CHAPTER 3: 2003 CAR SEAT USE

Parent/Caregiver Subgroup
The survey selected a subgroup of drivers to ask detailed questions about children’s use of child car seats. These drivers were considered most likely to have significant responsibility for transporting young children (“parents/caregivers”). The respondents were chosen for questioning if they fell into one of the following categories:

Parents of children under age 9. Usually this involved a parent living with their child. Sometimes it was a parent not living with their child, but who drove the child at least on occasion during the past year.

Non-parents living with children under age 9. These were drivers who indicated that they at least sometimes drove with a child under 9 who lives in their household.

Because the 1994, 1996 and 1998 Motor Vehicle Occupant Safety Surveys used age 5 rather than age 8 as the upper age limit for the child, the data from the 2000 and 2003 survey are derived from a somewhat different group. The age limit was raised to 8 in order to cover the age range for which booster seats are generally recommended (ages 4 to 8, see discussion below). The interviewers asked respondents to focus on one specific child for the questions. If there was more than one child under age 9 in the household, one child was randomly selected. Respondents were asked about car seat use with the selected child. This procedure yields a national sample of drivers for whom car seat usage issues would be most applicable.

Reported Frequency Of Car Seat Use
Interviewers asked the above driver subgroup how frequently the selected child uses a car seat when riding with them. They were told that car seats for purposes of the survey included infant seats, toddler seats, and booster seats. Responses to this question are to be interpreted with caution, as car seats may not be appropriate for larger children under age 9. The safety restraint system used should be the one appropriate for the child’s size and development. Children should ride rear facing until at least 20 pounds and one year of age. Children who reach 20 pounds before one year of age should ride rear facing in a child safety seat recommended at a higher weight. Keeping a child rear facing as long as possible helps protect the fragile baby from spinal cord injuries (i.e., the back of the car seat supports the infant’s head, neck and back and prevents spinal cord injuries in a frontal crash). Past the first year of age, children weighing about 20 to 40 pounds should ride facing forward in convertible seats or forward facing only seats. Children who have outgrown their child safety seats at 40 pounds or approximately 4 years of age should ride in booster seats until adult belts fit them properly, at least until the age of 8, unless 4’9” in height. Older children may wear vehicle safety belts when the lap belt stays low and snug across the hips without riding up over the stomach, and the shoulder belt does not cross the face or neck.

The majority of the parent/caregiver subgroup reported that the selected child used a car seat “all of the time” (60%). About one-third said the selected child “never” used a car seat (32%). Only 6% said that the child was a car seat user, but not all the time (3.3% most of the time, 1.4% sometimes, and 1.0% rarely). A few said they never drive with that child (1%). Less than 0.5% said they did not know or refused to respond. If the child never used a car seat, it usually was because the child reportedly had graduated to safety belt usage (see page 100).

Figure 24
Frequency Child Under 9 Rides In Car Seat

[d]

Qx: When you are driving and the (AGE) rides in the vehicle with you, how often does (he/she) ride in a child car seat? Child car seats include infant seats, toddler seats and booster seats. Would you say (he/she) rides in a child car seat all of the time, most of the time, some of the time, rarely, or never?
Base: Parents/caregivers as defined on page 30.
Unweighted N=1440
The sum of the percentages in the pie chart does not equal 100% because the numbers are rounded.

Consistent car seat use is related to weight of the child. Nearly all parents/caregivers in the survey reported that the selected child always used a car seat when riding with them if the child weighed less than 20 pounds (98%). “All the time” car seat use decreased to 93% of children 20-29 pounds, and 88% of children weighing 30-39 pounds. Regular use declined sharply to 43% of children weighing 40-60 pounds while only 14% of children weighing 61 pounds or more used a car seat all of the time (this largely reflected the graduation of these children to safety belts).

Figure 25
“All Of The Time” Car Seat Use By Child’s Weight (Children Under Age 9)

[d]

Qx: How much does (AGE) weigh?
Qx: When you are driving and the (AGE) rides in the vehicle with you, how often does (he/she) ride in a child car seat? Child car seats include infant seats, toddler seats and booster seats. Would you say (he/she) rides in a child car seat all of the time, most of the time, some of the time, rarely, or never?
Base: Parents/caregivers as defined on page 30.
Unweighted N's listed above.

Ninety-six percent of children age 2 and younger rode in child car seats all of the time. This number drops to 91% of 3 year olds, 80% of 4 year olds, and then more dramatically to 59% of 5 year olds.

