Several years ago, I knew that our messages about child passenger safety were getting across to families. During a check-up, a mother asked whether it made sense to buy the new pink booster seat that her 7-year-old daughter wanted, asking me, "How much longer should she sit in a booster?"  My answer: I'm so glad she likes her booster and that you are protecting your child! She needs to be in the booster until she reaches 4 feet 9 inches in height, likely not until your petite daughter reaches 12 years of age. While adult seat belts are better than no restraint at all, booster seats position the belt across the chest and thighs so that the belt can do the best job in protecting children.

For many parents, ensuring that their 15-month-old is securely fastened into their rear-facing child safety seat or their 7-year-old is in a booster seat is part of their daily routine. It may be hard to believe, but not so long ago these actions were more often "the exception" than "the rule" when it came to child passenger safety. Since the late 1990's, there has been a remarkable increase in child restraint system (CRS) use through age 8: from 51 percent in 1999 to 80 percent in 2007 (click here to view a chart showing this progress). This has translated into a 46 percent reduction of child traffic fatalities from 2001 to 2010. This progress can be attributed to increased legislation, education, and improvements to safety technology in motor vehicles.

While the good news is that today's parents and caretakers know the importance of using a CRS to keep their children safe in motor vehicles, there is a new challenge to be tackled - ensuring that children are accurately and securely restrained in the correct CRS. In 2004, a survey completed by the National Highway Traffic Safety Administration (NHTSA) found that 72.6 percent of child restraints observed in parking areas throughout the United States had at least one "critical" misuse, this included:

  • Not using the appropriate CRS for the child's age
  • Incorrectly attaching the CRS to the vehicle,
  • Not harnessing the child in the CRS correctly

Any of these types of misuse can introduce movement (child loose in the seat or seat loose in the vehicle) that, in the event of a crash, can result in sudden jerking, impact of the child with the inside of the vehicle or worst of all, ejection from the seat. More recently, NHTSA released the National Child Restraint Use Special Study, completed in the summer of 2011. This nationally representative study of U.S. children from birth to age 8 specifically identified the five most common types of CRS installation errors. The Children's Hospital of Philadelphia (CHOP) has created a checklist for parents and caregivers that explains these errors and how to avoid them. You can access the checklist here.

Research recently published by my CHOP colleague Jessica Mirman, PhD, reveals that parents are not always able to identify when a CRS is installed incorrectly. Of the 75 experienced caregivers that participated in the study, approximately 30 percent installed it inaccurately and insecurely, yet reported confidence that the installation was correct. This may provide some insight into why the rate of CRS misuse seems so high, as parents aren't always able to identify that an error has been made.

There is action you can take now to properly restrain your child on every car trip. The first step is to ensure that your child is in the appropriate "phase" of restraint for their height and weight based on best practice recommendations from the American Academy of Pediatrics: rear-facing car seat, forward-facing car seat, belt-positioning booster seat, or lap and shoulder belt. You can find information and videos on each phase of restraint on CHOP's Car Seat Safety for Kids website here.

Use your CRS and vehicle manuals to help you with installation, and take advantage of the free educational resources available from reliable resources like Safe Kids and NHTSA. There are also free car seat inspection stations nationwide where a trained Child Passenger Safety Technician will work with you to ensure your CRS is safely and securely installed in your vehicle. Click here to locate a car seat check near you.

It's important to remember that restraining your child in a CRS, even with some unintentional misuse, will still help to protect them from serious injury in the event of a crash. Research shows that young children restrained in child safety seats have an 80 percent lower risk of fatal injury than those who are unrestrained. However, being aware of common installation errors can help you to double-check that your child is as safe as possible in their CRS.

As a researcher, pediatrician, and parent, I understand that installing a child seat can be challenging, but there are many resources to help families best protect their children. Why take the risk?

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