Belt-positioning Booster Seats Research Articles

The Influence of a Booster Seat on the Motion of the Reclined Small Female Anthropomorphic Test Device in Low-Acceleration Far-Side Lateral Oblique Impacts.

Belt-positioning booster (BPB) seats may prevent submarining in reclined child occupants in frontal impacts. BPB-seated child volunteers showed reduced lateral displacement in reclined seating in low-acceleration lateral-oblique impacts. As submarining was particularly evident in reclined small adult female occupants, we examined if a booster seat could provide similar effects on the kinematics of the small female occupant to the ones found on the reclined child volunteers in low-acceleration far-side lateral oblique impacts. The THOR-AV-5F was seated on a vehicle seat on a sled simulating a far-side lateral-oblique impact (80 deg from frontal, maximum acceleration ∼2 g, duration ∼170 ms). Lateral and forward head and trunk displacements, trunk rotation, knee-head distance, seatbelt loads, and head acceleration were recorded. Three seatback angles (25 deg, 45 deg, 60 deg) and two booster conditions were examined. Lateral peak head and trunk displacements decreased in more severe reclined seatback angles (25-36 mm decrease compared to nominal). Forward peak head, trunk displacements, and knee-head distance were greater with the seatback reclined and no BPB. Knee-head distance increased in the severe reclined angle also with the booster seat (>40 mm compared to nominal). Seat belt peak loads increased with increased recline angle with the booster, but not without the booster seat. Booster-like solutions may be beneficial for reclined small female adult occupants to reduce head and trunk displacements in far-side lateral-oblique impacts, and knee-head distance and motion variability in severe reclined seatback angles.

Characterizing neck and spinal response in booster seated reclined children in frontal impacts

Objective Belt-positioning booster seats (BPB) and pre-pretensioner (PPT) belts may be effective in preventing injuries from submarining and head excursion in reclined children. It is unknown if injuries at the neck and spine could still occur. This study’s goal is to characterize neck and spine responses in reclined children with and without the BPB and the PPT. Methods Eleven frontal impact sled tests were performed (56 kph) with the Large Omnidirectional Child (LODC) dummy on a production vehicle seat. A 3-point simulated seat-integrated-belt was used with a load-limiter (∼4.5 kN). Testing was conducted with and without the BPB with the seatback at ∼25°, ∼45° and repeated once. One test was conducted at ∼60° with the BPB. 100 mm of belt-slack was removed to simulate PPT in two 45° BPB tests and the BPB 60° test. The LODC peak thoracic spine accelerations and angular rotations, and peak neck and lumbar force/moment loads were compared between conditions. Results Neck shear forces were the highest in the 60° BPB & PPT (−1.9 kN) and 45° noBPB (−1.3 kN) than all other BPB conditions (−0.5 to −0.8 kN). The highest peak neck moments were found in the 45° noBPB (−40.5 N-m), and in the 60° BPB & PPT (−34.2 N-m) conditions compared to all others (−20.8 to −27.9 N-m.). The 60° BPB and PPT condition demonstrated thoracic forward rotation similar to the 25° noBPB condition (25° noBPB −24.8 to −35.0 deg, 60° BPB&PPT −27.5 to −43.2 deg.). Thoracic spine peak resultant accelerations (T1, T6, T12) were higher in the 25° and 45° noBPB conditions (53 g to 71 g) and in the 60° BPB & PPT (T6: 61.8 g) compared to all other BPB conditions (48.4 g to 53.1 g). The lumbar peak shear forces and moments were the highest in the 45° noBPB (4.9 kN, −296 N-m) and the 60° BPB & PPT condition (1.7 kN, −146 N-m). Conclusion These findings show similarities in neck, spine, and lumbar responses between the 60° reclined condition with BPB and PPT and the 25° and 45° conditions without the same countermeasures. This study highlights the need for future restraint developments to protect moderate and severe reclined BPB-seated child occupants.

