The History of How the Car Seat Made American Kids Safer

Today, a child is involved in a vehicle crash every 33 seconds in the United States. However, when they are, child safety seats usually provide protection. This represents a remarkable sea change since the mid-20th century. Between 1975 and 2022, child fatalities in road accidents declined by 61%. While it is easy to take something commonplace like children’s car seats for granted, their normalization is an under-recognized public health achievement. Behind this success were a group of politically savvy characters whose relentless focus on improving the designs, awareness, and usage of child safety seats is an important model of citizen activism and public health advocacy.

The postwar economic boom built suburbs and federal highways and made family cars more affordable. But it also increased risks for child passengers. Typically, children rode in parents’ laps, or on their own in back seats without any safety protections. In 1965, lawyer and advocate Ralph Nader published Unsafe at Any Speed, detailing safety concerns about automobiles. Nader’s advocacy led to the creation of the U.S. Department of Transportation (DOT) and the National Highway Traffic Safety Administration (NHTSA). It also spurred a wider movement for legislated consumer protections.

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Within this movement were Physicians for Automotive Safety (PAS), a group of doctors who formed via a “dignified protest” at the 1965 New York Auto Show. The 30 members called on other doctors to advocate against the “epidemic” of automobile accidents. They called for “preventive countermeasures” to avert injuries, including for children, laying the foundation for a robust child passenger safety movement.

The issue gained broader recognition through pioneering motoring journalist Julie Candler. Writing for Women’s Day in 1970, she reflected on the 58,000 children under 5 years old who had been killed or injured in car crashes over the previous year. Candler wrote movingly of the “the fragile bundle of humanity” who, left unprotected, would “for the remainder of her days… be paralyzed” by an accident. Candler sparked a nascent interest in child passenger safety among parents, especially mothers.

Simultaneously, pushed in part by Nader’s consumer protection movement, the federal government had developed a design standard for child safety seats, known as “Federal Motor Vehicle Safety Standard 213” (FMVSS213). The standard focused on how child seats attached to vehicles. But it didn’t address the mechanisms of protection such as absorbing crash forces and preventing ejection. As a result, many experts believe the regulation didn’t do enough to protect children.

Advocates came forward to argue for improvements to car seat design and to raise public awareness about the importance of child safety seats. They included Annemarie Shelness, the executive director of PAS and Stephanie Tombrello, a social worker from Los Angeles. Shelness, Tombrello, and others worked to improve child safety seat designs, engaged in public education, and advocated for legislation.

By 1972, their primary focus was pushing for improvements to the federal standard. Tombrello was working with Women for Political and Social Action (WPSA), recording and reporting on childhood injuries, while Shelness was lobbying the government to recognize the shortcomings of the FMVSS213 standard. Consumers Union, a nonprofit watchdog organization (now Consumer Reports) published results of crash tests of 15 child safety restraints. In the tests, 12 failed.

These tests helped illustrate the need for better regulation, while showcasing what effective child safety seat design looked like. The next year, GM dealers began offering the seats to consumers, some even giving them away with the purchase of a family car.

Shelness and Tombrello astutely demonstrated the codependency of market and state to improve public health. They recognized what the market could offer—safe products from American industry—but also what it mostly provided: unsafe designs. They therefore highlighted the need for government intervention. Without improved standards, the market lacked the incentive to deliver better consumer protections. In 1981, their efforts resulted in the national FMVSS213 standard being made more rigorous.

However, child passenger safety advocates knew improved designs based on better standards was only half the battle. American drivers still had to actually use the seats. Mandating their use would be necessary—but this was not without resistance. A close friend of Shelness, pediatrician and PAS member Dr. Robert Sanders, frequently faced pushback in his efforts to pass child seat usage laws. Working throughout Tennessee during the mid-1970s, he heard arguments that babies belonged in their mother’s arms, that kids had a right to sit in truck beds, and that parenting choices were a matter of personal liberties.

Only a small fraction of families in the U.S. had or used a child car seat and state legislatures were hesitant to require it. But Sanders persisted. He relied on fellow doctors for support, met calmly with legislators, and always took a child seat with him to meetings for a demonstration. Sanders emphasized statistics, gave out fact sheets, and even told stories of signing death certificates of children in traffic accidents. His approach was to show that child passenger safety seats were a form of preventative healthcare.

When dissenting voices brought up the cost of child seats, Sanders compared that to medical costs: worth it to save and improve lives. He also floated ideas to establish funds to provide federally approved child seats to families unable to afford them. His efforts were rewarded in 1977 when the Tennessee legislature passed America’s first child seat usage law requiring any child under four years of age to be in a child safety seat starting in 1978. It set an important precedent. While federal law set standards for child seat design, the states became responsible for ensuring their use. By 1985 all states had child seat use laws.

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Shelness, Tombrello, and others, had successfully improved legislation regarding both design and use, and they had done so at federal and state levels. Now they kept up the work by turning to education for caregivers, who still needed to be convinced to use child safety seats, and police officers, who would need to help enforce laws requiring child safety seats. This meant distilling science, law, and statistics to be straightforward to these audiences. Leaflets were illustrated with minimal words. Parents were informed about free services they could access, while police officers were given power over new accident report forms which included information on child seat use. They sought to empower Americans to be agents of public health, allies in the fight for child safety, rather than passive consumers and obedient law followers.

By the mid-1980s, these educational materials were a de facto curriculum based around the “three Es”—education, engineering, and enforcement. The idea that simplification and invitation would strengthen and embed a national culture of child seat use reflected the movement’s practical agility and political savviness. Shelness and Tombrello showed how science supported law, how law guided the market, and how the market provided for investment in science. The approach was so successful that by 1984 NHTSA reported national car seat usage had reached 46%—an increase of over 500% in under a decade.