Researchers Report Child Safety Restraint Use Gaining in Auto Trips

May 4, 2004

Parents are increasingly placing their children in child safety restraints during automobile trips, according to a national study of children in car crashes.

In an important shift, parents are more likely to use child safety seats and belt-positioning booster seats, which are demonstrably safer than adult seat belts for younger children.

Despite these advances, the researchers found that 62 percent of 4- to 8- year-olds are restrained in adult seat belts, putting them at unnecessary risk of injury in a crash.

Partners for Child Passenger Safety (PCPS), a research partnership of The Children’s Hospital of Philadelphia and State Farm, published its results in this month’s issue of Pediatrics. The current study represents an in-depth analysis of more than 10,000 children under age 9 who were in crashes reported to State Farm from 1999 to 2002.

For children under age nine, overall child restraint use rose from 49
percent in 1999 to 63 percent at the end of 2002. Among 3-year-olds, optimal child restraint use rocketed from 50 percent in 1999 to 93 percent in 2002.

Most of these 3-year-olds moved from seat belts and shield booster seats to child safety seats with a harness, according to Flaura K. Winston, M.D., scientific director of TraumaLink at Children’s Hospital and principal investigator for PCPS. She added that 2003 data indicate these favorable trends are continuing.

The shifts in child restraint use, said Dr. Winston, reflect the results
of public health education campaigns and new legislation in more than two dozen states as well as the greater availability of child restraints that accommodate larger children. Although many children after age 4 are in adult seat belts, PCPS researchers note that the best protection for children aged 4 to 8 are either child safety seats with a harness or belt-positioning booster seats – depending on the child’s size.

Above age 2, in which child restraint usage was already high, the
researchers found increases in child restraint use for each year up to age 8. Among 4-year-olds, child restraint use doubled, from 37 percent in 1999 to 74 percent by 2002. Among 5-year-olds, the rate quadrupled, from 12 percent to 48 percent.

A majority of 6-year-olds remains restrained in seat belts, but the use of belt-positioning booster seats jumped from 1 percent to 25 percent in just four years. Only 5 percent of 7- and 8-year-olds were in child restraints by the end of 2002 – but this increased from nearly no child restraint use for these ages at the beginning of the study.

“I am encouraged that parents are more accepting of using child restraints with harnesses for their older children,” states Dr. Winston. “But I hope that parents are considering the maximum weight and height allowed for their child’s safety seat and not exceeding the limits of the manufacturer’s recommendations. Children should use belt-positioning booster seats once they have outgrown their child safety seat.”

For parents, Dr. Winston offers four simple steps to optimize safety for
children riding in motor vehicles:

1) Restrain children on every trip; 2) Use the rear seat for all children under age 13; 3) Use the appropriate restraint for a child’s age and size; 4) Use the restraints correctly. With each step taken, PCPS data indicate a significant reduction in risk of injury to children in crashes.

“Motor vehicle crashes still remain the leading cause of death for
children ages 4 to 14,” stated Dr. Winston. “It’s important that measures are taken to get more children into optimal restraints for their age and size on every trip.” The challenge for policymakers is to sustain and increase their efforts to ensure more children get buckled up correctly, added Dr. Winston.

Children’s Hospital provides a multimedia Web site to address the many questions people have about appropriate restraint and correct installation of child restraint systems. Parents can view brief videos, listen to helpful instructions and browse quick tips at

Co-authors of the Pediatrics study with Dr. Winston were PCPS researchers Irene Chen, Michael Elliott; Kristy Arbogast; and Dennis Durbin.

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