Airbags: Important Safety Information

Patient Education| 2021 Air Bag Safety Connected Content Translation: Seguridad asociada a la bolsa de aire: (Air Bag Safety) Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Air Bag Safety. Pediatric Patient Education 2021; 10.1542/peo_document002 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Topics: air bags An air bag can save your life. However, air bags and young children are a dangerous combination. The following information will help keep you and your children safe: The safest place for all infants and children younger than 13 years to ride is in the back seat.Never put an infant in the front seat of a car, truck, SUV, or van with a passenger air bag.All children should be properly secured in car safety seats, belt-positioning booster seats, or the lap and shoulder belts correct for their size.– All infants and toddlers should ride in a rear-facing car safety seat until they are 2 years of age or until they reach the highest weight or height allowed by their car safety seat’s manufacturer.– All children 2 years or older, or those... Copyright © 2011, American Academy of Pediatrics, All rights reserved.2011American Academy of Pediatrics You do not currently have access to this content.

Evaluation of static belt fit and belt torso contact for children on belt-positioning booster seats

Objective: Previous studies have indicated that gap between the seatbelt and torso (reduced belt torso contact) for children on belt-positioning booster seats (BPBs) may lead to less torso engagement and increased likelihood of shoulder belt slip-off during evasive vehicle maneuvers, potentially increasing injury risk during crashes. However, current BPB belt fit measures do not quantify belt gap and may not be able to fully discriminate between designs which provide good vs. poor dynamic outcomes. The goal of this study was to evaluate both novel (belt gap characteristics) and conventional measures of seatbelt fit for BPB-seated children. Methods: Ten BPBs and three seatbelt anchor locations were investigated. Fifty volunteers (4-14 years) were recruited and each evaluated on six unique combinations of BPB and seatbelt anchor location on a vehicle rear seat in a laboratory setting. A 3 D coordinate measurement system quantified positions of anatomic, seatbelt, BPB, and vehicle reference points. Novel belt gap (gap size, length, location, and percent torso contact) and conventional belt fit (position of belt on shoulder and pelvis) metrics were calculated using anatomic and seatbelt landmarks. Variation in belt fit and belt gap outcomes due to BPB, seatbelt anchor location, and anthropometry were investigated. Results: BPBs produced significantly different outcomes, while seatbelt anchor location did not. BPBs with features that directly routed the lower portion of the shoulder belt more forward on the buckle side produced the largest (29.3 ± 12.6 mm) and longest (106.9 ± 68.2 mm) belt gap on average, while BPBs that pulled the belt less forward or did not directly route the belt produced the smallest (13.9 ± 6.7 mm) and shortest (16.9 ± 33.9 mm) gap on average. Belt gap outcomes were not strongly correlated with conventional belt fit metrics, indicating that evaluation of belt gap may provide additional insight when attempting to discriminate between BPBs which provide good vs. poor seatbelt engagement during vehicle maneuvers and crashes. Conclusions: This is the first study to evaluate belt gap characteristics for BPB-seated children. Results suggest that belt fit and belt gap are influenced by BPB design, particularly lower shoulder belt routings, and may have implications for belt engagement during dynamic events.

TIPP—8 Years: Safety for Your Child

Patient Education| 2021 TIPP—8 Years: Safety for Your Child Connected Content Translation: TIPP—8 años: La seguridad de su hijo Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation TIPP—8 Years: Safety for Your Child. Pediatric Patient Education 2021; 10.1542/peo_document307_en Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Subjects: TIPP - The Injury Prevention Program Topics: bicycle safety, car seats, cardiopulmonary resuscitation, chest, child visitation, cushions, eye protection, firearms, first aid, foot Did you know that injuries are the greatest threat to the life and health of your child? Injuries are the leading cause of death of school-aged children. Yet you can prevent most injuries! At age 8, children are now taking off on their own. They look to friends for approval. They try to do daring things. They may not want to obey grown-up rules. But your child can learn safety rules with your help and reminders. Your child now goes out more without you and could drown, be hurt on a bike, or be hit by a car. And your child still can be hurt or killed while riding in a car if he or she is not buckled by a seat belt in a belt-positioning booster seat. Ask your doctor which sports are right for your child. Be... © 2019 American Academy of Pediatrics, Updated 08/2021. All rights reserved. You do not currently have access to this content.

