The vast majority of small children riding in taxis are not restrained in car safety seats, according to new research, even though there are tens of thousands of motor vehicle collisions involving taxis, limousines and car services each year.

With automobile crashes a leading cause of death among children in the United States, all 50 U.S. states require young children to be in car safety seats when travelling in a motor vehicle. However, in many municipalities taxis are exempt from these safety regulations.

Researchers presented the abstracts, ‘Underuse of Proper Child Restraints in Taxis: Are Weak Laws Putting Children in Danger?’ and ‘Availability of Car Seats Offered by Taxi Companies in Urban U.S. Cities’ at the Pediatric Academic Societies 2016 Meeting in Baltimore on May 1 and May 2 to shed light on how this legal exemption affects whether children are properly restrained while riding in taxis.

Stationed at 11 busy New York metropolitan area locations including airports, train stations, shopping malls and tourist locations, researchers looked for taxis loading or unloading passengers that included small children—infants, toddlers and children whose height did not exceed the height of the side view mirror. They observed 69 taxis picking up or dropping off passengers that included a total of 116 children and found that only 11 percent of small children were properly restrained. Almost all of these were infants in infant carriers.

The researchers also called 97 taxi companies in the New York area, and 39 percent reported car safety seat availability. Of those offering safety seats, 18 percent of the companies said the seats were limited in quantity or required a reservation, and 8 percent stated that there would be an extra fee to use one. Reasons given for not providing child safety seats included health code restrictions and allergy and hygiene concerns.

“Given that there were more than 40,000 motor vehicle collisions involving taxis, limousines, and car services in 2015 alone, exemptions to car seat laws put unrestrained children at risk,” said Sarah Koffsky, a student at West Islip High School in Long Island who served as the principal investigator in the study through a summer internship at the Cohen Children’s Medical Center, Division of Developmental and Behavioral Pediatrics. “Although it may be easier when travelling with young children to not have to worry about car seats, convenience should not factor into decisions regarding child safety,” she said.

The American Academy of Pediatrics recommends that infants and toddlers be secured in rear-facing child safety seats and that children continue to be secured by car safety seats or belt-positioning booster seats until they reach the height of 4’9″.

Changes in law or policy to mandate use of car safety seats in taxis are necessary to ensure that all children travelling in motor vehicles are protected, the authors said. “Given that car safety seats have been shown to significantly decrease the risk of death or injury from motor vehicle collisions, there should be no exemptions in car seat safety laws for taxi services. When it comes to child safety, even one preventable injury calls for a change in policy,” said senior investigator Ruth Milanaik, DO.