Booster Seat Research Articles

The perspectives of young people on barriers to and facilitators of bicycle helmet and booster seat use.

Mandatory bicycle helmet and booster seat laws for children are now common across Canada and the United States. Previous research has found that despite legislation, child compliance is often low. Our objectives were to identify and compare children's perspectives on barriers to and facilitators of their use of bicycle helmets and booster seats. Eleven focus groups were conducted with a total of 76 children; five groups of children between the ages of 4 and 8 years discussed booster seats and bicycle helmets, and six groups of children between the ages of 9 and 13 years discussed bicycle helmets. Efforts were made to include diverse participants from a variety of ethno-cultural and socioeconomic backgrounds. Poor fit and physical discomfort were most often described as barriers to bicycle helmet use. Helmet appearance was a barrier for some children but acted as a facilitator for others. Booster seat facilitators included convenient features such as drink cup holders and being able to sit higher up in order to have a better view, while barriers included fear of being teased, and wanting to feel and be seen as more mature by wearing a seatbelt only. The main barriers to usage of bicycle helmets and booster seats identified by young people were modifiable and fit within a theory of planned behaviour framework that includes subjective norms, child attitudes towards safety equipment and perceived behavioural control of its usage. Recommendations were made regarding how these elements can be utilized in future injury prevention campaigns.

Child passenger safety education in the emergency department: teen driving, car seats, booster seats, and more

BackgroundThe leading cause of death in children less than 19 years old is motor vehicle crashes (MVC). Non-use or improper use of motor vehicle car seats significantly adds to the morbidity and mortality. Emergency department (ED) encounters provide an opportunity for caregiver education. Our objective was to determine the effect of an educational intervention on knowledge and counseling behaviors of pediatric ED nurses regarding child passenger safety (CPS).MethodsA pre/post educational intervention study was conducted with nursing staff in an urban ED. Responses to CPS related knowledge and counseling behaviors were collected using surveys administered before and after the intervention. The ED nurse education intervention was a one-hour lecture based on the American Academy of Pediatrics (AAP) CPS guidelines and Alabama state law regarding ages for each car seat type and teen driving risky behaviors. Individual data from pre and post surveys were matched, and nominal variables in pre-post matched pairs were analyzed using McNemar’s test. To compare categorical variables within pre or post test data, we used the Chi-square test.ResultsPretests were administered to 83/110 ED nurses; 64 nurses received the educational intervention and posttest. On the pretests, nurses reported “never” or “occasionally” counseling about CPS for the following: 56% car seats, 62% booster seat, 56% teen driving, 32% seat belts. When comparing the pretest CPS knowledge between nurses working 0-1 year vs. ≥ 2 years there was no statistically significant difference. Two CPS knowledge questions did not show significance due to a high correct baseline knowledge rate (> 98%), including baseline knowledge of MVC being the leading cause of death. Of the remaining 7 knowledge questions, 5 questions showed statistically significant improvement in knowledge: age when children can sit in front seat, state GDL law details, seat belt state law for back seat riders, age for booster seat, and rear facing car seat age. All four counseling behavior questions showed increases in intent to counsel families; however, only intent to counsel regarding teen driving reached statistical significance.ConclusionsEducational efforts improved pediatric ED nursing knowledge regarding CPS. Intent to counsel was also improved following the education.

Booster seats: new committee chairs and legislative effectiveness

ABSTRACT Recent years have seen increased attention to legislative capacity and performance, including the development of individual Legislative Effectiveness (LE) scores for the US Congress. In comparing new committee chairs' scores to their scores prior to becoming chair I find significant variation in the ‘boost’ that committees impart to their chairs' LE, including several committees that do not significantly boost their chairs' LE scores at all. This study advances an organisational explanation for legislative effectiveness (at least as measured by LE scores) in contrast to previous work that emphasises member-level characteristics. Variation in committee tasks, roles, and member turnover significantly affect a committee chair's LE boost, often moreso than individual characteristics or shifts in party status. The LE boost a committee chair receives does not endure but disappears once the member is no longer chair, which challenges our understanding of the connections between experience, learning, and skill in the legislative process.

