Child Restraint Research Articles

Use of Child Restraint Systems in Thailand and Factors associated with it: A Cross-Sectional Study

Objective: To determine the use of child restraint systems among caregivers of children in Thailand and to identify factors associated with it. Materials and Methods: Caregivers of children under 12 years old who utilized medical services at Lampang Hospital between March 2023 and March 2024 were asked to participate in this cross-sectional study. Data on characteristics of child and caregiver, driving behavior, and knowledge about child restraint systems were collected via a questionnaire. Multivariable regression was applied to analyze associated factors. Results: Of the 322 eligible caregivers, 279 (86.6%) participated, of which 127(44.5%) used a child restraint system. A higher caregiver education level (odds ratio [OR] 2.28, 95% CI 1.18; 4.39), and driving 3–7 days per week (OR 3.92, 95% CI 1.82; 8.40) were associated with more frequent restraint use. A higher age of the child (OR 0.97, 95% CI 0.96; 0.98) was associated with less frequent restraint use. Conclusion: Fewer than half of the caregivers utilized child restraint systems. Higher caregiver education levels and more frequent driving were associated with more frequent use, while older child age was associated with less frequent use of child restraint systems. Targeted interventions are needed to improve the use of child restraint systems.

Evaluation of a distribution, education and awareness intervention for child passenger safety in Lebanon: a low-income and middle-income country setting

BackgroundThe Eastern Mediterranean Region suffers disproportionately from paediatric traffic-related injuries. Despite governmental laws, Lebanon—an eastern Mediterranean country—has low child restraint (CR) use prevalence. This study examined the impact of using...

Child Restraint use and Seating Position in Motor Vehicles: An Observational Survey in Ibadan Metropolis, Nigeria

Child Restraint use and Seating Position in Motor Vehicles: An Observational Survey in Ibadan Metropolis, Nigeria

Effects of head restraint (HR) interference on child restraint system (CRS) performance in frontal and far-side impacts.

Forward-facing child restraint systems (FF CRS) and high-back boosters often contact the vehicle seat head restraint (HR) when installed, creating a gap between the back surface of the CRS and the vehicle seat. The effects of HR interference on dynamic CRS performance are not well documented. The objective of this study is to quantify the effects of HR interference for FF CRS and high-back boosters in frontal and far-side impacts. Production vehicle seats with prominent, removeable HRs were attached to a sled buck. One FF CRS and two booster models were tested with the HR in place (causing interference) and with the HR removed (no interference). A variety of installation methods were examined for the FF CRS. A total of twenty-four tests were run. In frontal impacts, HR interference produced small but consistent increases in frontal head excursion and HIC36. Head excursions were more directly related to the more forward initial position rather than kinematic differences caused by HR interference. In far-side impacts, HR interference did not have consistent effects on injury metrics. Overall, these results suggest only slight benefits of removing the HR in frontal impacts specifically. Caregivers should use caution if removing a vehicle HR to ensure that the current child occupant and all future vehicle occupants have adequate head support available in case of a rear impact.

Effect Analysis of Different Use Ways of a Q10 Child Seat

In this paper, the injury situation of Q10 child dummy was optimized and analyzed by analyzing the impact of different ways of using a certain child seat ,and analyzing the crash test data of a real car based on LS-DYNA crash simulation analysis software after the vehicle benchmarking, by elaborating on the protection of child occupants in different ways of using this type of child seat, so as to provide a reference for the development of child restraint system of new cars. The results show that: Regardless of whether this type of child seat has an optional seat back, adding seat belt Secure Guard and not using ISOFIX fixing, the dummies' injuries show a decreasing trend. This study provides reference for the selection and use of this type of child seat in dynamic test.