TIPP—8 Years: Safety for Your Child

Patient Education| 2021 TIPP—8 Years: Safety for Your Child Connected Content Translation: TIPP—8 años: La seguridad de su hijo Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation TIPP—8 Years: Safety for Your Child. Pediatric Patient Education 2021; 10.1542/peo_document307 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Subjects: TIPP - The Injury Prevention Program Topics: bicycle safety, car seats, cardiopulmonary resuscitation, chest, child visitation, cushions, eye protection, firearms, first aid, foot Did you know that injuries are the greatest threat to the life and health of your child? Injuries are the leading cause of death of school-aged children. Yet you can prevent most injuries! At age 8, children are now taking off on their own. They look to friends for approval. They try to do daring things. They may not want to obey grown-up rules. But your child can learn safety rules with your help and reminders. Your child now goes out more without you and could drown, be hurt on a bike, or be hit by a car. And your child still can be hurt or killed while riding in a car if he is not buckled by a seat belt in a belt-positioning booster seat. Ask your doctor which sports are right for your child. Be sure your child... © 20192019 American Academy of Pediatrics. All rights reserved. You do not currently have access to this content.

Variations in booster seat use by child characteristics

IntroductionChild weight and height are the basis of manufacturer and best practice guidelines for child restraint system use. However, these guides do not address behavioral differences among children of similar age, weight, and height, which may result in child-induced restraint use errors. The objective of this study was to characterize child behaviors across age in relation to appropriate restraint system use during simulated drives. Methods: Fifty mother–child (4–8 years) dyads completed an installation into a driving simulator, followed by a simulated drive that was video-recorded and coded for child-induced errors. Time inappropriately restrained was measured as the total amount of the simulated drive spent in an improper or unsafe position for the restraint to be effective divided by the total drive time. Kruskal-Wallis tests were used to determine differences across age in the frequency of error events and overall time inappropriately restrained. Results: Children in harnessed seats had no observed errors during trips. Within children sitting in booster seats there were differences in time inappropriately restrained across age (p = 0.01), with 4 year-olds spending on average 67% (Median = 76%) of the drive inappropriately restrained, compared to the rest of the age categories spending less than 28% (Medians ranged from 3% to 23%). Conclusion: Some children may be physically compatible with booster seats, but not behaviorally mature enough to safely use them. More research is needed that examines how child behavior influences child passenger safety. Practical Applications: Not all children physically big enough are behaviorally ready to use belt positioning booster seats. Primary sources of information should provide caregivers with individualized guidance about when it is appropriate to transition children out of harnessed seats. Additionally, best practice guidelines should be updated to reflect what behaviors are needed from children to safely use specific types of child restraint systems.

Factors Affecting Child Injury Risk in Motor-Vehicle Crashes.

Current recommendations for restraining child occupants are based on biomechanical testing and data from national and international field studies primarily conducted prior to 2011. We hypothesized that analysis to identify factors associated with pediatric injury in motor-vehicle crashes using a national database of more recent police-reported crashes in the United States involving children under age 13 where type of child restraint system (CRS) is recorded would support previous recommendations. Weighted data were extracted from the National Automotive Sampling System General Estimates System (NASS-GES) for crash years 2010 to 2015. Injury outcomes were grouped as CO (possible and no injury) or KAB (killed, incapacitating injury, nonincapacitating injury). Restraint was characterized as optimal, suboptimal, or unrestrained based on current best practice recommendations. Analysis used survey methods to identify factors associated with injury. Factors with significant effect on pediatric injury risk include restraint type, child age, driver injury, driver alcohol use, seating position, and crash direction. Compared to children using optimal restraint, unrestrained children have 4.9 (13-year-old) to 5.6 (< 1-year-old) times higher odds of injury, while suboptimally restrained children have 1.1 (13-year-old) to 1.9 (< 1-year-old) times higher odds of injury. As indicated by the differences in odds ratios, effects of restraint type attenuate with age. Results support current best practice recommendations to use each stage of child restraint (rear-facing CRS, forward-facing harnessed CRS, belt-positioning booster seat, lap and shoulder belt) as long as possible before switching to the next step.

