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Home > Research
Research
Background Despite numerous campaigns to promote the use of safety belts and car seats, and despite child occupant protection laws in every state, motor vehicle crashes continue to kill and seriously injure children at an alarming rate. Each year approximately 1,800 children ages 14 and under are killed as occupants in motor vehicles, and more than 280,000 are injured. Car seats, when correctly installed and used, are extremely effective in saving children’s lives, reducing the risk of death by as much as 71 percent for infants. However, they are complicated to install and use, making mistakes extremely common. In fact, studies have found that as many as four out of five car seats are installed or used incorrectly. Factors contributing to the difficulty of using seats correctly include a variety of age and size requirements, incompatibility between car seat and vehicle design, improper seating position and gaps in child occupant protection laws. The following study is based on data gathered through the SAFE KIDS BUCKLE UP program. It is the largest national sample to date of how car seats are misused. These misuse patterns were revealed at car seat checkups held across the nation, involving thousands of families. Methodology Child Passengers at Risk in America captures information on the restraints of more than 17,500 children who were brought to checkup events over a 17-month period from July 1997 through November 1998. Data on seat use were gathered from observation forms completed by trained child passenger safety specialists for every seat checked. This standardized survey instrument assessed up to 40 elements of correct use of child restraints, including age-appropriateness, installation in the vehicle, child’s fit in the seat and whether the seat had been recalled (and not repaired) or involved in a crash. The Campaign collected these forms from all participating coalitions and entered them into a database for analysis of the most common types of misuse found among this population. Overall Findings *Importand note: Participants were invited to bring their car seats to be checked. Therefore, the nationally estimated 40 percent of children who are not restrained are significantly underrepresented in this sample. Eighty-five percent of car seats observed at SAFE KIDS BUCKLE UP events were misused, with an average of two errors per seat. The following were the most commonly found misuses for rear-facing and forward-facing seats:
*The following egregious misuses were even more likely to result in serious injury or death in the event of a serever crash:
*Note: The Campaign believes that instances of egregious misuse are underrepresented in this study due to the self-selected nature of checkup participants. Common Misuses of Rear-Facing Car Seats Ashely's Story Study results for infant seat misuse A - Child until at least 1 year and at least 20 pounds should be rear facing, 11 percent misuse B - Harness retainer clip should be at armpit level, C - Rear-facing car seat should recline at a 45 degree angle, 30 percent misuse D - Harness straps should be at or below shoulder level, 16 percent misuse E - Harness straps should be snug,* 35 percent misuse F - Safety belt should be in locked mode, G - Safety belt should hold seat in tightly, 61 percent misuse H - Locking clip should be used according to directions, 18 percent misuse I - Locking clip should be used according to directions, 15 percent misuse SAFE KIDS collected data from 6,263 infant-only seats and rear-facing convertible seats. To learn more about proper rear facing seat fit and installation, please visit our child Car Seat Locator. Common Misuses of Forward-Facing Car Seats
A - Harness retainer clip should be at armpit level, 19 percent misuse B - Harness straps should be at or above shoulder level, 23 percent misuse C - Harness strap should be snug*, 31 percent misuse D - Safety belt should hold seat in tightly, 65 percent misuse E - Belt should be in locked mode, 14 percent misuse F - Locking clip should be used according to directions, 18 percent misuse G - Locking clip should be used according to directions, * No more than one finger should fit between the harness and the child's collarbone. SAFE KIDS collected data from 8,477 forward-facing car seats, including both convertible seats and car seats/booster seats used with a harness system. To learn more about proper forward-facing seat fit and installation, please visit our child Car Seat Locator. Common Misuses of Belt-Positioning Booster Seats
B - Safety belt should fit snugly, 6 percent misuse C - Safety belt should be routed correctly, 12 percent misuse D - Safety belt should fit over shoulder and upper thighs, 14 percent misuse SAFE KIDS collected data from 1,284 belt-positioning booster seats. To learn more about proper belt-positioning seat fit and installation, please visit our child Car Seat Locator. Findings for Shield Booster Seats
Recommendations The findings from this study clearly indicate that as a nation we have not solved the problem of child passengers at risk. However, as we enter a new century, safety technologies continue to evolve. Restraint systems for both children and adults must ensure effectiveness and ease of use. Future research must address the correlation between patterns of misuse and injury outcomes. All sectors of society have roles to play in ensuring that children are restrained correctly on every ride. Experts must educate parents on proper car seat use and continue to refer them to car seat instructions and vehicle owner’s manuals. Checkup events must be institutionalized at dealerships and other appropriate sites across America. The media must further raise pubic awareness of the dangers of riding unrestrained or improperly restrained. The government should ensure swift implementation of an independent child restraint attachment system for car seats and motor vehicles and continue its surveillance, data collection and education efforts. Car seat manufacturers should produce affordable child restraints that better meet the various size and health needs of different children, as well as restraints that fit all cars. The automotive industry must enhance vehicle safety features so that child passengers are best protected. Legislators must continue to upgrade safety belt laws from secondary to primary enforcement and close the gaps in child occupant protection laws. The law enforcement community must be given support to enforce all traffic safety laws vigorously. Working together, the risks to child passengers in America can be greatly reduced as we enter the 21st century. Related Links What is the child occupant protection law in your state? Read the SAFE KIDS report, Child Passengers At Risk: A National Rating of Child Occupant Protection Laws, to learn how your state's law compares with the model law for ensuring maximum child occupant protection. Find a SAFE KIDS coalition and SAFE KIDS BUCKLE UP Car Seat Check Up event near you by selecting your state in the tool on the right sidebar of this page. Acknowledgements The Campaign expresses its appreciation for the collaboration of the many SAFE KIDS coalitions that contributed data from more than 650 Car Seat Check Up events to make this study possible. Special thanks to General Motors Corporation for its generous support of the SAFE KIDS BUCKLE UP program, and to Evenflo Company, Inc. for its support of this study. Note: The three injury cases included in this report are those of children admitted to Children’s National Medical Center in Washington, D.C. Their cases were reviewed as part of an investigation of the injurious effects of child restraint misuse in motor vehicle collisions supported by the National Highway Traffic Safety Administration. Children’s names have been changed to protect confidentiality. Suggested citation: Taft CH, Mickalide AD, Taft AR. Child Passengers at Risk in America: A National Study of Car Seat Misuse. Washington, D.C.: National SAFE KIDS Campaign. 1999 February
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