Certain groups of children are more at risk for motor vehicle occupant death. Specifically, American Indian and Alaska Native children under the age of fourteen have death rates almost one and a half times that of white children. Also, Hispanic children under the age of four have death rates one and a half times that of non-Hispanic children (Safe Kids Worldwide, n.d.).

Among children aged four to fourteen, motor vehicle crashes are the number one cause of brain injury. It is second major cause of pediatric brain injury, specifically with children as passengers (Brain Injury Association of America, n.d., “Brain Injury…”). A study by Langlois, et. al. indicates that between the years 1995 and 2001 an average of 9,000 (figure rounded) children under fourteen were reported to have been traumatically brain injured due to motor vehicle crashes. 1,481 children died from these injuries. A large disparity was noted between white and black children. For black children, the rate of traumatic brain injury (TBI) related deaths occurring due to motor vehicle crashes was 3.0 as compared to that of white children, 2.4. Again, for TBIs not only resulting in death but also injuries, the rate for black children is 20.3 as compared with 10.3 in white children. Differences are also observed in how subsets of the zero through fourteen age group experience brain injury. Black children die more frequently due to this cause in the age range of zero to four and for white children, in the ten to fourteen age range. For both injury and death, black children's rates are highest in the five to nine age group, and for white children rates are highest in the ten to fourteen age range. I found no explanation for these differences in the literature, but it is clear that different risk factors are at play.

For more information on types and levels of brain injury, select Appendix A.
For more information on the effects of brain injury, select Appendix B.

Information on trends in TBI due to motor vehicle crashes is difficult to find. However, we can tentatively predict that as populations continue to grow and Americans continue their typical pattern of high miles driven, TBIs in youth may worsen or simply continue to be the persistent problem that they are today. Obviously, in light of the apparent differences in incidence between ethnic groups, significant work is needed (Langlois, Rutland-Brown and Thomas, 2005).

As mentioned earlier, day of travel is a risk factor for motor vehicle crash deaths. Most deaths of those younger than thirteen occurred on Fridays, Saturdays, and Sundays in 2004 according to the Insurance Institute for Highway Safety. There was also a slight increase in these deaths in the months of May, June, and July. Additionally, most deaths occurred between three P.M. and nine P.M.

Alcohol use is another obvious risk factor for vehicle crashes and TBI in youth. In 2004, alcohol use was a factor in 442 or twenty-one percent of fatalities due to crashes. Approximately half of those fatalities occurred to passengers in vehicles with a driver who had been drinking and had a BAC level of at least .01 (NHTSA, 2004).

Other well known causes or contributing factors of motor vehicle crashes include excessive speed, distraction while driving, and drowsiness while driving. Legislation is an additional factor and is discussed under Legislation & Policy Strategies.

Despite increased use of restraints over the last few decades, use of restraints in motor vehicles continues to be a risk factor for TBI in youth. In a Brain Injury Association of America report, “Brain Injury: The Abc Years”, it is noted that eighty-five percent of infants (children under one) were restrained in motor vehicles in 1997, but only sixty percent of kids aged one to four were restrained. In general, restraint use appears to go down as a child grows older. Children who are unrestrained are more likely to be injured or die than those restrained in vehicles. Even those children who are restrained are often restrained improperly. The National Safe Kids Campaign reports that eighty percent of children who are placed in child safety seats are being improperly restrained. Finally, it is important to note that driver seat belt use is positively associated with child restraint use. In one study, forty percent of children riding with unrestrained drivers were also completely unrestrained themselves (Safe Kids Worldwide, n.d.).

For children under twelve seating placement in the vehicle is also important. Safe Kids Worldwide notes that children under the age of twelve are thirty-six percent less likely to die in a crash if they are seated in the back of a passenger vehicle rather than the front. The also estimate that one-third of children ride in the front. Children are more likely to ride in front if they traveling with unbelted drivers, riding along as sole passengers or are over the age of six.