Interaction between multiple convertible child restraint systems and pediatric occupants in oblique impacts

Objectives To assess the interaction of multiple rearward-facing (RF) and forward-facing (FF) CRS restrained pediatric occupants on their kinetics in oblique impacts. Methods A Q3s and a Q1.5 ATD were restrained in 2 CRSs of varying widths—standard (503mm) and slim-fit (425mm)—in the 2 rear outboard seats of a 2023 compact sedan rigidized rear seat bench. A surrogate door structure was mounted at the left outboard location. The Q1.5 was seated in an RF configuration, and the Q3s was seated in RF or FF configurations across tests. The ATDs were restrained as follows: (1) both ATDs in standard CRSs and (2) both ATDs in slim-fit CRSs, switching between the outboard seats for a total of 8 conditions. The condition with the highest head kinetic metrics from these tests was reproduced in a ninth test with the rear seat’s center armrest lowered between CRSs. The entire environment was subjected to an oblique impact at 60° using the FMVSS 213 impact pulse. Results The Q3s’ head contacted the nearby CRS shell when seated farside. When seated nearside, the Q3s’ head contacted the surrogate door structure in 1 of 4 conditions. The Q1.5’s head contacted the nearby CRS in 2 of 4 conditions when seated farside. The Q3s when seated RF had higher HIC15 and head 3ms clip acceleration (H3ms), regardless of farside or nearside position. When seated farside, upper neck tensile force (Fz) for the Q3s in FF configuration (2,317.4 and 2,077.9 N) was higher than that in RF configuration (1,850.8 and 1,802.8 N). When seated nearside, the same in FF configuration (701.3 and 1,029.4 N) was lower than that in RF configuration (997.6 and 1,261.7 N). Repeating the condition with the highest head kinetic metrics (HIC15 = 1246; H3ms = 114.4 g) but lowering the center armrest between the CRSs resulted in lower head kinetic metrics (HIC15 = 916, H3ms = 93.5 g). Conclusions In most cases, the farside seated ATD’s head contacted the nearside CRS shell, resulting in elevated injury metric numbers and higher loading in both CRS types. The nearside ATD did not experience detrimental effects of the interaction with the farside occupant and CRS.

User-driven instructions reduce errors in child restraint use: a randomised controlled trial in Sydney, Australia

Background and objectivesCrash injury risk is reduced when a child correctly uses an appropriate restraint; however, incorrect restraint use remains widespread. The aim of this study was to determine whether...

Impact responses and injury analyses of a three-year-old occupant seating in forward and rearward facing CRSs using different computational models

To investigate the reliability and necessity of utilising a human biomechanical model in automotive safety, the frontal collision simulation test was conducted employing the TUST IBMs 3YO model and the Q3 dummy model. The kinematic and biomechanical injury parameters of the occupants were comparatively analysed. The results indicate consistent trends in acceleration changes between the two computational models. Variations in neck structure resulted in a 25% to 28% difference in the peak values of neck injury parameters. Differences in spine structure and materials made the spine angle change trends of the Q3 model more sensitive to the type of child restraint system (CRS). The human biomechanical model allows for the evaluation of occupant injury risk from multiple perspectives. Therefore, employing an advanced computational model of the human body with higher biofidelity provides a more reliable and effective method for investigating injury mechanisms and developing protective countermeasures for child occupants.

Pediatric occupant-to-occupant interaction responses in side impact conditions using Q-dummy and child human body models

Objective Road safety of children has improved considerably over the past decade; however, there is still much scope to better protect these occupants. Ensuring adequate protection of children seated in the rear seats requires a greater understanding of how children are injured in side crashes. The purpose of this study was to enhance the knowledge of children’s potential injuries in side impact collisions by the investigation of two different child sizes seated in different positions in the rear seats. The injury metrics associated with the occupant-to-occupant or occupant-to-child restraint system interaction was also identified. Methods Finite Elements Method simulations were performed using a validated simplified vehicle model with fully deformable side components. Dynamic virtual tests according to the Euro NCAP Child Occupant Protection Protocol were performed considering three different scenarios in terms of occupants´ distribution in the rear seats. Simulations were conducted with dummy and human body models. The injury metrics associated with near-side and far-side positions and the occupant-to-occupant interaction were analyzed. Results The 10-year-old child seated in the far-side position presented higher injury values, especially in the head due to the contact with the adjacent child or child restraint occupying the near-side seating position. Similar responses were observed in human body and dummies models in terms of head and neck injury values. However, human body models showed an increase in the chest measurements. Conclusions This study highlighted that the potential injuries of a child seated on the rear seats in a side impact crash are likely to be increased by the presence of an adjacent seat occupant, especially when larger children were seated in the far-side seating location or a CRS was installed in the near-side seating position. Results offer insight into the occupant-to-occupant interaction and occupants’ size as relevant factors to improve children safety under side impact conditions.

