Far-Side 

 Impact 311,128 10% 

CI (9%- 10.2%) 

229,568 13% 

CI (12%- 14%) 

17,996 8% 

CI (7%-9%) 

81,598 8% 

CI (6%-9%) 

Side Impact/ 

Center Seat 185,158 6% 

CI (5%- 7%) 

38,820 2% 

CI (1.8%-2.5%) 

15,551 7% 

CI (6%-8%) 

113,545 10% 

CI (9%-12%) 

Rear Impact/ 

First Row 36,478 1% 

CI (0.9%- 1.4%) 

84,576 5% 

CI (4-5%.1%) 

6,497 

CI 

3% 

(2%-4%) 

28,366 

CI 

3% 

(2-3%.2%)

Rear 

Impact/Second 

Row & Rearward 

793,909 

25% 

CI (23%- 27%) 

354,682 

20% 

CI (18%-21%) 

25,957 

11% 

CI (9%-14%) 

218,779 

20% 

CI (19%-22%) 

Rollover 59,198 2% 

CI (1.5%- 2.3%) 

26,842 1.5% 

CI (1.2%- 1.8%) 

12,947 6% 

CI (5%-7%) 

16,885 1.8% 

CI (1%-2%) 

Other/Unknown 108,737 3% 

CI (2.6%- 4%) 

84,205 5% 

CI (3%-6%) 

31,530 14% 

CI (11%-17%) 

108,087 10% 

CI (8%-12%) 

Total 3,179,064 100% 1,811,272 100% 226,910 100% 1,082,161 100% 

Source: NASS-GES 1999-2008 
14 

Table 6b: Estimated Incidence Rates of Incapacitating Injuries by IPI and Restraint Systems Use for Child Passengers 

 Involved in Motor Vehicle Crashes 

Restraint 

Systems 

Child Safety Seat Lap & Shoulder None Used Other/Unknown 

IPI+ Seating 

Position 

Estimated 

Count 

Estimated 

(%) 

Estimated 

Count 

Estimated 

(%) 

Estimated 

Count 

Estimated 

(%) 

Estimated 

Count 

Estimated 

(%) 

Frontal 

Impact/First Row 674 1% 

CI (0.1%- 1.6%) 

4,328 2.4% 

CI (1%-4%) 

2,027 7% 

CI (2%-12%) 

1726 2.5% 

CI (1%-4%) 

Frontal 

Impact/Second 

Row & Rearward 

10,280 

1% 

CI (0.0%- 1.7%) 

5,372 

1% 

CI (0.1%- 2%) 

4,544 

6.5% 

CI (0.0% -

13%) 

3700 

1% 

CI (0.5%-1.6%) 

Near-Side Impact 3,352 1% 

CI (0.1%- 2%) 

3,965 2% 

CI (0.0%-3%) 

1,544 8% 

CI (5%-12%) 

1037 1% 

CI (0.2%-2%) 

Far-Side Impact 3,933 1.3% 

CI (0.0-% 2.7%) 

5,045 2% 

CI (0.2%- 4%) 

1,161 6.5% 

CI (1%-12%) 

1185 1.4% 

CI (0.6%-2%) 

Side 

Impact/Center 

Seat 

1,913 

1% 

CI (0.0%-2%) 

215 

0.5% 

CI (0.0 %-1.5%) 

1,167 

7% 

CI (2%-13%) 

1265 

0.7% 

CI (0.0%-2.5%) 

Rear Impact/First 

Row 

416 

1.2% 

CI (0.0%-2.4%) 

549 

0.6% 

CI (0.1% 

1.3%) 

– 71 

1% 

CI (0.0%-3%) 

30 

0.1% 

CI (0.0%.0.2%) 

Rear 

Impact/Second 

Row & Rearward 

3,450 

0.4% 

CI (0%-1%) 

2,299 

0.6% 

CI (0.1%- 1.2%) 

445 

2% 

CI (0.0%-4%) 

1038 

0.5% 

CI (0.0%-1%) 

