A Snapshot of Child Restraint Misuse

March 26, 2013

As one of my particular research interests revolves around the proper use of child restraint systems (CRS), I wanted to share with you what we know today about CRS misuse in the United States. 

Ten years ago, a survey of CRS misuse in the US found that 72.6 percent of child restraints observed in parking areas throughout the United States had at least one “critical” misuse. Improper CRS use can include not using the appropriate CRS for the child’s age, incorrectly attaching the CRS to the vehicle, and not harnessing the child in the CRS correctly. Although the number of children restrained in child safety seats has risen due to awareness and legislation, more recent assessments of CRS use indicate that misuse is still prevalent. 

In 2011, Safe Kids USA published a summary report of 79,000 car seat checklist forms completed at community car seat inspection locations across the nation from 2009-2010. The research revealed some promising statistics: 98.8 percent of children under age 13 years arrived in the back seat, and fewer than 1 percent (0.8 percent) of children were unrestrained. However, the study also identified misuse patterns involving seat belts, lower anchors, harnesses, and top tether use.

The National Highway Traffic Safety Administration (NHTSA) recently released the National Child Restraint Use Special Study (NCRUSS), a nationally representative survey of CRS use for child passengers from birth to age 8 years completed in the summer of 2011. The study uncovered five common mistakes parents and caretakers make when installing child safety seats, and revealed that 20 percent of all drivers of child passengers do not read any instructions when installing child safety seats. A full analysis of this data from NHTSA is forthcoming. The most common errors were:

1. The wrong harness slot was used in both rear- and forward-facing restraints.
2. The retainer/chest clip was not properly positioned.
3. The child safety seat was loose.
4. The harness strap was loose.
5. The lap belt was improperly placed for a child in a booster seat or a lap and shoulder belt.

As an emergency room physician, I know that in addition to identifying the common types of misuse, we also need to understand the potential consequences of these errors. CIRP@CHOP is currently conducting research that aims to reduce child restraint misuse through analyzing more recent real-world inspection data collected from the Pennsylvania Traffic Injury Prevention Project and Safe Kids, as well as crash testing of common types of misuse conducted in collaboration with Transport Canada. We are excited to compare these findings to the previous research conducted by NHTSA and Safe Kids, and to provide recommendations and resources to educate parents and caretakers on the dangers of CRS misuse. To read more about CIRP@CHOP’s CRS-related research, click here.