The common characteristics and behaviors of child occupants in motor vehicle travel

Objective: Child occupant behavior and head position when travelling in child restraint systems (CRS) may have an effect on injury risk in the event of a motor vehicle crash. The current study aimed to describe the common characteristics and behaviors of child occupants during everyday, real-world motor vehicle travel in a sample of Australian families to identify potential safety implications of observed behaviors and head position within the CRS.Methods: Two instrumented study vehicles were used by 42 families for approximately two weeks. Continuous video and audio data were collected across 1,651 trips (over 600 hours). An online survey provided additional parent, familial and child occupant data. The characteristics and behaviors of 72 child occupants (aged 14 months to 9 years) who travelled in a forward-facing CRS (FFCRS) or a belt-positioning booster seat (BS) were observed and recorded by manual review of a sample of the video/audio recordings. One quarter of all trips (n = 414) was randomly selected for coding/analysis and, within each trip, one child occupant was selected who was travelling in a FFCRS or BS. Child occupant behaviors, head position within the FFCRS or BS, and other relevant information was coded for each trip during nine discrete five second intervals or ‘epochs’ (5%, 17%, 25%, 30%, 50%, 53%, 75%, 89% and 95% of trip duration).Results: In the majority of epochs (74%), child occupants’ heads were observed to be ‘optimally’ positioned within the FFCRS or BS. For more than half of the epochs, child occupants were observed to be: correctly restrained (58%) and involved in an interaction with another vehicle occupant (59%). Bivariate analyses revealed that children travelling in a FFCRS were significantly more likely to be observed to have optimal head positions than those travelling in a BS (78% vs. 62%), χ2 (1) = 86.00, p < 0.001. Child occupants who were observed to be ‘correctly’ restrained were significantly more likely to be observed to have optimal head positions than those who were observed to be ‘incorrectly’ restrained (80% vs. 20%), χ2 (1) = 10.33, p < 0.01.Conclusions: This is the first naturalistic driving study (NDS) to specifically explore the factors associated with child occupants’ head position when travelling in a CRS. Findings from the current study can be used to inform the positioning of anthropometric test dummies (ATD) in CRS testing, guide improvements to CRS/vehicle design, and develop targeted educational strategies to improve child occupant safety.

Characterization of the motion of booster-seated children during simulated in-vehicle precrash maneuvers

