Q&A: Child passenger safety
June 2013
- 1 How common are child passenger deaths?
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Motor vehicle crashes remain a leading cause of death for children. A total of 910 children younger than age 13 died in motor vehicle crashes in 2011; more than 650 of these deaths were children riding in passenger vehicles.
The number of child passenger deaths has declined by half since 1975. The rate of child passenger deaths per million children also has fallen dramatically to 12 deaths per million children in 2011, a 59 percent reduction from 1975.
Proper restraint use can help reduce deaths even more. The proportion of fatally injured children who were restrained rose from 15 percent in 1985 to 59 percent in 2011. Still, more than 200 fatally injured child occupants were unrestrained in 2011, and others were improperly restrained.
- 2 Are children safer in the rear seats?
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Yes, rear seats are safer for infants and children. Placing children in back instead of the front reduces injury risk by 64 percent for newborns to 8 year-olds and reduces the risk by 31 percent for 9 to 12 year-olds. Arbogast, K.B.; Kallan, M.J.; and Durbin, D.R. 2009. Front versus rear seat injury risk for child passengers: evaluation of newer model year vehicles. Traffic Injury Prevention 10:297-301. Children younger than 13 in the front seat, particularly infants in rear-facing child restraints, may be at risk of injury or death from an inflating front airbag. Thirteen states require children to sit in the rear whether or not the vehicle has a front passenger airbag, and four states require them to be in the rear unless the front passenger airbag is deactivated.
Largely because of these state laws and publicity campaigns, many more children now ride in back seats. Observation surveys conducted in 2011 found that 97 percent of infants, 99 percent of children ages 1 to 3 and 92 percent of children ages 4 to 7 rode in back seats. Pickrell, T.M. and Ye, T.J. 2013. Occupant restraint use in 2011: results from the National Occupant Protection Use Survey Controlled Intersection Study. Report no. DOT HS-811-697. Washington, DC: U.S. Department of Transportation.
- 3 How do safety belt laws apply to children?
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All 50 states and the District of Columbia have child safety seat laws requiring children under a certain age to travel in federally approved child restraint devices. The age at which belts can be used instead of child restraints differs by state. Young children usually are covered by child safety seat laws, while safety belt laws cover older children and adults.
Ideally, all infants and children in all motor vehicles should be covered by safety belt laws, child safety seat laws or both. But differences in the wording of state laws mean some children aren't being covered by either law. Lawmakers are eliminating these gaps by amending child safety seat and safety belt laws. All children younger than 16 in 45 states and the District of Columbia are covered by one, or both laws.
- 4 How effective are safety belts and child safety seats for children?
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Any restraint is better than none at all, but an appropriate child safety seat provides the best protection in a crash until children are large enough for adult safety belts to fit properly, usually when a child is about 4 feet 9 inches tall and 80 pounds. The federal government estimates that adult safety belts reduce the risk of death in a crash among 1-4 year-olds by 36 percent. Among rear seat occupants 5 and older, lap and shoulder belts reduce the risk of death in a crash by 44-73 percent compared with no restraint. National Highway Traffic Safety Administration. 2009. Lives Saved FAQs. Report n. DOT HS-811-105. Washington, DC: U.S. Department of Transportation.
Appropriate child safety seats provide significantly more protection in a crash than safety belts alone. Harness-based child restraints reduce fatal injuries by 58-71 percent for infants (younger than 1 year old) and by 54-59 percent for 1-4 year olds compared with no restraint. National Highway Traffic Safety Administration. 2009. Lives Saved FAQs. Report n. DOT HS-811-105. Washington, DC: U.S. Department of Transportation. Children 2-6 years old in child safety seats (including child restraints and belt-positioning booster seats) are about 28 percent less likely to be fatally injured than those using safety belts alone. Elliott, M.R.; Kallan, M.J.; Durbin, D.R.; and Winston, E.K. 2006. Effectiveness of child safety seats vs. seat belts in reducing risk for death in children in passenger vehicle crashes. Archives of Pediatric and Adolescent Medicine 160:617-21. Children ages 4 to 8 using belt-positioning boosters are 45 percent less likely to be injured than children using belts alone. Arbogast, K.B.; Jermakian, J.S.; Kallan, M.J.; and Durbin, D.R. 2009. Effectiveness of belt positioning booster seats: an updated assessment. Pediatrics 124:1281-86.
