The number of motor vehicle fatalities involving children under age 15 varies widely by state, but occurrences are more common in the South, and are most often associated with improperly or unused restraints and crashes on rural roads, a new review of child–related auto fatalities shows.

The study, conducted jointly by researchers at Harvard and UT Southwestern Medical Center, is the first to look at state–level trends in child fatalities involving motor vehicle crashes, and to account for differences in geography and state laws and regulations. Overall, about 16 percent of children involved in fatal wrecks died – 2,885 children total over the four–year review period from 2010 to 2014.

The South proved deadliest: 1,550 children died in fatal wrecks; a mortality rate of 1.34 per 100,000 children per year. Safest was the Northeast, with 189 child fatalities and a mortality rate of 0.38 per 100,000 children per year. The Midwest had 585 child fatalities, a mortality rate of .89 per 100,000 children per year. The West had 561 child fatalities, a mortality rate of 0.76 per 100,000 children per year. The 2,885 child fatalities represented a mortality rate of 0.94 per 100,000 children per year.

“Broadly what we found is that state laws and regulations, as well as consistent enforcement, were crucial factors in preventing childhood motor vehicles fatalities – evidenced by the wide variation in child fatalities by state,” said Dr. Faisal Qureshi, Associate Professor of Surgery at UT Southwestern and a pediatric surgeon at Children’s Health?. “Our analysis also demonstrated that revising weak regulations and improving enforcement could have a substantial impact on saving lives. Improving proper use of restraints showed the most potential to prevent these deaths.”

Notably, analysis showed that a 10 percent increase in proper use of restraints such as seat belts and car seats would lower deaths by more than 230 children annually or more than 1,100 over five years – equal to nearly 40 percent of the deaths observed from 2010–2014.

Researchers reviewed child fatalities for those 15 and under involved in 18,116 fatal crashes from 2010–2014 using the Fatality Analysis Reporting System. More than 18,000 children were involved in fatality accidents during the four–year period, and about 16 percent of those (2,885 children) died.

The research appeared in the Journal of Pediatrics.

Among the study highlights:

• Mortality ranged from 0.25 per 100,000 children per year in Massachusetts to 3.23 per 100,000 children per year in Mississippi. Nationally, the mean mortality was 0.94 per 100,000.
• 52 percent of children involved in fatal crashes lived in the South; 21 percent in the West, 19 percent in the Midwest, and 7.5 percent in the Northeast.
• 62 percent of crashes occurred on rural roads and 35 percent on state highways.
• 20 percent of children were improperly restrained or unrestrained, and 13 percent were inappropriately seated in the front.
• 9 percent of drivers were under the influence. Vans and minivans had the fewest fatalities, followed by pickups, SUVs, and cars.
• The majority of crashes occurred at speeds between 45 and 60 mph.