Child safety in cars
Authors: Michael Hayes
Journal: BMJ (2006)

In 2005 in the United Kingdom, 24 children aged under 10 years were killed while travelling in cars and a further 226 were admitted to hospital.1 The numbers of injured children who were wearing baby and child restraints or seat belts were not given, but such devices are known to be effective in reducing the severity of injury.2 3 4 When used properly, child passenger restraints reduce injury by 90-95% for rear facing systems and 60% for forward facing systems compared with not using a restraint.5

On 18 September 2006 the law on carrying babies and children in cars, vans, and goods vehicles in the UK changed to correspond with the rest of the European Union. Limited use of child restraints and seat belts in cars in the UK has been required by law since 1983 in the front seat and 1989 in the rear seat. However, the UK adopted a minimalist approach—baby and child seats had to be used only if one was available in the vehicle—a fact not widely publicised for obvious safety reasons. The legislative changes reinforce what should always be good practice: that all children in cars should use appropriate child restraints and that adult seat belts are intended for adults, not children. 

The law states that children under 3 years cannot legally travel in cars unless they are in an appropriate baby or child seat (usually a rear facing baby seat for children under 1 year and a child seat with an integral harness for older children). The one exception is when a baby or young child is carried in a taxi and no child restraint is available; in these circumstances the child may travel unrestrained on the back seat. 

The law is more complicated for children over 3 years. When a child is 12 years old or reaches 1.35 m an adult seat belt can be used without increasing the risk of injury. Children under 12 years who are less than 1.35 m tall are now required to use appropriate child restraints. Such restraints are child seats with integral harnesses or so called booster seats, in which the adult seat belt passes around the front of the child; the function of the booster seat is to position the belt correctly on the child's body. 

There is one exception for children over 3 years, the “unexpected necessity” clause. This clause allows children to use an adult seat belt for an unplanned but necessary short journey if a child restraint is not available. The Department for Transport emphasises that this is not intended to cover regular school runs but is applicable when, for example, a child cannot be collected as planned and alternative arrangements are made at short notice. When the alternative to using an adult seat belt is leaving the child outside the school gate the exemption seems sensible, although it should be monitored through observational studies commissioned by the Department for Transport to detect abuse. 

Failure to comply with the law can result in a £30 (€44; $59) fixed penalty notice or a fine of up to £500 if the case goes to court. Although policing of the child restraint law has been barely visible in the past, in 2004 around 200 000 fixed penalty notices were issued. How strongly the police intend to (or need to) enforce the recent changes remains to be seen. A constructive approach will probably be taken initially, with police forces working with local authority road safety officers to ensure that parents and carers understand the law. Police officers are unlikely to start carrying height measuring equipment in their cars to enforce the detailed provisions of the law. 

Despite changes in the past 10 years, child restraints are still not that easy to use consistently. Child seats with Isofix attachments that are plugged into corresponding anchorages in cars are becoming more common in the UK. This system decreases the likelihood that the seat will be fitted incorrectly, but such seats can be twice the price of those restrained by an adult seat belt. Although not an argument against using Isofix, this is an example of poorer families being disadvantaged compared with better off families by the cost of technological development. 

Although the change to the legislation is welcome, we must remember that child restraints and seat belts are secondary safety measures. They have the potential, when fitted correctly and used consistently, to reduce the severity of injuries and the likelihood of death. They do not prevent car crashes, however, and prevention should continue to be the long term aim.