Notes from the Nanny State

After you’ve been discharged, hospital policy gives way to D.C. law, which stipulates that children less than a year old and under 22 pounds must ride in a rear-facing, infant car seat, installed in the back of your car. Children between one and four years old may ride in a forward-facing child safety seat, installed in the back of your car. And from ages five to eight, children must use a federally approved child booster seat, also in the rear of the car. These are primary offense laws, mind you, meaning that if a police officer spots you illegally transporting children–if, for instance, you buckle your seven-year-old into the front seat for a trip to the corner store–they can pull you over and issue a citation giving you a choice of attending a $25 safety class or paying a $75 fine.

The tyranny of the car seat isn’t confined to the mollycoddlers in Washington. Every state in the union has laws on the books mandating the use of car seats for infants and toddlers. Thirty-eight states now have laws also mandating the use of booster seats. If anything, the laws in the District of Columbia are on the lax side. In Massachusetts, once eight-year-olds graduate from their booster seats, they must remain in the backseat of the car, using normal seatbelts, until age twelve. In Maine, children over 40 pounds must be in a booster seat until they reach eight years of age or 80 pounds–whichever comes last. The penalty for violating these laws varies from state to state, ranging from $10 to $500 per infraction. (The District of Columbia also tacks two points onto your license for good measure.) In Nevada, you can be sentenced to up to 50 hours of community service.

Enforcement can be quite zealous. A few years back, the District of Columbia took to setting up roadblocks and pulling aside vehicles with car-seat-age children in order to perform random checks. The officers handed out mock summonses, instructing bad parents to attend car-seat safety classes. In 2000, Arkansas judge Doug Schrantz made news when he made an example out of Robyn Skillian, who had foolishly secured her three-year-old with a normal seatbelt in the back of her car. Schrantz fined Skillian $125 and ordered her to write an obituary for her daughter. You know, to teach her a lesson.

Oddly, parents are compelled to buy car seats but are discouraged from installing them on their own. Instead they are urged–by doctors, public safety advocates, even the car-seat manufacturers themselves–to have the devices professionally installed at a car-seat inspection center–usually a local firehouse or police station. Although the installation is free, it can aggravate other problems. For instance, car seats now have expiration dates. If you used a car seat for one child and want to re-use it for another, you may be out of luck. And if the car-seat installation inspector determines that your seat is past its “use by” date, they will likely refuse to install it. On parenting message boards, some people claim to have had their out-of-date car seats confiscated by the officials who were supposed to install them.

Thirty years ago, the child safety seat was a novelty device. Generations of American children had been transported sitting in a parent’s lap. In the front seat, no less! But in the blink of an eye–much faster, even, than the seat belt–the child safety seat became a staple of parenting and an object of legislative fetish, an embodiment of nanny-statedom. The story of how the car seat became a fixture in our lives is a weird synecdoche for how bureaucrats, private do-gooders, and corporate America cooperate to invisibly shape and change both culture and the law.

There have been kiddie seats for almost as long as there have been cars. But the early ones were not designed, or sold, with safety in mind. They were devices to keep junior happy during the ride. The Bunny Bear Company, for example, made such child seats in the 1930s and 1940s. During the 1950s and early 1960s, the typical car seat was a papoose board or a plastic seat with hooks that extended outward, allowing it to hang over a seatback. Some of them, like the kiddie seat made famous by Maggie Simpson, had toy steering wheels affixed in front of the child.

In 1965 Ford introduced the first American child safety seat. (A British inventor came up with a primitive forerunner in 1962.) The Astro-Guard was sold exclusively at Ford dealerships for $29.95. The safety-conscious automaker (Ford was one of the pioneers of the seatbelt movement) touted the Astro-Guard’s four-point harness system, which strapped the child into a small bucketseat. But the Astro-Guard had its problems–namely that children’s heads tended to snap forward upon sudden stops.

Ford immediately went back to the drawing board. As one press release from the time charmingly noted: “Research done by Ford Automotive Safety Research Engineers, starting in the fall of 1966, involved considerable technical and scientific study best understood by engineers.” The result of the engineers’ understanding was the Ford Tot-Guard. Released in November 1967, the Tot-Guard certainly looked like the future. It comprised three pieces, which latched into the seats of Ford automobiles: a booster seat, a molded, tubular, plastic shield, and a removable foam pad. In the event of sudden deceleration, the child’s entire body–including his head and neck–would be restrained.