The National Highway Traffic Safety Administration (NHTSA) estimates that restraint use saved the lives of 303 children younger than 5 riding in passenger vehicles in 2010. National Highway Traffic Safety Administration. 2012. Lives saved in 2010 by restraint use and minimum drinking age laws. Report no. DOT HS-811-580. Washington, DC: U.S. Department of Transportation.
- 5 Which type of child safety seat should I use for my child?
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The best seat for your child depends on your child's height, weight and age. All children younger than 13 should ride in the rear seat.
Infants and toddlers: All children should ride rear-facing in back seats until they are 2 years of age or until they reach the height and weight limit of their child restraints.
Infant seats are rear-facing seats with a handle for easy carrying. Most snap into a base that is attached to the vehicle. Convertible seats can typically be used rear-facing for infants and young toddlers and then forward-facing when children are ready. Three-in-one seats typically are designed to be used rear-facing, forward-facing and as boosters as children grow.
When children reach the height and weight limits of their infant seats, they should be moved to convertible seats, but should continue to ride rear-facing for as long as possible. Some convertible seats have rear-facing weight limits of 40 pounds or more.
Infant seat (rear-facing only)
Convertible seat (rear-facing and foward-facing)
Three-in-one (rear-facing, forward-facing and booster)
When children reach the rear-facing height and weight limit of their child restraint, they should be turned forward-facing in a convertible or another forward-facing child restraint. They should remain in forward-facing child restraints in back seats for as long as possible. Some forward-facing seats have weight limits only up to 40 pounds but many forward-facing seats now go up to 65 and even 85 pounds.
Convertible seats or 3-in-1 seats can be used forward-facing. Combination seats typically are designed for use as forward-facing restraints and then as belt-positioning boosters once children have reached the weight limit of the harness. Travel vests are harnesses with adjustable straps that are tethered to vehicle seat backs and provide an alternative to forward-facing seats.
Convertible seat (rear-facing and forward-facing)
Combination seat (forward-facing and booster)
Three-in-one (rear-facing, forward-facing and booster)
Travel vest
Children 4-8 years old: Children should ride in harness-equipped child restraints as long as possible, up to the height and weight limit of the seats. When they have outgrown child restraints, children should use belt-positioning booster seats until adult seat belts fit properly, usually when a child reaches 4 feet 9 inches and 80 pounds. Boosters elevate children to improve the fit of the vehicle's three-point safety belts, which are designed for adults and not children.
There are highback boosters, backless boosters and built-in boosters. Highbacks have built-in guides to route shoulder belts and lap belts and can offer some head support in vehicles without head restraints in the rear seat. Backless have lap belt guides but may need a plastic clip to properly position shoulder belts in many vehicles. Some highbacks convert to backless by removing their backs. These are known as dual-use boosters.
Combination and 3-in-1 seats typically are designed to be used as boosters as children grow. In booster mode, parents remove the built-in harness and use the vehicle lap and shoulder belts to restrain their child. Some manufacturers have built-in booster seats in their vehicles.
Highback booster
Backless booster
Built-in booster
Tweens: Children should use boosters until adult seat belts fit properly. The lap belt should rest across the upper thighs, and the shoulder belt should fit snugly across the center of the shoulder. Children should be able to sit against the seatback with their knees bent at the edge of the seat. The shoulder belt should never be tucked under a child's arm or behind the back.
- 6 My vehicle has lap belts but not shoulder belts in the rear seats.
Should I use a belt-positioning booster seat for my booster-age child? -
Yes. Research by the Institute and the Children's Hospital of Philadelphia suggests lower injury risk among children restrained in belt-positioning booster seats with lap belts compared with children restrained in lap belts alone. Kirley, B.B.; Teoh, E.R.; Lund, A.K.; Arbogast, K.B.; Kallan, M.J.; and Durbin, D.R. 2009. Making the best of the worst-case scenario: should belt-positioning booster seats be used in lap-belt-only seating positions? Traffic Injury Prevention 10:580-83. The safest way for children to travel is in a booster seat restrained with a lap belt and a shoulder belt. If possible, child restraints with built-in harnesses should be used in seating positions with only lap belts. However, faced with the need to restrain a booster-age child in a lap belt-only seating position, real-world crash data from two large crash databases suggest that it is safer to place the child in a booster secured with the lap belt rather than using the lap belt alone.