0989 Examining The Role Of Toddler Sleep Quality On Wake EEG And Language Ability

Abstract Introduction Sleep and the development of language are prominent concerns of many parents and until recently, many have examined these concerns tangentially. Children with developmental delays/disabilities have shown to have impaired sleep and poor sleep quality, and impairments or changes in sleep quality may play a prominent role in the acquisition of language and neuronal oscillatory patterns. This study examines the role of child sleep quality paired with a normed measure of language and wake electroencephalography (EEG). Examining the role of child sleep quality with language ability and wake EEG may provide nascent incremental utility to understanding the influences of sleep on healthy development. Methods Data from 109 toddlers (age range 24 to 30.5 m, M = 26.83 ± 1.58 m, 52% male) from the Brief Infant Sleep Questionnaire (BISQ), Mullen Scales of Early Learning (MSEL), and continuous EEG were collected and analyzed. EEG was recorded (32 electrode cap BioSemi) while toddlers sat in a booster seat and watched a silent video. Data were analyzed in RStudio and Matlab to examine toddler’s sleep quality (infant sleep and parent behaviors) and relations with the MSEL and EEG (controlling for child age and gender). Results Means and standard deviations appeared within expected limits based on the range of each variable. Toddlers with slow-developing language were associated with relatively poor sleep quality, explaining 9.75% of the variance. We find preliminary evidence to suggest a potential sleep disruption around the time when a child is undergoing a rapid expansion in their vocabulary (expressive language). Toddler’s sleep quality and language acquisition were also correlated with wake EEG (alpha and beta). Conclusion Sleep is regarded as an essential component supporting the myriad changes observed in early development. Sleep quality fundamentally influences healthy development across domains. Here, we showed child sleep quality is highly associated with toddler’s language ability, and wake EEG, providing new insights into the developing brain. Support National Institutes of Health R01DC016273, R01MH107652-03S1, and Johnson & Johnson Consumer Inc., Skillman, NJ, USA.

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.

A comparison of parent and child perspectives about barriers to and facilitators of bicycle helmet and booster seat use

To date, little work has compared similarities and differences between parent and young people’s perceptions of barriers to and facilitators of bicycle helmet and booster seat usage. Our goal was to conduct such a comparison in order to inform future safety campaigns. Eleven focus groups with a total of 68 parents and 11 focus groups with a total of 76 young people were conducted. Recruitment was conducted and focus groups were held in diverse neighbourhoods to facilitate participation by families from a variety of cultural, linguistic, and socioeconomic backgrounds. Overall, parents and their children agreed on 50% of the barriers identified for bicycle helmet use and approximately 40% of the barriers for booster seats. Barriers common to both types of equipment for parents and children included comfort, style and design, and fear of teasing. Common facilitators included perceived safety, and comfort. While there was considerable overlap between the perspectives of parents and young people, there were also differences, underscoring the importance of addressing both perspectives. The barriers and facilitators identified were modifiable to a large extent; based on these, recommendations for future injury prevention campaigns were outlined.

Influence of child restraint system design features on comfort, belt fit and posture

