INTRODUCTION

 

Over the past several years, the National Highway Traffic Safety Administration (NHTSA) and its partners in the private and public sectors have made a concerted effort to promote the use of child safety seats through public education, enforcement, and strong legislation.  As a result, the Nation has seen a dramatic increase in child restraint use for infants and toddlers, a reduction in fatalities and injuries, and the saving of countless lives.

Without State occupant restraint laws requiring drivers to place children younger than the age of 4 years in child safety seats, these increases would not have been as great.  Unfortunately, most of these laws do not address the need to place children ages 4 to 8 years [1] (who are too big for child safety seats, yet too small to ride safely in adult seat belts) in booster seats.  In many instances, loopholes in State laws allow children to ride unrestrained in the back seat.

The greatest risk to child passengers 4- to 8-years of age is the lack of any restraint use in a motor vehicle.  In 1999, more than half of the 4- to 8-year-old passengers killed in crashes were reported as totally unrestrained.  In addition to the high number of fatalities, thousands of children were seriously injured in crashes because they were unrestrained.  Persuading parents who do not restrain their children at all to place them in any kind of restraint would reduce the number of children killed or seriously injured.  Providing additional protection to these children using belt-positioning booster seats would enhance their overall safety.

Therefore, as the public is educated about the importance of age/size appropriate belt-positioning booster seats, it is imperative that they are aware of the dangers children face when they ride unrestrained.  Societal norms must change, making it socially unacceptable to place children at unnecessary risk by allowing them to ride unrestrained in a moving vehicle.

The passage of the Transportation Recall Enhancement, Accountability, and Documentation (TREAD) Act provides the U.S. Department of Transportation with a new opportunity to educate the public about the dangers children face when they ride unrestrained, and the importance of having all appropriate-size booster-seat-age children protected by belt-positioning booster seats when they are passenger vehicle occupants.

 

National Participation in Plan Development

On June 6, 2001, NHTSA published a Federal Register Notice announcing a Public Meeting and Request for Comments To Address the Development of a Booster Seat Education Plan (www.access.gpo.gov/su_docs/fedreg/a010606c.html).  NHTSA conducted a public meeting on July 10, 2001, which brought together nearly 100 participants and speakers to provide a forum for sharing viewpoints, information, ideas, and recommendations to increase booster seat use.  The attendees and presenters represented the general public, industry, government, child advocacy groups, and child restraint manufacturers.  Comments also were received at the public docket (http://dms.dot.gov, docket number 9785).  The information gleaned from these two forums was the starting point for the strategic plan.

 

Additional Contributions to Plan Development

NHTSA reviewed recommendations and goals from other arenas during preparation of the plan, including the following:

A Summary of the Issues Raised for Inclusion in Plan Development

NHTSA solicited and received national input, reviewed salient documents addressing child passenger safety, and conducted meetings with individuals involved with child passenger safety at the national and local levels.  Combining this information with the Agency’s expansive research capabilities and years of experience in child passenger safety, NHTSA identified several recurring issues:

Within the above mentioned issues, specific recommendations included: (1) tailoring messages for high-risk populations; (2) establishing a best-practices approach for all outreach and programmatic activities; (3) passing laws requiring lap and shoulder belts in all seating positions in motor vehicles; and (4) informing the public that when a booster seat is unavailable, a child should be placed in a seat belt in the back seat.  There was also strong support for NHTSA to continue providing incentive grants to States to increase age/size appropriate restraint use.

 

A Blueprint for the Nation

The purpose of the national strategy is to provide a blueprint for increasing the number of children ages 4 to 8 who are secured in booster seats.  The proposed framework of the strategy builds on NHTSA’s current Buckle Up America (BUA) campaign, which has been extremely successful in increasing the use of child safety seats for children from birth through 4 years of age, and reducing fatalities and injuries.  The elements of the BUA campaign are: (1) public-private partnerships; (2) strong legislation; (3) active, high-visibility law enforcement; and (4) effective public education.

This plan is divided into five sections: 

 


REFORMULATING THE TREAD OBJECTIVE

Under Section 14(i) of the Transportation Recall Enhancement, Accountability, and Documentation (TREAD) Act, the Secretary of Transportation is required to, “…develop [a] 5 year strategic plan to reduce deaths and injuries caused by failure to use the appropriate booster seat in the 4 to 8 year old age group by 25 percent.”  While it is highly desirable to “…reduce fatalities and injuries caused by failure to use the appropriate booster seat in the 4 to 8 year old age group by 25 percent,” NHTSA does not believe this to be an attainable objective.  This belief was corroborated by an examination of 10 years of fatal and injury crash data involving 4- to 8-year-old passengers[2].  The examination of the crash data revealed that:

NHTSA believes that its programs should focus on attainable objectives.  Because the crash data show that a program designed solely to increase use of belt-positioning booster seats would not result in a 25 percent reduction in the number of booster seat age children killed and injured in passenger vehicle crashes, it would not be an attainable objective. 

