American Academy of Pediatrics Committee on Injury and Poison Prevention: Children in pickup trucks.

Pickup trucks have become increasingly popular in the United States. A recent study found that in crashes involving fatalities, cargo area passengers were 3 times more likely to die than were occupants in the cab. Compared with restrained cab occupants, the risk of death for those in the cargo area was 8 times higher. Furthermore, the increased use of extended-cab pickup trucks and air bag-equipped front passenger compartments creates concerns about the safe transport of children. The most effective preventive strategies are the legislative prohibition of travel in the cargo area and requirements for age-appropriate restraint use and seat selection in the cab. Parents should select vehicles that are appropriate for the safe transportation needs of the family. Physicians have an important role in counseling families and advocating public policy measures to reduce the number of deaths and injuries to occupants of pickup trucks. Motor vehicle trauma remains a leading cause of death of children. Occupants in pickup trucks should receive the same level of protection provided in other vehicles according to national policies that address protection of motor vehicle occupants. The safety issues relevant for pickup trucks include the following: 1) prohibition of cargo area travel; 2) age-appropriate restraint use; 3) appropriate seat location in the cab; 4) appropriate use of rear seating positions in various models of extended cab vehicles; and 5) risk of air bag-related injuries. Pickup trucks have become increasingly popular vehicles for passenger transportation. Pickup truck registrations numbered 36.2 million in 1998, representing 17% of registered motor vehicles in the United States.1 Census data for 1992 indicated that 73% of pickup trucks were used for personal transportation.2 Restraint use in the cab of pickup trucks has been reported to be lower than restraint use in other passenger vehicles.3 TRAVEL IN THE CARGO AREA Travel in the cargo area of the pickup truck is a major occupant protection issue that disproportionately involves youth. Because the cargo area is not intended for passenger use, it is neither required nor designed to meet occupant safety standards applicable to passenger locations. Nevertheless, the cargo area is used for transporting passengers. In 1997, 161 deaths of occupants riding in the cargo area were reported; 77 (48%) were children and adolescents younger than 20 years. Of these occupants, 7 (9%) were younger than 5 years; 15 (19%) were 5 through 9 years of age; 14 (18%) were 10 through 14 years of age; and 41 (53%) were 15 through 19 years of age.4 Persons who are injured when traveling in cargo areas of pickup trucks are more likely to sustain multiple injuries and injuries of greater severity and have a greater likelihood of death than do occupants in the cab. The most significant hazard of travel in the cargo area of a pickup truck is ejection of a passenger in a crash or noncrash event (eg, sudden stop, turn, swerve, or loss of balance, as well as intentional or unintentional jumps and falls). Studies have demonstrated that the proportion of occupants ejected from the cargo area markedly exceeds the proportion ejected from the cab.5–11 In a recent study of fatalities in pickup trucks from 1987 through 1996, nearly one third of the deaths among occupants of the cargo area were a result of noncrash events. Of the deaths that occurred as a result of cargo area occupants being ejected, 40% were children and adolescents 17 years or younger. Cargo area passengers were 3 times more likely to die than were occupants in the cab. Compared with restrained cab occupants, the risk of death for those in the cargo area was 8 times higher.12 Enclosed cargo areas (camper shells) do not provide adequate protection against injury to occupants. In 1997, 14% of cargo area deaths of children and adolescents younger than 20 years were in enclosed cargo areas.4 Carbon monoxide poisoning, which may result in death, is an additional hazard to those traveling in the enclosed cargo area of a pickup truck.13 Fewer than 50% of the states restrict transport of passengers in the cargo area. No 2 states have identical laws, and only 1 state fully prohibits travel in cargo areas. Restrictions in other states vary according to the age groups to which they apply, conditions of travel (eg, if restrained), and presence of an enclosed cargo area.14 The application of seat belt and child passenger safety laws to travel in pickup truck cargo areas may be an option in some states; however, in certain states, even occupant area seat belt laws do not apply to pickup trucks. Many Native American nations have adopted occupant restraint laws that apply to pickup trucks as well as passenger cars; other nations use the laws of the state.15 The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. PEDIATRICS (ISSN 0031 4005). Copyright © 2000 by the American Acad-