Use of child safety seats has surged since 1999 among restrained children younger than 9 riding in insured vehicles. Restraint types also have changed. These are the main findings of new research from the decade-long Partners for Child Passenger Safety study of the Children's Hospital of Philadelphia (CHOP) and State Farm, with support from the Association of International Automobile Manufacturers. It's based on 1998-2007 insurance claims and phone survey data on more than 875,000 kids in crashes. Overall safety seat use among restrained children 8 and younger rose to 80 percent in 2007 from 51 percent 8 years earlier.
Virtually 100 percent of restrained children 3 and younger in crashes have been in safety seats since 1999. Safety seat use is much lower among older children. Progress has been made, but there's room to improve.
In 1999 only 15 percent of restrained 4-8 year-olds in the CHOP study were in an appropriate restraint — a harness restraint or booster. By 2007 appropriate restraint use in this group had quadrupled to 63 percent. The rest of restrained 4-8 year-olds rode in adult belts alone. Typically, such belts don't begin to fit properly until kids grow to about 4 feet, 9 inches tall.
"Along with the increase in the number of kids riding in child safety seats, we can also see changes in the types of restraints they are using now versus 10 years ago," says Kristy Arbogast, director of engineering at CHOP's Center for Injury Research and Prevention, where the study was conducted. She says more restrained 4 and 5 year-olds ride in boosters now instead of harness restraints.
Only 31 percent of appropriately restrained 4-5 year-olds rode in harness restraints during 2007. Highback boosters are slightly more popular now than backless ones among restrained 4-5 year-olds. But backless boosters are used nearly 3 times as often as highbacks for 6-8 year-olds.
Previous CHOP research shows boosters lower crash injury risk by 59 percent for 4-7 year-olds compared with belts alone. Boosters elevate children so lap and shoulder belts are properly positioned. Earlier this month the Institute released evaluations of 41 booster models, finding that several don't improve belt fit (see "First booster evaluations: New ratings show which seats work best," Oct. 1, 2008).
Arbogast attributes the increase in booster use among older kids to education of parents and caregivers plus state laws requiring older kids to ride in safety seats. Laws in 43 states and the District of Columbia include booster provisions.
"More parents than ever now realize that kids need the help of a booster seat to make sure the belt fits properly across the bony parts of their lap and shoulder rather than across the soft belly or the neck, which are more prone to injury," Arbogast says.
Of the states in the study, booster seat use among 4-8 year-olds was lowest in Ohio (18 percent) and Texas (20 percent). Not surprisingly, these states don't have booster seat laws. On the other hand, 2 of the 5 states with the highest use of boosters, Pennsylvania (72 percent) and Illinois (62 percent), do require child restraints or boosters for children through age 7.
CHOP researchers found that parents aren't widely using Lower Anchors and Tethers for Children, or LATCH, which are supposed to make it easier to attach infant and child restraints securely to vehicle seats (see "Car seat anxiety," Jan. 16, 1999). LATCH has been required in new vehicles and on child restraints since 2002. However, only 43 percent of all children buckled into restraints in vehicles equipped with LATCH in 2007 were riding in seats attached to the lower anchors, the CHOP study reports.
Among the study's other findings are that 60 percent of crashes involving children occur within 10 minutes of home, and 84 percent take place within 20 minutes of home. Only 14 percent of crashes are on roads where posted speed limits are 55 mph or higher, but these crashes result in the highest rates of injury. Nearly half of all crashes involving children occur on roads with posted speed limits of 25 to 44 mph.
Although the American Academy of Pediatrics recommends that children younger than 13 ride in the back seats of vehicles, about 30 percent of all 8-12 year-olds ride in the front. Positioning children in back seats reduces the risk of fatal injuries in crashes by about one-third among kids 12 and younger (see "Kids are safer restrained in back," Nov. 29, 1997).