Q&A: Child passenger safety

May 2011

1 How common are child passenger deaths?

Motor vehicle crashes are the leading cause of death for children age 3 and older. A total of 1,062 children younger than age 13 died in motor vehicle crashes in 2009; more than 750 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 14 deaths per million children in 2009, a 54 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 54 percent in 2009. Still, nearly 300 fatally injured child occupants were unrestrained in 2009, and others were improperly restrained.

2 Are children safer in the rear seats?

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.1 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. Fourteen states require children to sit in the rear whether or not the vehicle has a front passenger airbag, and three 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 2008 found that 99 percent of infants, 98 percent of children ages 1 to 3, and 88 percent of children ages 4 to 7 rode in back seats.2

3 How do safety belt laws apply to children?

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 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.

Details on laws in each state

4 How effective are safety belts and child safety seats for children?

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 4'9" tall and 80 pounds. The federal government estimates that adult safety belts reduce the risk of death in a crash among toddlers (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.3

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 toddlers compared with no restraint.3 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.4 Children ages 4 to 8 using belt-positioning boosters are 45 percent less likely to be injured than children using belts alone.5

The National Highway Traffic Safety Administration (NHTSA) estimates that restraint use saved the lives of 309 children younger than 5 riding in passenger vehicles in 2009. If all children younger than 5 used child safety seats, an additional 63 lives would have been saved in 2009.6

5 Which type of child safety seat should I use for my child?

The best seat for your child depends on your child's height, weight, and age.

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 small seats with a handle for easy carrying. Many snap into a base that is attached to the vehicle. Convertible seats can be used rear-facing for infants and young toddlers and then forward-facing when children are ready. Three-in-1 seats are designed to be used rear-facing, forward-facing, and as boosters as children grow.

Infant seat	Convertible seat	3-in-1

 

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 higher.

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 80 pounds.

Toddler seats are forward-facing seats with a harness for children up to 80 pounds depending on the model. Convertible seats or 3-in-1 seats can be used forward-facing. Combination seats are designed for use as forward-facing restraints and then as belt-positioning boosters once children have reached the weight limit of the harness. Built-in child safety seats are in some vehicles and vary in their weight limits. Travel vests are harnesses with adjustable straps that are tethered to vehicle seat backs and provide an alternative to forward-facing seats.

Convertible seat	Combination seat	Toddler seat	3-in-1	Built-in	Travel vests

 

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 4'9" in height 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. Some dual-use highbacks convert to backless by removing their backs. 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. Combination and 3-in-1 seats 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.

See videos about keeping children safe in crashes

See more Institute research about child restraints

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.7 The safest way for children to travel is in a booster seat restrained with a lap belt and a shoulder belt. 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 surveillance systems 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?

National observation surveys indicate that 89 percent of child passengers younger than age 13 were restrained in 2009. Ninety-eight percent of children from birth to 12 months were restrained, compared with 96 percent of children ages 1 to 3 and 87 percent of children ages 4 to 7.8

While most child passengers are restrained, they aren't always in the proper restraint for their age and size. In 2009, 77 percent of children who should have been in rear-facing restraints actually were; most of the other children were prematurely placed in forward-facing child restraints. (At the time the standards called for children to ride rear-facing only until they turned 1 and weighed at least 20 pounds.) The majority of children between 20 and 40 pounds were restrained correctly; 59 percent were in forward-facing child restraints and an additional 4 percent were in rear-facing seats. The others were in booster seats (22 percent), safety belts only (9 percent), or unrestrained (6 percent).9 Premature graduation to safety belts was common among older children. Among 4-7 year-olds, 32 percent were using belts only rather than booster seats in 2009. An additional 13 percent were unrestrained.8

8 Is it safe to purchase a used child safety seat?

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?

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.

See Status Report, Vol. 35, No. 4

10 How can I find out how to properly install my child safety seat in my vehicle?

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. LATCH stands for Lower Anchors and Tethers for Children. Child restraints have lower attachments that connect to anchors in the seat, making it easier to attach child restraints securely. For forward-facing seats, top tethers attach to anchors on the vehicle's rear shelf, on the seatback, floor, or other location. These top tethers provide an additional attachment to the vehicle seat and reduce restraint tilting during a frontal crash. 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.

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

11 When should I use the top tether with my child restraint?

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 restraints also may require 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 as many as 3 tether anchors in rear seating positions. The tether anchors 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

12 How do I use the harness correctly in a rear-facing or forward-facing child restraint?

Rear-facing seats: The harness should be routed through the slots that are at or below your infant'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 toddler'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

13 How do I know if my booster seat fits my child correctly?

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 thigh, not across the child's soft abdomen. The shoulder belt should cross snugly over the center of the shoulder.

The Institute evaluates boosters sold in the United States to see whether they provide good lap and shoulder belt fit. In September 2010 the Institute published belt fit ratings for 72 booster seat models. Twenty-one 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. Seven boosters were Good Bets and would provide good belt fit in almost as many passenger vehicles. Eight boosters were not recommended because they do not provide good belt fit.

See a complete list of booster seats and their ratings

14 Are child safety seats commonly misused?

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.9 An earlier observational study in 1997-98 by SAFE KIDS found similar results. Eighty-five percent of rear-facing and forward-facing restraints were being misused, although not all the misuses were critical. The most common misuses were loose safety belts and loose harness straps.10

Top tethers are recommended for use with all forward-facing child restraints but many parents do not use them. In a recent Institute observational study, top tethers were used in only 43 percent of forward-facing restraints. Top tether use was particularly low for older vehicles and pickups.11

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.12

15 How can I tell if my child safety seat has been recalled?

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

16 My vehicle has side airbags in the rear seat; could they injure my child?

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.

17 Can inflatable safety belts be used with child safety seats?

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 2011 Ford Explorer models. Ford has tested the inflatable safety belt with child-sized dummies, belt-positioning boosters, and child restraint installations using the belt. 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. Currently, some manufacturers prohibit the use of inflatable belts with their boosters and child restraints. In such cases, it may be appropriate to use the seats in different seating positions that don't have inflatable belts. Alternatively, some child restraints may be installed using the LATCH system to avoid using the inflatable belt.

References

¹Arbogast, 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.

²National Highway Traffic Safety Administration. 2009. Child restraint use in 2008-overall results. Report no. DOT HS-811-135. Washington, DC: US Department of Transportation.

³National Highway Traffic Safety Administration. 2009. Lives Saved FAQs. Report n. DOT HS-811-105. Washington, DC: US Department of Transportation.

⁴Elliott, 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.

⁵Arbogast, 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.

⁶National Highway Traffic Safety Administration. 2010. Traffic Safety Facts: Children. Report no. DOT HS-811-387. Washington, DC: US Department of Transportation.

⁷Kirley, 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 10:580-583.

⁸National Highway Traffic Safety Administration. 2010. The 2009 national survey of the use of booster seats. Report no. DOT HS-811-377. Washington, DC: US Department of Transportation.

⁹National Highway Traffic Safety Administration. 2004. Misuse of child restraints. Report no. DOT HS-809-671. Washington, DC: US Department of Transportation.

¹⁰Taft, 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.

¹¹Jermakian, J.S.; Wells, J.K. 2010. Observed use of tethers in forward-facing child restraint systems. Arlington, VA: Insurance Institute for Highway Safety.

¹²O'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.