Car Seats, Booster and Seat Belt Safety Fact Sheet

Key Facts

Car Seats

Child restraints and seat belts, when installed and used properly, can prevent injuries and save lives. Motor vehicle crashes are the leading cause of death to children 3-14 in the United States. During 2009, there were a total of 33,803 fatalities. Children under 14 accounted for 1314 deaths (4%) of which 181 (14%) involved alcohol impaired driving.
Fatalities represent only the tip of the iceberg. For every fatality, approximately 18 children are hospitalized and more than 400 receive medical treatment.
All 50 states and the District of Columbia have child restraint laws. Child restraint laws require children to travel in approved child restraint devices, and some permit or require older children to use adult safety belts. The age at which belts can be used instead of child restraints differs among the states. Young children usually are covered by child restraint laws, while safety belt laws cover older children and adults.
Child restraint laws are standard for all children covered except Nebraska, Ohio, and Pennsylvania. Nebraska's law is secondary only for those children who may be in safety belts and standard for those who must be in a child restraint device. Ohio's law is secondary for children ages 4 through 14 years. In Pennsylvania, the law is secondary only for children ages 4 through 7 years who must be in booster seats.
Research on the effectiveness of child safety seats has found them to reduce fatal injury by 71% for infants younger than 1 year of age and by 54% for toddlers ages 1-4. Children ages 2-6 years old in child safety seats (including child restraints and belt positioning booster seats) are approximately 28% less likely to receive a fatal injury than those using safety belts alone.
When children ride in a rear vehicle seat they reduce their injury risk by 64% for newborns to 8 year olds and 31% for 9-12 year olds. It appears to be a norm now that young children ride in vehicle back seats as observation studies from 2008 found that 99% of infants and 92% of children 1-3 and 89% of children 4-7 ride in back seats.
During 2009, 5366 passenger vehicle occupants age 4 and younger were involved in fatal crashes. For those children where restraint use was known, 23% were unrestrained; among those who were fatally injured, 46% were unrestrained.
Restraint use for children driven by a belted driver was higher (92%) than for those with an unbelted driver (54%).
Among children under age 5 in passenger vehicles, an estimated 309 lives were saved in 2009 by restraint use. Of those 309 lives saved, 284 were associated with the use of child safety seats and 26 with the use of adult seat belts. At 100% child safety seat use for children under age 5, an estimated 372 lives (that is an additional 63) could have been saved in 2009.
In a study observing the misuse of 3,442 child restraint systems in six states, approximately 73% of seats showed at least one critical misuse.
84% of child restraints showed critical misuses. Booster seat misuse was 41%.
The most common form of misuse for all child restraints included loose safety belt attachment to the child restraint and loose harness straps securing the child to the child restraint system.
For children from birth to age 8, restraint use has increased from 15% in 1999 to over 80% in 2008.
Children are more likely to be properly restrained when the driver is properly restrained.

Booster Seats

As of February, 2011, 47 states and the District of Columbia have booster seat laws that require restraints for children who have outgrown child restraints with a harness. Three states, Florida, Arizona and South Dakota remain without a law.
The 2011 Recommendations from the American Academy of Pediatrics suggest as best practice: all children whose weight or height is above the forward- facing limit for their CSS should use a belt positioning booster seat until the vehicle lap-and-shoulder belt fits properly, typically when they have reached 4 feet 9 inches and are between 8 and 12 years of age.
Best practice found in NHTSA’s National Child Passenger Safety Certification Training Program recommends booster seat use for children who have outgrown child restraints with harnesses prior to moving into a seat belt alone.
When using a booster seat, be sure to position the lap belt low on the hips and the shoulder belt across the chest and onto the shoulder or collar bone. Adjust the shoulder belt guide to assure a proper fit. In 2009, 89% of children under 13 were restrained based on observational surveys. Ninety-eight percent of children under 1 were restrained, 96% of children from 1-3 were restrained and 87% of children from 4-7 were restrained.
Children seated in a booster seat in the rear of the car are 45% less likely to be injured in a crash as compared to those using a seat belt alone.

Seat Belts

Use the Safe Kids safety belt fit test to determine when a child is big enough to use the adult seat belt in a vehicle.

The Safety Belt Fit Test (Safe Kids Worldwide)

Have your child sit in a back seat with her bottom and back against the vehicle’s seat back. Do the child’s knees bend at the seat’s edge? If yes, go on. If not, the child must stay in a booster seat. If yes, go on. If it rests on the soft part of the stomach, the child must stay in a booster seat.

Buckle the seat belt. Does the lap belt stay low on the hips or high on the thigh? If yes, go on. If it rests on the soft part of the stomach, the child must stay in a booster seat.

Look at the shoulder belt. Does it lie on the collarbone and shoulder? If yes, go on. If it is on the face or neck, the child must remain in a booster seat. Never put the shoulder belt under the child’s arm or behind the child’s back. Do not allow children to play with the shoulder portion of a seat belt. Treat it like any cord.

Can the child maintain the correct seating position with the shoulder belt on the shoulder and the lap belt low across the hips, or high on the thighs? If yes, the child has passed the Safety Belt Fit Test. If no, the child should return to a booster seat and re-test in a month.

In 2009, the use of seat belts in passenger vehicles saved an estimated 12,713 lives. Seat belts have saved over 72,000 lives during the 5-year period from 2005 through 2009.

Seat belts generally fit a child when they are at least 4’9” tall (57 inches) between the ages of 8-12 and who weigh between 80-100 pounds. Have all children pass the Safety Belt Fit Test before moving them from a booster seat into the adult seat belt.

As children get older, their seat belt use rates tend to decline.

Adult lap and shoulder seat belts attach to the vehicle at 3 points and protect the body at 3 points- both hips and the shoulder. They provide both upper and lower body protection. The shoulder belt should never be placed under the arm or behind the back.

NHTSA recommends that if the seat belt does not fit properly, the child should use a belt positioning booster (BPB) seat.

Compared with other age groups, youths 16-24 have the lowest seat belt use rate. In 2008, 80% of teens in this age group wore seat belts. The national use rate is 83%.

Parents tend to overestimate their teen’s seat belt use rate.