- 7 Do most children ride restrained?
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National observation surveys indicate that 91 percent of child passengers younger than age 13 were restrained in 2011. Ninety-eight percent of children from birth to 12 months were restrained, compared with 96 percent of children ages 1 to 3 and 90 percent of children ages 4 to 7. National Highway Traffic Safety Administration. 2013. The 2011 national survey of the use of booster seats. Report no. DOT HS-811-718. Washington, DC: U.S. Department of Transportation.
While most child passengers are restrained, they aren't always in the proper restraint for their age and size. In 2011, 86 percent of children younger than 1, who should have been in rear-facing restraints, actually were; most of the others were prematurely placed in forward-facing child restraints. National Highway Traffic Safety Administration. 2013. The 2011 national survey of the use of booster seats. Report no. DOT HS-811-718. Washington, DC: U.S. Department of Transportation. Children should ride rear-facing until at least age 2. Among 1 to 3 year-old children, 7 percent were still in rear-facing seats, while 75 percent were in forward-facing child restraints. The others were in booster seats (12 percent), were using safety belts only (2 percent) or were unrestrained (4 percent). Premature graduation to safety belts was common among older children. Among 4-7 year-olds, 25 percent were using belts only, rather than booster seats, in 2011. An additional 10 percent were unrestrained.
- 8 Is it safe to purchase a used child safety seat?
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A new child safety seat is likely better. Used seats purchased at a garage sale or hand-me-down seats may have been recalled or damaged in a crash. If you must use a pre-owned seat, make sure it has a manufacturer label so you can check for recalls. Most manufacturers recommend that their seats not be used if they are more than 6 years old. Check with the manufacturer.
Don't purchase or use a seat with cracks in the frame, because it may have been damaged in a crash. Never use one that has missing parts.
- 9 Do child restraints need to be replaced after a crash?
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It depends on the severity of the crash. Child restraints should be replaced any time there's damage such as cracked plastic, bent metal parts, or stretched or elongated belts, but damage like this doesn't occur in most crashes. There is almost never any reason to replace a child restraint after a crash of minor or even moderate severity. Potential damage should be a concern only in more serious crashes. After a crash, a child restraint should be inspected carefully, and if there's no damage, its performance in subsequent crashes shouldn't be affected.
When the Institute subjected child restraints to successive crash tests at high speeds, most of the restraints kept their structural integrity despite minor damage. Investigations of restraint durability by the Insurance Corporation of British Columbia found no visible damage to child restraints after 50 consecutive low-speed tests; X-rays revealed no hidden damage lurking beyond the scope of visual inspection. Insurance Institute for Highway Safety. 2000. Child restraints take their punches in repeated crash tests at high speed. Status Report 35(4):1-6.
- 10 What is LATCH?
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LATCH, which stands for Lower Anchors and Tethers for Children, is a system designed to make it easier to attach child restraints to vehicles securely. Child restraints have lower attachments that can be connected to anchors in the seat, replacing the vehicle safety belt as the primary attachment to the vehicle. Top tethers attach to anchors on the vehicle's rear shelf, the seatback, floor or other location. Although the top tether is considered a component of LATCH, it should be used whenever a child restraint is installed forward-facing, whether it’s installed using the safety belt or with the lower anchors. The top tether provides an additional attachment to the vehicle seat and prevents the child from moving too far forward in a crash. LATCH has been required in passenger vehicles since model year 2003 and on child restraints manufactured beginning in 2002. In most vehicles, two rear seating positions must have lower anchors, and three must have a tether anchor.
- 11 How can I find out how to properly install my child safety seat in my vehicle?
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Consult the manual that came with your child seat and also your vehicle owner's manual for instructions on proper installation. Child restraints for infants and toddlers need to be secured to vehicle seats using either safety belts or the LATCH system. If done correctly, either type of installation will keep your child safe. Check your vehicle owner's manual to see if your vehicle has LATCH. If your vehicle or seating position is not equipped with LATCH, use the vehicle safety belts to secure the child restraint. Many vehicles have some seating positions with top tether anchors but not lower anchors. If this is the case, use the top tether plus safety belts to secure the child restraint.
