Progress Made Among Infants and Toddlers, Less So Among Older Children;
Restraint use by young children reached record levels in 2002, and those gains were sustained in 2004. NHTSA’s 2004 National Occupant Protection Use Survey showed that 98 percent of infants (children under age 1) and 93 percent of toddlers (age 1 to 3) were restrained.
In contrast, in 2004, only 73 percent of children age 4 to 7 were restrained, down from 83 percent in 2002. NHTSA is analyzing the study findings to determine the factors responsible for this unexpected decline.
At the same, however, in 2004, there was marked improvement in placing child passengers age 4 to 8 in the rear seat away from the possible harm of a front-seat air bag. Eighty-six percent of these children were in the back seat in 2004, compared to only 71 percent in 2002. Older children continue to be in the front seat far too often, however, with 14 percent of children age 4 to 8 observed in the front seat.
The 2003 report from NHTSA’s Fatality Analysis Reporting System determined that the overall number of fatalities among children from birth through 3 remained at historically low levels, and declined among children 4 to 8. This continued decrease in the number of child deaths is in large part due to the significant increase in child restraint use since the Buckle Up America campaign began. In 1996, just before the campaign began, restraint use among infants was 85 percent and only about 60 percent of toddlers were restrained while riding in vehicles.
Unfortunately, older-child passengers did not fare as well in 2003 as their younger counterparts. Although overall crash-related fatalities among children 4 to 8 decreased in 2003 (including children who died while cycling, riding in cars, crossing streets and in other venues), fatalities among child passengers 4 to 8 increased by 5.1 percent.
Premature Graduation to Adult Safety Belts Poses Great Risks
Moving a child to a safety belt too early greatly increases risk of injury. Children 2 to 5 who are prematurely graduated to safety belts are four times more likely to suffer a serious head injury in a crash than those restrained in child safety seats or booster seats (“The Danger of Premature Graduation to Safety Belts for Young Children,” Pediatrics, June 2000).
Research from Children’s Hospital of Philadelphia and other entities confirms a continuing and disturbing nationwide trend in which the incidence of incorrectly restrained children increases steadily with age. Of the four stages of child restraint (rear-facing infant seat, forward-facing child safety seat, booster seat, and adult safety belt), the stage in which the appropriate restraint device is the most frequently underused is the booster seat stage.
At around age 4, when most children outgrow their forward-facing harness restraints, they do not yet have the physical stature or maturity to correctly use the adult safety belt system. These children are frequently moved prematurely to vehicle safety belt systems designed for adult passengers, not for children.
Adult safety belts do not fit small children correctly; a child placed in one prematurely is at grave risk for abdominal, spinal, head, facial, neck, and other injuries. A booster seat offers optimal protection for children until they are large enough to use vehicle safety belts properly.
Defining Correct Safety Belt Fit
Booster seats raise children up to a height at which the adult lap-and-shoulder belt system fits them properly, and prevents them from being ejected or partially ejected from the vehicle in the event of a crash. Booster seats secure child passengers in the vehicle, and correctly position the shoulder belt to provide optimal upper torso protection, and the lap belt to prevent abdominal injuries.
A child is ready for a safety belt when the shoulder belt crosses the child's chest and rests snugly on the shoulder, and the lap belt rests low across the pelvis or hips -- never across the stomach. The shoulder belt must never touch the child’s neck, and children must never place the shoulder belts behind their backs or under their arms, which they often do to minimize the discomfort of ill-fitting shoulder belts. The child should sit all the way back against the vehicle seat-back cushion, and the child's knees should bend comfortably at the edge of the auto seat.
For optimal protection, booster seats must never be used with the vehicle lap belts only; they must always be used with both the vehicle lap and shoulder belts.
Booster Seat Use Is Still Far Too Low
Estimates of booster seat use in the United States (see page 14) range from only 10 to 20 percent, leaving the vast majority of booster-age children at risk, even in the most optimistic scenario. While booster seat use has increased in recent years, due in part to efforts led by the States and NHTSA, and by improvements in child restraint laws, NHTSA estimates that at least 4 out of 5 children who should ride in booster seats do not do so.
Many parents and caregivers turn to State laws for guidance on which child restraint to use as their children grow. As of November 1, 2005, 33 States and the District of Columbia had enacted provisions in their child restraint laws requiring booster seat use (see pages 16-17).
Due to a number of factors, including lack of education, economic barriers, and insufficient provisions in State child restraint laws, many consumers incorrectly assume
Booster seats are now widely available for purchase, but this was not the case until relatively recently. For these and other reasons, NHTSA and its many partners are reaching out to parents, retailers, auto dealers, educators, and child care providers to make sure parents and caregivers take advantage of the lifesaving benefits of booster seats for the children in their care.