Objective: Precrash occupant motion may affect head and trunk position and restraint performance in a subsequent crash, particularly for young children. Others have studied seat belt–restrained adult drivers and adult and adolescent passengers in precrash maneuvers. For younger children, optimal restraint includes a belt-positioning booster seat, which in precrash maneuvers may contribute in unique ways to the overall body motion. Therefore, the objective of this study was to quantify booster-seated child occupant kinematic, kinetic, and muscle responses during precrash maneuvers and characterize booster movement with respect to the overall occupant kinematics.Methods: Vehicle maneuver tests were conducted with a recent model year sedan at the Transportation Research Center Inc. (TRC, Marysville, Ohio). Three precrash vehicle maneuvers were simulated: Automated and manual emergency braking (AEB and MEB) and oscillatory swerving or slalom (SLA). Each maneuver was repeated twice for each participant. Seven 6- to 8-year-old booster-seated children participated in the study and all subjects were seated in the right rear seat. Vehicle dynamics (i.e., motion, position, and orientation) were measured with an inertial and Global Positioning System navigation system (Oxford RT 3003). Kinematic data from human volunteers were collected with an 8-camera 3D motion capture system (Optitrack Prime 13 200 Hz, NaturalPoint, Inc.). Photoreflective markers were placed on participants’ head and trunk. Electromyography (EMG; Trigno EMG Wireless Delsys, Inc., 2,000 Hz) sensors were placed on bilateral muscles predicted to be most likely involved in bracing behaviors.Results: Children demonstrated greater head and trunk velocity in MEB (head 123.7 ± 13.1 cm/s, trunk 77.6 ± 14.1 cm/s) compared to AEB (head 45.31 ± 11.5 cm/s, trunk 27.1 ± 5.5 cm/s; P < .001). Participants also showed greater head motion in MEB (18.9 ± 1.4 cm) vs. AEB (15.1 ± 4.8 cm) but the differences were not statistically significant (P < .1). Overall, the booster seats themselves did not move substantially (<3 cm) in the braking maneuvers. During the SLA, however, the booster seat moved laterally up to 5 cm in several subjects, contributing substantially to peak trunk (6.5–14.0 cm) and head (9.9–21.4 cm) excursion during the maneuver. Booster-seated children also exhibited a greater activation of biceps and deltoid muscles and abdominal and middle trapezii muscles than the sternocleidomastoids during these maneuvers.Conclusions: The quantification of booster seat motion and neuromuscular control and the relationship between kinematics and muscle activation in booster-seated children in precrash maneuvers provides important data on the transition between the precrash and crash phases for this young age group and may help identify opportunities for interventions that integrate active and passive safety.

Child Passenger Safety.

Child passenger safety has dramatically evolved over the past decade; however, motor vehicle crashes continue to be the leading cause of death for children 4 years and older. This policy statement provides 4 evidence-based recommendations for best practices in the choice of a child restraint system to optimize safety in passenger vehicles for children from birth through adolescence: (1) rear-facing car safety seats as long as possible; (2) forward-facing car safety seats from the time they outgrow rear-facing seats for most children through at least 4 years of age; (3) belt-positioning booster seats from the time they outgrow forward-facing seats for most children through at least 8 years of age; and (4) lap and shoulder seat belts for all who have outgrown booster seats. In addition, a fifth evidence-based recommendation is for all children younger than 13 years to ride in the rear seats of vehicles. It is important to note that every transition is associated with some decrease in protection; therefore, parents should be encouraged to delay these transitions for as long as possible. These recommendations are presented in the form of an algorithm that is intended to facilitate implementation of the recommendations by pediatricians to their patients and families and should cover most situations that pediatricians will encounter in practice. The American Academy of Pediatrics urges all pediatricians to know and promote these recommendations as part of child passenger safety anticipatory guidance at every health supervision visit.

An ecological model to factors associated with booster seat use: A population based study

Belt-positioning booster seat use (BPB) is an effective technology to prevent severe child injury in cases of car crash. However, in many countries, age-appropriate car restraint use for children aged 4–7 years old remains the lowest among all age groups. The aim of this study was to identify the main determinants of BPB use through a comprehensive approach. An ecological model was used to analyze individual, parent-child relationships, and neighborhood characteristics. Parents of children enrolled in the first and second grades completed a self-reported questionnaire (n=745). The data were subjected to multilevel modeling. The first level examined individual and parent-child relationship variables; in addition the second level tested between neighborhood variance. According to parental self- reports, 56.6% of their children had used a BPB on each car trip during the previous month. The results indicated that the determinants positively related to BPB use were individual and parental; namely, the number of children in the family, the parents' car seat belt use, parental knowledge of children's car safety principles, and a highly authoritative parenting style. Children's temperaments and parental supervision were not associated with BPB use. At the neighborhood level, a small difference was found between neighborhoods for BPB users compared to non-users.

The Large Omnidirectional Child (LODC) ATD: Biofidelity Comparison with the Hybrid III 10 Year Old.

