No one would consider driving with an infant without placing the child in a car seat, yet few people think twice about letting a 7-year-old ride using only the adult seatbelt. But it is becoming clear that they should. At least 21 states have recognized this by passing laws that require booster seat usage up to a certain age, weight and height limits. New Jersey and Pennsylvania are among them, but New York is lagging behind. Now hard statistics make it difficult to deny the effectiveness of belt-positioning booster seats. A new study published in a recent issue of the Journal of the American Medical Association suggests that the risk of injury to 4- to 7-year-olds secured in belt-positioning booster seats is less than half that of children restrained only by seatbelts. The study also indicates that 4- to 7-year-olds who use only adult seatbelts are likely to sustain injuries to all body regions during a crash. In contrast, those in booster seats have a reduced chance of suffering damage to the abdomen and the neck/back/spine area — a set of injuries commonly known to pediatricians as “seatbelt syndrome.” Belt-positioning booster seats come in two varieties — backless and high-backed. Prices range from $20 to over $100, depending on type and brand. Backless versions are meant to be used only in vehicles that provide high seat backs on the rear seats. However, both types serve the same purpose: to prevent the adult seatbelt from being improperly positioned across the child’s stomach and neck. Shield-type booster seats are also available, but the American Academy of Pediatrics recommends the use of belt-positioning boosters instead. The authors of the report partnered with State Farm Insurance Company to identify car accidents that involved at least one child under the age of 15. Telephone interviews with drivers and parents, as well as crash site investigations, yielded the data, and the authors focused on a sampling of approximately 4,000 children in the 4- to 7-year-old range. A total of 1.81 percent of these children were injured in the collisions, representing 1.95 percent of those in seatbelts, and 0.77 percent of those secured in belt-positioning booster seats. Five deaths were included in the study, but none of those children was in a booster seat. The bottom line: belt-positioning boosters reduced the chance of injury by 59 percent. The authors statistically adjusted for the fact that children using seatbelts instead of boosters were more likely to be riding in the front seat and to be driven by young, less experienced drivers.
Promoting booster seat usage The report also demonstrates that booster seat usage is extremely low in the 15 states from which the data was derived. Seatbelts were used by 42 percent of 4-year-olds, 72 percent of 5-year-olds, and 89 percent of 6- and 7-year-olds. In contrast, belt-positioning booster seats were used by 16 percent of 4-year-olds, 13 percent of 5-year-olds, and 4 percent of 6- and 7-year-olds. The report shows clearly that word has not spread about the potential benefits of these safety devices. The National Highway Traffic Safety Administration (NHTSA) intends to change this. Their aim is to increase overall awareness of using proper restraints for children, and their “4 steps for kids” campaign is part of that plan. They say that parents should start a child in a rear-facing infant seat, move to a forward-facing convertible or toddler restraint after the child reaches 1 year and 20 pounds, transition to a belt-positioning booster seat at approximately 4 years old and 40 pounds, and use the booster until 8 years old or 57 inches tall. The NHTSA maintains that parents should allow children to use adult lap and shoulder belts alone (without a booster seat) only when they are big enough to sit against the vehicle seat back with their knees bent comfortably over the seat cushion. It is clear that part of the challenge of increasing booster seat usage lies with kids’ perceptions. Many resent having to ride in restraints that they consider to be “baby seats.” Unfortunately, many parents cave in to their wishes, perhaps without realizing the trade-off in safety.
New infant, toddler and booster seat ratings Encouraging parents to use the proper restraint for the age of their child is key. However, it is equally important to educate parents about the right way to install a seat in their vehicle, and how to correctly secure their child in the restraint. Loose or improperly positioned safety seats will not perform well. So the simpler a seat is to use, the more likely it is going to be effective in an accident. To help parents wade through the array of options, the NHTSA has recently posted an Ease of Use Report on child restraints (http://www.nhtsa.dot.gov/CPS/CSSRating/Index.cfm ). The report evaluates the effort required to assemble the restraint, to read the labels, to understand the instructions, to secure the child, and how easy it appears to install the seat in a car. However, it does not rate crash protection or actual installation in different types of vehicles — information that most parents would consider critical. Nevertheless, the information is a welcome complement to other resources, such as the rest of the Child Passenger Safety portion of the NHTSA website (www.nhtsa.dot.gov), which provides information about how to properly use a car seat, and where parents can have their car seat installations inspected. Consumer Reports has also recently released ratings of over 20 booster seats and LATCH (Lower Anchors and Tethers for Children)-equipped car seats. Unlike the NHTSA ratings, Consumer Reports does address the issues of safety and fit to the vehicle, as well as ease of use. The ratings are found in the Babies & Kids section of the Consumer Reports website (www.consumerreports.org) and do not require a subscription. The LATCH system allows parents to secure an infant or toddler car seat without using the vehicle seatbelt. All new vehicles manufactured after September, 2002, are required to have hardware installed in the back seat to allow attachment of LATCH seats. To test safety, Consumer Reports hired an outside lab to crash test the restraints in a simulated 30-mph head-on collision, using dummies of various sizes and weights strapped into the seats. Surprisingly, they found that some seats perform better in the crash test when the traditional vehicle seatbelt fastening system is used instead of the LATCH attachments. They also found that while the LATCH system is supposed to make installation easier for parents, that was not always the case. While both the NHTSA and Consumer Reports addressed ease of use, they did not always agree on how a seat should be rated (see sidebar). For example, the Britax Starriser Comfy booster seat, a popular choice for New York parents, was given a B for ease of use by the NHTSA, but an Excellent rating (the highest) by Consumer Reports. So, along with using the two rating systems as a guide, parents may wish to consult websites that offer feedback on products, such as babycenter.com, babiesrus.com and epinions.com to find out what other consumers have to say about a particular seat. With so many resources available, parents should find it easier than ever to protect their little passengers throughout childhood. And no doubt researchers will continue to provide evidence that car seats really do make a difference.