The Tot-Guard took some getting used to. The brochure that accompanied its release noted that “Children often regard confinement of any kind as punishment, and the Tot-Guard is confining.” In order to keep your child from rebelling against the Tot-Guard, Ford recommended that you:

Children may not have been hostile to the Tot-Guard, but parents were not overwhelmingly affectionate: Only 75,000 of the safety seats were sold in their first seven years of production. There was, however, one group that fell positively head-over-heels for the Tot-Guard.

Founded in 1965 by Seymour Charles, Physicians for Automotive Safety (PAS) was a Nader-style advocacy group. Charles and Ralph Nader were friends, actually, and it was Nader who urged Charles to form PAS in the early 1960s. PAS was devoted to combating what Charles referred to as America’s “highway epidemic.”

Charles was a New Jersey pediatrician, and in the early 1960s one of his young patients was killed by being thrown from a car during an accident. The child was not restrained; Charles found his mission. He began attending auto safety conferences and started to see the issue as one of public health. “The automobile is the etiological agent in an epidemic accounting for some 50,000 deaths and 4 million injuries each year,” he wrote in a 1966 issue of the Journal of the American Medical Association. Charles believed automobiles were a disease that killed children. And child safety seats could be the cure. PAS achieved a remarkable degree of influence in a short period of time. Nearly 500 doctors signed up with Charles to picket auto shows and issue warnings and press releases. Charles began testifying before Congress. Lyndon Johnson invited him to the Rose Garden ceremony where the Department of Transportation was signed into existence.

In the Tot-Guard, Charles found what he had been looking for: a device that he could sell–not to parents, but to the government. He lauded the Tot-Guard, giving it testimonials and claiming that if all Americans under age five were to be buckled into a Tot-Guard, more than 1,300 lives would be saved every year. A child restraint like the Tot-Guard, Charles claimed, was “just as vital and effective preventive medicine as any immunization procedures available in modern pediatrics.”

In 1971, only six years after his group’s founding, Charles’s efforts were rewarded when the federal government issued the first standard for child safety seats: a static crash test, which the Tot-Guard passed with flying colors. By then, other manufacturers had begun producing safety-minded car seats, most notably GM’s Infant Love Seat. Some efforts were better than others. In 1972, Consumer Reports did its first set of car-seat ratings and declared twelve of the fifteen seats it tested “Not Acceptable.” But the problem remained that no matter how hard Charles and other advocates fought to get manufacturers to make better car seats, parents weren’t interested in buying them. That’s when another pediatrician, Robert Sanders, had an epiphany: If people wouldn’t buy car seats on their own, then the government would have to force them.

Sanders’s involvement in the car-seat movement was something of an accident. Bob Sanders, according to his widow, Pat, had always been a safety nut, but had never been politically active. He was, however, involved in the Tennessee Pediatric Society, where one year, by chance, he ended up chairman of the Accident Prevention Committee. As a consequence of this position, when the state formed a task force on highway safety a few months later, they invited Sanders to join. And it was on the state task force that Sanders met a man named Ed Casey.

Casey was not a physician, but he believed that child safety seats were mandated from a power above even government. As Bob Sanders Jr. explains in his excellent biography of his father, Casey believed that Deuteronomy 22:8 required the use of car seats: “When you build a new house, you shall make a parapet for your roof, that you may not bring the guilt of blood upon your house if any fall from it.” As Sanders’s son wrote, “Casey thought of the parapet, or low wall or railing around the edges of a roof, as being analogous to a child restraint device itself, including its anchorage inside the car.”

Sanders never shared Casey’s fundamentalist views on public safety, but he did become convinced of the dangers of automobiles and the need to protect children from them.

Like Charles, Bob Sanders saw traffic accidents as a disease in need of a cure, calling them the “epidemic of our time” and likening them to polio. In 1975, Sanders and Casey drew up a bill requiring the use of car seats for children. It was a radical idea, but they found a local representative to sponsor it. It ultimately failed, and Sanders redoubled his efforts. He enlisted the help of his wife and the two began lobbying doctors across Tennessee to support another pass at the legislation. By 1977 they had assembled enough support to bring it back to the floor.

