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October 13, 2003

Mandatory Infant Restraints on Airplanes Ill-Advised

Sitting on a packed flight next to an empty seat is one of life’s small and random joys. Airlines should give parents flying with infants the first call on this privilege, according to David Bishai, MD, PhD, associate professor with the Department of Population and Family Health Sciences at the Johns Hopkins Bloomberg School of Public Health. Dr. Bishai says that having babies strapped into a safety carrier in an unsold seat whenever available would save more lives than requiring parents to purchase a seat every time an infant flies. Requiring parents to pay for seats for their infants is bad public health policy, he explains, because the cost will lead some parents to make the trip in a car, which is far more dangerous per mile traveled.

The Federal Aviation Administration is contemplating new regulations to require children under age 2 to ride in approved child-restraint seats on airplanes. Right now, these children may fly in a parent’s lap, free-of-charge.

Dr. Bishai’s views appear in an editorial published in the October 14, 2003, edition of the journal Archives of Pediatric and Adolescent Medicine. They are supported by the findings of a study (Effects and Costs of Requiring Child-Restraint Systems for Young Children Traveling on Commercial Airplanes) from the University of California, San Francisco, School of Medicine and the Harborview Injury Prevention and Research Center at the University of Washington, Seattle, which appears in the same journal issue. In the study, Thomas B. Newman, MD, MPH, and his colleagues show statistically that more infants would die in car crashes than are saved from plane crashes if only 5 to 10 percent of parents switch from air travel to automobile travel.

“Nobody disputes that airborne infants are safer in child safety seats than in parents’ laps,” says Dr. Bishai. “But they are safer in a lap in an airplane than in the safest car seat, in the safest car, on the safest road. Even if we put aside the entire issue of automobile crashes and assume that nobody would switch from flying to driving, mandatory infant safety seats would rank as the most expensive life-saving intervention on record.”

In his editorial, Dr. Bishai explains that parents who pay $200 for an airline seat for their infant purchase a reduction in risk of infant death that translates into $1.3 billion per life saved. He argues that although there are plenty of worse things to spend $1.3 billion on, there are also plenty of ways to save more than just one life with this amount of money.

“Whereas these parents bask in the glow of their good intentions, a health economist would hope for the sake of their child that the $200 could not have been better spent reducing the child’s risk of dying from drowning, suffocating, choking, poisoning, or riding in a car—all of which pose greater numerical hazards to the child,” writes Bishai.

“Hearts and Minds and Child Restraints in Airplanes” was written by David Bishai and appears in the October 14, 2003, edition of the Archives of Pediatric and Adolescent Medicine.

Public Affairs Media Contacts for the Johns Hopkins Bloomberg School of Public Health: Tim Parsons or Kenna Brigham at 410-955-6878 or paffairs@jhsph.edu.