The single most important life-saving decision parents can make for their child is to use the rear seat and appropriate restraint devices every time they travel by car. A new study finds children are 40 percent safer in the backseat than the front in car crashes, and the risk of injury drops to less than 2 percent when safety seats and seat belts are used.

The report also concluded that minivans, large cars and SUVs were the safest for children, while smaller vehicles had higher injury rates.

In 2003, car crashes killed 1,794 children under age 16 and injured an additional 241,000 according to the National Highway Traffic Safety Administration. Of these children, one-third were seated in the front seat and more than half were completely unrestrained at the time of the crash.

"Crashes happen to the best of drivers and often on the most routine occasions like grocery shopping or picking the kids up from soccer practice. No one is immune from a crash," said Flaura Winston, M.D., Ph.D., principal investigator of the Philadelphia Children's Hospital/State Farm study.

Since 1998, more than 370,000 State Farm policyholders have shared their crash experience with researchers at Children's Hospital, who are then able to determine the best ways to protect children in crashes. Researchers say it's the largest study of its kind.

The Children's Hospital/ State Farm data demonstrate that parents forget the importance of rear seating, especially as children grow out of child safety seats. When children were the sole passengers of the vehicle, meaning rear seat positions were available, 30 percent of 4- to 8-year-olds and 73 percent of 9- to 12-year-olds were riding up front.

According to the study, parents have the ability to greatly lessen the risk of injury or death to their child passengers by following simple guidelines:

• Make sure that everyone in the vehicle is restrained on every trip.
• Move children under 13 to the back seat.
• Use the correct restraint for the child's age and size.
• Use the restraints correctly. Using age- and size-appropriate restraint reduces the risk of serious injury by more than three times. The combination of rear seating and restraint use reduces the risk of injury to less than two percent.

"We know that, overall, children seated in the front seat are 40 percent more likely to sustain serious injuries in a crash than are children who sit in the rear seat of vehicles," said Dr. Winston. "The deployment of passenger airbags and contact with the hard surfaces of the dashboard and windshield are common injury mechanisms for children who ride up front."

Dr. Winston and her team are particularly concerned about families driving older vehicles manufactured before 1998 that still have the first generation of passenger airbags, which have proven extremely dangerous for children.

The report on safe seating for children was released to pediatricians through the May issue of the American Academy of Pediatrics' AAP News.