The agency’s research also shows that the lack of any restraint use in a motor vehicle is the greatest risk to 4- to 8-year-old passengers.  In 2000, almost half of the 4- to 8-year-old passengers killed in crashes were reported as totally unrestrained.  In addition to the high number of fatalities, thousands of children were seriously injured in crashes because they were unrestrained.  NHTSA research has shown that the use of adult belts alone by a booster seat age child reduces his/her risk of fatality by 48 percent (in the back seat) and that the use of a belt-positioning booster seat reduces the child’s risk of being killed in a crash by 54 percent[3].  This 6 percent improvement, though significant, is marginal when compared to the 48 percent gain realized by restraining a child in a lap/shoulder belt alone over not restraining the child at all.   Thus, while it must be kept in mind that increasing booster seat use to 100 percent is NHTSA’s ultimate goal, the greatest gain in occupant protection for this age group would be obtained by getting unrestrained child passengers into any form of occupant restraint.

Therefore, the objective of NHTSA’s program will be to reduce the number of unrestrained booster seat age children (placing them into any form of occupant restraint), while emphasizing that booster seats are the best and proper restraints for children in this age group.  Such a program, while not completely departing from the objectives of the TREAD Act, reformulates them.

To measure progress towards the success of a program to eliminate non-restraint use among 4- to 8-year-olds and promote booster seat use, NHTSA proposes the following goal:

2006 Goal: Increase restraint use (of any type) by 4- to 8-year-old occupants to
85 percent (from 63 percent in 1999), as measured by the National Occupant Protection Use Survey (NOPUS).

An increase in restraint use (booster seat or otherwise) should result in a reduction in the number of 4- to 8-year-old children killed or seriously injured in motor vehicle crashes.  NHTSA’s program, therefore, will include the following goals to track the effect of increasing restraint use on fatalities and injuries to booster seat age children:

Goal for 2006: Reduce the percentage of unrestrained 4- to 8-year-old occupants that die in passenger vehicle crashes to 39 percent (from 63 percent in 1999), as measured by the Fatality Analysis Reporting System (FARS).

Goal for 2006: Reduce the number of moderate to severe injuries per 100,000 4- to 8-year-old passenger vehicle occupants involved in motor vehicle crashes to 1,050 (from 1,509 in 1999), as measured by the National Automotive Sampling System (NASS) Crashworthiness Data System (CDS).[4]

Goal for 2006: Reduce the number of incapacitating injuries 4- to 8-year-old passenger vehicle occupants per 100,000 to 5,700 (from 6,540 in 1999), as measured by the NASS System General Estimate System (GES).[5]

Persuading parents who do not restrain their children at all to place them in any kind of occupant restraint would reduce the number of children killed or seriously injured.  Providing additional protection to these children from belt-positioning booster seats would further enhance their overall safety. 

 

 

 

THE CHALLENGE OF GETTING CHILDREN PLACED IN
BOOSTER SEATS

There are numerous challenges to getting 4- to 8-year-old children secured in booster seats, in addition to the many situational factors that affect booster seat use.  The first challenge is the lack of information among parents and other caregivers about: (1) the correct progression of restraint use for children; (22) how booster seats work; and (33) the safety benefits of booster seats.  The second challenge is the desire of young children to act grown up and not have to sit in any type of child restraint.  A third challenge is the inconsistency of State laws pertaining to protecting older children and booster seat use.  Without consistent laws, or laws that provide for mandatory booster seat use for the older child, parents and other caregivers will continue to question the need for, and benefits of, booster seats.

Finally, even though lap belts and shoulder belts for front-seat occupants have been required in cars for more than 30 years, NHTSA did not require combination lap and shoulder belts in the rear outboard seating positions until 1989 (vehicle model year 1990).  While the presence of lap-only belts did not preclude manufacturers from offering various restraint systems for older children, shield booster seats (designed for use with lap-only belts) were the only type of booster seat available at the time.  Once NHTSA required shoulder belt restraints for the rear seating positions, child safety seat manufacturers responded by developing belt-positioning booster seats.  Hence, belt-positioning booster seats have only recently been available.  

