Backup camera mandate linked to fewer severe pediatric backover injuries

Backup camera mandate linked to fewer severe pediatric backover injuries | Image Credit: © Виталий Сова - stock.adobe.com.

The 2018 federal mandate requiring backup cameras in all new vehicles has been associated with a significant reduction in both the rate and severity of pediatric backover injuries, according to research presented at the American Academy of Pediatrics (AAP) 2025 National Conference & Exhibition in Denver, Colorado.^1,2

Backover trauma occurs when a pedestrian is struck by a motor vehicle in reverse. These injuries disproportionately affect small children due to limited visibility. Researchers reported that since the federal safety requirement went into effect, both fatal and severe injuries in children under age 5 have decreased.

“Our study demonstrates an important association between the federal mandate in 2018 requiring all new vehicles be equipped with a backup camera, and the reduction in both rate and severity of pediatric backover trauma,” said Natalie A. Drucker, MD, MS, assistant professor of pediatric surgery at UTHealth Houston.

Study design

The retrospective cohort study examined cases of children under 5 years of age who experienced backover trauma between January 2011 and November 2024. Researchers analyzed 2 data sources:

• Trauma registry data: Records from a level one pediatric trauma center identified 71 patients.
• Public records data: A case list curated by Kids and Car Safety included 28 publicly reported cases from surrounding metropolitan counties.

Injury rates and severity were compared between the pre-mandate period (January 2011–April 2018) and the post-mandate period (May 2018–November 2024).

Key findings

The analysis revealed consistent trends across both datasets:

• Incidence reduction: Trauma registry data showed an average of 7.2 backover cases per year before the mandate compared with 2.7 cases per year after (rate ratio 0.38; 95% CI, 0.21-0.66; P<.01). Publicly reported cases showed a similar decline, from 1.8 per year pre-mandate to 0.9 per year post-mandate.
• Severity: Among trauma center patients, 19% of pre-mandate cases were classified as severe (injury severity score >25) compared with 11% post-mandate. Publicly reported fatal cases decreased from 77% pre-mandate to 67% post-mandate.
• Fatalities: The absolute number of publicly reported fatal cases decreased by 78% in the trauma registry cohort and 60% in the public records cohort.

Overall, the findings indicate that backup cameras substantially reduced pediatric backover injuries and improved survival outcomes.

Ongoing risks and recommendations

Despite these gains, researchers cautioned that backover trauma continues to occur, particularly in families using older vehicles manufactured before the 2018 mandate. “While this is exciting, necessary progress toward injury prevention in a vulnerable population, these events continue to occur and thus demand attention and continued advocacy efforts to promote the safety of our children," Drucker said.

The study authors recommend prioritizing the installation of backup cameras in older vehicles. They suggest that public health and safety policies should include subsidies or incentives to ensure widespread adoption of this safety technology.

Implications for pediatricians

Pediatricians remain key advocates for injury prevention and family counseling. Educating caregivers about the risks of backover trauma and encouraging safe play practices, such as ensuring children are supervised when vehicles are in use, are important steps to reduce injuries.

The authors emphasized that regulatory action, such as the backup camera mandate, demonstrates how federal safety measures can directly improve pediatric health outcomes. Expanding access to this technology in older vehicles could further reduce preventable injuries and deaths.

References:

1. American Academy of Pediatrics. A mandate for backup cameras in new vehicles is associated with a near-50% reduction in severe injuries, 78% fewer deaths in small children. Eurekalert. September 26, 2025. Accessed September 26, 2025. https://www.eurekalert.org/news-releases/1098749
2. Joly J. The Impact of a Federally Mandated Car Safety Feature on Rate and Severity of Pediatric Backover Trauma. Abstract. Presented at: American Academy of Pediatrics 2025 National Conference & Exhibition. September 26-30, 2025. Denver, Colorado.