Child Passenger Safety: Get the Facts

The Scope of the Problem

In the United States, motor vehicle crashes are a leading cause of death among children. In 2018, 636 children 12 years old and younger died in motor vehicle traffic crashes, and more than 97,000 were injured. Of the children 12 years old and younger who died in a crash in 2018 (for which restraint use was known), 33% were not buckled up. Parents and caregivers can make a lifesaving difference.

Risk Factors for Children & Teens

• Of the children who died in a crash:
  • In 2017, 49% of 8-12 year olds were not buckled up, compared to 36% of 4-7 year olds and 22% of children less than 4 years old (with known restraint use).⁴
  • 45% black and 46% Hispanic children were not buckled up, compared to 26% of white children (2009-2010; aged 12 and under).⁶
• From 2001 to 2010, approximately 1 in 5 child passenger (<15 years old) deaths in the U.S. involved alcohol impaired driving (BAC ≥ 0.08 g/dl); 65% of the time, it was the child’s own driver that had been drinking. ⁷
  • Most child passengers (<15 years old) of drunk drivers (61%) were not buckled up in the fatal crash.⁷
• Restraint use among young children often depends upon the driver’s seat belt use. Almost 40% of children riding with unbelted drivers were also unrestrained.⁸
• Child restraint systems are often used incorrectly. An estimated 46% of car seats and booster seats (59% of car seats and 20% of booster seats) are misused in a way that could reduce their effectiveness.^9,10

Risk Reduction for Every Age

Buckling children in age- and size-appropriate car seats, booster seats, and seat belts reduces the risk of serious and fatal injuries.

• Car seat use reduces the risk for injury in a crash by 71-82% for children, when compared with seat belt use alone.^2,15
• Booster seat use reduces the risk for serious injury by 45% for children aged 4-8, when compared with seat belt use alone.³
• For older children and adults, seat belt use reduces the risk for death and serious injury by approximately half.⁴

Preventing Motor Vehicle Injuries in Children

• Based on strong evidence of effectiveness, the Community Preventive Services Task Force recommends car seat laws and car seat distribution plus education programs to increase restraint use and decrease injuries and deaths among child passengers.¹¹
• Car seat distribution plus education programs are also recommended in a more recent review for increasing restraint use.¹²
• A study of five states that increased the age requirement to 7 or 8 years for car seat and booster seat use found that the rate of children using car seats and booster seats increased nearly three times, and the rate of children who sustained fatal or incapacitating injuries decreased by 17%.¹³

Guidelines for Parents and Caregivers

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Know the stages
Make sure children are properly buckled in a car seat, booster seat, or seat belt— whichever is appropriate for their weight, height, and age.

• Rear-facing car seat: Birth until age 2-4.
  For the best possible protection, infants and toddlers should be buckled in a rear-facing car seat in the back seat until they reach the upper weight or height limits of their seat. Check the seat owner’s manual and labels on the seat for weight and height limits.
• Forward-facing car seat: After outgrowing rear-facing seat and until at least age 5.
  When children outgrow their rear-facing seats, they should be buckled in a forward-facing car seat in the back seat until they reach the upper weight or height limit of their seat. Check the seat owner’s manual and labels on the seat for weight and height limits.
• Booster seat: After outgrowing forward-facing seat and until seat belts fit properly.
  Once children outgrow their forward-facing seat, they should be buckled in a belt-positioning booster seat until seat belts fit properly. Seat belts fit properly when the lap belt lays across the upper thighs (not the stomach) and the shoulder belt lays across the chest (not the neck). Proper seat belt fit usually occurs when children are about 4 feet 9 inches tall and 9-12 years old.
• Seat belt: Once seat belts fit properly without a booster seat.
  Children no longer need to use a booster seat once seat belts fit them properly. Seat belts fit properly when the lap belt lays across the upper thighs (not the stomach) and the shoulder belt lays across the chest (not the neck). Proper seat belt fit usually occurs when children are about 4 feet 9 inches tall and 9-12 years old. For the best possible protection, keep children properly buckled in the back seat.
• Install and use car seats & booster seats properly.
  Install and use car seats and booster seats according to the seat owner’s manual, or get help installing them from a certified Child Passenger Safety Technician.
• Find a child passenger safety technician external icon.
• Seat children in the back seat.
  Properly buckle all children aged 12 and under in the back seat.
• Don’t seat children in front of an airbag.
  Airbags can kill young children riding in the front seat. Never place a rear-facing car seat in front of an air bag.
• Seat children in the middle of the back seat.
  Properly buckle children in the middle of the back seat when possible, because it is the safest spot in the vehicle.¹⁴
• Use proper restraints on every trip.
  Buckle children in car seats, booster seats, or seat belts on every trip, no matter how short the trip is.
• Parents and caregivers: Always wear a seat belt.
  Set a good example by always using a seat belt yourself.