Rollover 5,475 9% 

CI (0.4%- 18%) 

2,709 10% 

CI (1.1%- 19%) 

3,353 26% 

CI (14%-37%) 

2613 15% 

CI (6%-25%) 

Other/Unknown 893 1% 

CI (0.1%- 1.5%) 

814 1% 

CI (0.3% -1.6%) 

1,735 6% 

CI (2.4%-9%) 

1266 1% 

CI (0.5%-2%) 

Total 30,388 1% 25,297 1.4% 16,048 7% 13,859 1.3% 

CI (0.0%-2%) CI (0.2%-2.6%) CI (3%-12%) CI (0.5%-2%) 

Source: NASS-GES 1999-2008 
15 

4.2. ANALYSIS OF NTDB-NSP DATA 

An estimated 1,731 children under 1 year old, 4,062 children between 1 to 3 years old, and 6,339 

children between 4 to 7 years old were identified in NTDB-NSP dataset between 2003 and 2007. 

An estimated 1,188 (69%), 2,319 (57%), and 4,169 (66%) of the children under 1 year old, 1 to 3 

years old, and 4 to 7 years old had Maximum Abbreviated Injury Scale (MAIS) 2+, respectively 

(Table 7). 
16 

Table 7: Estimated Incidence Rates of MAIS by Child Passengers 

 Involved in Motor Vehicle Crashes 

Age 

< 1 Year 1 to 3 Years 4 to 7 Years 

Count Count Count Estimated (%) 

MAIS Estimated Unweighted Estimated (%) Estimated Unweighted Estimated (%) Estimated Unweighted 

MAIS-1 487 103 28% 

CI (23%-33%) 1,664 397 41% CI (36%-46%) 2,027 515 32% CI (27%-37%)

MAIS-2 383 69 22% 

CI (18%-26%) 959 289 24% CI (20%-27%) 2,024 505 32% CI (29%-35%)

MAIS-3 454 93 26% 

CI (22%-30%) 865 236 21% CI (19%-24%) 1,209 374 19% CI (16%-22%)

MAIS-4 215 69 12% 

CI (9%-16%) 375 104 9% CI (7%-11%) 704 196 11% CI (9%-13%)

MAIS-5 126 27 7% 

CI (2%-13%) 116 45 3% CI (2%-4%) 225 76 4% CI (2%-5%)

MAIS-6 10 3 1% 

CI (0.0%-1.4%) 4 2 0% -- 7 5 0% --

Unknown 56 18 3% 

CI (1.2%-5.3%) 79 42 2% CI (0.4%-3%) 143 52 2% CI (1%-4%)

Total 1,731 382 100% 4,062 1,115 100% 6,339 1,723 100% 

MAIS 2+ 1,188 68% 2,319 57% 4,169 66% 

Source: NTDB-NSP 2003-2007 

The estimates may not sum to the totals due to rounding

Injuries by Body Region 

In this section the percentages are calculated as the total number of children who sustained 

certain type of AIS 2+ injury divided by the total number of children who had MAIS of 2+ 

within each age group. For example, a total of 1,188 children under 1 year old sustained MAIS 

2+ injuries and of those, 827 sustained AIS 2+ head injuries. The incidence rate of head injuries 

among this age group = 827/1,188 X 100 or 70 percent. 

As shown in Table 8 and Figure 4, the head was the most common body region injured in motor 

vehicle crashes for the three age groups included in the analysis. However, children under 1 year 

old had a higher percent of AIS 2+ head injuries at 70 percent as compared to 51 percent and 39 

percent among children 1 to 3 years and 4 to 7 years old, respectively. Thoracic injuries were 

noticeably higher among children under 1 year old at 31 percent when compared to 14 percent 

and 12 percent among children 1 to 3 years and 4 to 7 years old, respectively. 