ObjectiveThis study examined the relationship between restraint design features and comfort, posture and seat belt position of children in booster seats during a driving trial. The relationship between comfort and errors introduced by a child throughout a trip were also explored. MethodFifteen children were recruited in this study. Due to technical issues affecting video capture of three participants, the comfort, belt fit, errors and posture of twelve Australian children aged 4–8 years were analysed during two, one hour on-road drives in an instrumented study vehicle fitted with in-vehicle video monitoring equipment. Each child sat in two different types of booster seats, which varied markedly in design. Restraint 1 featured an adjustable headrest, sash belt guide and side wings, whilst Restraint 2 had a longer cushion length (R1: 29 cm, R2: 34 cm), no sash belt guide or side wings. Three five-minute video segments were analysed per seating condition; at the beginning, middle and end of the trip. The Discomfort Avoidance Behaviour (DAB) rate, DAB time, errors and average participant trip time observed in shoulder belt, sagittal torso and head positions were quantified. ResultsThe average DAB rate was higher in R2 than R1 (R2 = 2.79 vs. R1 = 1.85, p = 0.009) and the average number of errors across time points was greater in R2 than R1 (R2 = 0.81 vs. R1 = 0.38, p = 0.01). The DAB rate was associated with increases in the number of child induced errors (log (errors in use) = −2.07 + 0.57 × DAB, p < 0.0001). Whilst both seating conditions most commonly displayed mid-shoulder belt position, a greater proportion of time was observed in R1 than R2 (R1 = 74% vs. R2 = 50%, p = 0.020). On average, children in R2 spent more time with the sash belt contacting the neck (R2 = 36% vs. R1 = 15%, p = 0.038). In R2, a greater proportion of trip time was spent with the head against the head rest (R2 = 48% vs. R1 = 25%, p = 0.005), whilst a greater proportion of trip time in R1 was observed with the head upright relative to the torso (R1 = 71% vs. R2 = 45%, p = 0.002). Children in R2 spent a greater proportion of time with their back and shoulders against the backrest (R2 = 79% vs. R1 = 61%, p = 0.003), whilst more time was spent by children in R1 with their entire back but not shoulders against the backrest (R1 = 36% vs. R2 = 16%, p = 0.001). ConclusionsThe design of a restraint and its influence on comfort, errors, shoulder belt fit and posture may provide an effective avenue to enhance the correct use of child restraints throughout a trip.

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.

Comparative Analysis of Child Restraint Systems Safety Parameters in Relation to the New Regulation No. 129 of the Economic Commission for Europe of the United Nations (UN/ECE)

This study presents a comparison of the common Child Restraint Systems (CRS) which reduces the value of dynamic loads affecting the child’s body during car accidents. The analyzed systems were: child seats, booster seats, and straps—adjustable vehicle seat belts adapted to children’s stature. The effectiveness of the analyzed devices was assessed on the basis of experimental tests carried out in the accredited laboratory approving the Child Restraint Systems. The tests were carried out in accordance with the new Regulation No. 129 UN/ECE. The authors examined whether the tested devices meet the guidelines of the new Regulations No. 129 despite approval in accordance with Regulation No. 44. Based on the research results, better safety parameters of some new solutions dedicated to children’s safety could be observed. Almost all the selected CRS met requirements stated in Regulation No. 129. The only exception was for abdominal pressure in one of the tested devices. Head Resultant Acceleration in tested devices was 14.7–39.0% less than the limit determined in Regulation No. 129 whereas Chest Resultant Acceleration was 17.4–37.6% less. Abdominal pressure was 46.4–81.4% beneath the limit (apart from one case which did not meet the requirements). The HPC parameter (Head Performance Criterion) was 45.4–74.5% less. The final results show that there are still some possibilities for improving the safety of young vehicle passengers.

Frontal Crash Injury Metrics Are Below Mandated Limits for a Spica Casted Child Dummy in Currently Available Restraints.

There is a paucity of data defining safe transport protocols for children treated with hip spica casting. Although restraint devices for casted children are available, all federally mandated testing uses a noncasted anthropomorphic test device (ATD or crash dummy). The purpose of this study was to evaluate current restraint options in simulated frontal crash testing using a casted pediatric ATD to determine injury risk to the head, cervical spine, chest, and pelvis. Using a 3-year-old ATD, dynamic crash sled tests simulating frontal crash were performed in accordance with government safety standards. The ATD was casted in a double-leg spica and the following restraint devices were tested: a seat designed for spica casted children, a restraint vest-harness, a traditional booster seat, and 2 traditional forward-facing car seats. Although the presence of the cast increased many of the injury metrics measured, all seats passed current federal guidelines for the head and chest. No single seat performed best in all metrics. The greatest magnitude of neck loading and second-highest head injury criterion values were observed for the booster seat. The vest-harness produced the highest head injury criterion and the chest compression exceeded proposed federal limits. The results suggest safe transport in commercially available seats is possible with the child properly restrained in a correctly fitting seat. However, parents should not assume a child restraint system is appropriate for use just based on fit as, for example, seats with harnesses outperformed an easy to fit booster seat. Each child and the position of the child's cast are unique and discharge planning involves consideration of safe transportation. Although this study suggests several seats used to transport spica casted children pass the federal head and chest injury prevention requirements, it is important to recognize that some children may still require emergency vehicle transport.

