Making sure children are properly buckled up in the car is the single biggest thing that could be done to save young lives in car crashes, according to a new study that looked at traffic deaths state by state. 
 
 The researchers also found that some states do much better than others when it comes to children's survival in car crashes. 
 
 Using data from Department of Transportation reports on motor vehicle accidents involving children, along with information from the U.S. Census on how many children live in each state, researchers from Brigham and Women's Hospital were able to compare death rates state by state. Their study is published in The Journal of Pediatrics. 
 
 Between 2010 and 2014, the data showed that 18,116 children were involved in fatal motor vehicle crashes and 15.9 percent died. 
 
 Rates were calculated as the number of deaths in each state for every 100,000 children under the age of 15. 
 
 The five states with the lowest rates of death: 
 
 Massachusetts 0.25 
 
 New York 0.29 
 
 New Jersey 0.32 
 
 Washington 0.33 
 
 Rhode Island 0.33 
 
 
 
 The five states with the highest rates of death: 
 
 West Virginia 2.16 
 
 Montana 2.23 
 
 Alabama 2.71 
 
 Wyoming 3.06 
 
 Mississippi 3.23 
 
 
 
 "We looked at a ton of variables: characteristics of kids, state policies, locations of crashes. Being unrestrained or inappropriately restrained was the biggest factor in more kids dying," said the study's lead author Dr. Lindsey L. Wolf, a general surgery resident at Brigham and Women's Hospital and a research fellow at the Center for Surgery and Public Health there. 
 
 "In severe car crashes, 20 percent of kids nationally, across the board, were not restrained or were misrestrained," Wolf told CBS News. 
 
 In Mississippi – the state with the worst track record on seatbelts – 38 percent of children who died in crashes were not restrained or were improperly buckled. On the flip side, only 5 percent of children in Washington state who died in accidents were not restrained properly. 
 
 Seatbelt education efforts have been pretty strong in recent years, said Wolf, including updated car seat recommendations for children published in 2011 by the American Academy of Pediatrics, so the findings came as somewhat of a surprise to the authors. 
 
 "The death rates were way higher than we expected them to be," Wolf said. 
 
 The states with the highest child fatalities due to car accidents tended to be more rural. For example, 92 percent of crashes in Montana and 89 percent of crashes in Wyoming occurred on rural roads. 
 
 "There's information that generally these roads may not be as well-maintained and they may be less well lit and more windy – some characteristics that may lead to these severe crashes," said Wolf. 
 
 Parents living in rural areas need to be aware that the risks there are higher and that they're driving as carefully as possible, and to make sure children are buckled up correctly in car seats, according to their size and weight, Wolf added. 
 
 Motor vehicle injuries are a leading cause of injury and death among children, but about 232 childrens' lives could be saved each year if little ones were appropriately restrained while traveling in cars, the study authors said. ||||| 43 Percent Of Children Who Died From Car Crashes Were Improperly Restrained 
 
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 Twenty percent of children who were in a car crash where someone died were not buckled in properly or were not wearing a seat belt at all, a study finds, as were 43 percent of children who died themselves. 
 
 And child fatality rates in deadly car crashes vary widely by state. 
 
 The results add evidence to the argument that state regulations and public information tactics can affect motor vehicle safety for kids. The Centers for Disease Control and Prevention has noted that, for example, seat belt use across all age groups is higher in states with more stringent seat belt enforcement laws. 
 
 Overall, traffic fatalities in the U.S. are going up, as we have reported. The latest study set out to look at what factors affect child deaths in fatal car accidents, breaking down the data by state and region. 
 
 The study authors analyzed data collected in the National Highway Traffic Safety Administration's Fatality Analysis Reporting System between 2010 and 2014. In all, they identified more than 18,000 children under 15 years old who were involved in fatal car crashes, 15.9 percent of whom died as a result of the crash. 
 
 From The Archives: Car Seat Safety Tips All children under 13 should ride in the back seat, according to the National Highway Traffic Safety Administration. Here are some additional tips the agency recommends: Rear-facing seats: The American Academy of Pediatrics recommends children remain in rear-facing car seats until at least age 2. Forward-facing seats: When kids outgrow rear-facing seats, they should ride in forward-facing child safety seats placed in the back seat of vehicles. Use forward-facing seats until the age of 4 or reaching a weight of 40 pounds. Booster Seats: Kids between 4 and 8 years old who are under 4 feet 9 inches tall may use booster seats located in the back seat of vehicles. Seat Belts: Children may begin to use adult seat belts in the back seat once they reach the age of 8 and are at least 4 feet 9 inches tall. Source: Child Passenger Safety: A Parent's Primer, NHTSA 
 
 But some parts of the country had much worse fatality rates than others. The majority, 52 percent, of children who were in a fatal car crash lived in the South. And across all states, 43 percent of children who died were improperly restrained or not restrained at all, according to Faisal Qureshi, an associate professor of surgery at the University of Texas Southwestern Medical Center and an author of the study. 
 
 The study was published in The Journal of Pediatrics. 
 
 The authors write that they hope their findings will help lawmakers beef up motor vehicle safety regulations. "The significant state-level variation evident in our findings emphasizes the need for close collaboration between the injury prevention community and those enacting and enforcing legislation," says Qureshi. 
 
 In fact, he says, there may be "potential for a federal intervention in the area of child traffic safety." 
 
 A 10 percent improvement nationally in the use of appropriate child restraints in cars, they predict, would decrease the national child crash fatality rate significantly, cutting it from 0.94 per 100,000 to 0.56 per 100,000. 
 
 For years, the federal government has collected data on child traffic safety deaths, and offered information about the importance of seat belts and car seats. But decisions about traffic safety laws have been largely left to states. 
 
 The CDC does offer risk reduction information, including warnings about not letting children sit in the front seat, and using appropriate car seats for babies and children. 
 
 The findings also underscore the importance of proper seat belt use, as opposed to simply using a seat belt at all. The National Highway Traffic Safety Administration announced last year that seat belt use is at its highest level since 1994. But this latest analysis points out that, at least for children, if the seat belt is not correctly fastened across the body, or the child does not have an appropriate car or booster seat, the result can be deadly. 
 
 The researchers also found that states with red light cameras, which are meant to enforce stoplights, had lower child fatality rates from car crashes. That finding could be of particular interest to local law enforcement and public safety officials, since red light camera laws are often instituted at the municipal level. Past research on red light cameras has found they decrease the number of dangerous "right-angle" collisions at intersections.
– A new study published in the Journal of Pediatrics found ensuring children under 15 are properly restrained—or wearing seat belts at all—could save about 232 lives every year. Researchers found 20% of children who died in fatal car crashes between 2010 and 2014 weren't buckled in or were improperly restrained, NPR reports. Of the more than 18,000 children involved in fatal car crashes in those years, 15.9% died. The biggest factor in those deaths was whether the children were properly restrained. Other factors included rural roads, which increased the likelihood a child would die in a car crash, and red light cameras, which decreased that likelihood. The study found child fatality rates varied widely by state, which makes sense as seat belt laws, public information on car seats, rural roads, and the use of red light cameras also vary widely by state. More than half of all children who died in a car crash lived in the South. The highest rates of death were in Mississippi, Wyoming, Alabama, Montana, and Virginia, CBS News reports. The lowest were in Massachusetts, New York, New Jersey, Washington, and Rhode Island. In Mississippi, 38% of children who died in a fatal car crash weren't restrained properly or at all. The study's authors advocate for stronger seat belt laws and better public information—potentially at the federal level—to protect children in car crashes.