Similar to thoracic injuries, spine injuries were noticeably higher among children under 1 year 

old at 16 percent when compared to 4 percent and 5 percent among children 1 to 3 years and 4 to 

7 years old, respectively. 
17 

Table 8: Estimated Incidence Rates of AIS 2 + Injuries by Body Region and Child Passengers 

 Involved in Motor Vehicle Crashes 

Age 

 < 1 Year 1 to 3 Years 4 to 7 Years 

Count Count Count 

Body Region 

Estimated Unweighted Estimated 

 (%) 

Estimated Unweighted Estimated 

(%) 

Estimated Unweighted Estimated 

(%) 

Head 827 163 70% 1,189 321 51% 1,640 449 39% 

Thorax 369 63 31% 334 94 14% 481 156 12% 

Lower 

Extremity 218 34 18% 412 111 18% 707 192 17% 

Abdomen 205 36 17% 217 55 9% 694 202 17% 

Spine 192 37 16% 84 26 4% 226 57 5% 

Upper 

Extremity 182 35 15% 196 52 8% 600 147 14% 

Face 57 12 5% 168 47 7% 445 102 11% 

Source: NTDB-NSP 2003-2007 

 Note: Percents do not add to 100% as one occupant might sustain more than one injury 
18 

Injury Diagnosis 

This section provides the frequency distribution of injury diagnosis for different body regions. 

Some injuries were grouped into one category due to their relevancy, such as small and large 

bowel injuries, lung contusion and laceration, cerebrum contusion and laceration, etc. 

1- Head Injuries 

Cerebrum injuries (contusions or lacerations) were the most common type of head injuries 

among all children included in the analysis. Concussions/unconsciousness were more common 

among children under 1 year old, when compared to the other 2 groups. Skull base fractures were 

more common among children 1 to 3 and 4 to 7 years old when compared to children under 1 

year old (Table 9). 

Table 9: Estimated Distribution of AIS 2+ Head Injuries by Child Passengers Age 

 Involved in Motor Vehicle Crashes 

 < 1 Year 1 to 3 Years 4 to 7 Years 

Count Count Count 

Estimated Unweighted Estimated 

(%) 

Estimated Unweighted Estimated 

 (%) 

Estimated Unweighted Estimated 

(%) 

Cerebrum 

Injury 

300 62 26% 

CI (19%-32%)

561 148 33% 

CI (25%-40%)

848 227 34% 

CI (28%-40%)

Skull Vault 

Fracture 

234 42 20% 

CI (11%-29%)

361 87 21% 

CI (18%-25%)

489 102 20% 

CI (17%-23%)

Unconsciousness/ 

Concussion 

215 46 18% 

CI (6%-30%)

156 58 9% 

CI (4%-14%)

272 90 11% 

CI (6%-16%)

Subarachnoid 

Hemorrhage 

159 34 14% 

CI (10%-17%)

143 43 8% 

CI (6%-11%)

218 52 9% 

CI (6%-12%)

Subdural 

Hematoma 

120 31 10% 

CI (6%-14%)

144 42 8% 

CI (5%-12%)

184 46 7% 

CI (5%-10%)

Skull Base 

Fracture 

69 15 6% 

CI (3%-9%)

222 49 13% 

CI (9%-17%)

303 82 12% 

CI (10%-14%)

Other 

74 19 6% 

CI (2%-9%)

128 34 7% 

CI (3%-11%)

169 49 6% 

CI (5%-9%)

Source: NTDB-NSP 2003-2007 

2- Thoracic Injuries 

Rib fractures were more common among children under 1 year old (37%, 95% CI 22%-52%) 

when compared to the other two age groups. On the other hand, lung injuries (contusions or 

lacerations) were more common among children 1 to 3 and 4 to 7 years old when compared to 

children under 1 year old (Table 10). 
19 

Table 10: Estimated Distribution of AIS 2+ Thoracic Injuries by Child Passengers Age 

 Involved in Motor Vehicle Crashes 

< 1 Year 1 to 3 Years 4 to 7 Years 

Count Count 

 

