Rear seat safer: seating position, restraint use and injuries in children in traffic crashes in Victoria, Australia

Car crashes are a major cause of death and serious injury to children but most analyses of risk are based on US data. The Australian context is different in at least three ways: 1. the proportion of passenger-side airbags, a potential risk to children in front seats, is much lower; 2. unlike in the US, Australian airbags are designed to work with restrained passengers; 3. restraint use for children 0-12 years is high (>90%). Official data drawn from Victorian crash records (n= 30 631) were used to calculate relative risks of death or serious injury for children (0-3 years, 4-7 years; 8-12 years) traveling in passenger cars during 1993-1998 and 1999-2004. Over 90% were reportedly wearing a restraint, and 20% were travelling in the front seat. For children under 4 years traveling in the front seat, the relative risk of death was twice as great as when traveling in the rear, and that of serious injury was 60% greater. The relative risk of death whilst traveling in the front seat was almost four times greater for children aged under one year. We suggest that serious consideration should be given to mandating rear seating for children, particularly those aged 4 and under