What's key to safe teen driving


It’s not just alcohol and seatbelts that factor into teen driving safety. A recent report reveals additional guidance pediatricians should offer to teenaged drivers and their parents.

headshot of Elizabeth M Alderman, MD, FAAP

Elizabeth M Alderman, MD, FAAP

Earning a driver’s license is a milestone for adolescents and for their worried parents. Pediatricians can and should help, offering guidance on navigating safety issues beyond seatbelts.

New guidance from the American Academy of Pediatrics (AAP) Committee on Adolescence and Council on Injury, Violence, and Poison Prevention published in Pediatrics goes beyond the traditional warnings about seatbelts and drinking and driving to offer pediatricians and families a roadmap to keep teenagers safe behind the wheel.1

Elizabeth M. Alderman, MD, FAAP, a pediatrician specializing in adolescent medicine at the Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, coauthored the guidance and says there are many factors to consider in keeping teenagers safe on the road.

“One of the big things we talk about is parents as role models. This really starts years before the child is ready to drive. They pick up how we are driving,” Alderman says. “If we’re texting or playing music to distract us, they notice. These are not behaviors that lend themselves to safe driving.”

Risky rite of passage

A major rite of passage of teenagers, earning a license is also challenging because of inexperience, immaturity, and risky behaviors, the report notes. Adolescents have the highest rate of motor vehicle crashes, and more than half of 8- to 17-year-olds who die in car crashes are passengers of drivers aged younger than 20 years. Although driving gives teenagers autonomy and independence, Alderman notes that novice drivers are 4 times more likely to crash or have near-misses. A leading cause of death for teenagers, these crashes affect their passengers and other drivers on the road as well.

Despite these concerning statistics, the report notes that motor vehicle deaths among teenagers decreased in the past year, partly because of improvements in vehicle safety, graduated licensing laws, and increased compliance with seat belt laws. Additionally, there are fewer teenagers on the road, with a decrease in licensed high school seniors of 12% from 1996 to 2010. However, these advances are fading, and crash rates are slowly creeping back up, the report notes, with deaths and injuries from motor vehicle crashes among teenagers increasing by 9% and 14%, respectively, since 2014.

Pediatricians are used to counseling teenagers on safe driving practices such as avoiding alcohol or other substances while driving, wearing seatbelts, and limiting the number of passengers in their car. However, the high-risk attitude of some youths, coupled with inexperience behind the wheel, still can result in high-speed driving, distraction, and other behaviors that pediatricians need to keep on the radar of both teenaged drivers and their parents. Alderman says other issues that might not be so obvious are also addressed in the guidelines, including sleepiness, certain medical conditions, and medication use.

Other risks to safe driving practices

Adolescents don’t get enough sleep as a whole, and this could impair driving, Alderman notes. Medical conditions such as attention-deficit/hyperactivity disorder (ADHD) also can increase risk, with teenaged drivers with ADHD facing a 36% higher risk of being in a crash than their peers.

“Drivers with ADHD may be less attentive to driving tasks at baseline and at least as susceptible to distraction caused by technology, passengers, and external factors,” the report notes.

The report continues that data suggest that adults with ADHD who were prescribed medication had a 40% reduction in emergency department visits related to motor vehicle crashes. The problem, Alderman says, is that many children don’t take ADHD medication on days they don’t attend school, and parents and teenagers may want to consider medication regimens based not just on school time, but also on driving practices.

Concussions are also a consideration, with almost 250,000 sport-related concussions diagnosed in 2009 alone. Concussions can impair driving, and pediatricians should counsel teenagers with concussions and their families about their increased risk behind the wheel.

The guidance offers other specific recommendations, including support for a graduated licensing programs, an examination and improvement in driver education programs, adherence to seatbelt laws, avoidance of alcohol and other drugs while driving, and parental support-not just in education, but also in setting a good example of safe driving practices for their teens.

Pediatricians also should, as discussed above, review with teenagers any medical conditions or medications that may impact their driving abilities before they get their license. Reviewing laws and recommendations on distracted driving is also important, and not just in terms of other passengers in the car, but also regarding cell phone use and other technology while driving. Not all technology is bad, however. The recommendations also support the use of new technologies that increase driver safety such as backup cameras, and finding vehicles that are in good working order for teenagers and that have good safety features in the event an accident should occur.

Key takeaway

In the end, Alderman says the takeaway is that pediatricians must drive home to teenagers that they have to follow the rules in their state and adhere to safety recommendations, and to parents that they have to continue to teach their children about road safety and that their job doesn’t end at the driver’s exam.


“We talk about how experience makes you a better driver,” Alderman says. “Parents shouldn’t shy away once their children get their license.”

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