Epidemiological analysis of a 10-year retrospective study of pediatric trauma in intensive care

Pediatric trauma plays a crucial role in pediatric mortality, with traffic injuries and falls frequently cited as leading causes of significant injuries among children. A comprehensive investigation, including geographical factors, is essential for developing effective strategies to prevent injuries and alleviate the burden of pediatric trauma. This study involved a retrospective analysis of clinical data from pediatric patients admitted to our hospital’s intensive care unit (ICU) due to trauma over a 10-year period. Comprehensive analyses were conducted to elucidate trends, demographics, injury patterns, and risk factors associated with these admissions. This retrospective study included 951 pediatric patients (mean age: 4.79 ± 3.24 years; mean weight: 18.45 ± 9.02 kg; median time to ICU admission post-injury: 10.86 ± 14.95 h). Among these patients, 422 (44.4%) underwent emergency surgery, and 466 (49%) required mechanical ventilation support, with a mean duration of 70.19 ± 146.62 h. The mean duration of ICU stay was 6.24 ± 8.01 days, and the overall mean hospitalization duration was 16.08 ± 15.56 days. The predominant cause of unintentional injury was traffic accidents (47.9%), followed by falls (42.5%) and burns/scalds (5.3%). Most incidents involved children aged 0–6 years (70.7%), with males comprising 60.0% of patients. Injury incidents predominantly occurred between 12 and 6 PM (44.5%) and on non-workdays (37.6%). The most common locations where injuries occurred were roadsides (49%) and rural areas (64.35%). Single-site injuries (58.78%) were more prevalent than multiple-site injuries (41.22%), and head injuries were the most common among single-site injuries (81.57%). At ICU admission, the mean injury severity score was 18.49 ± 8.86. Following active intervention, 871 patients (91.59%) showed improvement, while 80 (8.41%) succumbed to their injuries. Traffic injuries remain the primary cause of pediatric trauma leading to ICU admission, underscoring the importance of using appropriate child restraint systems and protective gear as fundamental preventive measures. The increased incidence of injuries among children aged < 6 years and those residing in rural areas highlights the need for targeted preventive strategies, necessitating tailored interventions and public policy formulations that address these high-risk populations.

Predictors of child restraint usage among Chinese parents

Objective: To investigate psychological predictors of the use of child restraints among Chinese parents following passage of national law requiring their use. Methods: Grounded in the Prototype Willingness Model (PWM) and guidance from previous research, we developed and administered a questionnaire to assess child restraint usage and understand psychological factors that predict usage. 413 parents with child(ren) aged 0–8 years completed the questionnaire through the WenJuanXing online survey platform. Results: Among the 413 parents, 321 (77.7%) used child restraints regularly when taking their children on car trips, with the highest use reported among parents with children under 1 year (83.8%). Among the psychological predictors, willingness to use a restraint was the strongest predictor of intention and self-reported behavior to use restraints, but the predictive effect of intention on behavior was not significant. Descriptive norms – a belief that trusted friends and family use restraints – was the strongest predictor of behavior to use child restraints, and prototype favorability – the belief that prototypical parents of similar age and gender use restraints – also showed significant effects in predicting behavior. Conclusions: Following the passage of national laws requiring child restraints in China, it is becoming more common for parents to use restraints when their children travel by car. Parents’ use of child restraints for children follows a socially reactive (through willingness) decision-making path rather than a reasoned (through intention) decision-making pattern. The influence of the behavior of others, both trusted friends and family (descriptive norms) and prototypical similar parents (prototype favorability) are strong predictive factors for use of child restraints, suggesting prevention programs might leverage behavior of others to impact parents and encourage use of child restraints.