When the Hybrid III 10-year old (HIII-10C) anthropomorphic test device (ATD) was adopted into Code of Federal Regulations (CFR) 49 Part 572 as the best available tool for evaluating large belt-positioning booster seats in Federal Motor Vehicle Safety Standard (FMVSS) No. 213, NHTSA stated that research activities would continue to improve the performance of the HIII-10C to address biofidelity concerns. A significant part of this effort has been NHTSA's in-house development of the Large Omnidirectional Child (LODC) ATD. This prototype ATD is comprised of (1) a head with pediatric mass properties, (2) a neck that produces head lag with Zaxis rotation at the atlanto-occipital joint, (3) a flexible thoracic spine, (4) multi-point thoracic deflection measurement capability, (5) skeletal anthropometry representative of a seated child, and (6) an abdomen that can directly measure belt loading. The objective of this study was to evaluate the LODC by comparing its body region and full-body responses to both standard HIII-10C responses and pediatric biomechanical data. In body region tests, the LODC (BioRank = 1.21) showed improved biofidelity over the HIII-10C (BioRank = 2.70). The LODC also exhibited kinematics more similar to pediatric PMHS kinematics in a reconstruction test. In FMVSS No. 213 tests, the LODC was observed to have lower HIC values with the absence of hard chin-to-chest contacts, indicating that chin-to-chest contact severity is mitigated in the LODC design. LODC abdomen pressures and belt penetrations discriminated between restraint conditions. These results suggest the LODC has biofidelic characteristics that make it a candidate for improved assessment of injury risk in restraint system development.

Effectiveness of Booster Seats Compared With No Restraint or Seat Belt Alone for Crash Injury Prevention

The objective was to evaluate the effectiveness of belt-positioning booster seats, compared with no restraint use and with seat belt use only, during motor vehicle crashes among U.S. children. This was a retrospective matched cohort study with data from the 1998 through 2009 National Automotive Sampling System (NASS) Crashworthiness Data System (CDS). The study sample consisted of children aged 0 to 10 years who were not seated in the front seat of the vehicle. We used Cox proportional hazards models to estimate the risk of overall, fatal, and regional body injury. Children using seat belts in belt-positioning booster seats experienced less overall injury (Injury Severity Score [ISS] > 0, adjusted risk ratio [RR] = 0.73, 95% confidence interval [CI] = 0.55 to 0.96; Abbreviated Injury Scale [AIS] score of 2 or higher, adjusted RR = 0.30, 95% CI = 0.16 to 0.58; ISS > 8, adjusted RR = 0.19, 95% CI = 0.06 to 0.56), and less injury in most body regions except the neck (adjusted RR = 4.79, 95% CI = 1.43 to 16.00) than did children with no restraint use. Children using seat belts in belt-positioning booster seats had an equal risk of injury but higher risks of neck (adjusted RR = 1.86, 95% CI = 1.02 to 3.40) and thorax (adjusted RR = 2.86, 95% CI = 1.33 to 6.15) injury than did children restrained by seat belts only. Children using belt-positioning booster seats appear to experience a higher risk of AIS > 0 injury to the neck and thorax than do children using seat belts only. Future research should examine whether the observed increase in neck and thorax injuries can be attributed to improper use of booster seats.

Boosting Restraint Norms: A Community-Delivered Campaign to Promote Booster Seat Use

Objective: The objective of this study was to evaluate the effectiveness of a theoretically grounded community-delivered marketing campaign to promote belt-positioning booster seat (BPB) use among vulnerable populations when disseminated by community members. Methods: A prospective, nonrandomized community intervention trial was conducted to evaluate the “Boosting Restraint Norms” social marketing campaign delivered by community partners in Norristown, Pennsylvania (intervention community), between October 2008 and November 2008. York, Pennsylvania, served as the comparison community. In total, 800 vehicles with 822 children aged 4 to 7 years were observed for BPB use, the primary outcome of interest, at baseline (September 2008) and at 6 months after intervention (April 2009). Results: During the study period, a 28 percent increase in the prevalence of BPB use at 6 months was observed in the intervention community with no change in the prevalence of BPB use in the comparison community. After adjustment for child age and gender, vehicle type, driver gender, and driver level, BPB use increased from 39 to 50 percent in the intervention community. Conclusions: The “Boosting Restraint Norms” social marketing campaign, distributed through community organizations combined with caregiver education and a one-time free distribution of BPBs, was effective in increasing BPB use. This study demonstrates the feasibility of utilizing community organizations with established audiences to spread the “No Regrets” messaging of the campaign in the community. This study also indicates that spreading evidence-based messages in this manner may effectively change behavior in populations that are often hard to reach. Future studies are needed in which this methodology is tested in additional communities and rural settings.

