The Child Passenger Safety Story
Early Efforts
In the late 1960s, following a shift in national consciousness regarding consumer protections, child passenger safety emerged as a public health issue. Initially, activity was disparate including only a handful of engineers, parents, and doctors. What they shared, and ultimately what brought them together, was the idea not only that vehicles should be safer, but the realization that child occupants were never considered in their design. If the nation’s youngest passengers were to enjoy freedom from danger, they required specialized solutions.
Such solutions first took shape outside the United States. Child safety seats—those designed to protect and not just position infants—had been available in the United Kingdom and Australia from around the early 1960s. Among the earliest American engineers to work on a child restraint was Ford safety engineer Emile Grenier, designer of the Ford Tot-Guard. General Motors also marketed their Infant Safety Carrier. As America’s automotive heartland, Detroit made for easy connections to universities. This drove conversation and debate among experts and faculty at the University of Michigan and other key figures such as anatomy Professor Huelke, president of the American Association for Automotive Medicine (AAAM).
These ideas and debates all led back to one question: did these designs actually work? More questions followed. What was the benchmark for knowing? With what standard should these designs comply? What real world issues should influence that standard? By 1970, it was apparent the number and variety of voices necessitated serious consideration of legislation. One year later, it arrived as Federal Motor Vehicle Safety Standard (FMVSS) 213. It did not however, satisfactorily answer the questions for it focused on the attachment of child safety seats to vehicle seats, not how child seats might offer protection. In 1972, Consumers Union (now Consumer Reports) filled the void, consistently crash testing a number of FMVSS213 compliant products and finding many offered little to no protection.
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Lots of Laws
That child safety seats could meet the standard yet not provide protection became a central concern, one shouldered not only by scientists but citizens. The issue had been popularized by pioneering journalist Julie Candler. Writing for Woman’s Day in 1970—one year after 58,000 children under 5 years old had been injured in car crashes—she shed light upon “the fragile bundle of humanity” who, should child passenger safety efforts not progress, would “for the remainder of her days…be paralyzed from the neck down.” Other women soon joined in chorus. Among the most active and vocal in prompting change was Annemarie Shelness. Founder of the Northern Westchester Highway Safety Council in 1965, she later joined Physicians for Automotive Safety (PAS) as Executive Director.
The connection between physicians and grassroots community groups proved powerful. Across the country, Stephanie Tombrello (née Russell) contacted Women for Political and Social Action (WPSA) in Los Angeles to improve campaigning. Working closely with Annemarie Shelness they refined ways of uniting physicians, lawmakers, and parents such as using periodic newsletters. This proved successful with one publication, Safe Ride News, later being published by funding from the American Academy of Pediatrics (AAP).
What Candler, Shelness, Tombrello, and others like them recognized was that informed parents made informed citizens which energized the legislative and lobbying processes. Caregiver education was at its strongest and most effective with short channels of communication. One such case was that of Tennessee doctor Robert Sanders who, when it came to public health initiatives, was “like a dog with a tire in it’s mouth.” Informed, tenacious, and traveled (including visits to Sweden and Australia), Dr. Sanders held a strong belief that past failures were no indication of future impossibilities. Specifically, while more than 30 states had not adopted seat belt laws for adults, he saw no reason to believe the same of child passenger safety laws. He divided his time between house calls, medical conferences, state public health boards, legislatures’ chambers, and journalists’ offices. He and his wife Pat brought together a powerful coalition of parents, doctors, lawmakers, advocates, scientists, and government officials.
Perhaps the most significant member was a 3-year-old child who testified alongside his father before the state legislature in 1977. Having been thrown from the rear seat against the dashboard of his father’s car, subsequently requiring brain surgery costing $13,000, he showed his scars to members of the assembly. While there was still no certainty the bill would pass, it did, becoming law in 1978. The first in the nation.
It was not a perfect law, and even left scope for the lap of any vehicle passenger 12 years of age or older to act as a child safety restraint (known as the “Babes in Arms Amendment”). Four years later, the amendment would be abolished, at which time Rhode Island and West Virginia had also passed Child safety restraint laws. Within 12 months, 17 more states had laws, with all 50 states requiring the use of some sort of child safety restraint by 1985.
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Creating Curriculums
State laws were not only the product of determined individuals and well-organized coalitions. As these groups continued to apply pressure to the federal government to change design standards, national agencies responded. Significantly, in 1979, the National Highway Traffic Safety Administration (NHTSA) awarded the University of North Carolina Highway Safety Research Center a key grant. This effectively established a network of larger child passenger safety advocacy groups with most enjoying sustained management and communication.
Ultimately, the formation of these groups would give rise to annual conferences despite a lack of security over long-term government funding. The National Child Passenger Safety Association (NCPSA) began hosting much larger events where in-person discussions further improved the efficiency of communications. As caregiver awareness proliferated, the new shape of the child passenger safety movement provided for better educational materials such as the first public service film produced by Physicians for Automotive Safety (PAS) called “Don’t Risk your Child’s Life.”
In 1982, a major national newspaper wrote an article stating that the “movement really seems to have picked up steam…kind of an emotional issue. It caught the fancy of a lot of people, and it's getting to be a pretty big movement.” Such coverage coincided with state legislatures who were prioritizing bills on child safety restraint use in ever increasing numbers. Two years later, the Journal of the American Medical Association published a wide ranging study showing 46% of children were traveling in some form of child safety restraint. In 1984, public consciousness was widespread with research, education, and legislation all contributing to a presidential establishment of a National Child Passenger Safety Awareness Day (which would later become National Child Passenger Safety Week).