An evaluation of front seat distance from rear facing child restraint systems in prevention of injury in frontal crash tests

Objectives Elevated head injury incidence in infants compared to toddlers involved as occupants in motor vehicle crashes has been demonstrated in multiple population-representative crash databases. Further, experimental studies have revealed a potential injury mechanism via impact between a rear-facing, CRS-restrained child and the back of the vehicle seat or console on the row in front of the CRS. Subsequently, experimental studies have suggested that bracing the CRS against the seat immediately in front of the CRS could mitigate head injury, but also indicated that more research was necessary. Thus, we investigated the effect of bracing against the front seat, as well as distance from the front seat with rear-facing infant carriers and rear-facing convertibles, with a focus on changes to measured head, neck and chest injury metrics in rear facing CRSs. Further, we examined the effect of using the infant carrier with and without a base on these injury metrics. Methods 34 frontal sled tests at 30 or 35 mph were conducted using a simulated rear-row vehicle seat and structure representing the front seatback. A Q1.5 anthropomorphic test device (ATD) was placed in a single make/model LATCH-affixed rear-facing convertible or single make/model infant carrier; infant carrier without base was affixed with lap and shoulder belt. To evaluate the effect of bracing and distance, tests were conducted with a 300, 140, 70, or 15 mm gap between the CRS seatback and the front seatback, or a touching (0 mm) or braced (-20 mm) condition. Bayesian regression models quantified the effects of various predictors and model uncertainty. Results For tests with the convertible CRS, no head contact was observed between the head and the front vehicle seatback. For the infant carrier, head contact occurred at both 70 and 140 mm distances but not the other distances. On average, the −20, 0, or 15 mm distances yielded a 60% reduction in head injury criterion with 15 millisecond window (HIC15), and a 60% to 80% reduction in neck tension, compared to the 70 and 140 mm distances; chest acceleration also decreased for the convertible seat only. In the case of both carriers and convertibles, each mm of distance the CRS moves away from the front seatback up to 70 mm, adds 5.3 HIC15 points (95% Credible Interval (CrI):[4.6, 6.2]), and 3.5 Newtons (95% CrI: [2.2, 4.8]) of neck tension, on average. Conclusions Placing a rear facing CRS, both convertibles and infant carriers, against or close to the seatback of the seat immediately in front of the CRS reduces head and tensile neck injury criteria in ATDs. The amount of gap between the front seat and the rear facing CRS is strongly and positively correlated with HIC for both convertibles and infant carriers. RF infant carriers with and without a base yield comparable injury metrics and kinematics when touching or nearly touching the back of the front vehicle seatback.

How Safe Are Nepal’s Roads? A Study of Road Safety Legislation and WHO Standards

Around the world, traffic accidents result in significant catastrophes. The consequences of traffic accidents go far beyond the immediate suffering of the individuals involved. This paper aims to examine the road safety legislation and WHO standards adopted in Nepal. The paper is based on secondary data and policy documents related to road safety and WHO standards in the context of Nepal. It presents Nepal’s road network, significant improvements in road safety indicators, and encouraging advancements in road safety. The study finds five major areas for improvement in road safety laws in Nepal: seat-belt regulations, helmet laws, speed laws, child restraint laws, and drinking and driving laws. The study also reveals that Nepal’s current regulatory framework needs to be improved by monitoring actual appropriate helmet fastening and standardization. There is a lack of precise BAC restrictions for drivers and insufficient speed limits under WHO recommendations. Nepal’s child restraint rules also need to be expanded to include seat belt usage in all cars and forbid children from sitting in the front seats. To close those regulatory gaps and protect Nepalese citizens’ safety on the roads, it ends by providing a strict set of recommendations, such as increased enforcement, public awareness campaigns, and changes to road design and concrete making plans. Policymakers, researchers, and stakeholders working to promote street safety measures in Nepal and abroad would find great assistance from this article, which offers a detailed examination and smart recommendations.