Effects of Booster Seat Laws on Injury Risk Among Children in Crashes

Objective: Belt-positioning booster seats have been shown to reduce injury risk among child passengers aged 4 to 8 in motor vehicle crashes. To encourage the use of booster seats, many states have enacted laws that require the use of either a child restraint with internal harness or a belt-positioning booster seat, but the specific age range covered by the laws varies by state. Previous studies have found evidence that booster seat laws are effective in reducing injury risk among children, but these studies primarily have included states with younger age requirements (e.g., ages 4–6) for booster seats. The objective of the present study was to examine the effectiveness of booster seat laws in several states that cover children through age 7 or 8. Methods: Police-reported crash data from 5 states—Missouri, North Carolina, Pennsylvania, Wisconsin, and Wyoming—were used to compare population-based injury rates, restraint use, and seating position among children before and after booster seat laws. The pre-law period was comprised of the 2 calendar years prior to the year of enactment of the booster seat law, and the post-law period was comprised of the 2 calendar years after the year of the effective start of the booster seat law. Effectiveness estimates were adjusted using a comparison group of children aged 9 to 12 in the same states who were not covered by the booster seat laws. Results: Among children in crashes who were affected by law changes in the 5 study states, the per capita rate of children using child safety seats (either a harnessed child restraint or booster seat) increased nearly 3 times, and the per capita rate of children riding in rear seats increased 6 percent after the booster seat laws were implemented. Booster seat laws were associated with a 5 percent reduction in the per capita rate of children who sustained injuries of any severity and a 17 percent reduction in the per capita rate of children who sustained fatal or incapacitating injuries. Conclusions: Results provide evidence that booster seat laws are effective in increasing the use of child safety seats, increasing the placement of children in rear seats, and reducing injuries, especially severe injuries, among children covered by the laws. [Supplementary materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention for the following free supplemental resource(s): Appendix – Population, counts of children injured, and injury rates per 10,000 population for each state before and after amendments strengthening child restraint laws.]

Seat Belt Misuse by a Child Transported in Belt-Positioning Booster Seat With Deadly Consequences

Child passenger safety has been a major public health victory, but there is still work to be done. This case presentation is about a 5-year-old boy who placed the shoulder portion of the lap-shoulder seat belt behind his back who was recently killed in a motor vehicle crash. This article reviews what trauma nurses need to know about the latest improvements in child passenger safety practices. Also presented are important resources for trauma nurses to share with families to improve travel safety.

Child passenger safety: protecting your patients on every trip

Motor vehicle crashes continue to be the leading cause of death and acquired disability for children < 19 years old in the United States, 1 and road traffic injuries account for more than 260,000 pediatric deaths worldwide each year.2 Fortunately, for children who are too small for adult seat belts, child safety seats (CSS), in the form of either a harness-based restraint or belt-positioning booster seat, can significantly reduce the risk of injury and death 3-5 in a crash by helping to distribute forces over hard, bony surfaces and preventing ejection from the vehicle. Substantial increases in child restraint use in the United

Effects of vehicle seat and belt geometry on belt fit for children with and without belt positioning booster seats

