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Status Report, Vol. 38, No. 5 | June 11, 2003 Subscribe

How can child restraints be improved to save more lives?

The answer is that it won't be easy. Many fatal crashes involving child occupants are so severe that better child restraints wouldn't have prevented the deaths. These are the conclusions of a new study of nearly 100 crashes in which children riding in restraints were fatally injured. Previous research has shown that child restraints provide excellent protection, reducing fatality risk by more than 70 percent for infants and more than 50 percent for toddlers.

For the new study, researchers identified crashes from the Fatality Analysis Reporting System in which a child was fatally injured during 2001 while riding in a child restraint. Then the researchers obtained detailed police reports, often including photos from the crash sites, and attempted to determine the primary cause of the children's injuries. The idea was to get a better understanding of how child restraints are performing in fatal crashes.

"No one had really looked systematically at police reports to determine the sources of the fatal injuries," says Chris Sherwood, research scientist at the University of Virginia's Automobile Safety Laboratory and lead author of the research report. The study was conducted jointly by the Institute and the university group.

"To find opportunities to improve child restraints, we first have to find out whether they're failing and, if so, how," Sherwood adds.

Most of the children who died in the crashes (70 percent) were age 2 or younger, and they were riding in forward-facing restraints. More than 80 percent of the known fatal injuries were to the head.

Of the crashes examined, half were judged unsurvivable. Intrusion into the vehicle resulted in complete loss of survival space for the children who died. Where some space remained around a restrained child's seating position, the researchers considered additional factors.

Deaths of children riding in infant and child restraints

Characteristics of the fatal crashes


Struck or striking vehicle or object


Side impacts accounted for more deaths of restrained children than any other crash configuration. Two-thirds of the vehicles in which restrained children died were struck by heavier vehicles, including commercial trucks, SUVs, pickups, and vans.

Gross misuse of restraints — either failing to attach them to vehicles or attaching them too loosely — led to deaths in 12 percent of the cases. Ejection from restraints or contacts with other occupants or cargo accounted for another 8 percent. Twenty-nine percent of the crashes studied (16 percent side, 13 percent frontal) were judged potentially survivable, but it wasn't clear why the children didn't survive.

Two-thirds of the vehicles in which restrained children died were struck by heavy commercial vehicles, SUVs, pickup trucks, or vans. This compares with one-third of the deaths of fatally injured children who weren't in restraints.

"These findings confirm that child restraints are doing a very good job. Most deaths of properly restrained children occur in crashes so severe that there's really no room left for survival," says Susan Ferguson, Institute senior vice president for research. The severity of the crashes studied is apparent from the number of other deaths in the vehicles in which the children died. In 80 percent of the crashes that researchers deemed unsurvivable for a child, at least one other occupant also was killed. This compares with 37 percent of the crashes that researchers judged potentially survivable.

Side impacts accounted for the largest number of child deaths (40 percent). Frontal impacts accounted for another third of the deaths. Almost half of the side impacts were deemed unsurvivable, and the remainder involved at least some intrusion into the child's survival space. Only 12 percent of the fatal crashes studied were rear impacts, but 80 percent of these were considered unsurvivable due to massive intrusion into the child's survival space.

The misuse of restraints that led to some of the child deaths could have resulted from well-known installation problems. There's widespread incompatibility between child restraints and vehicle seats and between restraints and the safety belts that have been used to attach them (see "Car seat anxiety: New federal rule will make it easier to install child safety seats," Jan. 16, 1999). To reduce incompatibilities, all new restraints and vehicles are required to have a universal attachment system known as LATCH.

These requirements "are intended to increase the number of children who ride properly restrained, and increasing restraint use still is key to saving lives. It could be more difficult to find effective ways to improve the restraints," Ferguson says.

A federal standard requires child restraints to meet performance requirements in a 30 mph frontal sled test. The National Highway Traffic Safety Administration has requested comments about options for testing restraints in side impacts. Given that so many of the child deaths in potentially survivable crashes occurred in side impacts, improving the performance of restraints in such crashes "should be a priority for future upgrades to the standard. This may require time because there aren't yet any side impact test dummies representing children. Nor are there established procedures for representing the intrusion to which child restraints are exposed in severe side impacts," Ferguson points out.

Head injuries in frontal impacts potentially could be reduced by increasing the use of top tethers, which limit the distance a child travels forward in frontal crashes. This could prevent facial and head injuries from contact with seatbacks or instrument panels, but tethers aren't being widely used.

Even with LATCH, installation is tough

Institute researchers found that LATCH generally made installing child restraints easier, but it didn’t work in every vehicle with every seat.

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