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Study: Child Restraints on Planes Would Backfire

Finds more would die by switching to less-safe car travel

MONDAY, Oct. 13, 2003 (HealthDayNews) -- Researchers say a Federal Aviation Administration (FAA) proposal to require "car seats" for children traveling on planes would likely increase the number of deaths, not decrease them as intended.

The conclusions hinge on how many families would opt to drive rather than pay higher air fares, a decision that could easily lead to more road accidents.

"It seems likely that the net effect of the regulation would be an increase in deaths because of substitution to car travel, which is less safe," says Dr. Thomas Newman, lead author of a study appearing in the October issue of the Archives of Pediatrics and Adolescent Medicine. "There are heartbreaking stories [of children dying in plane crashes] that make you want to do something, but good intentions don't always lead to good policies."

According to the study authors, the FAA proposal would require the use of child restraint systems (CRS) for children under age 2. This means that a child would have to have his or her own seat on the aircraft, as opposed to sitting on a parent's lap.

An FAA spokesman emphasized the rule has not been proposed yet, that there is no timeline for its introduction, and that the agency doesn't know who would pay for it. "The rule is not a foregone conclusion," says spokesman Paul Takemoto. He could not say what statistics the proposal was based on, only that "it's obviously safer for kids to be in a child restraint system."

Even within the FAA, there has been considerable debate about such an initiative, the study authors write. In a 1995 report to Congress, FAA officials said such a rule would result in more deaths than it prevented because of families turning to the roads.

Neither the U.S. National Transportation Safety Board nor the American Academy of Pediatrics bought this argument and have lobbied instead for putting the seats on planes.

The authors of this study did a risk and economic analysis to estimate the number of deaths that would be prevented, the number that would be caused, and the cost of such a policy.

After a great deal of number-crunching, they estimated that CRS use could prevent about 0.4 child plane-crash deaths each year. If the proportion of families switching to car travel exceeded 5 percent to 10 percent, this number would quickly be counterbalanced by deaths on roads and highways.

According to Dr. David Bishai, author of an accompanying editorial, parents who pay $200 for a seat for their infant would get a reduction in the risk of their infant dying of 8.3 per 100 million. If that same $200-per-ticket price were used, each life saved would cost more than $1 billion.

The calculations involved a large number of assumptions, such as the number of people switching to car travel and the cost of the new ticket, all of which are hypothetical.

Still, it's highly unlikely that airlines would start giving away baby seats for free and, Bishai says, "in economics, we believe that, if you charge something, less people are going to use it. As the price of a baby ticket goes up, people are not going to travel at all or, what we worry about, they will make the trip to Grandma's for Thanksgiving in a car."

Everyone wants to save lives. The question is whether this is the best way to do it.

"If we as a society wish to spend money to save lives by improving safety, almost any other way in which we might spend the money we would save more lives," Newman adds. "This is an incredibly expensive regulation in terms of the number of lives it will save. If families have $200 to spend to try to reduce the risk of accidental death, this isn't how you would want them to spend it."

Nevertheless, as Bishai points out, the image of a baby without a restraint system dying on an airplane and the FAA at fault is a powerful one.

"These are real dead babies that flight attendants see haunting them for life," he says. "I'm haunted by the dead babies on the side of I-95, but nobody takes pictures of them. They're just as dead. Here we are about to make a decision that's going to kill those kids on the side of I-95, because they're statistical babies with no faces."

More information

Visit the Federal Aviation Administration for more on current child safety recommendations. This is the American Academy of Pediatrics statement.

SOURCES: Thomas B. Newman, M.D., professor, epidemiology, biostatistics and pediatrics, School of Medicine, University of California, San Francisco; David Bishai, M.D., Ph.D., associate professor, population and family health sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore; Paul Takemoto, spokesman, Federal Aviation Administration, Washington, D.C.; October 2003 Archives of Pediatrics and Adolescent Medicine
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