A Reminder to Buckle Up, Slow Down, and Ride With a Mature Driver

Anticipatory guidance may help keep youngsters safer in the car.

As pediatricians, we have been encouraging car seat and seat belt use by our patients for many years—checking them off our list of anticipatory guidance to be given at health maintenance visits. If we are not running short on time, we may even remember to remind preteens that they should not get in the car with anyone who has been drinking or using drugs. But are there other issues we should be mentioning related to getting into cars that pose a risk to our patients?

In a study recently published in Archives of Pediatrics and Adolescent Medicine, Winston and colleagues1 investigated risk factors for death among pediatric passengers in motor vehicles. Using 2 US National Highway Traffic Safety Administration databases (the Fatality Analysis Reporting System and the National Automotive Sampling System [NASS]/Crashworthiness Data System [CDS]), the authors examined records from 2000 through 2005 of over 45,000 children aged 8 to 17 years who had been involved in motor vehicle accidents severe enough to require a vehicle to be towed away. In addition, because the NASS/CDS is a representative sample, the crashes included can be considered to correspond to ones involving over 2.5 million children.

The authors included accidents in which a pediatric passenger died, someone else was killed but a pediatric passenger survived, or a pediatric patient survived a tow-away crash. They separated the passengers into 3 groups—those 8 to 12 years old (“older children”), 13 to 15 years old (“predrivers”), and 16 to 17 years old (who may be drivers themselves). The researchers then looked at several variables to determine the role each played in fatality rates: these included driver age and license status, driver alcohol use, passenger restraint use, passenger seat position, time of day, day of the week, season, type of car, and speed limit.

The greatest predictors of an increased risk of fatality included:
•Lack of use of restraints.
•Travel at medium or high speed (between 45 and 54 mph and at least 55 mph, respectively).
•A young driver (under 16 years of age).

Almost two thirds of the fatalities occurred with male drivers. Also, fatalities were more common on weekends. More than one fifth of the cases involved alcohol. While the risk of death was greatest with drivers under 16 years of age, the frequency of these crashes was much lower than those with drivers 16 to 19 years old (presumably because of the higher number of drivers in the latter age group). The risk of death was at least double with a driver younger than 19 years than with a driver at least 25 years old. As passenger age increased through the preteen and teen years, the fatality rate increased as well.

While the study is limited by some missing information in the databases, it does highlight the importance of making our patients aware of the dangers of getting into a car with a young driver. In addition to reminding preteens and teenagers about the risks of intoxicated drivers, we should educate them and their parents about other hazardous driving situations. We can discuss the risks of getting in the car with a young driver, driving on medium- and high-speed roads, and not wearing a seat belt. We also can remind parents about the importance of knowing who is driving their child, and of staying on top of the safety of a situation.

It is easy to get caught up in the excitement when friends and siblings get their driver’s license. We need to remind patients and their families that driving can be dangerous—and that good judgment must be exercised at all times.