When it comes to the all-important business of keeping children alive, the United States has much to learn. While we’re far ahead of the poor countries on the globe (for a variety of reasons, including the sad fact that manufacturers readily make lower-grade cars to sell overseas due to weaker regulations protecting their populations), we’re actually rather behind nations that exist on a level playing field–fellow rich countries like Sweden, Norway, and the United Kingdom, among many others.

We’ve compared the rates of child deaths in Norway to the United States in the past and seen how we’ve come up short in comparison. Today we’re going to make the same comparison with the latest data available between Sweden, another fellow rich country from which most of my research on best practices in car seat safety is based, and the United States. To put it bluntly, we lose far more children (a disproportionately greater amount) to road trauma each year in the United States than Swedes do in Sweden. And as is almost always the case in road fatalities, these deaths are almost always preventable.

How many children die in road traffic crashes each year in Sweden?

Per the NTF, 5 children died due to road traffic in Sweden in 2018. Four of them were pedestrians while one was a vehicle passenger. Between 2016 and 2018, on average, there were 4 deaths of children under 13 each year.

How many children die from road trauma in the United States each year?

Per the IIHS, who pulls numbers from the Fatality Analysis Reporting System (FARS) of the US Department of Transportation, there were 880 deaths of children younger than 18 in 2018, with 639 (73%) occurring with passenger vehicle occupants, 157 (18%) with pedestrians, and 26 (3%) with bicycling children.

How do Swedish and US child crash deaths compare proportionally?

We know there were 880 child car crash deaths in the US in 2018 and 5 in Sweden in the same year. The US number is much higher, but how much higher is it? After all, there are more children in the US than there are in Sweden since the US population is larger than that of Sweden.

This is where proportions come in. For simplicity’s sake, we won’t compare the number of children in Sweden to the number in the US, but will compare populations and presume there are proportionally similar percentages of children in both countries. This is actually a rather accurate assumption, as the Swedish government notes the average Swedish woman has 1.75 children, while the World Bank notes that the fertility rate in Sweden in 2016 was 1.85 births per woman, which was nearly identical to the US’ rate at 1.8.

With that assumption out of the way, the population in Sweden in 2018 was approximately 10.12 million, while that of the United States was 327.2 million. In other words, the US population was 32.33x larger, or there were 32.33 Americans for each Swede. Let’s assume then, that there were roughly 33.33 American children for each Swedish child. The death toll in the US at 880 was 176x that of Sweden’s at 5. In other words, 176 American children died due to car crashes for each Swedish child who passed away.

The proportions are not even. It was much safer to be a child in Sweden in terms of odds of surviving a country full of cars than it was to be a child in the United States. Specifically, despite the fact that there were 32 times as many children in the US as there were in Sweden, the number of children killed was not 32 times higher, as one would have expected had the proportions held. Rather, the death toll was 176 times higher.

We’ve seen this before when comparing adult death rates between the US and Norway, Sweden, and the UK, or child death rates between the US and Norway.

What would the death tolls look like if the US were like Sweden, or if Sweden were like the US?

If the US had the same safety record as Sweden, we’d have lost 32.33 * 5, or roughly 162 children to car crashes in 2018. Instead, we lost 880, or roughly 5.44 children for each Swedish child lost after controlling for population differences.

That’s a huge difference.

To see it the other way, if Sweden had our safety record, they would have lost 5 * 5.44, or roughly 27 children to car crashes in 2018. Instead, they lost 5.

Make no mistake; we’d still have lost more than a hundred children to car crashes even if we’d had as much of a safety-minded culture as that in Sweden. But the difference would have been completely explained by our much greater population. This is not the case here. As things are, if Sweden magically grew to the point where it had a population of 300+ million individuals, they’d still only have lost 1/5th to 1/6th as many children to crashes as we did. They’re doing something (several things) differently there.

Running the numbers this way gives us a different way of understanding what a difference exists between child safety in the United States vs that in Sweden. Due to a variety of reasons, things are different there. It’s safer. But why?

Why are road conditions so much safer for Swedish children than for American ones?

Some of these reasons include the fact that children in Sweden rear-face much longer than ours do (it’s recommended to do so until 4-5 there) and booster much longer than those here (the recommendation is until 10-12) .

However, there are also a variety of differences in driver behavior (e.g., a much more demanding driver’s education program, much as the one in Norway, the fact that drivers use snow tires religiously in the winter and drive with headlights all day long, and alcohol limits are much more stringent there than here) and road infrastructure (there are far more traffic cameras and far more attention to creating divided highways and reducing opportunities for high speed crashes), the road environment there is a far less dangerous and far more cohesive one than ours. This is the case despite the fact that Swedes face much more difficult weather-related driving conditions than we do.

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