Nonetheless, while 15 years of efforts had been successful at making available, developing, and getting caregivers to use child safety restraints, it did not equate to correct usage, and even potentially dangerous usage. With more awareness and resources within the movement, ideas of what constituted caregiver education, how it should be structured and conducted, and how it should be assessed became more immediate and more important.
Tombrello had already started working on such educational programming. First used throughout her native California, Tombrello developed an outline related to the selection and proper use of car seats. Drawing upon all her experience in founding and operating the L.A. Area Child Passenger Safety Association (later SafetyBeltSafe U.S.A.), Tombrello made every effort possible to include law enforcement, medical professionals, and educators in the design and implementation of the training. By the late 1980s, much of the material had been passed to NHTSA staff who used it to develop a series of training workshops aimed at standardizing child passenger safety knowledge.
These efforts were supported, sometimes indirectly but all the same effectively, by organizations such as the Children’s National Medical Center, Johnson and Johnson, as well as General Motors. This choreography, which needed refining, nevertheless shifted the child passenger safety movement into a more coherent and efficient system of knowledge whereby initiatives and their effectiveness could be better designed, delivered, and evaluated. With clear goals, reliable planning, and experienced advocates in a wide range of positions and an equally wide range of qualifications, the NTSB made the additional recommendation for child safety restraints inspections as a way to gather data and ensure the everyday safety of child passengers. In 1998, following a $30m, 4-year funding allocation from Congress, NHTSA finalized a national certification training curriculum. Those who qualified from the course were to be Child Passenger Safety Technicians, more commonly called “CPSTs” or “Techs.”
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Revolutionary Restraints
This effectively professionalized child passenger safety programming while legislation changes had important implications for the child safety restraint market. While changes to federal design standards had improved product safety, laws pertaining to the use and classification of child safety restraints had made parents and caregivers more discerning consumers. While this had advantages and shortcomings, manufacturers began to innovative with an increasing range of features and options.
What had once been the domain of a few niche engineers, had for some time been primarily managed by industrial product designers. In response to better laws and more informed parents, child safety restraint manufacturers began to hire specially-trained engineers including some from the aerospace industry.
As design complexity increased, so did the technology offered in some products. In 1996, the first convertible (a safety seat which can be installed both rear-facing and forward-facing) child seat was offered, while other systems once thought safe such as “overhead shield” seats were phased out. Of the major innovations of the late twentieth century, the Lower Anchors and Tethers for CHildren, or “LATCH” system was the most wide reaching in terms of research and implementation. Initially discussed in the mid-1990s, the universal system sought to address increasingly problematic issues of incompatibility between vehicle seats and child safety restraints. Since 2002, all new vehicles sold in the United States have been required to have some seating positions with the LATCH system.
In subsequent years, child safety restraint design became more cognizant of such issues. Various new types of seats and installation mechanisms emerged including designs aimed at catering for a wide range of sizes and ages of children, special features to simplify installation for caregivers, higher weight and size limits, and specialist designs for use aboard school buses, and those for children with disabilities.
The expansive range of child safety restraints subsequently influenced the management of knowledge and education resulting in specialist industry-wide publications and detailed databases of child safety restraints and vehicle safety features.
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Normal Is Not Done
The twenty-first century saw further advances in the key areas of technology, legislation, and education. The Child Passenger Protection Act, passed in 2000 was the first of many bills which would assist with funding and standards development. Booster seats - child safety restraints designed so a child can safely use the vehicle seat belt - became a key focal point, effectively extending safety measures to older children. Mostly, these were children who had outgrown a typical harnessed safety restraint but who were not adequately protected by the vehicle seat belt alone.
An expanding range of child safety restraints designed for children across broader size and age ranges naturally dictated that educational efforts also be expanded. Child Passenger Safety Technicians (CPST) became increasingly professionalized with many law enforcement agencies, hospitals, non-profits, and government programs having a CPST on staff. Since 2002, the number of CPSTs has almost doubled from 22,000 to 39,000 across the United States.
Federal standards for school bus seating were updated in 2009, and specialist qualifications in the transportation of children with disabilities were developed by The Riley Hospital for Children at Indiana University. Child passenger safety has developed into a broad and complex system with dedicated professionals in governmental, engineering, design, healthcare, and educational roles.
The movement has worked with and for an increasing product marketplace, and has fostered one of the most underrecognized and underappreciated agents of public health success - the Child Passenger Safety Technician. The community is now so active that a dedicated global conference—Kidz In Motion—runs every year as the central hub for the specialists who continue to push for greater awareness, better standards, improved education, and most of all, safer transportation.
Child passenger safety has been an undoubted public health success. In 2022, the number of child occupants killed in road accidents was 61% less than in 1975. But even with such progress, that’s still 856 children under 14 years old killed on America’s roads. 856 too many.
The child passenger safety story is therefore unfinished. CPSOMA tells only the beginning and invites all those interested in continuing this progress to be authors of an ending the work of so many deserves. A living museum, CPSOMA is about making the past a useful future...
