Effects and costs of requiring child-restraint systems for young children traveling on commercial airplanes.
BACKGROUND
The US Federal Aviation Administration is planning a new regulation requiring children younger than 2 years to ride in approved child-restraint seats on airplanes.


OBJECTIVE
To estimate the annual number of child air crash deaths that might be prevented by the proposed regulation, the threshold proportion of families switching from air to car travel above which the risks of the policy would exceed its benefits, and the cost per death prevented.


METHODS
Risk and economic analyses.


RESULTS
Child-restraint seat use could prevent about 0.4 child air crash deaths per year in the United States. Increased deaths as a result of car travel could exceed deaths prevented by restraint seat use if the proportion of families switching from air to car travel exceeded about 5% to 10%. The estimate for this proportion varied with assumptions about trip distance, driver characteristics, and the effectiveness of child-restraint seats but is unlikely to exceed 15%. Assuming no increase in car travel, for each dollar increase in the cost of implementing the regulation per round trip per family, the cost per death prevented would increase by about $6.4 million.


CONCLUSIONS
Unless space for young children in restraint seats can be provided at low cost to families, with little or no diversion to automobile travel, a policy requiring restraint seat use could cause a net increase in deaths. Even excluding this possibility, the cost of the proposed policy per death prevented is high.
Newman
Thomas B
TB
Department of Epidemiology and Biostatistics, University of California, San Francisco, School of Medicine, 94143, USA. newman@itsa.ucsf.edu
Johnston
Brian D
BD
Grossman
David C
DC
D000056:Accident Prevention; D000063:Accidents, Traffic / Q000331:legislation & jurisprudence / Q000401:mortality / Q000517:prevention & control; D000401:Aircraft / Q000191:economics* / Q000331:legislation & jurisprudence*; D001336:Automobiles / Q000191:economics / Q000331:legislation & jurisprudence; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis / Q000191:economics / Q000331:legislation & jurisprudence; D006293:Health Promotion / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D007223:Infant; D015370:Infant Equipment / Q000592:standards / Q000706:statistics & numerical data; D007229:Infant Welfare; D007231:Infant, Newborn; D012149:Restraint, Physical / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D012306:Risk; D040242:Risk Reduction Behavior; D012622:Seat Belts / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology