Children 4-8 years old who ride in booster seats are 45 percent less likely to sustain crash injuries than children restrained by vehicle safety belts alone. This is a main finding of a new analysis from the Children's Hospital of Philadelphia (CHOP) updating previous work. Results show boosters provide the biggest benefits for youngsters in side crashes. A separate observational study by the Riley Hospital for Children indicates widespread booster misuse.
CHOP examined 1998-2007 State Farm insurance claims data from crashes in 16 states and the District of Columbia. The study includes 6,591 crashes involving 4-8 year-olds in vehicle back seats who were restrained in boosters or by belts alone. Seventy percent were restrained by just belts and 30 percent were in boosters. After adjusting for potential confounding factors such as crash severities, researchers found the overall risk of injury was reduced by 45 percent when kids were in boosters compared with safety belts alone.
Kids in side crashes benefited the most. The injury risk reduction was 68 percent in near-side impacts and 82 percent in far-side impacts for kids in boosters.
Sixty-one percent of children were in highbacks while 39 percent were in backless boosters. Benefits weren't significantly different for children in either type of seat.
CHOP's earlier study found a 59 percent reduction in injury risk for children ages 4-7 in boosters compared with children using belts alone. That analysis used 1998-2002 data and focused on 4-5 year-olds who typically are smaller and the most susceptible to poor belt fit. Since then appropriate restraint use has risen threefold. CHOP's new analysis includes a greater percentage of 6-8 year-olds.
More children ride in boosters today, due in part to increasing age requirements in many states for child safety seat use. The National Highway Traffic Safety Administration reports that booster use among 4-7 year-olds was 43 percent in 2008, up from 37 percent in 2007.
Indiana's Riley Hospital for Children indicates that misuse of booster seats is a problem. Researchers observed booster use during 2006-07 at 25 sites in rural and urban areas throughout the state. In all, 2,287 children were observed, including 570 in boosters, and nearly 65 percent of the children riding in boosters had at least 1 belt misuse. The most common problem was the shoulder belt over the booster armrest (36 percent). About a third of the shoulder belt guides weren't used properly. Other problems were shoulder belts not positioned at mid-shoulder, lap or shoulder belts too loose, and a shoulder belt either behind a child's back or under an arm. Lap belts should be low on the hips, but they were improperly positioned in 14 percent of cases.