 Count 

Injury Type Estimated Unweighted 

Estimated 

(%) Estimated Unweighted 

Estimated 

(%) 

 

Estimated Unweighted 

Estimated 

 (%) 

Rib Fracture 

214 32 37% 

CI (22%-52%)

36 11 8% 

CI (5%-12%)

86 23 14% 

CI (10%-18%)

Lung Injury 

194 32 33% 

CI (25%-42%)

276 82 65% 

CI (55%-74%)

415 137 67% 

CI (61%-72%)

Thoracic 

Cavity Injury 

121 20 21% 

CI (10%-32%)

86 19 20% 

CI (13%-28%)

93 31 15% 

CI (10%-20%)

Other 

50 7 8% 

CI (3%-14%)

27 3 6% 

CI (1%-12%)

28 8 4% 

CI (1%-8%)

Source: NTDB-NSP 2003-2007

3- Abdominal Injuries 

Small-bowel injuries and large-bowel injuries were more common among children 4 to 7 years 

old, accounting for 30 percent (95% CI 23%-37%) of all abdominal injuries compared to only 14 

percent among children under 1 year old (CL 5%-23%) and 19 percent (CI 12%-26%) among 

children 1 to 3 years old (Table 11). 

Table 11: Estimated Distribution of AIS 2+ Abdominal Injuries by Child Passengers Age 

 Involved in Motor Vehicle Crashes 

< 1 Year 1 to 3 Years 4 to 7 Years 

Count Count Count 

Injury Type Estimated Unweighted Estimated 

(%) Estimated Unweighted Estimated (%) Estimated Unweighted Estimated (%) 

Liver Injury 87 14 32% 104 27 30% 263 71 25% 

CI (23%-42%) CI (22%-38%) CI (21%-30%)

Spleen 67 15 25% 124 30 36% 268 73 26% 

Injury CI (8%-42%) CI (27%-44%) CI (20%-32%)

Small/Large 38 8 14% 66 12 19% 311 86 30% 

Bowel Injury CI (5%-23%) CI (12%-26%) CI (23%-37%)

Kidney 41 6 15% 30 8 9% 122 31 12% 

Injury CI (5%-25%) CI (6%-11%) CI (8%-15%)

Other 38 7 14% 22 6 6% 70 23 7% 

CI (5%-23%) CI (1%-12%) CI (4%-9%)

Source: NTDB-NSP 2003-2007 

4- Upper Extremity Injuries 

Humerus fractures accounted for 43 percent (95% CI 33%-53%) of upper extremity injuries for 

children 1 to 3 years old. Fracture radius and ulna combined (forearm) accounted for 26 percent, 

24 percent and 35 percent for children under 1 year, 1 to 3 and 4 to 7 years old, respectively 

(Table 12). 
20 

 Table 12: Estimated Distribution of AIS 2+ Upper extremity Injuries by Child Passengers Age 

Involved in Motor Vehicle Crashes 

< 1 Year 1 to 3 Years 4 to 7 Years 

Estimated Estimated 

Injury Type 

Count Estimated 

 (%) 

Count (%) Count (%) 

Estimated Unweighted Estimated Unweighted Estimated Unweighted 

Clavicle Fracture 

59 12 25% 

CI (12%-38%)

52 18 21% 

CI (12%-30%)

191 48 26% 

CI (20%-32%)

Humerus Fracture 

48 10 20% 

CI (12%-29%)

107 22 43% 

CI (33%-53%)

209 49 29% 

CI (24%-34%)

Radius Fracture 

36 7 15% 

CI (0.0%-31%)

31 9 12% 

CI (5%-19%)

176 44 24% 

CI (18%-30%)

Ulna Fracture 

25 5 11% 

CI (0.2%-31%)

30 5 12% 

CI (7%-17%)

82 21 11% 

CI (8%-15%)

Other 

69 13 6% 

CI (0.0%-31%)

30 5 12% 

CI (4%-20%)

72 22 10% 

CI (6%-14%)

Source: NTDB-NSP 2003-2007 

5- Lower Extremity Injuries 

Pelvic fractures were higher among children under 1 year old when compared to the other two 

age groups. Below knee injuries were higher among children 1 to 3 (37%, 95% CI 26%-48%)

and 4 to 7 years old (35%, 95% CI 27%-42%) compared with only 17 percent (95% CI 10%-

23%) among children under 1 year old (Table 13). 