Discontinuation of car seat use by most children occurred by 6 years of age. Only 35% of children age 6 reportedly used a child seat all the time, and this number dropped by more than half (to 16%) by age 7, and then again by half to only 8% by age 8.

Figure 26
“All Of The Time” Car Seat Use By Child’s Age (Children Under Age 9)

[d]

Qx: What is the age of the (CHILD)?
Qx: When you are driving and the (AGE) rides in the vehicle with you, how often does (he/she) ride in a child car seat? Child car seats include infant seats, toddler seats and booster seats. Would you say (he/she) rides in a child car seat all of the time, most of the time, some of the time, rarely, or never?
Base: Parents/caregivers as defined on page 30.
Unweighted N's listed above.

Research on adult safety belt use has found that some drivers will report wearing safety belts “all the time” but admit on a follow-up question that they did not use their safety belt recently (7% of drivers in 2003; see Volume 2 of this series: Safety Belt Report). Figure 27 examines whether this discrepancy also occurs for reported car seat use. Among drivers who said the child always used a car seat when riding with them, 2% also said the child had not ridden in a car seat at least once in the past day or week when the respondent was driving the child. The survey recorded another 2% as saying that the child never uses a car seat, contradicting the response to the previous question that the child always used a car seat.

Figure 27
Last Time Child Didn’t Use Car Seat (If Child Was Reported To Use Seat “All Of The Time”)

[d]

Qx: When you are driving and the (AGE) rides in the vehicle with you, how often does (he/she) ride in a child car seat? Child car seats include infant seats, toddler seats and booster seats. Would you say (he/she) rides in a child car seat all of the time, most of the time, some of the time, rarely, or never?
Qx: When was the last time the (AGE) DID NOT ride in a child car seat when you were driving?
Qx: [If “don't know”] Has there been any occasion in the past 12 months when the (AGE) did not ride in a car seat when you were driving?
Base: Drivers who said child uses car seat “all of the time” when they drive.
Unweighted N=885
**Includes 2% past month (but not within past week) and 2% past year (but not within past month).
The sum of the percentages in the pie chart does not equal 100% because the numbers are rounded.


Type And Location Of Car Seat
The remainder of this chapter summarizes data exclusively for those children that the survey determined at least on occasion used a child restraint while riding in motor vehicles. Excluded from the analyses were children whom parents/caregivers said never used a child seat (infant seat, front facing child safety seat, or booster seat), and children whom the parents/caregivers never drove. Also excluded were cases where parents/caregivers did not respond when asked how often the child used a child seat (an entry question to the series), and cases where an initial response that the child used a child seat was subsequently contradicted (primarily during the immediate follow-up question shown on page 34).

Parents/caregivers who reported car seat use for the designated child were asked questions to identify the type of seat being used. This was a complicated matter because persons may use terms to identify their child seat that differs from terminology employed by safety professionals. Thus, for example, directly asking a respondent if the seat is a booster seat may lead to error because “booster seat” may be an unfamiliar term to the respondent or have a different meaning. To address this problem, the interviewers asked respondents about strap location over the child’s shoulders. Beginning with the 1994 MVOSS, the interviewers asked “When the [CHILD] is fastened in the child car seat, are there straps over both shoulders, a strap across only one shoulder, or are there no straps over either shoulder”? Both infant seats and front facing child safety seats have straps crossing both of the child’s shoulders. A strap over one shoulder is characteristic of a belt positioning booster. If neither shoulder has a strap over it, then this should be a shield booster. Thus, if the parent/caregiver said there was a strap over only one shoulder, or over neither shoulder, then the survey considered that a booster seat. If the parent/caregiver said there were straps over both shoulders, then the interviewer asked if the child usually sat front facing or rear facing in the seat, with rear facing being indicative of an infant seating position.

The strap location question did not resolve all problems in identifying type of child seat. For example, the 1998 survey identified one-tenth of infants as using booster sets. As a result, the 2000 survey added follow-up probes to the strap location question. These were asked only of parents/caregivers who said there was a strap over one shoulder or neither shoulder, and were intended to corroborate the “booster seat” determinations. While in many cases they did so, there were sufficient discrepancies to underscore the difficult nature of determining type of child seat over the telephone. The probes were unable to provide clear direction for making adjustments to identified seat type, therefore the 2003 survey continues the practice of past Motor Vehicle Occupant Safety Surveys of defining as booster seats all seats that met the strap definition described above (i.e., parents/caregivers reported a strap over one shoulder or neither shoulder).