Oblique pole-side crash assessment using the six-year-old HBM PIPER

Side impact crashes are one of the most dangerous impact scenarios that a child can suffer. Studies by the National Highway Traffic Safety Administration (NHTSA) have shown that the head and Thorax regions are affected severely. The objective of this work is to perform a numerical evaluation of the oblique pole-side test considering the FMVSS 214-P standard to estimate the Head, Neck, and Thorax injuries for a six-year-old child positioned in the rear seat without any Child Restraint System, two configurations were performed for the oblique pole-side impact: a nearside and a far-side positioning configuration. A six-year-old Human Body Model (HBM) denominated Scalable PIPER Child Model, and the Ford Explorer 2003 were used to perform the test in the LS DYNA® software to assess the biomechanics involved in the crash scenarios. The approach considered a comparative case study with the baseline of the six-year-old child PIPER model to ensure that the positioning adjustment has not affected the mesh quality and interior components for the PIPER child model. The outcomes obtained in case 1 show that the modified PIPER child model has slight outcomes at the shoulder and pelvis zone due to the differences in the body positioning and not by the mesh or the interior interaction between the components. The outcomes obtained in case 2 reflect that the nearside setup obtained the higher measurements for the child occupant. The Ac3ms for Head at nearside test to overcome the Side Criteria established by the Assessment Protocol Child Occupant Protection by Euro NCAP, the kinematics behavior demonstrates the importance of researching children in side crashes to enhance child security, especially in the oblique pole side impact.

Congruency of Crash- and Hospital- Reported Injuries Among Child Passengers

Introduction: Prior work has found incongruencies in injury information reported by crash and hospital records. However, no work has focused on child passengers. The objective of this study was to compare crash scene and hospital-reported injury information for crash-involved child passengers. This study also explored injury location and severity by child age and restraint type. Methods: Utilizing linked New Jersey data from 2017 through 2019, the authors identified crash-involved child passengers <13 years old and their injuries in crash and hospital reports. Then, they characterized the congruency of injury frequency, severity, and location, as well as the frequency of injuries by child age and restraint type. Analyses were conducted from December 2023 through February 2024. Results: Of 84,060 crash-involved child passengers, crash reports documented 7,858 (9%) children with at least “possible” injuries, while 2,577 (3%) had at least one injury in hospital events. Crash report and hospital data were incongruent for both body region of injury and injury severity. The proportion of children injured increased as children's ages increased and as restraint type progressed. Conclusions: Crash reports overestimated the number of injured child passengers and misrepresented injury severity and locations. Child restraint systems mitigated a child's injury risk. Importantly, injury information documented on crash reports currently informs the allocation of traffic safety resources. These results highlight the importance of improving these reports’ accuracy and underscore calls to link administrative datasets for public health efforts.

Nasogastric tube feeding under physical restraint of children and young people with mental disorders: a comprehensive audit and case series across paediatric wards in England

ObjectiveTo estimate the number of patients on paediatric wards in England who received nasogastric tube (NGT) feeding under physical restraint from April 2022 to March 2023, identify the demographics and...

Evaluating Child Passenger Restraint Use Education.

Despite recommendations and laws for child restraint use in motor vehicles, evidence of low restraint use remains, and there is a lack of evidence addressing the effectiveness of restraint use education. This project aims to measure the impact of an education initiative on child passenger restraint use. This pre- and postintervention study was conducted in six elementary schools in a Southwestern U.S. metropolitan area over 5months from October 2022 to March 2023. Motor vehicle restraint use was collected from occupants arriving at elementary schools during the morning drop-off times. Participants were provided one-on-one education regarding child passenger safety guidelines and state laws. Comparison data were collected 1-3weeks later at the same schools to evaluate the education provided. A total of 1,671 occupants in 612 vehicles were observed across six schools, with 343 adults and 553 children preintervention and 306 adults and 469 children postintervention. Overall restraint adherence in children improved postintervention from 42.3% to 56.1%, a 32.6% increase (p =<.001). In the primary age group of 4-8years, restraint adherence improved postintervention from 34.8% to 54.2%, a 55.8% increase (p =<.001). The study results demonstrate that one-on-one education increases child passenger restraint use.