Table 13: Estimated Distribution of AIS 2+ Lower Extremity Injuries by Child Passengers Age 

 Involved in Motor Vehicle Crashes 

< 1 Year 1 to 3 Years 4 to 7 Years 

Count Estimated 

(%) 

Count Estimated 

(%) 

Count Estimated 

(%) 

Injury Type Estimated Unweighted Estimated Unweighted Estimated Unweighted 

Pelvis Fracture 

111 19 34% 

CI (24%-44%)

54 20 11% 

CI (6%-16%)

218 61 23% 

CI (17%-30%)

Femur Fracture 

91 12 28% 

CI (12%-45%)

246 61 49% 

CI (39%-60%)

354 98 38% 

CI 3(4%-41%)

Tibia/Fibula 

Fracture 

55 9 17% 

CI (10%-23%)

184 51 37% 

CI (26%-48%)

327 80 35% 

CI (27%-42%)

Other 

68 10 22% 

CI (18%-24%)

15 7 3% 

CI (0.4%-6%)

43 10 5% 

CI (2%-7%)

Source: NTDB-NSP 2003-2007 
21 

CONCLUSION 

This analysis demonstrates that the use of child safety seats are effective in reducing the 

incidence rates of incapacitating injuries for the three age groups and in any motor vehicle traffic 

crash type. All children involved in rollover crashes had the highest incidence rates of 

incapacitating injuries. In rollover crashes, the estimated incidence rate of incapacitating injuries 

among unrestrained children was almost three times that for restrained children. In near-side 

impacts, unrestrained children were eight times more likely to sustain incapacitating injuries 

when compared with children restrained in child safety seats. 

The head injuries were the most common injuries sustained by children in motor vehicle crashes. 

Children under 1 year old had higher incidence rates of head injuries when compared to the other 

two age groups. Similar to head injuries, children under 1 year old had higher incidence rates of 

thoracic injuries when compared to the other two age groups. 

Cerebrum injuries (contusions or lacerations) were the most common type of head injuries 

among all children included in the analysis. Concussion/unconsciousness were more common 

among children under 1 year old, when compared to the other two groups. Skull base fractures 

were more common among children 1 to 3 and 4 to 7 years old than children under 1 year old. 

Children under 1 year old were more likely to sustain rib fractures than the other two age groups. 

On the other hand, lung injuries (contusions or lacerations) were more common among older 

children than children under 1 year old. 

Small-bowel injuries and large-bowel injuries were more common among older children. Pelvic 

fractures were higher among children under 1 year old when compared to the other two age 

groups. Below-knee injuries were higher among older children. 

The injury outcome in children can be worse than similar injuries sustained by adults.4 There is a 

special need to prevent head injuries among children due to their long-term complications. For 

example, children who suffer traumatic brain injuries can experience lasting or late-appearing 

neuropsychological problems, highlighting the need for careful monitoring as they get older. 

In children, some neurological deficits after head trauma may not manifest for many years.2

Frontal lobe functions, for example, develop relatively late in a child's growth, so that injury to 

the frontal lobes may not become apparent until the child reaches adolescence as higher level 

reasoning develops. Since the frontal lobes control our social interactions and interpersonal 

skills, early childhood brain damage may not manifest until such frontal lobe skills are called 

into play later in development. Likewise, injuries to reading and writing centers in the brain may 

not become apparent until the child reaches school age and shows signs of delayed reading and 

writing skills. 

The information presented in this report aims to provide researchers, parents and policy makers 

with statistics on children injured in motor vehicle traffic crashes, and it stresses the importance 

of the using child safety seats. 
22 

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