More infants and toddlers being positioned correctly in car safety seats

September 15, 2017

CHICAGO - New research shows that overall, child passenger safety education programs are a success, with more infants and toddlers riding in the rear-facing position than ever before.

The study abstract, "Trends in Child Passenger Safety Practices in Indiana From 2009-2015," will be presented Monday, Sept. 18 at the American Academy of Pediatrics National Conference & Exhibition in Chicago.

For the study, researchers observed 7,725 children 15 years and younger in motor vehicles at 25 different locations throughout Indiana between 2009 and 2015, noting the type, position and location of the child safety seats.

The AAP recommends children be placed in rear-facing safety seats until at least age 2. In the study, researchers noted that for infants, rear-facing seat placement increased from 84 percent in 2009 to 91 percent in 2015. For toddlers age 12-17 months, rear-facing increased from 12 percent to 61 percent during that time.

However, among children 4-7-year-old children, booster seat use decreased from 72 percent to 65 percent. The AAP recommends children use booster seats until at least 8 years of age.

"This study shows that child passenger safety education has been a success in making sure young children are positioned correctly in the car, but there is still room for improvement." said lead researcher Joseph O'Neil, MD, MPH, FAAP, medical director of the Automotive Safety Program at Riley Hospital for Children, Indiana University Health.

Overall, the research shows an improvement in child passenger safety practices among Indiana drivers, O'Neil said. Educational campaigns to improve child passenger safety could focus on the gaps identified by the study, including the recommendation to keep children rear-facing in safety seats through age 24 months, to use booster seats through age 8, and the recommendation that children sit in the back seat through age 13.
O'Neil will present the abstract, available below, on Monday, Sept.18, from 3:10 p.m. to 3:18 p.m. CT in McCormick Place West, Room S106.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.

The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit

Abstract Title: Trends in child passenger safety practices in Indiana from 2009-2015

Objective: This study reviews trends in rear facing direction, top tether use, booster seat use and seating position for children 12 years or younger among motor vehicle passengers in Indiana. Methods: This is an observational, cross-sectional survey of drivers transporting children 15 years and younger collected at 25 convenience locations randomly selected in Indiana during summers 2009-2015. Observations were conducted by Certified Child Passenger Safety Technicians (CPST). ). As the driver completed a written survey collecting demographic data on the driver, the CPST recorded the child demographic data, vehicle seating location, the type of restraint, direction the car safety seat (CSS) was facing, and use of the CSS harness or safety belt as appropriate. Data was analyzed for infants and toddlers younger than 24 months, children in forward facing CSS, booster seat use, and seating position for children 12 years or younger. Results and conclusions: During the study period, 4,876 drivers were queried, and 7,725 children 15 years and younger were observed in motor vehicles. Between 2009 and 2015, 1,115 infants and toddlers (age birth to 23 months) were observed in motor vehicles. For infants rear facing increased from 84% to 91%. During the study years the greatest increase in rear facing was for toddlers age 12-17 months (12-61%). Rear-facing from 18-23 months did not significantly change. Of the 1,653 vehicles observed with a forward facing car seat, using either the seat belt system or lower anchors an average of 27% had the top tether attached. For installations of forward facing seats using the lower anchor, 66% employed the top tether. Among children 4-7 years observed booster seat use decreased from 72% to 65% during the observation period. Finally, for vehicle seating position, in our sample, more than 85% children 12 years or younger were seated in a rear seat vehicle position. Unfortunately, 31% of 8-12 year old children were observed in the front seat. Overall, these trends demonstrate an improvement in child passenger safety practices among Indiana drivers. However, this study illuminates areas to improve child passenger safety such as rear-facing for toddlers 18 to 23 months, increasing top tether use, booster seat use, and an emphasis on rear seat position for children 8 to 12 years. This information can be used by primary care providers and child passenger safety technicians and other child passenger safety advocates to develop counseling points and targeted educational campaigns.

American Academy of Pediatrics

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