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References

1. Web-based Injury Statistics Query and Reporting System [online]. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). [2019 Aug 19].
2. Arbogast KB, Durbin DR, Cornejo RA, Kallan MJ, Winston FK. An evaluation of forward-facing child restraint systems. Accident Analysis and Prevention 2004;36(4):585-9.
3. Arbogast KB, Jermakian JS, Kallan MJ, Durbin DR. Effectiveness of belt positioning booster seats: an updated assessment. Pediatrics 2009;124:1281–6.
4. National Highway Traffic Safety Administration. Traffic safety facts, 2017 data: occupant protection. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration; 2019. Available at https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812719 external icon
5. Greenspan AI, Dellinger AM, Chen J. Restraint use and seating position among children less than 13 years of age: Is it still a problem? Journal of Safety Research 2010;41:183-185.
6. Sauber-Schatz EK, West BA, Bergen G. Vital Signs: Restraint Use and Motor Vehicle Occupant Death Rates Among Children Aged 0–12 Years — United States, 2002–2011. Morbidity and Mortality Weekly Report (MMWR) 2014;63(5):113-118.
7. Quinlan K, Shults RA, Rudd RA. Child passenger deaths involving alcohol-impaired driverspdf iconexternal icon. Pediatrics 2014;133(6). Advance online publication. doi:10.1542/peds.2013-2318.
8. Cody BE, Mickalide AD, Paul HP, Colella JM. Child passengers at risk in America: a national study of restraint use. Washington (DC): National SAFE KIDS Campaign; 2002.
9. Greenwall N.K., Results of the National Child Restraint Use Special Studypdf iconexternal icon. May 2015, National Highway Traffic Safety Administration: Washington, D.C. p. 66.
10. Greenwall N.K., National Child Restraint Use Special Study (Traffic Safety Facts Research Note)pdf iconexternal icon. June 2015, National Highway Traffic Safety Administration: Washington, D.C. p. 2.
11. Zaza S, Sleet DA, Thompson RS, Sosin DM, Bolen JC, Task Force on Community Preventive Services. Reviews of evidence regarding interventions to increase the use of child safety seats. American Journal of Preventive Medicine 2001;21(4S):31-47.
12. Ehiri JE, Ejere HOD, Magnussen L, Emusu D, King W, Osberg SJ. Interventions for promoting booster seat use in four to eight year olds travelling in motor vehicles. Cochrane Database of Systematic Reviews 2006;1.
13. Eichelberger AH, Chouinard AO, Jermakian JS. Effects of booster seat laws on injury risk among children in crashes. Traffic Injury Prevention 2012;13:631–9.
14. Committee on Injury, Violence, and Poison Prevention. Child passenger safety. Pediatrics 2011;127(4):788-93.
15. Zaloshnja E, Miller TR, Hendrie D. Effectiveness of child safety seats vs safety belts for children aged 2 to 3 years. Archives of Pediatrics and Adolescent Medicine 2007;161:65-8.

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