Car Seat Anxiety

Right, I’m going to go a bit polemical and a tad over the top but I’ve been driven to it. The car seat industry thrives on parental fear, and I believe much of that fear is misplaced and deliberately manufactured. With a better treatment of risk, I think we could help parents worry less, and have more children.

Background

There’s a really famous paper (Car Seats as Contraception) in this space which basically shows that the creep of car seat legislation has led to a reduction in the probability of having a third child in America, just because the average American car can’t fit 3 car seats in the back. So people postpone, or in some cases, don’t have a third child because it’d require a new car. It’s a funny look at incentives and unintended consequences. Well, funny if you don’t think about it too hard.

If you look at the number of children’s lives that the legislation have saved (57) and compare that to the number of children who weren’t born because of the impact of car seat legislation (~8,000), you end up with a big big child-shaped gap. Net, car seat legislation is costing us children’s lives.

Now there’s all kinds of philosophical musings here on how you value people who have never been born, especially when compared to those who already exist. Maybe you think that only existing people count morally, and so 57 saved lives outweighs 8,000 people who were never born. 8,000 people who never experienced the magic of life, and who never enriched the lives of others. While that’s an interesting argument to have - it’s not what I’m really here for. Personally, I think an unborn person is worth less than a born one, and probably quite substantially less. But not nothing. Anyway, the point is, even if we consider mandatory car seats versus not mandatory car seats…I think there’s a chance you could argue pretty well for not mandatory car seats.

Car Seat Anxiety

However, once you look into things, It’s not enough just to have a car seat. There’s a collective anxiety about the type of car seat, its provenance, and its orientation. I’m knee-deep in all this right now as the proud owner of 3 small children, so let me share a little of my anxiety with you.

The Type of Car Seat

91% of observed car seats demonstrate serious installation errors amongst newborns. Improper installation is a bigger safety concern than differences in crash test performance between seats. And so ISOFIX seats are recommended, not because they’re safer but because they’re harder to install incorrectly.

So far, so sensible, right? Even if you put the car seat in right every time, what happens if somebody else doesn’t? Does it matter that ISOFIX seats are harder to put in a row and fewer cars exist that’ll take 3 ISOFIX seats? Of course not. Where safety is concerned, are we willing to compromise?

Second Hand

So much baby stuff is available on second hand markets. Babies grow out of everything really quickly and so being able to buy/sell things to other parents as you move into/out of sizes is invaluable. Except the advice with second-hand car seats is “if you can’t verify that the seat has never been in a crash, it’s not safe.”

What a way to completely kill a second-hand market. Sure, you can buy a second-hand car seat. But what happens if it’s been in a major crash that’s structurally weakened the car seat, but in a way that’s completely non-visible? The people selling it swear they haven’t been rallying with their toddler in the back…but are you willing to take the risk? Where safety is concerned, why risk it?

Extended Rear-Facing

It’s been shown that the safest way to travel with kids in the car is to have them rear-facing: their back pressed against a chair pressed against a front-seat, and their feet resting against the back row of seats. Is it more boring for the child? Sure. Does it exclude them from the communal experience of driving together (mainly I-Spy in our car)? Sure. Then there’s the complex array of mirrors that you now need to keep an eye on them. But where safety is concerned…

The Risk

22 children (aged 0-15) died as car passengers in Great Britain in 2024. I don’t have specific stats on that age-based distribution so let’s assume linear and say around 11 children aged 0-7 died in 2024. Around 2,900 children aged 0-7 died in the same period of any cause - but around 2,300 of them were under 1, dying primarily of birth complications and defects.

In short, the risk of a child dying in a car crash in miniscule. Even without car seats, a child is incredibly unlikely to die due to a car crash.

Perhaps car seats aren’t primarily about saving children’s lives but instead about preventing them from injury. I don’t have good stats on that, I’m afraid. However, as they’re not the stats that we tend to report on in the child safety industry, I can only assume that they’re not the primary means of judging the efficacy of the car seats.

Relative versus Absolute Risk

So when we say that car-seats are often installed incorrectly, or second-hand could be dangerous, or rear-facing is safer…what do we actually mean? I don’t dispute that any of those things are true. But my point is that the absolute risk of a child dying in a car crash is so small that the relative risk becomes increasingly irrelevant. At what point should we consider it to be negligent to give advice on a topic and to talk about relative safety levels? Technically it’s safer to put your children in cycle helmets when getting in the car (and if not, we could make helmets that made that true). Mercifully, I don’t think anybody is suggesting that particular intervention just yet. At the extreme, rummer shoes reduce the risk of dying by lightning strike. Yet the NHS (or other, similar bodies) don’t say that wearing rubber shoes is safer. Doing so, in fact, would be wildly irresponsible.

Follow the Incentives

There’s a much larger essay on this lurking somewhere, but for now, I’m not even going to focus on the fact that the car seat industry (manufacturers, sellers, fitters and safety testers) are all incentivised to act as though a 5% improvement in crash test actually matters. Of course manufacturers would like the second-hand market to be dead. Of course they’d like ever more stringent regulations and legislation mandating usage.

Instead, let’s look at what public health bodies recommend. The NHS says that you should not buy a secondhand car seat because “it could have been damaged in an accident, and may not have all its parts, including the instructions. It may also not be the safest and most user-friendly model, plus it may not fit your car properly”

Jesus Christ. Is that really public health advice?

The NHS isn’t going to get into any trouble for recommending that people be safer, are they? The risk, from their perspective, is that somebody follows NHS advice and then their kid gets hurt/killed in an unsafe car seat. The potential public risk of the advice is thousands fewer children being born, and more stressed and more impoverished parents. Also known as: “Things that won’t show up in statistics or get us sued”.

I believe that when it comes to public health advice on parenting (and to a large extent, pregnancy), most advice is focussed on directly measureable and attributable risks, and completely ignores a more rounded and holistic perspective (i.e. being a parent). As more of us get advice online and not from the older generation, we’re losing advice that centres our overall happiness and instead getting advice that eliminates measurable tail risk at the expense of…well, life.

Conclusion

Car seat safety is one of those things that plays off all our worst mental tendencies. Cars are ever-present in our lives and driving is probably one of the riskier things that we all engage in. The death of a child is the most terrible thing we can imagine. Combine these things and we yearn for a way to feel as though we have some control over this situation. Enter the car seat industry, where we invest hundreds or thousands of pounds over a child’s life in order to eke out basically negligble gains in safety.

I expect it of the car seat industry: their job is to build and sell the safest possible car seats. Parents, without training and blinded by love, can’t be expected to argue against the rising tides of safetyism. But I think public health bodies should know better - advice is a dangerous thing, and a public health body should consider holistic health before recommending something