Most children younger than 15 who were killed in such crashes were riding unrestrained in a car with someone old enough to be a parent or caregiver, according to a study in Wednesday's Journal of the American Medical Association.
"This is different than what might be assumed from the popular media reports of children who are killed when the vehicle in which they are riding is hit by a drinking driver," wrote the authors, led by Dr. Kyran Quinlan of the National Center for Injury Prevention at the federal Centers for Disease Control and Prevention.
Their analysis of U.S. motor vehicle accidents that killed child passengers from 1985-96 found that 5,555 deaths involved a drunken driver.
Of those, 64 percent -- 3,556 -- happened while the child's own driver was intoxicated. Sixty-seven percent of the drivers were old enough to be a parent or caregiver -- not an underage drunken driver.
A total of 1,999 child passengers died in multiple-vehicle crashes in which the drunken driver was in another vehicle.
The authors say the number of child deaths involving non-stranger drivers is probably even higher than reported because police mostly test for alcohol use in crashes that kill the driver as well.
"For the cases in which a child's driver survived, driver alcohol use was probably underreported," they wrote.
Of the 3,556 children who died while being transported by a drunken driver, researchers were able to find out in most cases whether the children had been buckled into safety seats or seat belts. They found just 18 percent had been buckled in.
The national president of the advocacy group Mothers Against Drunk Driving, or MADD, called the findings shocking.
"I was astonished when I realized that over 60 percent of the deaths were caused by a loved one," said MADD president Millie Webb, whose own daughter and nephew were killed by a drunken motorist who was not their driver.
"Maybe this will make society wake up" to the problem, Webb said.
The authors say better drunken-driving prevention efforts are needed, including possibly lowering the blood-alcohol limit for drivers transporting children.
They note that 27 states have special sanctions for such drivers.
In addition, families should adopt "zero-tolerance" policies for drivers transporting their children, the authors said.
An editorial in the same issue of the journal says the findings underscore the need for a federal zero-tolerance policy and nationwide limit making it illegal to drive with a blood-alcohol limit aove a "minimum reliably detectable level."
"The alternative is tacit acceptance of thousands of preventable deaths each year," said the editorial by Dr. Guohua Li of Johns Hopkins University's medical school.