Despite rapid rise in car booster seat use, most children not in best safety restraints

December 04, 2001

PHILADELPHIA, PA -- Researchers at The Children's Hospital of Philadelphia have seen a rapid increase in booster seat use in recent years that may indicate parents are more likely than ever before to use booster seats for older children. Despite the increase, the vast majority of children in United States are not optimally restrained.

Findings from "Trends in Booster Seat Use Among Young Children in Crashes," published in the December 2001 issue of Pediatrics, show that booster seat use among children between the ages of 4 and 8 increased 74 percent per year during the two-year study. When the study began, only 4.6 percent of children enrolled were restrained in a booster seat at the time of a crash. At the end of the study period, the percentage of children restrained in booster seats had risen to 13 percent. The 4-year-old age group saw the largest increase -- 80 percent per year, rising from 14 percent in 1998 to 34 percent in 2000.

"This rapid increase over such a short period of time indicates a heightened interest and acceptance among parents toward optimally restraining their older children, compared to low interest levels in 1998," states Dennis Durbin, M.D., M.S.C.E., author of the study and co-principal investigator of the Partners for Child Passenger Safety study. "State legislators and federal policy-makers may take notice that parents could be more receptive to booster seat legislation and other educational efforts."

Best practice recommendations from the American Academy of Pediatrics and the National Highway Traffic Safety Administration state that children should ride in a forward-facing car seat with full harness until the seat is completely outgrown according to manufacturer height and weight limits. All children who have outgrown the forward-facing car seat should be properly restrained in a belt-positioning booster seat until they have reached at least age 8 or a height of 4 foot 9 inches. Most state child occupant restraint laws are not in alignment with these recommendations with only seven states having any booster seat requirements written into their laws. They are Arkansas, California, Oregon, New Jersey, Rhode Island, South Carolina, and Washington.

The study was performed as part of the national Partners for Child Passenger Safety (PCPS) project, an ongoing, child-specific crash surveillance system involving a collaboration among Children's Hospital, State Farm Mutual Automobile Insurance Company, and the University of Pennsylvania. PCPS is the largest single research project in the world devoted exclusively to pediatric motor vehicle injury. For this specific study, researchers looked at crashes occurring between December 1998 and November 2000. The study sample represented 53,834 children between ages 2 and 8; of those, 11.5 percent were restrained in a booster seat at the time of the crash.

Overall reported restraint use (including seat belts, car seats and boosters seats) was 97 percent among children 2 to 8 years old. "That is good news, since any restraint is better than no restraint," states Dr. Durbin. "We have seen significant progress in promoting booster seat use in the last several years, but our findings indicate there is still more to do to better protect child passengers."

PCPS data show that booster seat use peaked at 30 percent at age 3, when children should still be restrained in a forward-facing car seat. Booster seat usage declined dramatically beginning at age 5, and was virtually non-existent after age 6. As of November 2000, 87 percent of the children between 4 and 8 years were still not restrained in booster seats.

Previous PCPS findings have shown that children between ages 2 and 5 who use adult seat belts are 3.5 times more likely to suffer significant injury and four times more likely to suffer significant head and brain injury when compared to the same age group who use car or booster seats ("The Danger of Premature Graduation to Seat Belts for Young Children," Pediatrics, June 2000).

In addition to identifying head and brain injuries, Dr. Durbin recently documented that 1 percent of children seeking medical attention following a car crash suffer from a pattern of intra-abdominal and spinal injuries known as seat belt syndrome, caused by adult seat belts. Dr. Durbin identified children among the ages of 3 to 9 as being at greatest risk for seat belt syndrome. ("Seat Belt Syndrome in Children," Pediatric Emergency Care, December 2001.)

Extensive promotion of key findings from the Partners study, as well as educational outreach campaigns by advocacy groups such as National Safe Kids Coalition and Boost America!, among others, have helped to spur the dramatic increases in booster seat use.

However, Dr. Durbin cautions that this study looked only at children in crashes involving State Farm-insured vehicles. In comparison to the general U.S. population, the study population may have an increased awareness of booster seats due to State Farm's own educational initiatives toward its policyholders. Thus, the 13 percent usage rate may be higher than the actual national average.
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Founded in 1855 as the nation's first pediatric hospital, The Children's Hospital of Philadelphia is ranked today as the best pediatric hospital in the nation by a comprehensive Child Magazine survey. One of the leading research facilities in the world, Children's Hospital has fostered discoveries that have benefited children worldwide through its pediatric research program, which is among the largest in the country and ranks second in National Institutes of Health funding. As a teaching hospital, Children's Hospital is responsible for training new generations of pediatric healthcare professionals. Its unique family-centered care and public service programs have brought the 381-bed hospital recognition as a leading advocate for children and adolescents from before birth through age 19.

Children's Hospital of Philadelphia

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