I read with great interest the article by Newman et al1 in the October 2003 issue of the ARCHIVES. Future federal aviation regulations may recommend that all infants have their own seat with a child restraint system (CRS), which may in turn influence more families to travel by car and cause an increased mortality due to road traffic accidents.1 However, providing parents who opt to fly with the best safety information available needs to be improved. In addition to the lack of adequate child restraints on aircraft, young children are also excluded from many other safety devices. Age-appropriate flotation devices are not uniformly available for young children. Oxygen masks are not only unavailable but are also of incorrect size. To assess available parent information and safety education, we studied the Web sites of 20 international airlines. This revealed that 12 airlines had a special children’s section and 13 mentioned reduced children’s fares, although all fares had restricted availability. Infant CRSs were not allowed on 2 airlines, and 6 did not mention them. Only 1 carrier supplied infant CRSs, and 9 gave advice and CRS specifications. Infant oxygen masks and flotation devices were not mentioned by any airline. A single airline had specific staff training, and 3 had information for parents of infants. We suggest that airline companies provide information to parents regarding practices that maximize the safety of flying with young children. This includes advice on booking bulkhead seats, the quietest time for travel, and use of restraints, flotation devices, and oxygen masks. In addition, we propose that airlines create a child safety package that contains an age-appropriate CRS, oxygen mask attachment, and flotation device for each infant booked. These infant safety kits could be stored in airports and loaded once the infant has been checked in. Parents could then be instructed on the use of the devices and management of the infant in an emergency. Increased parental education about safety guidelines and accommodation on the airline could be considerably improved. While appreciating that the design of the Newman et al article is “risk and economic analyses” with comparison with car travel options, most international flights entail a passage over water without road travel choice. Furthermore, parents of infants deserve to be offered the best advice and safety equipment available, in accordance with the American Academy of Pediatrics (Elk Grove Village, Ill) guidelines.2
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