Car Seat Safety

When I gave birth to my first child in 2014 in the UK we were not able to leave the hospital without first demonstrating that we had a suitable child car seat in which to transport our new baby home. Indeed, the UK has stringent rules on car seat safety for children:

• All children should remain in an EU-approved car seat until they are 12 years of age and/or 135cm tall.
• Children should remain rear facing until at least 15 months of age.

Our second child was born in Dubai in 2017 and, prior to leaving hospital, there were no such restrictions. Nobody checked how we were getting home and what preparations we had in place for our newborn. Thus, I was actually of the impression, that no such rules were in place in this region.

It came as a surprise to me therefore, that in the UAE there are laws with regards to children travelling in cars.

• Children up to the age of four must be provided with a child safety seat.
• Children under the age of 10 are not allowed to travel in the front passenger seat.

Unfortunately, I see plenty of evidence of these laws not being adhered to in my day to day driving in the region.

Why are car seats so important?

In 2018, it was estimated that the global number of road traffic deaths was 1.35 million and amongst children aged 5 -29, road traffic accidents (RTA) were the leading cause of death.

Child car seats, when used correctly, can reduce the number of RTA deaths by 60%.

What guidelines should be followed?

The American Academy of Pediatrics has five evidence-based recommendations for best practices:

• Children should be rear-facing for as long as possible, and at least until the age of two.
• Children should be in a forward-facing car safety seat, which includes a harness, until at least four years of age.
• Belt-positioning booster seats should be used until at least eight years of age.
• Lap and shoulder belts are required for those who have outgrown booster seats.
• Children below the age of 13 should always ride in rear seats.

Whilst these are based on statistics taken from American data and were devised by experts and scientists based in the USA; it makes a lot of sense to implement them globally.

Why are these guidelines important?

Studies have shown that the use of child car seats saves lives. The risk of injury is reduced by between 70 and 80% and the risk of death by 28% when child restraint systems are used in place of standard seat belts.

What is the situation in the MENA region?

According to data gathered by the World Health Organisation (WHO), much of Europe meets best practice guidelines; much of MENA does not.

Of course we can only really speculate why this might be the case. We do know that, globally, 84 countries have laws covering the use of child restraints in vehicles; how rigorously these laws are enforced is invariably going to vary on a country-by-country basis. It is likely that some people perceive these recommendations as suggestions, rather than legal requirements.

Saudi Arabia: a case study

Much of the data on the use of car safety seats in the region seems to have come from the Kingdom of Saudi Arabia (KSA), where laws are in place, but compliance with them is worryingly low.

• In one study, 150 new mothers were monitored as they left hospital in Riyadh; not a single one used a car seat and all carried the infant in their arms.
• Another study, involving 385 women found that only 37% had a child restraint system in place and of these, only half used it consistently.

One small qualitative study aimed to better understand why women in KSA were less likely to use child safety seats than in other parts of the world:

• Cultural pressures and traditions.
• Advice from family members. Women were particularly likely to base their decisions on what their husband believed they should do.
• A desire to remain close to their child during the car journey.
• Larger family sizes meaning insufficient space for a car seat.

This highlights a need for, not only improved law enforcement, but also better education on the benefits of car safety seats. However, it should be noted that these studies were performed prior to females being able to drive in KSA. It remains to be seen whether the fact that women can now drive themselves will have a positive effect on the use of car safety seats for children.

Conclusion

The use of car safety seats for children is essential. Globally, laws differ from country to country. Even within the UK, where rules are strict and generally closely adhered to, there is no mention of an age limit for riding in the front passenger seat. In other countries, the laws in place do abide by the WHO best practice guidelines, but enforcement rates are low.

There needs to be more consistency, harsher penalties for breaking the laws and improved education with regards to the health benefits of using age-appropriate car seats.

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Sources:

• Alsanea, Mohammd, et al. “Use of Child Restraint System and Patterns of Child Transportation in Riyadh, Saudi Arabia.” Plos One, vol. 13, no. 1, 2 Jan. 2018, doi:10.1371/journal.pone.0190471.
• Durbin, Dennis R., and Benjamin D. Hoffman. “Child Passenger Safety.” Pediatrics, vol. 142, no. 5, 30 Nov. 2018, doi:10.1542/peds.2018-2460.
• “Global Status Report on Road Safety 2018.” World Health Organization, World Health Organization, www.who.int/publications-detail/global-status-report-on-road-safety-2018.
• Government Digital Service. “Child Car Seats: the Law.” GOV.UK, GOV.UK, 1 Apr. 2015, www.gov.uk/child-car-seats-the-rules.
• Nelson, A M, et al. “Using the Theory of Planned Behavior to Predict Infant Restraint Use in Saudi Arabia.” Saudi Medical Journal, vol. 35, no. 9, 2014, pp. 959–966.
• Nelson, Anna, et al. “Saudi Womens Beliefs on the Use of Car Infant Restraints: A Qualitative Study.” Traffic Injury Prevention, vol. 16, no. 3, 2014, pp. 240–245., doi:10.1080/15389588.2014.931578.
• “Road Safety.” Road Safety – The Official Portal of the UAE Government, U.AE. The United Arab Emirates’ Government Portal, u.ae/en/information-and-services/justice-safety-and-the-law/road-safety.