Check for a secure installation by pushing and pulling the restraint where the safety belt or LATCH webbing passes through. The child restraint should not move more than 1 inch side-to-side or back-and-forth.
Finally, you can take your vehicle to a child safety seat inspection station to have a certified technician look at it to make sure it's been installed correctly.
See NHTSA child safety seat inspection station locator
Most booster seats don't attach to the vehicle seat, but people may route the safety belt incorrectly or make other mistakes. Child safety seat inspectors can make sure boosters are being used correctly and can evaluate them for proper fit.
See Institute videos and other information on the installation of child safety seats
- 12 When should I use the top tether with my child restraint?
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Top tethers should be used whenever a child restraint is installed forward-facing. Attaching the top tether achieves a more secure installation and prevents your child from moving too far forward in a crash. It is important to use the tether whether installing the child restraint with LATCH (Lower Anchors and Tethers for Children) or the vehicle safety belt. Some child restraint manufacturers also may encourage the tether when rear-facing, so it is important to review the instructions in the child restraint owner's manual.
Since 2001, all passenger vehicles are required to have tether anchors. They are typically located on the rear shelf in passenger cars or on the seatback, floor, cargo area or ceiling in minivans and SUVs. If you have an older vehicle and there is no tether anchor available, check with your dealer — tether anchors can be retrofitted in many vehicles.
See Institute videos and other information on the installation of child safety seats
- 13 Is LATCH easy to use?
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Not always. Only 21 of the 98 top-selling 2010-11 model passenger vehicles evaluated in a 2012 Institute study had LATCH designs that were easy to use. A common problem is that safety belt buckles, plastic housing or vehicle seats obscure or interfere with lower anchors. In some vehicles, lower anchors are buried deep within the back seats, so parents have to dig around in the cushions to find them. Some LATCH systems require excessive force to attach the lower connectors. Few vehicles have lower anchors in the center of the second row, even though that is the safest place for children to travel. Some minivans and SUVs don't have any lower anchors in the third row. Klinich, K.D.; Flannagan, C.A.C.; Jermakian, J.S.; McCartt, A.T.; Manary, M.A.; Moore, J.L.; and Wells, J.K. 2012. Vehicle LATCH system features associated with correct child restraint installations. Arlington, VA: Insurance Institute for Highway Safety.
If you're struggling to use LATCH, first check the vehicle and child restraint owners' manuals for directions. If you still have problems, try securing your child restraint with a safety belt plus top tether.
Consider taking your vehicle to a child safety seat inspection station to have a certified technician look at your child restraint to make sure it's been installed correctly.
See NHTSA child safety seat inspection station locator
When shopping for a new vehicle, take along your child restraint to see how it fits. Pay attention to the location of lower anchors and top tether anchors and consider where you would install a child restraint. Don't forget to plan for times when you might carpool and need to use multiple child restraints.
- 14 How do I use the harness correctly in a rear-facing or forward-facing child restraint?
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Rear-facing seats: The harness should be routed through the slots that are at or below your child’s shoulders. The harness should be snug, and the locking chest clip should be at chest/armpit level.
Harness below shoulders and chest clip at chest/armpit level
Forward-facing seats: The harness should be routed through the slots that are at or above your child's shoulders. The harness needs to be snug, and the locking chest clip needs to be at the chest/armpit level.
Harness above shoulders and clip at chest/armpit level
- 15 How do I know if my booster seat fits my child correctly?
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Boosters are supposed to improve the fit of safety belts designed for adults so that the belts are properly positioned to protect children in crashes. However, not all boosters provide good belt fit.
The lap belt should fit low across the upper thighs, not across the child's soft abdomen. The shoulder belt should cross snugly over the center of the shoulder.
Good lap belt fit
outline = arm rest removed to show belt positionPoor lap belt fit
outline = arm rest removed to show belt positionGood shoulder belt fit
Poor shoulder belt fit
Poor shoulder belt fit
The Institute evaluates boosters sold in the United States to see whether they provide good lap and shoulder belt fit. In October 2012 the Institute published belt fit ratings for 91 booster seat models. Forty-seven seats were recommended as Best Bets. These boosters should provide good belt fit for a typical 4-8 year-old in almost any passenger vehicle. Five boosters were Good Bets and would provide good belt fit in almost as many passenger vehicles. The 37 boosters in the Check Fit category may provide good fit for some children in some vehicles, but not as many as a Best Bet or Good Bet. Two boosters were not recommended because they do not provide good belt fit.