The remainder of this chapter presents data only for those children using child restraints at least on occasion. Readers who wish to know the percentage of all children at a specified age or weight using a particular type of restraint can find that information on pages 107-108.

Based on the definition described on the previous section, the survey determined that about 25% of children under age 9 who at least on occasion were using child restraints were riding in booster seats. Of the remainder, 60% were riding in front facing child safety seats, 14% in rear facing infant seats, and about 1% did not provide information from which the type of child seat could be determined.

Figure 28
Type Of Child Car Seat

[d]

Qx: When the (AGE) is fastened in the child car seat, are there straps over both shoulders, a strap across only one shoulder, or are there no straps over either shoulder?
Qx: When you are driving and the (AGE) is riding in the child car seat, is he/she usually front facing or rear facing?
Base: Child at least on occasion rides in a child car seat.
Unweighted N=915

Infants who have not reached their first birthday should always ride in a rear facing position in a car seat regardless of the child’s size. Most infants who used car seats (72%) did ride in a rear facing position. But 20% rode in front facing child safety seats, with another 7% in booster seats. Front facing child safety seats predominated among one-year-olds (87%), two-year-olds (89%), three-year-olds (83%), and four-year-olds (64%). Booster seats accounted for 13% of car seat users among three-year-olds, and then nearly tripled to 35% at age 4. After age 4, booster seats became the predominant child restraint used by children although the listed percentages exaggerate the extent of booster seat use among children over 5 because the majority of children past age 5 never use any type of child seat (see page 107).

Some of the Table 3 numbers reflect the difficulties discussed on page 35 about collecting accurate data on type of child restraint. For example, the survey identified booster seat use by some infants, as well as some older children using rear facing infant seats. Thus readers are cautioned about error within the data.

Table 3
Type Of Child Car Seat By Child’s Age

Qx: When the (AGE) is fastened in the child car seat, are there straps over both shoulders, a strap across only one shoulder, or are there no straps over either shoulder?
Qx: When you are driving and the (AGE) is riding in the child car seat, is he/she usually front facing or rear facing?
Base: Child at least on occasion rides in a child car seat.

About four-fifths (82%) of children weighing less that 20 pounds who used a child seat rode in a rear facing position. A portion (8%) appeared to be using booster seats although, as mentioned earlier, at least some respondents may have made mistakes in describing the seat. Others (10%) provided information suggesting that the child usually rode front facing in a child safety seat. Front facing child safety seats predominated at 20 to 39 pounds. Children 40-60 pounds were only slightly more likely to ride in booster seats (51%) than in front facing child safety seats (46%). Children over 60 pounds were much more likely to ride in booster seats (58%) than front facing child safety seats (29%). Readers are cautioned that some respondents may have been guessing at children’s weights.

Table 4
Type Of Child Car Seat By Child's Weight

Qx: When the (AGE) is fastened in the child car seat, are there straps over both shoulders, a strap across only one shoulder, or are there no straps over either shoulder?
Qx: When you are driving and the (AGE) is riding in the child car seat, is he/she usually front facing or rear facing?
Base: Child at least on occasion rides in a child car seat.

Children should ride rear facing until at least 20 pounds and one year of age. Children who reach 20 pounds before one year of age should ride rear facing in a child safety seat recommended at a higher weight. Keeping a child rear facing as long as possible helps protect the fragile baby from spinal cord injuries. Figure 29 uses the above criteria to identify what percentage of children who should be riding rear facing (those not yet one year old; those not yet 20 pounds) actually were doing so. While most (71%) were riding in the correct rear facing position, many were not.

Figure 29
Car Seat Position Of Children Who Should Be
Riding Rear Facing

[d]

Qx: When the (AGE) is fastened in the child car seat, are there straps over both shoulders, a strap across only one shoulder, or are there no straps over either shoulder?
Qx: When you are driving and the (AGE) is riding in the child car seat, is he/she usually front facing or rear facing?
Base: Children under 1 year of age, and children under 20 pounds, who at least on occasion ride in a child car seat. Unweighted N=137

Some car seats are convertible and can be used in both a front facing and a rear facing position. Thus the same seat could be used for a child who had grown from infant (rear facing) to toddler (front facing), or could revert back to a rear facing position for an infant when an older child has outgrown the seat, or could be used for both infants and toddlers if the driver interacts with children of multiple ages. In cases where the car seat was not a booster seat, 41% of parents/caregivers reported that the seat was convertible. Among children riding in a rear facing position, 52% said the seat can be used in either a front facing or rear facing position.

