Child heat deaths: Thorny issue, few fixes

Editor’s note: An earlier version of this story incorrectly stated that researcher Aditya Belwadi believed technological solutions could reduce the heat stroke fatality rate to zero. He believes technological solutions could reduce the fatality rate further, but not to zero.

On a hot Sunday in July, a father in Mississippi tried to coax his 3-year-old daughter into learning how to release the buckle on her car seat.

The preschooler couldn't figure it out. So he tried to get her to learn how to open the back door on her own. That didn't work either.

"She just couldn't do it, which is terrifying to me," said Lawrence Patihis, a memory researcher at the University of Southern Mississippi. Patihis had become concerned about his daughter after hearing news of the spike in heat-stroke deaths in children left behind or trapped in cars.

Safety experts are pushing regulators and the auto industry to come up with technological solutions to help solve the problem of pediatric heatstroke in cars. But it has been hard to get momentum on the issue in large part because the public blames parents for being irresponsible rather than seeing the issue as one that could affect anyone.

But as an academic who has studied the way memory works, Patihis said he knows he's just as likely as anyone else to forget his daughter in the car.

"People are much more confident about how accurate their memory is compared to how accurate it actually is," Patihis said. "In this case, I think people might overestimate how their enormous instinct to protect their child would overcome memory lapses."

As of Friday, Aug. 5, 26 children have died from overheating in cars this year, including a set of twins in Georgia on Thursday. That surpasses the number of deaths for all of 2015, which hit 25. Not all children are forgotten -- some children climb into vehicles to play or retrieve a favorite toy. And others are left by their caregivers on purpose; people who are unaware or disregard how dangerous hot car interiors can be for small bodies.

The problem is complex, with no simple answers. The National Highway Traffic Safety Administration has addressed it with a public education campaign aimed at teaching parents the dangers of hot cars and providing memory tips and tricks. Most aftermarket products aimed at alerting parents of a forgotten child are unreliable, and only General Motors has come up with a reminder technology that could tackle the issue, now on the 2017 GMC Acadia but expected for more models.

But unlike other issues that have involved child entrapment -- like the instances of children trapped in abandoned refrigerators in the 1950s or heatstroke deaths of children trapped in trunks in the 1990s -- legislators have been unmotivated to tackle this issue. Caregivers who have dealt with this problem, researchers and safety experts say they believe that's because society places the blame solely on parents.

"Before the accident, I thought it was incredibly bad parenting that led to this," said Eric Stuyvesant, a landscaper from Garland, Texas, who left his 3-year-old son Michael in the back of his car one hot morning in June 2015. "I was a parent-shamer on the Internet for years before realizing it could happen to anybody."

If Internet commenters are any indicator of public opinion, Americans have a harsh view of parents when these kinds of accidents occur. When a child climbs into a car and gets trapped, commenters accuse the parents of not being vigilant enough. If a parent forgets their child in the car, the comments will often skew to calls for criminal charges. Of the 26 deaths this year, nine parents or caregivers have been charged with a crime, usually neglect or manslaughter.

"The vitriol after something like this happens is amazing; the comments are beyond mean and cruel," said Janette Fennell, founder of KidsAndCars.org, an activist group that has heatstroke as one of its top priorities. "It tends to be a bit of a defense mechanism. If you make monsters out of those people, then it won't happen to you."

But Patihis said memory lapses can happen to anyone. These cases usually happen when there has been some change in the daily routine -- one parent is sick and relies on the other parent to take the baby to daycare, or the parent makes an unusual stop or a grandparent is doing the drop-off instead of the regular caregiver. Those kinds of changes mess with our habitual memory, which is ingrained. To remember a change in routine, people need to keep reminding themselves of that change, he said. And once they stop reminding themselves, habitual memory takes over.

And if a baby is asleep in the back or just quiet, it could get unintentionally left behind.

The American public has dealt with child entrapment issues before. In the 1950s, people began disposing of old refrigerators that typically closed with a latch and were impossible to open from the inside. Quickly, local legislators began passing laws that made it illegal to dispose of the appliances with the latch or door attached, and in some places violators faced jail time if found guilty. In 1954 President Dwight Eisenhower signed a law making it illegal to ship fridges across state lines unless they could be opened from the inside. Today, refrigerators are held shut with magnets instead of latches to avoid those problems.

And in the summer of 1998, five children died from heatstroke after being trapped in car trunks. They all had been playing inside the cars. Those cases helped push for a law that forced manufacturers to install handles that can open trunks from the inside.

Also in the late '90s, states began introducing laws making it illegal to drive with young children in the front seat of a car because new front airbags were causing children harm -- which may have inadvertently caused heatstroke deaths to rise because they force children to be placed out of sight. In 1998, 35 children died from injuries caused by front-seat airbags, which were designed to lessen the impact of crashes on adult bodies but proved too harsh for children. 

Fennell said there is a correlation between the rear-seat rule and heatstroke deaths. 

"When you make a significant change in the way children are transported, there is an unintended consequence," she said. 

Aditya Belwadi, a research scientist at Children's Hospital of Philadelphia's Center for Injury Research and Prevention, said that public education is helping a bit, but he believes there are technological solutions that could reduce the fatality rate even further.

"We are definitely making progress, but we have a long way to go," he said. 

But beyond its public education campaign "Look Before You Lock," NHTSA is not pushing for any new rules related to the issue. Last summer, NHTSA Administrator Mark Rosekind told Reuters that if automakers "develop [systems], and they work, and they're effective, we don't need to get into it."

In 2012, NHTSA took a look at the aftermarket products aimed at alerting parents when their children were left in car seats and deemed the products unreliable and limited in their effectiveness.

Since then, only one car seat has been praised by Consumer Reports for its ability to connect with parents. The Evenflo SensorSafe worked most of the time in most cars tested by Consumer Reports. The seat connects with a car's OBD-II port and when buckled, chimes to alert parents a child is in the seat as soon as the car turns off. Consumer Reports said the technology is "promising."

The GMC Acadia uses a similar alert system, but it's not connected to a car seat. Instead, the system detects when the back door has been opened at any time during a trip or if it was opened within 10 minutes of the car starting. If either of those things happens, when the car is turned off it chimes five times and a message pops up on the dashboard reminding the driver to check the back seat.

Tricia Morrow, GM's global safety strategy engineer, said the system was designed to chime when the vehicle is shut off because that's when the most important car chimes sound off, such as reminders to turn off your headlights or to nudge you into taking your car keys with you. The technology will be rolled out across GM's brands within the next few years, standard on all cars.

"Nobody thinks they are going to leave their child in a vehicle, so why would we put it on only one or two cars?" she said. "We're really excited to be part of a solution, at least the first step of the solution."

But more solutions are needed, Fennell said. About 30 percent of all child heatstroke deaths since 1998 have come from children getting trapped inside a car, not being forgotten. Not enough research has been done to determine what exactly is happening in those cases: Are the child locks in the back row keeping kids from getting out?

Do the children get overheated so quickly they get disoriented before trying to escape? Are inside door handles too difficult for them to operate?

Fennell said she's seen the beginnings of some promising technology that could detect movement inside a car, or sensors that could detect heartbeats or rising internal temperatures.

"When you look at all the other reminders we have in cars, we as consumers have said we're OK with it," Fennell said. "What's more important? Is it the dead battery you get from leaving your headlights on, or is it a child that will die in the car?"

But the thing about human attention spans and memory is that they are finicky things. Patihis cautioned that any chime that sounds too often could become part of people's habitual memory.

"Once you become habituated to it, you will ignore it," he said. "Parents would be better off assuming they are going to forget once and doing what they need to do to remind themselves of that every day."