The need to educate parents and caregivers on the correct progression of restraint use is illustrated in NHTSA research conducted by the Children’s Hospital of Philadelphia (CHOP).  Researchers found that “while parents generally do a good job of restraining children who are under age 3 and over 8, the number of appropriately restrained children between ages 3 and 8 drops significantly.  Instead of using car seats or belt-positioning booster seats, many of these children are inappropriately restrained in adult seat belts.”[6]

In another study conducted by CHOPhis, parents identified potential barriers to using booster seats, including the child’s behavior and discomfort.  They also found that, due in part to peer pressure, children often balk at being in a child safety seat as they get older.  These studies also note that increasing booster seat use is difficult because parents are confused by a patchwork of child occupant protection laws with inconsistent provisions. 

Ultimately, we must rely on parents and other caregivers to take responsibility for placing
4- to 8-year-olds in booster seats when they ride in motor vehicles.  To address the many aspects of this challenge, NHTSA and its public and private sector partners must continue to promote passenger safety for all motor vehicle occupants.  We must create and maintain a cultural norm that equates children’s safety with placing 4- to 8-year-olds in age/size appropriate occupant restraints.  In doing so, and recognizing that proper fit of booster seats does not solely depend on age, NHTSA makes the following recommendations about booster seat use: “all children who have outgrown child safety seats should be properly restrained in booster seats until they are at least 8 years old, unless they are 4’9” tall.”  Children can move to a seat belt when they can firmly place their back against the vehicle seat back cushion with their knees bent over the vehicle seat cushion.

 


A STRATEGIC APPROACH BUILT ON THE SUCCESSES OF THE
BUCKLE UP AMERICA CAMPAIGN

NHTSA proposes to model its strategic approach for promoting protecting older child passengers and increasing the use of booster seats after the four elements of the BUA campaign.  These elements are: (1) public-private partnerships, (2) strong legislation, (3) active, high-visibility law enforcement, and (4) effective public education.  Under the BUA campaign, combining these four elements into a strategic approach was so successful that the campaign reached its child passenger safety goal one year early.  It reduced child occupant fatalities among children age 4 and younger by 15 percent in 1999 instead of the target date of 2000.

 

Public-Private Partnerships

Over the past several years, NHTSA has helped form a cadre of hundreds of strong partnerships with public and private organizations that have contributed time, millions of dollars, and other resources to promote child passenger safety.  Partner contributions have included promoting and disseminating child passenger safety messages, providing child safety seats to local loaner programs, and establishing a network of fitting/inspection stations.  NHTSA will work with existing partners and bring on new ones to assist in increasing booster seat use.

 

Strong Legislation

Although every State has a child occupant protection law, some laws include only very young children (some cover only ages 2 and younger) and some only cover passengers riding in the front seat. Some States exempt pickup trucks and vans.  Child occupant protection laws should cover every child (up to age 16), in every seating position, in every passenger vehicle.

To close the gaps in child occupant protection laws, NHTSA will continue to provide sound scientific data and technical assistance that will make it easier for States and communities to enact and strengthen legislation (and ordinances) to address the need to place all children in occupant protection restraints, emphasizing securing 4- to 8-year-olds in booster seats.

 

Active, High-Visibility Law Enforcement

A commitment to enforcing child occupant protection laws does not require extensive training on correct use.  An officer need only observe a child who is at risk and do something about it.  To ensure that children ride safely, law enforcement should take action on every child restraint law violation they see.  Law enforcement officers are in a unique position to educate the public about the importance of securing children in age/size appropriate occupant restraints and about always seating children in the back seat of motor vehicles.

Therefore, NHTSA will continue to encourage law enforcement agencies to enforce child occupant protection laws and to educate the public about the importance of securing children in age/size appropriate occupant restraints.

 

Effective Public Education

Public education, especially when combined with enforcement, plays an integral role in any effort to encourage people to acquire new habits and behaviors.  Public education includes a broad range of activities, such as high-visibility enforcement campaigns, promotional events, and community-based initiatives.  Through these activities, public education can raise awareness about the dangers children face when they ride unrestrained and promote the benefits of age/size appropriate occupant restraints.  However, to be effective, these activities must be well planned and well coordinated.

To educate the public about the benefits of using and the proper fit of booster seats, activities can range from national campaigns, to instructional programs at schools and inspection stationsfitting/inspection stations, to one-on-one discussions delivered by health care professionals or childcare workers.  The crucial element is that the public receive a single, simple message - often and in many different ways.  As appropriate media and channels for educating the public about booster seats are identified, NHTSA will build on existing child passenger safety programs and initiatives and identify the need for new strategic ones. 

