The U.S. Federal Aviation Administration (FAA) is expected to propose that all children younger than two years be required to travel in child safety restraint systems. This ruling would require adults to purchase seats specifically for children younger than two years instead of allowing these children to travel on an adult’s lap. The American Academy of Pediatrics Committee on Injury and Poison Prevention released a policy statement supporting the FAA proposed rule. However, there is some concern that these regulations may force more travelers to use automobiles to transport children on long trips. Newman and colleagues performed a risk and economic analysis of the proposed new regulations focused on the number of prevented child air-crash deaths, the threshold for persons switching to car travel above which the risk of the policy exceeds its benefit, and the cost per death prevented.

The first input was the estimated number of enplanements (defined as “a revenue passenger boarding an aircraft”) of children younger than two years. Next, an estimate of the number of deaths of children in this age group was calculated if the use of child safety restraint systems was in place. The next step was to calculate the relative risk of death in survival plane crashes in unrestrained versus restrained young children, and the risk of restrained children compared with overall passenger risk.

With regard to ground travel, the calculations included the average size of the family traveling and the average U.S. motor vehicle occupancy. Additional calculations included average motor vehicle deaths per 100 million vehicle-miles traveled and average net number of miles driven per diverted enplanements.

The use of child safety restraint systems for airplane travel would prevent about 0.4 child air-crash deaths per year. The increase in deaths resulting from increased car travel because of the proposed rule on airplane restraints for children could exceed the number of deaths prevented by child safety restraints if 5 to 10 percent of families switch from air to car travel. This percentage is unlikely to exceed 15 percent, although it depends on assumptions concerning trip distance, driver characteristics, and the effectiveness of child safety restraint seats. If there was no increase in car travel with the implementation of the proposal, the net cost per life saved would be approximately $6.4 million.

The authors conclude that a policy requiring the use of child safety restraint systems for children younger than two years during air travel could result in a net increase in deaths and injuries in this age group if the cost of the seats is high enough that most families divert to car travel to save money.

editor’s note: The concept of improving child safety during air travel has created controversy on both sides of the issue. The use of child safety restraints during air travel would reduce the death rate for infants involved in airplane crashes. Unfortunately, any increase in airfare that results from implementing this protocol could lead to parents of these infants increasing their reliance on car transportation. Additional car transportation could actually result in a net increase in death rates for children younger than two years. The best solution is to avoid placing the economic cost of this proposed policy on parents of traveling children. One suggestion is to allow parents with children younger than two years to reserve a seat next to them (at no cost) on planes that are not full so the children can be placed in a restraint system. This solution would increase the use of child safety restraint systems in airplanes without diversion to car travel. The goal would be to develop a policy that would increase the use of restraint systems without changing the parents’ travel plans.—K.E.M.