Still, there was resistance. Some parents claimed it was financially and logistically burdensome. They were not altogether wrong. Because while the car seat is objectively pro-child, it is also vaguely anti-family. If you had five small children in 1977–a situation not particularly rare back then–few vehicles could accommodate enough car seats to transport the entire brood at the same time. (In an accidental way, the car seat prefigured, and perhaps contributed in some small part, to two trends we would soon see in America: smaller families and giant SUVs.)

But most of the hesitant legislators were worried more by the specter of government intrusion into the everyday lives of citizens. In response, Sanders and the car-seat lobby argued that while no one wanted the government intruding unnecessarily into family matters, not securing children in car seats was a form of child neglect–something which the government already had a mandate to police. As Pat Sanders now explains it, “Adults can make their own choices; but children have no choice.” It proved to be a powerful argument.

By the close of 1977, a compromise was struck: Tennessee would require the use of car seats until age four, but with an exception for mothers who were holding newborns in their arms. Sanders, now known as “Dr. Car Seat” (later activism would change his nickname to “Dr. Seat Belt”) was triumphant because he understood that the ratchet turns only one way. Some day, compulsory car-seat usage would force even young mothers to give up the foolish practice of cradling newborns as the family car rocketed toward danger and death. As it happens, the ratchet turned faster than Sanders ever could have hoped: Four years later the “babes in arms” exception was rescinded.

With the first domino tipped, state legislatures began to fall into line. Partly this was because the epidemiological evidence in Tennessee was encouraging. Car crash deaths of children under four in Tennessee dropped from seventeen in 1978 to ten in 1981, even though only about half of the population was using child safety seats. But the bigger hastening factor was an obscure organization in the federal bureaucracy–the National Highway Transportation Safety Administration (NHTSA)–that was teaming with local advocacy groups to organize and lobby state legislators and entice them with federal incentive grants. At the time, NHTSA’s child-restraint specialist was a woman named Elaine Weinstein. She helped put together a series of workshops across the country to teach advocates how to get car-seat laws passed in their states. In 1981, Rhode Island became the second state to put a car-seat law on the books. Four years later, all 50 states and the District of Columbia had some form of law mandating their use.

All of these were primary enforcement laws. But of course, that wasn’t enough. Once states required the use of car seats for infants and toddlers, there was pressure to expand the zone of protection as other dangers became clear. In 1993, the increasing prevalence of airbags created concern that this new safety feature for adults was actually a hazard for children. Advocates began to request that children be relegated to the back seat, where they would be safe from airbag trauma. In Washington State in 1996, four-year-old Anton Skeen was killed after being ejected from his car during an accident, even though he was secured by an adult seatbelt. Four years later, Washington passed the first booster-seat law–the “Anton Skeen Act”–introducing a new class of required child-safety seats and raising the age during which the government claims responsibility over the transportation of children.

Booster-seat laws have caught on a little more slowly than the first car-seat laws–this spring Massachusetts became the 38th state to mandate their use. But for perspective on the rapidity of this progress, consider that doctors first started recommending the use of seat belts during the 1920s when the Automobile Safety League of America was created. It took until 1958 for seat belts to be installed as standard equipment on any cars–Saab was first–and it wasn’t until 1964 that they were common in new American models. The first state law requiring the use of seat belts didn’t come until 1984, and even today, while all 50 states have some form of seat-belt statute, only half of them are primary offense laws.

You might think, then, that the car-seat forces would be basking in this accomplishment. (Though, once a crusader, always a crusader: With the child safety seat a total triumph in American law and culture, Seymour Charles turned his attention to campaigning against medical insurance companies and handguns. Bob Sanders went on to campaign for seat belt laws, health care reform, and environmental protection.) Yet you would be wrong. Because it turns out that while it’s one thing to tell people that they need car seats and another to require that they use them, even the full force of law isn’t enough to make sure that America’s dull little Babbitts actually use their car seats correctly. And this last problem is a continuing source of frustration for car-seat champions.