Figure 30
Whether Car Seat Is Convertible
(Seats Other Than Booster Seats)

Child Presently in Either Front Facing Position, Rear Facing Position, or Not Sure (N=671)	Child Presently in Rear Facing Position (N=107)
		[d]

Qx: Can the seat be used in a front facing position only, a rear facing position only, or can it be used in either position?
Base: Child under age 9 uses a car seat that is not a booster seat.
Unweighted N's listed above.
*One percent said their child car seat only faces the front and is not convertible to face the rear, although they said their child rode in a rear-facing car seat in an earlier question.

As noted in Chapter 1, the safest seating position for a child in a motor vehicle is the back seat. The vast majority of parents/caregivers (94%) stated that the child usually sat in the back when riding in a car seat in a vehicle they were driving, most often behind the front passenger (42%), less often in the middle of the back seat (29%) or behind the driver (29%). Six percent reported that the car seat was usually placed in the front.

Figure 31
Placement Of Child’s Car Seat

[d]

Qx: When you are driving and the (AGE) rides in the child car seat, is (he/she) usually in the front seat or the back seat?
Qx: Is the child car seat usually behind the driver, behind the passenger, or in the middle of the back seat?
Base: Child under age 9 at least on occasion rides in a child car seat.
Unweighted N's listed above.
The sum of the percentages in the pie chart does not equal 100% because the numbers are rounded.

The dominant location for placement of the child car seat was the back seat of the vehicle regardless of whether the child was riding in a front facing toddler seat (96%), a rear facing infant seat (93%), or a booster seat (91%).

Figure 32
Placement Of Child’s Car Seat By Type Of Car Seat

[d]

Qx: When you are driving and the (AGE) rides in the child car seat, is (he/she) usually in the front seat or the back seat?
Base: Child under age 9 at least on occasion rides in a child car seat.
Unweighted N's listed above.

Proportionally fewer parents/caregivers permitted the child car seat to be placed in the front if there was a frontal passenger air bag installed in their primary vehicle. If there was no frontal passenger air bag in the respondent’s primary vehicle, then 11% of the parents/caregivers said that the child seat was usually in the front. If the primary vehicle had a frontal passenger air bag, then only 3% said the car seat was usually in the front.

Figure 33
Placement Of Child's Car Seat By Presence Of
Frontal Passenger Air Bag In Primary Vehicle

[d]

Qx: Does the (car/truck/van) you normally drive have an air bag?
Qx: Does that (car/truck/van) have an air bag in front of where a passenger would sit in the front seat?
Qx: When you are driving and the (AGE) rides in the child car seat, is (he/she) usually in the front seat or the back seat?
Base: Child under age 9 at least on occasion rides in a child car seat.
Unweighted N’s listed above.

Where Parents/Caregivers Believe It Is Safest To Place A Child Car Seat
Almost all parents/caregivers (99%) considered the back seat the safest location to place a child car seat in a vehicle. The 1% who thought the front seat was safest contrasts with the 6% who said that the child car seat was usually in the front seat when they drove (see page 41).

Figure 34
Where It Is Safest To Place A Child Car Seat
In The Vehicle

[d]

Qx: Where would you say it is safest to place a child car seat in the vehicle… in the front seat or in the back seat?
Base: Child under age 9 at least on occasion rides in a child car seat.
Unweighted N=915

Child Car Seats That Face Forward In Vehicles With Frontal Passenger Air Bags
Parents/caregivers were asked if they thought it was safe to place a rear facing car seat in the front seat of a vehicle having a frontal passenger air bag. The correct answer is no, because it could place the child in the air bag’s path, with the force of impact being too great for the child. Most parents/caregivers (92%) correctly said it was unsafe while 3% considered it safe. The remainder either did not know the answer to the question (4%) or else refused to answer (< 0.5%).

Figure 35
Safety Of Child In Front Seat With Frontal Passenger Air Bag When Car Seat Is Rear Facing

[d]

Qx: Some child car seats are designed so that the child faces backward, to the rear of the motor vehicle. Suppose a child is riding in a child car seat facing backward. If the vehicle has a passenger side air bag, is it safe or unsafe to have the child car seat in the front seat?
Base: Child under age 9 at least on occasion rides in a child car seat.
Unweighted N=915