Safe Transport of Spica Casted Children in Passenger Vehicles is Possible: A Frontal Crash Test Analysis of Child Restraint Systems Using Spica Casted Crash Test Dummies

Purpose: There is a paucity of data defining safe transport protocols for children treated with hip spica casting. No current restraint device has been tested using casted anthropomorphic test devices (ATDs). Our goal was to evaluate current restraint options in simulated frontal crash testing using a casted pediatric ATD.&#x0D; Methods: Using an ATD simulating a 3-year-old child, dynamic crash sled tests simulating a frontal crash were performed in accordance with Federal Motor Vehicle Safety Standards 213 (FMVSS 213). Sensors within the ATD recorded: HIC36 (Head Injury Criterion score; predictive of skull fracture), neck injury assessment (Nij), chest compression, chest acceleration, and pelvic injury assessment. Test crash video visual assessment was performed (Figures 1&amp;2). The ATD was casted in a double-leg spica. Five restraint devices were tested: seat designed for spica-casted children (Merrit Wallenberg), modified restraint harness (Modified EZ-On-Vest), commercially available booster seat (Britax Parkway SGL Booster), and two commercially available forward-facing car seats able to accommodate the casted ATD (Diono Radian R100, Graco Nautilus 65 LX). One test was performed for each restraint system. All tests were performed at 30 MPH on a deceleration sled.&#x0D; Results: Although the presence of the cast increased many of the injury metrics measured, all 5 seats that were tested passed current FMVSS 213 federal guidelines for the head and chest. However, there were marked differences between the 5 restraint options (Figures 3-5). No single seat performed best in all metrics. Additionally, visual analysis of the video from the test crash of the EZ-On-Vest demonstrated that the face and upper extremities of the ATD are impacted during the crash. The ATD does not have a way to record injury to the extremities, thus this is not captured in the quantitative data.&#x0D; Conclusions: Per the FMVSS 213 standard, these results suggest safe transport in the five evaluated restraint systems is possible with the child properly fitted and restrained. However, the Nautilus and Diono were found to have both the lowest HIC36 and chest acceleration values, suggesting casted children may not need specially designed seats. Additionally, review of the video of the EZ-On Vest appears to demonstrate that the vest may expose the casted child to additional facial and extremity injuries compared to systems that allow the child to sit upright.&#x0D; Significance: Parents should not assume a restraint system is automatically appropriate for use with their child. While there were differences in the performances of the tested restraint systems, each child is unique and a trained healthcare provider should be consulted to ensure the child is properly restrained.

Effect of the Q10 dummy upgrade kit in UN Regulation No. 129 front and side impact tests

Objective: The objective of this study was to compare the kinematics and dummy loadings between the original Q10 and the Cellbond Q10 upgrade kit and determine the effect of the kit on the type approval of booster systems in United Nations (UN) Regulation No. 129.Methods: Front and side impact pilot experiments were carried out according to dynamic test procedures in UN Regulation No. 129. In each case, the original Q10 and Q10 upgrade kit were compared in a booster seat.Results: In front impact, the Q10 and Q10 upgrade kit displayed very similar kinematics and seat belt interaction. The peak dummy loads were also very similar. In side impact, the Q10 and Q10 upgrade kit displayed similar kinematics and interaction with the side structure of the booster seat. Once again, the peak dummy loads were also very similar.Conclusions: The original Q10 and the Q10 upgrade kit generated very similar kinematics and loadings in both front and side impact. Adoption of the kit for UN Regulation No. 129 would be unlikely to have significant effects on the type approval of booster seats. However, it would also appear not to offer any specific benefits. This will be verified in a larger program of experiments with a broader range of booster systems.

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.