 

Tracking and Monitoring

To monitor successes and activities in each strategic area, NHTSA will use a variety of information gathering and data analysis techniques.  To measure the goals and the objectives, NHTSA will use data from FARS, GES, NASS, CDS, and NOPUS.  It also will monitor trends in booster seat use through its household and observational surveys, and it will collect information on the following types of activity:

 

 


WORK IN PROGRESS

The promotion of booster seats has been an important part of the BUA campaign’s child passenger safety activities.  For the past several years, NHTSA, its partners, and the private sector have incorporated messages, statistics, and best practices information about the lifesaving benefits of booster seats throughout their wide-ranging child passenger safety programming and communications activities.

These child passenger safety initiatives have included a special focus on reaching traditionally underserved populations.  NHTSA will continue this focus as it expands these initiatives to promote the use of booster seats.  The following information highlights current efforts that promote the correct progression of occupant restraint use for children.

 

Public Awareness and Education

 

Training and Technical Assistance

 

Outreach

 

Research

 

Federal Motor Vehicle Safety Standard 213 (49 CFR  571.213)

In response to other requirements of the TREAD Act, NHTSA is considering amendments to Federal Motor Vehicle Safety Standard (FMVSS) 213, which specifies performance requirements for child restraints.  The agency is considering several initiatives to more fully evaluate the dynamic performance of booster seats recommended for a wider range of children.

Further, the agency is in the process of developing, in conjunction with the Society of Automotive Engineers, a 10-year-old dummy that is envisioned to be used in the evaluation of booster seats for children weighing approximately 80 pounds.

Assuming amendments to FMVSS 213 are finalized, manufacturers may need to examine current booster seat models and make decisions about developing new ones.  This circumstance will provide them with opportunities to produce new booster seats that may be more appealing to children and easier to use in a variety of motor vehicles.

 

Funding

TEA-21 (P.L. 105-178) authorized programs for fiscal years (FY) 1998 – 2003.  States and communities have been applying for a number of highway safety grants that are used in part to promote child passenger safety activities.  The grant programs are as follows:

In addition to the grant programs described above, under 23 U.S.C.§403, NHTSA conducts demonstration grant programs to develop new approaches and strategies to reduce motor vehicle related deaths and injuries.  Under Section 403, NHTSA awarded six Booster Seat Community Demonstration Grant Programs (FY 2000-2001) totaling approximately $900,000 for pilot and demonstration programs to implement strategies in the community, to increase booster seat use for children weighing between 40 and 80 pounds.[7]  The demonstration programs also promoted seat belt use for children ages 8 to 15.  Messages and activities targeted parents, children, young teens, and diverse populations.

Reauthorization of highway safety funding will occur during the 5-year span of this strategic plan.  As the U.S. Department of Transportation develops its reauthorization proposal, the goals and initiatives identified in this report will be taken into consideration.   

NHTSA also provides funding and a wide range of other support to the annual Lifesavers Conference.  Sessions on booster seat use and issues facing older child passengers are a staple of this conference.

 

 


A NATIONAL MOVEMENT FOR CHANGE—IMPLEMENTING
THE STRATEGIC APPROACH

Citizens from across the country contributed their ideas for this strategic plan in public meetings and through written comments.  As described previously, considerable activities, funding, and resources have already been committed to increase awareness and promote the use of booster seats.  This section contains specific efforts that individuals representing a variety of public and private sector organizations and groups can undertake.

 

Congress  

To assist citizens, communities, and States to increase awareness and booster seat use rates, members of Congress can:

 

Federal Government Agencies

The Department of Transportation currently oversees a department-wide initiative to promote seat belt use among all its employees and customers.  Agencies throughout the Department regularly disseminate passenger safety messages and support programs that encourage the use of seat belts, child safety seats, and booster seats.  Although the mandate for child passenger safety clearly falls under the purview of the Department of Transportation, numerous opportunities exist for other Government agencies to participate in activities to promote the correct progression for child restraint use.  The following list, which focuses on the Department of Transportation, includes activities that all Government agencies can undertake (including State and local agencies):

 

State and Local Agencies and Organizations

National change takes place at the local level.  State and local leaders, along with State Highway Safety Offices, must work together to support legislative change and programs that encourage
4- to 8-year-olds to be placed in booster seats, make booster seats available to all children, and educate parents and other caregivers on the correct progression of occupant restraint use for children.  To this end, State and local leaders should work to accomplish the following objectives:

 

National Organizations and Coalitions

Many national organizations and coalitions currently support child passenger safety.  NHTSA will continue its work with current partner organizations and identify new ones.  These organizations share information with members and other constituent groups, develop materials on child passenger safety tailored to the needs of its members, voice public support for child passenger safety, and stimulate grassroots activity on child passenger safety, including booster seat use.  This network includes, but is not limited to, the following types of organizations:
National organizations and coalitions can participate in this effort to raise awareness about the dangers children face when they ride unrestrained.  They can help promote booster seat use in the following ways:

 

Health and Medical Providers

Health and medical providers play a vital and continuing role in providing counseling to parents and children on many matters of health and safety.  Physicians and nurses (especially in pediatric practices), attending hospital staff, emergency room medical staff, school nurses, and others see most children from birth through their immunization periods.  During this time, these health care providers are in a unique position to educate parents and other caregivers on the importance of using the appropriate safety restraint system for their children, including the importance of placing 4- to 8-year-olds in booster seats.  The health and medical community can support the use of booster seats by adopting the following suggestions:

 

Child Safety Seat Manufacturers/Automobile Manufacturers/Retailers

Child safety seat manufacturers, automobile manufacturers, and retailers are critical to the success of all national efforts to promote the use of booster seats.  They can support the use of booster seats by considering these suggestions:

 

Child Passenger Safety Technicians

More than 25,000 certified child passenger safety technicians have been trained to educate parents and other caregivers about the correct use of child safety seats and booster seats and to ensure their proper installation.  Recognizing the low usage rate for booster seats, child passenger safety technicians can help increase their use by carrying out the following activities:

 

Media

National and local media organizations have shown strong support for child passenger safety programs.  It is time to build on that support by educating the media and obtaining their buy-in (even in States that have gaps in their existing laws) for placing 4- to 8-year-olds in booster seats.  The access that broadcast, print, and out-of-home media have will be critical to getting the word out about the risks associated with children riding unrestrained.  In addition to requesting publicity through their broadcast, print, and out-of-home channels, NHTSA will make a point of requesting the placement of information about booster seats and child passenger safety on their Web sites.  Suggestions for media activities supporting booster seat use are as follows:

 

Educators

The community of public and private school educators encompasses preschool and elementary school teachers and their assistants, school administrators and their staff, boards of education, and other professionals and volunteers.  Individually and collectively, members of these groups can help prevent death and injuries by participating in and initiating activities that promote the use of child occupant restraints.  Opportunities for involvement are as follows:

 

Law Enforcement

Law enforcement agencies and professional associations have actively supported child passenger safety through enforcement, training, and public education.  Additional and expanded activities for their involvement are presented below:

 

Businesses

As responsible corporate citizens, businesses know that safe, healthy families are good for business.  Through internal and external communications, businesses can help educate employees, customers, and the public at large.  Businesses can promote the use of booster seats and child occupant protection in many ways:

 

Private Citizens

Because young children are unable to protect themselves, parents and other caregivers must take responsibility for placing them in age/size appropriate occupant restraints, and seating them in the back seat where they are the safest.  However, as children get older, parents and other caregivers can begin educating them about the importance of occupant restraints and should involve them in selecting a booster seat.  All adult citizens can promote child passenger safety by doing the following:

 

 

 



[1] The term “4 to 8 years” refers to children who are 4, 5, 6, and 7 years old.

[2] Based on data used in the report, Fatalities and Injuries to 0-8 Year Old Passenger Vehicle Occupants based on Impact Attributes, DOT HS 809 410, March 2002.

[3] Based on data used in the report, Effectiveness of Lap/Shoulder Belts in the Back Outboard Seating Positions, DOT HS 808 945, June 1999.

[4] The NASS CDS examines medical records and classifies all injuries to occupants by severity – AIS 1 (least severe) to AIS 6 (most severe or non-survivable).

[5] The NASS GES uses the KABCO scale:  K- killed, A- serious or incapacitating, B – non-incapacitating, C – possible injury or complaint of pain, O – not injured.

[6] Winston, et al., The Premature Graduation of Children from Child Restraints to Vehicle Safety Belts. DOT HS 809 259, 2001, p.18.

[7]  At the time of the funding, the agency’s policy stated that children between 40 and 80 pounds be secured in a belt-positioning booster seat.  The new recommendation to determine readiness for a booster seat is that “all children who have outgrown child safety seats should be properly restrained in booster seats until they are at least 8 years old, unless they are 4’9” tall.”