Skip to main content
You can also sort pages by filters.
Table of Contents
Download the Full Book

Effectiveness: 3 Star Cost: $$
Use: High
Time: Short

In addition to using a restraint, it is also important to choose a restraint appropriate for a child’s weight, height, age, and developmental stage, and to make sure the restraint is installed correctly. Research has shown high rates of misuse. The National Child Restraint Use Special Study (NCRUSS), a nationally representative survey from 2011, found 46% of car seats and booster seats had at least one major error (an error to installation or use that could reduce the effectiveness of the seat in a crash) (Greenwell, 2015). Similarly, a study of caregivers who brought their car seat to an inspection station in Los Angeles found nearly all seats had some misuse, though the definition of misuse was broader than used in NCRUSS (Bachman et al., 2016).

Both the AAP and NHTSA have recommendations for how to best protect children in vehicles (AAP, 2021; Durbin et al., 2018; NHTSA, 2019). However, research shows that some children are being transitioned to the next restraint type prematurely. For example, all children under age 1 should ride rear-facing. However, observational data from the 2021 National Survey of the Use of Booster Seats show that 7.0% of children under 1 were moved prematurely to forward-facing child restraints. Similarly, 13.2% of children 1 to 3 were not in a rear- or forward-facing child restraints but were instead in booster seats, seat belts alone, or were unrestrained (Boyle, 2023).

Booster seats are recommended until the lap/shoulder combination belt fits properly on its own, typically when a child is 8 to 12 years old or 4 feet, 9 inches or taller. However, 2021 NSUBS data show that many children are moving into the seat belt much earlier than is recommended. In 2021 some 16.1% of children 4 to 7 years old and 73.3% of children 8 to 12 years old were restrained using the seat belt alone (Boyle, 2023). However, due to differences in growth, some children may meet the requirements for seat belts or booster seats earlier than their peers. If a child has grown to meet the requirements of a booster seat or a seat belt before reaching the recommended age group, it is not necessarily misuse.

Several programs have been implemented to provide parents and other caregivers with “hands-on” assistance and education about the proper installation and use of child restraints to combat widespread misuse and prematurely transitioning to the next stage. CPS inspection stations, sometimes called “fitting stations,” are places or events where parents and caregivers can receive this assistance from certified CPS technicians. Certification courses for child safety seat checks are available through the National Child Passenger Safety Certification program.

Because CPS inspection stations are staffed by certified CPS technicians, the overall availability of CPS technicians throughout a State is an important consideration. A study conducted in Michigan compared where CPS technicians lived/worked to where the greatest needs existed, as defined by at-risk children under age 9 (Macy et al., 2016). In general, there was a reasonable match between where the CPS technicians were located and where the most at-risk children resided. In most counties, the estimated distance that families traveled from home to the nearest seat check location was less than 10 miles. However, there were still many counties that had too few Technicians to adequately meet local needs. Training new CPS technicians at underserved locations may be an important part of maintaining the effectiveness of this countermeasure.

In addition to having CPS technicians and inspection stations available to a community, it is also important that the community is aware of this resource. A study by Levi et al. (2020) examined awareness of CPS resources in a nationally representative sample of caregivers. They found that only two-thirds of respondents had heard of inspection stations and of those who were familiar with the resource, only 44% had received assistance at one. When caregivers who hadn’t been to an inspection station were asked why they hadn’t used the resource, the most common answer was that they already knew how to install their child restraint. Given that other research has shown caregivers to be overconfident in their abilities to correctly install and use child restraints (Benedick et al., 2020), this suggests a need to conduct better outreach to caregivers who are not actively seeking out assistance from CPS technicians.


Child restraint inspection stations have become common components of State and local CPS programs. As of 2021 there are about 5,000 inspection stations registered with NHTSA.


One study found that Safe Kids Worldwide-sponsored child restraint inspection events held at car dealerships, hospitals, retail outlets and other community locations positively changed parents’ behavior and increased their knowledge over a 6-week follow-up period: Children arriving at the second event were restrained more safely and more appropriately than they were at the first (Dukehart et al., 2007). Another small study found that attending inspection stations may be more effective for increasing restraint use in children older than 4 (Kroeker et al., 2015). Specifically, children in this age range were more likely to depart the inspection in a restraint configuration that was appropriate for their size and weight than prior to the inspection. Inspection stations were included in a multifaceted program to increase child restraint use in five tribal communities. At inspection stations, child restraint seats were checked, replaced, and re-installed if needed, and new seats were provided to caregivers that did not have them. Although the specific contribution of the inspection stations was not assessed, the full program resulted in four of the five tribes exceeding their overall restraint-use goals—some by a substantial margin.

Another study evaluated whether a “hands-on” educational intervention makes a difference in whether or not parents correctly use their child restraints. All study participants received a free child restraint and education, but the experimental group also received a hands-on demonstration of correct installation and use of the child restraint in their own vehicles. Parents who received this demonstration were also required to demonstrate in return that they could correctly install the restraint. Follow-up observations found that the intervention group was four times more likely to correctly use their child restraints than was the control group (Tessier, 2010).

An evaluation of the child restraint fitting station network in New South Wales, Australia, found that children whose parents attended fitting stations were significantly more likely to be properly restrained than children whose parents had not visited fitting stations (Brown et al., 2011). While specific to Australia, these results suggest similar benefits are possible in the United States. In fact, a U.S. study found that parents and caregivers who were initially taught how to install a child restraint by a CPS technician were more likely to achieve an accurate installation than those that initially learned from other sources, typically the manufacturer’s manual (Mirman et al., 2017).

With an increase in digital technologies and more widespread internet access, program managers are considering different approaches to reach caregivers. A small study in Florida provided parents with a phone app to interact directly with a CPS technician located elsewhere, to receive help installing child seats (Schwebel et al., 2017). The results indicated that the accuracy of installations improved significantly compared to the installation prior to the instruction, and that parents felt more confident about the installation.

Kuroiwa et al. (2018) investigated two educational approaches (traditional lecture/instruction versus brief lesson/video) aimed at increasing caregiver knowledge and car seat installation accuracy. Caregivers of children from birth to 3 were randomized into one of two educational programs, and CPS knowledge and car seat installation accuracy were assessed before and after the class. While the traditional group had a larger increase in knowledge, both groups performed equally when demonstrating car seat installations following the class. In the pre-period only 17% of caregivers in the traditional group and 16% of caregivers in the video group had their car seats installed correctly. Following the educational intervention this increased to 52% and 50%. While a notable improvement, it is important to note that approximately 50% of participants still made at least one error when installing their car seat. The study demonstrated that the video format produced similar installation outcomes as the traditional class. This class format could be both cost- and time-efficient when compared to the traditional class.


Program costs will depend on the size of the target audience, the components of the program, and the level of services offered. For example, permanent inspection stations listed on NHTSA’s locator must have a currently certified CPS technician on site during the posted hours. Costs for maintaining the service includes personnel costs as well as operational expenses.

Time to implement:

Complete programs typically require several months to plan and implement.