Stressful by design: Exploring health risks of ride-share work

IntroductionFor-hire driving work, such as taxi driving, is characterized by long hours of sedentary behaviour, passenger assault, lack of benefits or support, and isolating working conditions that jeopardize good health. The for-hire driving industry has recently expanded to include a new group of ride-share drivers from digital platforms such as Uber and Lyft; this has substantially increased the number of people engaged in for-hire driving. However, there is very little existing research on ride-share drivers’ health and safety in relation to their work, and no research on the Canadian context. MethodsThis paper draws from a qualitative study consisting of in-depth interviews and focus groups with ride-share drivers and passengers, taxi drivers, taxi and ride-share managers, and other industry key informants in a large Canadian city. This paper focuses on ride-share drivers’ health risks on the job. ResultsThis study finds that ride-share drivers face physical and mental health risks resulting from ride-sharing work that are distinct to ride-share work, as well as ones similar to taxi driving and other transportation work. We find that the nature of the work is stressful by design: ride-share drivers face regular stressors and pressures from passengers, such as to speed and drive young children without proper booster seats. They also describe weight gain and muscle pain. ConclusionAs greater numbers of passengers opt for ride-share transportation and more people take up ride-share work, understanding potential short- and long-term health implications is an important area of inquiry. Understanding the working conditions of ride-share drivers can support the development of appropriate policy and practice tools to improve ride-share drivers’ health and safety.

A bivariate probit analysis of child passenger’s sitting behaviour and restraint use in motor vehicle

Motor vehicle injuries are a leading cause of death among children worldwide, though many of these deaths are preventable. Buckling young children in age- and size-appropriate car seats, booster seats, or seat belts and also seating them in appropriate position can lead to a significant reduction of serious and fatal injuries. This study investigated sitting behaviour and restraint use among child passengers through cross-sectional observational surveys conducted in Kumasi, Ghana. A bivariate probit model was developed for simultaneous determination of the contributing factors influencing child passenger’s sitting behaviour and restraint use. The results showed that 26% of the child passengers observed were occupying the front seat and the prevalence rate of restraint use was 4.5%. The developed bivariate probit model clearly highlights the existence of interrelationship between child passenger’s sitting position and restraint use. The key factors simultaneously influencing child passenger’s sitting position and restraint use include vehicle type, driver’s gender, driver’s belt use, child’s age, and the presence of other child or adult passenger. Furthermore, time of day and day of week also influence child passenger sitting behaviour but not their restraint use. These findings provide insight for better understanding of child transporting practices and the contributing factors influencing their sitting behaviour and restraint use. The findings also highlight the need for policy makers to design effective countermeasures to promote rear sitting and restraint use among child passengers.

Pelvis kinematics assessment for improving far-side child protection positioned in a booster seat

The objective of this study is to demonstrate the modulation of pelvis kinematics on the improvement of child protection in a far-side impact scenario. Sled tests have been carried out employing Hybrid-III 6-year-old anthropomorphic test device (ATD) in lateral impact configuration. Four test conditions have been tested and compared to assess the influence of pelvis biomechanics on the head excursion values and neck tensile loads. The conditions are: (1) booster seat installed using rigid ISOFIX and ATD restrained using a pre-tensioned belt; (2) booster seat installed using rigid ISOFIX and ATD restrained with a slacked belt; (3) booster seat and child restrained using slacked vehicle seatbelt; and (4) booster seat and child restrained using a pre-tensed seatbelt. Results indicate that the pretensioned seatbelt with or without rigid ISOFIX produces most favorable pelvis kinematics leading to reduced head excursions and neck tensile load.

Child passenger fatality: Child restraint system usage and contributing factors among the youngest passengers from 2011 to 2015

Objective: Motor-vehicle crashes (MVC) remain a leading cause of preventable injury and death for children aged 0–3 in the United States. Despite advancement in legislation and public awareness there is continued evidence of inappropriate child restraint system (CRS) use among the youngest passengers. The current study focuses on appropriate CRS use from 2011 to 2015 using data from the Fatality Analysis Reporting System (FARS) for children aged 0–3. Methods: Child-, driver-, vehicle-, and trip-related characteristics were investigated within a sample of 648 children from 625 crashes over 5-years in which a child aged 0–3 was fatally injured while unrestrained or wearing an identified CRS type. Multivariable log-binomial regression was used to obtain relative risk. Results: Only 48% of the fatally injured children were appropriately restrained in a CRS. Premature transition to a booster seat and seat belt was evident. The largest proportion of rear-facing restraint use was reported in <1 year olds (40%), with less reported in 1 (11%) and 2 year olds (2%) and no usage in 3 year olds. Younger children were more likely to be in an appropriate CRS, while Black children, driver not restrained in a lap-shoulder belt configuration, and riding in a pickup truck were less likely to be restrained appropriately. Conclusions: Evidence of inappropriate CRS use supports the use of more stringent legislation and parental interventions to communicate best practice recommendations and educate caregivers regarding appropriate child restraint methods. Practical applications: Public health campaigns focused on increasing appropriate restraint use in children are of great importance as optimally restrained children are less likely to sustain injuries, or require crash-related hospitalization compared to unrestrained children. Researchers and practitioners may find these surveillance findings essential when developing education and interventions targeting child–parent dyads at the greatest risk for a MVC-related fatality.

