Recent Research Findings

Child Restraint Misuse Study Finds Alarming Trends for Older Child Passengers -
- Rates of Nonuse and Misuse of Child Safety Seats Remains Too High

The incorrect use of child restraints can lead to serious injury to a child in the event of a crash. A study conducted for NHTSA in the mid-1990s found that four out of five child restraints were being used incorrectly. A NHTSA-sponsored study published in March 2004 updated that research. Key findings relevant to booster-aged children follow.

The purpose of the 2004 study was to obtain a measure of the misuse of child restraints among the general public. The study focused on forms of misuse that could reasonably be expected to raise the risk of injury to a child in the event of a crash.

The study, conducted by TransAnalytics, LLC, collected data on 5,527 children less than 80 pounds in 4,126 vehicles. The study, which was initiated in 2001, examined children by weight – rather than by height, such as in the NHTSA 4’ 9” recommendation – because weight was the guiding determinant at the time the study was designed and awarded.

Most children (62.3 percent) were restrained in a child restraint, but 25.9 percent (more than one in four) were using safety belts, and another 11.8 percent were completely unrestrained. Only about 22 percent of booster-age children (4 through 8) were in booster seats. Child safety seat use was very high among infants and toddlers, but fell sharply among children who should be in booster seats: children from 4 to 8, and weighing 40 to 59 pounds (41.7 percent), and 60 to 79 pounds (10.9 percent). Many of these children were using the vehicle safety belts prematurely.

The data confirmed that children riding unrestrained remain a serious problem. Nearly one in four children weighing 60 to 79 pounds (24.2 percent) and nearly one in six children weighing 40 to 59 pounds (15.2 percent) were not using any type of restraint.

While misuse occurred at lesser levels among children riding in booster seats than among children riding in infant and toddler seats, misuse was still observed among all types of booster seats, in spite of their comparative ease of installation and use. Misuse rates for booster seats observed in the study were: belt-positioning booster seats: 39.5 percent; shield booster seats: 60.5 percent; integrated (built-in) booster seats: 42.9 percent; and other booster seats: 20 percent.

Widespread Incidence of Improperly Fitting Safety Belts Found

About one-fourth of the observed children under 80 pounds (25.9 percent%) were not using child restraints but were wearing safety belts. In most cases, the safety belts did not fit them correctly. Improper fit was observed for 69 percent of the children in lap/shoulder belt combinations, 70 percent of the children in lap-belt-only systems, and 88 percent of the children in shoulder-belt-only systems.

Booster Seat Use Has Increased, But Remains Far Too Low

NHTSA repeated its large-sample national telephone survey on occupant protection -- the Motor Vehicle Occupant Safety Survey (MVOSS) -- during the first quarter of 2003. Findings from the survey indicated that just 21 percent of children 4 to 8 ride in booster seats "at least on occasion" while traveling in passenger vehicles. The MVOSS found that another 19 percent of children in this age range were restrained "at least on occasion" in front-facing child safety seats. About two-in-five (39 percent) of those who had used booster seats said they had started using the booster seats with their children before age 4.

These findings were derived from two telephone questionnaires, each administered to a randomly selected sample of about 6,000 people 16 and older. The interviewing was conducted between January and March 2003. According to the survey, 85 percent of the parents and caregivers of young children had heard of booster seats. Among those who were aware of booster seats, 60 percent said they had used them "at some time."

Parents and caregivers of children under 9, including children who were not using child restraints, were asked a series of questions about booster seats. Among the parents and caregivers who had seen or heard of booster seats, 22 percent had concerns about their children’s safety. These parents/caregivers described booster seats as loose-fitting and perceived them to be unstable systems that would not adequately restrain their children in a crash.

In addition, Children's Hospital of Philadelphia (CHOP) researchers found that in 2002, nearly two-thirds (62 percent) of 4- to 8-year-olds were riding inappropriately restrained in only a safety belt. Later CHOP research concluded that booster seat use rose from 3.4 percent in 1998 to 16 percent by the end of 2002.

Children's Hospital of Philadelphia Conducts Landmark Booster Seat Research

According to another important study conducted at CHOP, transitioning children from child safety seats to belt-positioning booster seats instead of vehicle safety belts provides significant safety benefits for children at least through age 7.

CHOP found that the use of belt-positioning booster seats lowers the risk of injury to children in crashes by 59 percent compared to the use of vehicle safety belts alone. The finding comes from a study of children 4 to 8 by Partners for Child Passenger Safety (PCPS), a long-term research project based at CHOP and funded by State Farm Mutual Automobile Insurance Company.

The study – “Belt-Positioning Booster Seats and Reduction in Risk of Injury Among Children in Vehicle Crashes” – was published in the June 4, 2003, issue of the Journal of the American Medical Association, and provided the first real-world evidence of the added safety benefits of belt-positioning booster seats over safety belts alone.

In addition, the study demonstrated that proper positioning of the safety belt by the booster seat virtually eliminates injuries associated with safety belt syndrome, including injuries to the abdomen, neck, spine, and back, as well as lower extremity injuries. In contrast, children in the study who were restrained in safety belts alone suffered injuries to every body region.

CHOP/PCPS conducted in-depth analyses on 4,243 children 4 through 7 who were in crashes reported to State Farm from 1998 through 2002. The PCPS data demonstrates that booster seat use, while on the rise, remains quite low. Only 16 percent of 4-year-olds, 13 percent of 5-year-olds, and 4 percent of 6- and 7-year-olds were using booster seats.