- 16 Are child safety seats commonly misused?
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Child safety seats reduce child deaths and injuries, but they can be difficult to install and are commonly misused. In 2002-03, NHTSA observed more than 5,000 children riding in vehicles and found more than 70 percent of the children were riding in child safety seats that were being critically misused — defined as a misuse that could increase the risk of injury in a crash. The most common types of misuse were loose safety belts attaching the seat to the vehicle and loose harness straps. National Highway Traffic Safety Administration. 2004. Misuse of child restraints. Report no. DOT HS-809-671. Washington, DC: U.S. Department of Transportation. An earlier observational study in 1997-98 by SAFE KIDS found similar results. Taft, C.H.; Mickalide, A.D.; and Taft, A.R. 1999. Child passengers at risk in America: A National study of car seat misuse. Washington, DC: National SAFE KIDS campaign.
Top tethers are recommended for use with all forward-facing child restraints but many parents do not use them. In an Institute observational study conducted in 2010, top tethers were used in only 43 percent of forward-facing restraints. Top tether use was particularly low for older vehicles and pickups. Jermakian, J.S. and Wells, J.K. 2011. Observed use of tethers in forward-facing child restraint systems. Injury Prevention 17: 371-74. Top tether use was higher, 56 percent, in an Institute observational survey conducted in 2012. For parents who were not using the top tether, the most common reasons drivers reported were related to insufficient knowledge, including not knowing the tether was on the child restraint (22 percent) and not knowing how to use it (15 percent). Ten percent were unsure of where to attach it in the vehicle. Eichelberger, A.H.; Decina, L.E.; Jermakian, J.S.; and McCartt, A.T. 2013. Use of top tethers with forward-facing child restraints: observations and driver interviews. Arlington, VA: Insurance Institute for Highway Safety.
Misuse of belt-positioning boosters also is common. In 2006-07, Indiana's Riley Hospital for Children found nearly 65 percent of children in boosters had at least one belt misuse. The most common error was the shoulder belt over the booster armrest (36 percent), and about a third of the shoulder belt guides weren't used properly. O'Neil, J.; Daniels, D.M.; Talty, J.L.; and Bull, M.J. 2009. Seat belt misuse among children transported in belt-positioning booster seats. Accident Analysis and Prevention 41:425-29.
- 17 How can I tell if my child safety seat has been recalled?
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It is important to register your child safety seat when you purchase it so that the manufacturer can contact you in the event of a recall. In addition, NHTSA records recalls. The list of recalls can be searched at http://www-odi.nhtsa.dot.gov/cars/problems/recalls/childseat.cfm
- 18 My vehicle has side airbags in the rear seat; could they injure my child?
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The risk of injury from a side airbag in the rear seats is extremely low for properly restrained and positioned adults or children. Children shouldn't lean against doors because the initial deployment force may be harmful.
- 19 Can inflatable safety belts be used with child safety seats?
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Inflatable safety belts are a new technology designed to better protect rear-seat occupants. When the vehicle senses a collision, the belt's airbag deploys, expanding across the occupant's body. Inflatable safety belts aim to reduce head, neck and chest injuries by deploying over the occupant's torso and shoulder, so that crash forces are distributed to over 5 times more area of the body than conventional safety belts.
The first inflatable belts have been developed by Ford and are available as an option in the second row of certain Ford and Lincoln models. Ford has tested the inflatable safety belt with child-sized dummies, belt-positioning boosters and child restraint installations using the belt and believes it is compatible with child seats. Caregivers should consult the vehicle owner's manual and the manufacturer of the child safety seat for guidance on whether an inflatable belt can be used with a particular child safety seat. Some manufacturers explicitly prohibit the use of inflatable belts with their boosters and child restraints, but not all child seat manuals address the issue. If you have any doubt about using a particular seat with an inflatable belt, use the LATCH system instead or move the seat to a seating position that doesn’t have the inflatable belt.