Cervical and thoracic spine injury in pediatric motor vehicle crash passengers

Objective: Motor vehicle occupants aged 8 to 12 years are in transition, in terms of both restraint use (booster seat or vehicle belt) and anatomical development. Rear-seated occupants in this age group are more likely to be inappropriately restrained than other age groups, increasing their vulnerability to spinal injury. The skeletal anatomy of an 8- to 12-year-old child is also in developmental transition, resulting in spinal injury patterns that are unique to this age group. The objective of this study is to identify the upper spine injuries commonly experienced in the 8- to 12-year-old age group so that anthropomorphic test devices (ATDs) representing this size of occupant can be optimized to predict the risk of these injuries.Methods: Motor vehicle crash cases from the National Trauma Data Bank (NTDB) were analyzed to characterize the location and nature of cervical and thoracic spine injuries in 8- to 12-year-old crash occupants compared to younger (age 0–7) and older age groups (age 13–19, 20–39).Results: Spinal injuries in this trauma center data set tended to occur at more inferior vertebral levels with older age, with patients in the 8- to 12-year-old group diagnosed with thoracic injury more frequently than cervical injury, in contrast to younger occupants, for whom the proportion of cases with cervical injury outnumbered the proportion of cases with thoracic injury. With the cervical spine, a higher proportion of 8- to 12-year-olds had upper spine injury than adults, but a substantially lower proportion of 8- to 12-year-olds had upper spine injury than younger children. In terms of injury type, the 8- to 12-year-old group’s injury patterns were more similar to those of teens and adults, with a higher relative proportion of fracture than younger children, who were particularly vulnerable to dislocation and soft tissue injuries. However, unlike for adults and teens, catastrophic atlanto-occipital dislocations were still more common than any other type of dislocation for 8- to 12-year-olds and vertebral body fractures were particularly frequent in this age group.Conclusions: Spinal injury location in the cervical and thoracic spine moved downward with age in this trauma center data set. This shift in injury pattern supports the need for measurement of thoracic and lower cervical spine loading in ATDs representing the 8- to 12-year-old age group.

Evaluating the response of the PIPER scalable human body model across child restraining seats in simulated frontal crashes

Objective: Booster seats ensure appropriate belt fit for children that a traditional vehicle seat belt cannot offer to small occupants. In this study, the responses of the PIPER 6-year-old human body model are compared to the traditional Q6 anthropomorphic test dummy (ATD).Methods: Eight frontal impact finite element simulations were run using 4 different child restraining systems on the FMVSS 213 test bench. Kinematics and kinetics were extracted and compared between the 2 child models.Results: The PIPER 6-year-old showed variation by 11.2 ± 14.1% (head resultant acceleration, G), 20.4 ± 50.3% (chest resultant acceleration, G), 272.9 ± 188.4% (chest displacement, mm), 24.8 ± 17.5% (maximum head excursion, mm), −31.5 ± 5.1% (neck force, Fz, N), −73.8 ± 2.8% (neck moment, My, N.m), and −60.4 ± 7.2% (Nij) compared to the Q6. However, the kinematics of both models were nearly similar.Conclusions: The PIPER model has a flexible neck and shows higher chest displacement compared to the Q6. We hypothesize that this is due to the inherent anatomical and mechanical differences between the human body model and the ATD model. More research is needed to explore these differences systematically.