In 1983, the Physicians for Automotive Safety were exasperated to discover that, despite all of their hard work, parents were misusing their car seats at alarmingly high rates. Despite the fact that car seats were being used by virtually all parents (at least through age three), very few parents were using them “satisfactorily.” One NHTSA study in 1996, for instance, suggested that 80 percent of child safety seats “had one or more things wrong with how they were being used.” The government would have to fix that, too. In 1995 NHTSA established a blue-ribbon panel to provide recommendations on both child safety seat technology and education. The panel recommended a standardized course designed to “teach the fundamentals of [child safety seat] use to safety professionals and other interested parties.” These educated individuals could then go forth and spread the good news to the rest of the public.

Taking this advice to heart, NHTSA spent a year and a half developing and testing a curriculum for teaching the installation and use of car seats. The resulting coursework consists of 32 hours of instruction, at the end of which, trainees might then become certified to install car seats. NHTSA subsequently revised this education process twice, in 2001 and 2004.

The fruit of this labor was a 2006 study showing that improper car-seat usage had fallen just eight points, to 72 percent. This persistence suggests that either the car seat had become impossibly complicated; the government was bumping up against diminishing returns; or today’s parents are particularly daft. Or perhaps all of the above.

Whatever you think about the car-seat regime, its benefits are undeniable. Child safety seats reduce the risk of death in car crashes by 71 percent for infants and 54 percent for toddlers. Which means that, during the 30 years between 1975 and 2005 (which includes ten years when car-seat laws were not prevalent), 7,896 young lives were saved by car seats. Every one of them, of course, is precious and we are grateful to have those little souls with us. Yet at the same time, one is struck by the modesty of the number. Charles had predicted that more than 1,300 children would be saved every year by car seats–that would have been 39,000 young lives saved, not 7,900. And Sanders had likened childhood deaths by auto accident to the polio epidemic. This, too, somewhat overstated matters: In 1916, 6,000 Americans were killed by polio. The American polio epidemic reached its height in 1952 when 3,145 Americans died from the disease and 21,269 were left paralyzed. The gains of the car seat have been more modest.

And the costs have not. It is difficult to fully comprehend the costs associated with the car-seat regime. There is no knowing, for instance, how much money the government has spent on the project, either through education or enforcement. The best, though imperfect, way to examine the matter is by looking at the amount of money consumers have spent on the devices over the years.

A 1995 study, published in the Journal of Consumer Policy, made the case that, as a matter of public health, child safety seats were quite cost effective. Using sales data and accident data from 1987, the study calculated not the cost per life saved, but the cost per life year saved. Because car-seat sales totaled only about $3 million in 1987, and because each child saved adds a great number of life years, the study concluded that car seats were more cost effective in buying life years than, for example, dialysis treatment.

A cruder survey of the data today looks somewhat different. The Juvenile Products Manufacturing Association reports that in 2004, 5,412,000 child safety seats were sold in the United States, totaling $423 million in sales. In 2005, sales rose to $429 million. During those periods, according to NHTSA, 455 children’s lives were saved in 2004 and 420 lives were saved in 2005. (In 2006, sales jumped to $559 million, but we do not have data for the number of lives saved that year.) This is only crude, back-of-the-envelope estimating–and it ignores injuries prevented, constant dollars, dollars spent on car seats in previous years which are still in use, etc.–but to get a sense of the order of magnitude, that’s something like $974,000 per life saved. Because this guestimate ignores dollars spent on car seats in previous years, the real number would almost certainly be greater. Just for comparison, consider that, according to studies by the Disease Control Priorities Project, spending $500 million on malaria prevention–bed nets, drugs, etc.–would save 500,000 lives. That’s not $1,000 per life year, but $1,000 per life. Spending $200 million on providing heart disease medicines to poor countries would save 300,000 lives–$665 a life. But if you want to get back to life years, Bjorn Lomborg’s Copenhagen Consensus calculates that $1 million, spent wisely, could save as many as 100,000 life years in the developing world.

Yet the push for greater car-seat safety continues. Elaine Weinstein, who helped organize the passage of the first state car-seat laws while at NHTSA, is now director of the Office of Safety Recommendations and Advocacy at the National Transportation Safety Board (NTSB), where she’s trying to fit together the last few pieces of the car-seat puzzle. If Drs. Charles and Sanders were the founding fathers of the movement, Weinstein is the car seat’s godmother. She is not some sort of hectoring busybody. A kind, intelligent woman, she is in many ways everything we might hope for in a public servant.