A laboratory study was conducted to quantify the effects of belt-positioning boosters on lap and shoulder belt fit. Postures and belt fit were measured for forty-four boys and girls ages 5–12 in four highback boosters, one backless booster, and on a vehicle seat without a booster. Belt anchorage locations were varied over a wide range. Seat cushion angle, seat back angle, and seat cushion length were varied in the no-booster conditions.All boosters produced better mean lap belt fit than was observed in the no-booster condition, but the differences among boosters were relatively large. With one midrange belt configuration, the lap belt was not fully below the anterior–superior iliac spine (ASIS) landmark on the front of the pelvis for 89% of children in one booster, and 75% of children failed to achieve that level of belt fit in another. In contrast, the lap belt was fully below the ASIS for all but two children in the best-performing booster. Child body size had a statistically significant but relatively small effect on lap belt fit. The largest children sitting without a booster had approximately the same lap belt fit as the smallest children experienced in the worst-performing booster. Increasing lap belt angle relative to horizontal produced significantly better lap belt fit in the no-booster condition, but the boosters isolated the children from the effects of lap belt angles. Reducing seat cushion length in the no-booster condition improved lap belt fit but changing cushion angle did not.Belt upper anchorage (D-ring) location had a strong effect on shoulder belt fit in conditions without shoulder belt routing from the booster. Unexpectedly, the worst average shoulder belt fit was observed in one highback booster with a poorly positioned shoulder belt routing clip. The shoulder belt was routed more outboard, on average, with a backless booster than without a booster, but raising the child also amplified the effect of D-ring location, such that children were more likely to experience poor shoulder belt fit due to outboard and forward D-ring locations when sitting on the booster. Taller children experienced more-outboard shoulder belt fit in conditions without shoulder belt routing by the booster and in the one booster with poor shoulder belt routing. Adjustable shoulder belt routing on three of the highback boosters effectively eliminated stature effects, providing approximately the same shoulder belt fit for all children. Seat back angle did not have a significant effect on shoulder belt fit.The results of this study have broad applicability toward the improvement of occupant restraints for children The data show substantial effects of booster design on belt fit, particularly the effects of alternative lap and torso belt routing approaches. The data quantify the critical importance of belt anchorage location for child belt fit, providing an important foundation for efforts to optimize belt geometry for children.

Head Impact Contact Points for Restrained Child Occupants

Objective: Head injuries are the most common injuries sustained by children in motor vehicle crashes regardless of age, restraint, and crash direction. For rear seat occupants, the interaction of the subject with the seat back and the vehicle side interior structures has been previously highlighted. In order to advance this knowledge to the development of countermeasures, a summary of vehicle components that contributed to these injuries is needed. Therefore, the objective of this study was to create a contact map of the vehicle interior for head and face injuries to rear-seated restrained children in front crashes. Methods: The Crash Injury Research and Engineering Network (CIREN) was queried for rear-seated, restrained child occupants (age 0–15 years) in forward-facing child restraints, booster seats, or lap and shoulder belts who sustained an AIS2+ head and/or face injury in a frontal motor vehicle crash. Cases were analyzed to describe injury patterns and injury causation scenarios. A contact point map was developed to summarize the vehicle components related to injury causation of the head/face injury. Results: Twenty-one cases met the combined inclusion and exclusion criteria. Seven of the child occupants were restrained in forward-facing child restraints, 2 in belt-positioning booster seats, and 12 in lap and shoulder belts. There were 28 head and 17 facial injuries. For left rear occupants, the most common contact point was the pillar in front of the occupant's seat row; that is, B-pillar for second-row occupants, indicating a leftward kinematics. For right rear occupants, due to differences in crash dynamics, the most common contact point location was the passenger's seat back, suggesting that these occupants moved predominantly forward. Conclusions: Contact points associated with head/face injury for restrained children 0 to 15 years in frontal crashes have been delineated. In a majority of the cases, the head/face injury was the most severe injury and severe injuries to other body regions were uncommon, suggesting that efforts to mitigate head injuries for these occupants would greatly improve their overall safety. The majority of the head/face contact points were to the first row seat back and B-pillar. In these frontal crashes, the importance of head/face contact with the vehicle side structure suggests that deploying a curtain air bag in frontal impacts may help manage the energy of impact. These data advance the current understanding of injury patterns and causation in frontal crashes involving restrained rear-row occupants and can be used to develop solutions to mitigate the injuries sustained.