Seating Positions, Airbags, and Children

From the early days of child restraint regulation, the center rear seat position has been considered the safest place in the car, since it is farthest from the exterior of the vehicle. Analyses of field injury data continue to bear this out (Kallan et al. 2008, Braver et al. 2008, Mayrose and Priya 2008). Before the implementation of frontal-impact airbags for the right-front passenger, infants were often restrained in the front seat to allow monitoring by the driver (Edwards and Sullivan 1997). In addition, until lap-and-shoulder belts were required in rear outboard seats in 1989, the front seat offered the only passenger position with the more complete lap-and-shoulder belt restraint.

When frontal-impact airbags were required in the United States to provide protection for unbelted right-front passengers in the early 1990s, the unintended consequence of a restraint system designed for adults was the potential for lethal loading of children riding in the front seat. (Quinones-Hinojosa 2005, Braver et al. 1997). To date, 28 infants and 152 older children sustained fatal loading attributed to the airbag in the United States (NHTSA 2009). The increased risk of fatality to children in the right-front passenger seating position in vehicles with first-generation airbags is estimated to be 34%–63%. (Braver et al. 1998). These fatalities almost always involved head or neck injury from direct contact with the inflating bag and/or the airbag housing cover delivered to children who were either riding in a rear-facing child restraint or unrestrained and/or were out of position and close to the airbag at the instant of deployment (NHTSA 2000).

The immediate response to the injuries and fatalities to children by first-generation airbags was to recommend that children under 13 years of age use the rear seat. The combination of airbag warnings on child restraints and in vehicles along with educational campaigns has led to high use of the rear seat by children, increasing to 83% of children under age 7, including most children in rear-facing restraints and 50% of children aged 8–12 (Greenspan et al. 2010). Another study indicates that 99% of children under age 1, 98% of children aged 1–3, and 88% of children aged 4–7 rode in rear seats in 2008 (NHTSA 2008). In addition, vehicles are now equipped with occupant detection systems that are meant to automatically turn off the airbag and prevent frontal-airbag deployment with child occupants and occupants who are too close to the deploying airbag. Federal testing requirements have also changed so airbags deploy with less force. Braver et al. (2008) showed that relative to first-generation airbags, second-generation airbags led to reductions in fatal injuries of 65% for children aged 0–4, 46% for children aged 5–9, and 32% for children aged 10–12 who were seated in the front seat. Olson et al. (2006) found a 34% reduction in risk for children under 6 between second- and first-generation airbags.

Regardless of what type of airbag system exists in the vehicle, children under age 13 should ride in the back seat (Arbogast et al. 2009, AAP 2011, NHTSA 2011). Despite the improvements in airbag technology, this recommendation remains important because the vehicle fleet still includes vehicles where the airbag can pose a danger. In addition, the rear occupant compartment provides a safer environment during a frontal crash because of intrusion that is more likely to occur in the front occupant compartment (Evans et al. 2009). Several studies have documented the protective effect of the rear seat for belted occupants (Berg et al. 2000, Durbin et al. 2005).

As side impact airbags have been introduced to the vehicle fleet, more precautions have been taken to avoid the unintended dangerous consequences experienced with frontal-impact airbags. Voluntary testing procedures used by vehicle manufacturers evaluate whether the side airbags pose a danger to an “out-of-position” child next to the airbag module (Side Impact Working Group 2003). Curtain airbags deploy from the vehicle roofline and provide head protection during side impacts and rollovers. Field investigations of crashes have identified almost no unintended injuries to children caused by side or curtain airbags, indicating that the efforts to ensure the safety of their implementation have been effective (Hallman et al. 2009, Arbogast and Kallan 2007).