Motor vehicle-related trauma is the leading cause of death in children in the United States. All states have pediatric restraint requirements for passenger vehicles to help prevent these deaths and injuries. Only a few states, however, possess safety laws or restrictions for passengers who ride in the back of pickup trucks. A retrospective review of medical records for a 40-month period revealed 40 patients whose injuries were a direct result of being a passenger in the cargo area (bed) of a pickup truck. Their injuries and other pertinent data are discussed. Representatives from the Highway Safety Commission of each state were surveyed about their specific highway safety laws. The responses revealed that all states and the District of Columbia have child restraint requirements for passenger automobiles, 34 states have adult restraint laws, but only 17 states have any type of restriction for passengers riding in the back of pickup trucks. Seventy-one percent of the states with pickup truck regulations include only the preschool-age child. Data from the National Highway Traffic Safety Administration concerning pickup trucks and passenger fatality are presented and discussed.

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