Interactions between rearward-facing child restraint systems and the center console in frontal impact sled tests

Objective To quantify the head and chest injury metrics associated with a pediatric anthropomorphic test device (ATD) in rearward-facing infant child restraint system (CRS) models positioned directly behind a center console during frontal impact sled tests. Methods Sled tests using the Federal Motor Vehicle Safety Standard (FMVSS) 213 frontal crash pulse were performed. The test buck comprised a second row middle seat and center console from the same 2023 model mid-size SUV spaced as per the in-vehicle relative dimensions, a force plate covered with an automotive floor mat, a post-mounted shoulder belt simulating the in-vehicle roof-mounted seatbelt and an array of high-speed cameras. The 12-month-old Child Restraint/Air Bag Interaction (CRABI-12) ATD was seated in one of two rearward-facing infant CRS models (model A, rigid lower anchors; model B, flexible lower anchors), which was installed with either the base (support leg or no support leg; attached using lower anchors or the seatbelt) or without the base (attached using the European or US belt path). Conductive foil was attached to the rear surface of the center console and to the shell of the CRS and/or base to quantify contact. The vehicle seat was replaced every second test and the center console was replaced when damaged. Results For sled tests of the CRS models with a base attached using lower anchors, there was no contact of the CRS with the center console when the support leg was used, and all head and chest injury metrics were reduced compared to the tests of CRS with no support leg. However, there was contact between the CRS and the center console when the base of the CRS models was attached using the seatbelt, which typically increased head and chest injury metrics compared to the lower anchor attachment method. For CRS model B with the base attached using either the lower anchors or the seatbelt but no support leg, head acceleration 3 ms clip exceeded the injury assessment reference value (IARV) of 80 g. All tests resulted in HIC36 values below the IARV of 1000. The tests of the CRS models without a base using the European belt path did not result in contact and had the lowest head and chest injury metrics of all tests, which were all below IARVs. For the tests of the CRS models with the base attached using the seatbelt and tests using the US belt path, chest acceleration 3 ms clip values exceeded the IARV of 60 g. Peak normal support leg reaction forces in this study ranged from 3.6 to 4.3 kN. Conclusions The rearward-facing CRS models with a base and a support leg attached using lower anchors, or without a base using the European belt path, resulted in the lowest head and chest injury metrics due to not contacting the center console.

Evaluation of a novel head and neck restraint for harness-restrained children

Motor Vehicle Crashes (MVCs) are a common source of neck injury and, although rare, catastrophic neck injury occurs in restrained children up to age 10 years old. Recently, a head/neck support (HNS) that cradles the head during sleep was developed. The objective of this study was to determine if the HNS improves injury criteria measured on anthropomorphic test devices (ATDs) in front facing 5-point harness child restraint systems (FFCRS). Nineteen matched pair frontal impact sled tests were conducted with ATDs representing the 12 month old, or 3 or 6 year old child in FFCRS. HNS reduced HIC36 by median 22.2%, maximum resultant head acceleration (3ms clip) by 16.2%, head excursion by 8.2%, and neck tension by 12.2%. Providing supplemental restraint directly to the head has the potential to improve injury outcomes while not adding to harm during common misuse scenarios, but further research is needed to determine if these benefits persist in real-world crashes.

Numerical Dolly Rollover Evaluation Using a Damping-Harmonic System with a Low Back Booster to Reduce Injuries in a Six-Year-Old Child

This study examined injuries sustained by a six-year-old child dummy in a numerical dolly rollover crash using a Toyota Yaris 2010. A harmonic dynamic system (HDS) composed of spring, dampers, and masses with a Low Back Booster (LBB) is denominated as HDS-LBB model. The HDS-LBB was designed to allow damping movements along three Cartesian axes (X, Y, Z) to reduce the energy transferred to the child by a motor vehicle accident and avoid a high injury risk. The HDS-LBB incorporates springs into the vertical axis to decrease the vertical movement during the rollover. The numerical analysis was conducted using LS-Dyna® R12.1 version during an interval of 1 s, and the boundary conditions were set by the Federal Motor Vehicle Safety Standard (FMVSS) 213 for child restraint recommendations and the FMVSS 208 for a dolly rollover procedure. Data on head and thorax decelerations, neck flexion-extension, and thoracic deflection were acquired at a rate of 1 ms. The injury values obtained by the HDS-LBB were compared with the injury values by another configuration denominated LBB-ISOFIX to assess the effectiveness of the model proposed. The results show a higher peak injury value in the neck and thorax because of seatbelt displacement across the child’s shoulder. Nevertheless, despite this seatbelt behavior, the injuries sustained remained below the Injury Assessment Reference Values (IARVS).