By Greg Schneider
Washington Post Staff Writer
Sunday, December 5, 2004; Page F01

When a pickup truck rear-ended a minivan in Tennessee on June 30, 2001, none of the adults in either vehicle was seriously injured. But Joshua Flax, an 8-month-old baby in a car seat in the minivan's second row, was killed.

That's because the 1998 Dodge Caravan's seats were designed to collapse backward to absorb the force of such an impact. The passenger in front fell back and hit Joshua's head, fracturing the baby's skull. Joshua's family -- the minivan was being driven by his grandfather -- recently won a $101.75 million judgment against DaimlerChrysler from a jury in Tennessee.

The company is appealing the award, arguing that the seats exceeded federal safety standards and that almost all vehicles are designed to do the same in such an accident. But the case illustrates how hard it can be to keep kids safe in cars even today, when technology and seat-belt laws are aimed at making driving safer than ever.

"The very first thing I think people need to understand is that when vehicles are being designed, they're not even thinking about kids," said Janette Fennell, founder of the advocacy group Kids and Cars. "That's just the way it's been and people work around it, doing different things to try to make [the car environment] more flexible."

New cars and trucks are loaded with devices to help occupants survive crashes or even avoid accidents, from air bags in ceilings to seat belts that grab harder before impact, to cruise control that senses vehicles in the roadway ahead. Most of those innovations are aimed at adults, and some -- such as air bags -- actually pose hazards to children.

Even some measures aimed at protecting kids can have dangerous unintended consequences. A generation ago -- when today's parents were kids -- children rolled around freely in the backs of station wagons and sometimes sat up front next to the unbelted driver. Now they're strapped into the back seat in high-impact plastic cocoons. While that protects them in most cases, it isn't perfect, as shown by the death of Joshua Flax. And the practice of confining kids to the back seat has coincided with a sharp rise in incidents in which parents forget their children and leave them locked in the car.

Overall, the rate of highway fatalities for adults and children alike has declined over the past 20 years, but experts say there are still many child deaths that might have been prevented.

The number of children 15 and younger killed in traffic accidents nationwide rose last year to 2,570 from 2,550 the year before, according to the National Highway Traffic Safety Administration. With Americans driving more than ever, though, the rate of child deaths per miles traveled declined slightly.

Motor vehicle accidents remain the leading cause of death for U.S. children over age 1, as they have been for years, according to the Centers for Disease Control and Prevention. In fact, traffic accidents are the top killer of Americans through age 34.

In addition, children fall victim every year to incidents in driveways, garages and parking lots that the government doesn't officially count. When a child is hit by a car backing out of the driveway, that's called a "non-traffic, non-crash" incident and is not reported by state police to NHTSA and therefore not factored into the federal government's annual tally of highway fatalities.

Because NHTSA is charged with regulating safety in the auto industry, the agency has been studying ways of tracking such dangers. "It's a very difficult, time-consuming task because there's no central repository for collecting these things as there is for fatalities that occur on highways," agency spokesman Rae Tyson said.

In studies published in 2002 and again earlier this year, NHTSA used death certificates from selected states to chart such cases and found the results incomplete. Deaths reported in the news media didn't turn up in the death certificate survey, sometimes because documents were coded wrong or because officials had failed to note that a vehicle was involved in a death caused by, say, heat exposure.

NHTSA is continuing to study ways of compiling such information, Tyson said.

That's frustrating to safety advocates, who want NHTSA to press automakers for design changes but have a hard time provoking action without hard statistics. In a few cases, the agency has acted anyway. In 2000, spurred by intensive campaigning from Fennell's Kids and Cars group, the agency required all new passenger cars with trunks to include latches that enable the trunk to be opened from within. That followed a deadly summer in 1998 in which 11 children died in three separate incidents of being trapped inside trunks.

Earlier this year, Fennell used news clippings to document eight deaths of children caused by getting their neck caught in the power window of a car or truck. NHTSA later proposed a regulation requiring automakers to mount window switches in ways that prevent children from accidentally activating them by leaning or standing on the switch.

The regulation is a good step, Fennell said -- she would have preferred that NHTSA ban dangerous switches outright -- but there are other areas that also need attention. Her list of the other top child-safety concerns:

• Children being struck or run over by vehicles backing out of a family driveway. Fennell has counted 15 such cases in the past two years, and said the problem is getting worse because of the popularity of high-riding pickups and sport-utility vehicles. Such trucks have unusually large rear blind spots, she said. Fennell would like automakers to make greater use of sensors to alert drivers to obstacles in their path. Most manufacturers offer such devices as optional equipment, and some are developing systems that actually stop the car or truck automatically if they sense something in the way.

• Cars being knocked into gear by children. Many carmakers are installing systems that require the driver to have one foot on the brake before the vehicle can be shifted out of park; Fennell said she continues to see examples of injuries or deaths from cars that don't have the safety feature.

• Another major concern is hyperthermia, or fatal overheating from being left in a hot car. This problem seems to have gotten worse since people realized that a deploying front-seat air bag can kill a small child. Now that children are strapped into car seats in the back, busy parents seem more likely to forget them when running errands, Fennell said. According to statistics she has compiled from news reports and the government, child air-bag deaths peaked at 60 in 1995, then declined to fewer than 10 in 1999. Just as those fatal incidents fell, though, heat-related deaths rose, from none in 1998 to 25 in 1999, and more than 40 already this year, according to Fennell.

Automakers could use relatively simple technology to help alleviate the problem, she said, such as equipping cars with buzzers that sound if a rear seat belt is still latched when the car shuts off or if the back seat senses weight.

Carmakers have looked into such back-seat warning equipment, but found that "there are so many ways the system could be overridden it's just not practical," said Eron Shosteck, a spokesman for the Alliance of Automobile Manufacturers. There are too many other factors that could trip the sensor, he said: An adult could be sitting in back with a child, or someone might leave a car seat buckled in place even when the child is not present.

Other safety features are coming into use thanks to market forces, Shosteck said, such as backup sensors and safer power-window switches. "With any safety technology there is always a phase-in period. Early adopters are willing to pay, and as that takes hold it becomes more of an item in demand in the mass market," he said.

Ultimately, Shosteck said, it's up to parents to ensure that their kids are safe in vehicles and never left unattended. "No technology is ever going to substitute for smart parenting," he said.

For its part, NHTSA would add another safety concern to the list: poorly installed car seats for small children and under-used booster seats for kids ages 4 to 8. In a survey earlier this year, NHTSA found that only 21 percent of the older children ever used booster seats, which are designed to make children ride higher so safety belts fit properly.

Fennell agrees that parents bear top responsibility for keeping children safe, but said that doesn't let automakers or the government off the hook. If nothing else, she said, they need to work harder to make sure people know how to prevent dangerous situations.

"What we're trying to do is let people understand these are real problems," she said. "The public hasn't been educated. We're doing as much as we can to get the word out there."