From 1970 to 1980, Weinstein worked for NHTSA, helping state and local grassroots organizers work to pass the first sets of laws requiring the use of car seats. As the last of those first-generation laws were going on the books, Weinstein left the government to work for a nonprofit group, the National Child Passenger Safety Association, where she was able to advocate on behalf of car seats from the other side of the table. Eventually she returned to government, serving on the NTSB, a division with a much broader purview than NHTSA. You see, where NHTSA is responsible for merely setting government regulations, the NTSB’s portfolio is more global. They can issue safety recommendations to other federal agencies or to state governments, to private industry–to whomever they want, really. It was from her perch at NTSB that Weinstein was able to first push for the establishment of booster-seat standards all the way back in 1991, when she saw the airbag crisis looming on the horizon.

Today Weinstein works to solve the perpetual problem of improper usage rates. She’s also working to bring the last few states without booster-seat laws onboard. And then, the NTSB will begin trying to get states with weak booster-seat laws to strengthen their statutes in order to cover children up to eight years old–there’s that ratchet again. Thus far, the NTSB hasn’t found any evidence that child safety seats are required after age eight. So perhaps we’ve reached the terminus of the car-seat project. Asked if the booster seats are the last needed measure, Weinstein says that research says “there’s no evidence of the need to expand beyond [booster seats at] age eight.”

But as another NTSB expert noted more cautiously, “In the advocacy world, they’re really pushing the ‘Five Step Test.’ ” This standard de-emphasizes age in favor of an evaluation of the child’s body positioning in an adult seatbelt. Typically, children have to be somewhere above 4’9″ and 80 pounds to pass the Five Step Test. (Thereby making them eligible to leave their car booster seat behind and use a normal seatbelt–in the back of the car, of course.) According to growth chart data from the CDC, a 50th percentile child would not meet both of these requirements until around the age of eleven. A move to the Five Step Test would probably result in a further extension of the car-seat regime, since a quarter of twelve-year-old girls weigh less than 80 pounds.

There’s no future in bellyaching about the car seat. It will only become more prevalent as the nanny state–I use the term descriptively, not pejoratively–continues to educate us about the dangers of transporting our progeny. But while it’s a waste of time trying to turn back the clock, it is instructive to ask why the car seat became indomitable.

Part of the answer is garden-variety political expediency: What lawmaker was going to stand against saving the lives of children? Might as well campaign against puppies and ice cream. And it would be easy to cluck about how the squeaky activists get the legislative grease. The work of Drs. Charles and Sanders is actually a testament to the American way: If you organize a small number of people and lobby the government fiercely enough about something others generally don’t care about, you’ll usually get some satisfaction.

On a deeper level, however, one gets the sense that modern American parents actually want to be told what to do with their children. Babies don’t come with instruction manuals, a fact lamented throughout the ages. But in generations past, while babies didn’t have manuals, parents usually had several babies–and so eventually learned parenting by experience, through trial and error. They discovered what worked, and what didn’t, and learned in the process that children are not made of glass.

The central fact of modern America–the modern world, really–is the steady and uniform decline in fertility rates. In 1910, the average white American woman had 3.42 children during her lifetime. (There is no general fertility rate for American women in these years when census data was still broken out by race: In 1910, the average black woman had 4.61 children.) Today, the average American woman has 2.09 children. When people have only one or two children, it’s harder to learn from experience. You look for help. And as we enter a period where, for the first time in American history, even most grandmothers had only one or two children, the government is a logical place to look to for guidance. After all, the government looks after us in our dotage, why shouldn’t it instruct parents on how to care for us in our infancy?

Like most intrusions of the government into the private sphere, the great car-seat revolution is a mitigated success. It’s generally very good that children now use safety seats. Lives have been saved (though not nearly as many as had been promised). But while safety is a rational public good, should it be the paramount public good? It should not need saying, but there are things in life more important than safety. Some of them are bedrock ideals, such as freedom. Some of them are quotidian matters, such as convenience. After all, we would be safer if cars could not exceed 15 mph. For that matter, we would be safer if we strapped on helmets every time we left the house.

But let’s not go giving anyone ideas.

Jonathan V. Last is a staff writer at THE WEEKLY STANDARD.