Child Restraint Research Articles

Simulation and experiment study on the deviation influence factors of dynamic collision test for child safety seat

To investigate the prime causes of test deviations for child restraint systems testing in different laboratories, this article selected four types of child safety seats. Simulation and experiment had been done to quantitatively evaluate the factors which influence test deviations based on China GB27887 standard. The results show that the difference of acceleration pulse in different laboratories, the foam stiffness of sled cushion, the friction coefficient of safety belt guide, the three-point seat belt initial tension, the five-point harness initial tension, the five-point harness initial position offset, the overall position offset of child safety seat, the initial installation angle of supporting leg and the image recognition method of head excursion have significant effects on the deviations of test data. This article put forward a modifier formula which reduced the deviation of image recognition method of head excursion effectively. In addition, the effective control methods and measures were recommended to reduce the test deviations and ensure the consistency of the test data.

Supporting Caregiver Use of Child Restraints in Rural Communities via Interactive Virtual Presence.

When used correctly, child restraint systems (CRS) effectively reduce the risk of serious injury and death to child passengers in motor vehicle crashes. However, error rates in CRS use among caregivers are extremely high. Consultation with child passenger safety technicians (CPST) reduces misuse rates, but access to CPST is limited, particularly in rural areas. Remote consultation via interactive virtual presence (IVP) may increase access to CPST. One hundred and fifty caregivers in Southeast Montana completed remote consultation with CPST via IVP. Errors in CRS selection, installation, and child positioning were coded at baseline and postintervention in a within-subjects, pretest-posttest design. The proportion of caregivers making one or more errors in CRS selection (McNemar's test p < .001) and installation (McNemar's test p < .001), but not child positioning, significantly decreased following remote consultation. IVP is a promising mobile health (mHealth) strategy for providing remote consultation with CPST to improve rates of correct CRS use and mitigate child injury risk.

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.

Study protocol: a randomised non-inferiority trial using interactive virtual presence to remotely assist parents with child restraint installations

BackgroundMotor vehicle crashes are the third-leading cause of death to American children aged 1–5 years. When installed correctly, child restraints (car seats) reduce risk of serious injury and death. However,...

Analysis on influence of the self-confidence, motivation and authoritative advice factors on the use of child restraint

Objective: To establish the model of the self-confidence, motivation and authoritative advice factors influencing the use of child restraint and use structural equation model to test it to provide scientific basis for promoting the advocacy of use of child restraint. Methods: Using multi-stage cluster random sampling method, 9 112 parents from the family with one or more private cars and 0-6 years old children in Shanghai and Shenzhen were investigated about the use of child restraint. A theoretical model of the self-confidence, motivation and authoritative advice factors influencing the use of child restraint was constructed. The theoretical model was validated and quantitatively analyzed by structural equation model. Results: The overall model accords with the expected theoretical model, and the goodness of model fit was fine. The indicators had met the standard. RMSEA=0.03, CFI=0.97. The standardization coefficients of each route showed statistical significance (P<0.05). The standardization coefficients of the influence of authoritative suggestions and motives on self-confidence were 0.45 and 0.30 respectively, and the standardization coefficients of the influence of self-confidence on the use of child restraint was 0.40. The standardization coefficient of the influence of authoritative suggestions on motivation was 0.61. Conclusions: In the advocacy of the use of child restraint, we should attach importance to the use of recommendations from experts and organizations with professional authority, good credibility and public welfare. We should take the status of children's road traffic safety and the mechanism of the role of child restraint as one of the key points of propaganda.

Effects of child restraint misuse on dynamic performance

Objective: Estimates of child restraint misuse rates in the United States range from 49% to 95%, but not all misuse modes have similar consequences in terms of restraint effectiveness. A series of laboratory sled tests was conducted to determine the effects of common misuses and combinations of misuses, including loose harness, loose installation, incorrect installation angle, incorrect belt path, loose/no tether, and incorrect harness clip usage.Methods: Three commercial convertible child restraint models were loaded with the Hybrid III 3-year-old anthropomorphic test device (ATD) and secured by either LATCH or seat belt on a modified FMVSS No. 213 bench. Tests were conducted in forward-facing (FF) and rear-facing (RF) modes. The response variables included ATD accelerations, excursions, and restraint kinematics. Belt/LATCH loads, tether loads, ATD kinematics, and restraint structural response data were also documented. A fractional factorial test design on 8 factors was used to define an initial series of 32 tests. The first series also included 4 tests of correct CRS, 2 forward facing and 2 rearward facing. The analysis of those data determined the selection of conditions for the remaining 20 tests to focus on factors and interactions of high interest and significance.Results: In the RF condition, misrouting the LATCH belt or seat belt through the incorrect belt path was the only misuse that significantly affected outcomes of interest and was associated with high levels of undesirable CRS rotation. In FF tests, loose installation and tether misuse had large adverse effects on 3 of 4 key response variables.Conclusion: The study provides strong evidence for prioritizing tight restraint installation and proper tether use for FF restraints. In particular, use of the tether helped offset the adverse effects of loose installation or loose harness. Because the results show that performance of a RF child restraint system (CRS) installation is less affected by user error, they also provide support for extended RF restraint use. In addition, packaging convertible child restraints with the LATCH belt routed through the RF belt path could help prevent the most consequential RF CRS misuse.

Assessment of Caregiver-Targeted Interventions for Use of Motor Vehicle Passenger Safety Systems for Children

Caregiver-targeted interventions to improve the use of child restraint systems (CRS) in motor vehicles are common and heterogeneous in their implementation. The effectiveness of these interventions is unknown. To quantify the effects of caregiver-targeted interventions using meta-analytic methods, assess the quality of published studies, and assess for publication bias. PubMed and PsychINFO (January 1, 2004, to April 1, 2019) were searched for English-language studies using a list of search terms. The search and screening process was completed between May 25, 2018, and April 1, 2019. Studies met inclusion criteria if they included a caregiver-targeted intervention that focused on increasing CRS use for children (age, ≤9 years) and report the use of CRS before and after the intervention. Cochrane and PRISMA guidelines were used for the meta-analysis and risk-of-bias review. Information was extracted on intervention type, setting, implementation, and attributes of the study independently between 2 coders. Data were pooled from independent samples, with 1 outcome measure from each intervention implementation or study. This study was an exploratory random-effects meta-analysis. Unadjusted odds ratios were calculated using the sample size and the observed number of children in incorrect or correct restraints in motor vehicles before and after the intervention to determine the odds of incorrect CRS use after completing an intervention. Setting, measurement method, randomization, use of vouchers, and types of restraint were tested as moderators. A funnel plot was used to assess for publication bias. Of 1240 potential articles, 51 were deemed eligible for screening and 10 (8238 participants total) were included in the meta-analysis. Caregiver-targeted interventions were associated with a reduction in the number of children not riding in a CRS (odds ratio, 0.51; 95% CI, 0.36-0.71; P < .001). Variance in the averaged effect size was driven by self-report methods (when removed from analyses, I2 = 61.8%; R2 change = 26.3; P = .02) and hospital settings (when removed from analyses, I2 = 70.7%; R2 change = 17.4; P = .002). Risk of bias was high in most studies; however, there was low evidence for publication bias. In this meta-analysis, caregiver-targeted interventions were associated with a reduction in the number of children not riding in a CRS in motor vehicles; however, the methodological rigor of intervention studies should be enhanced.

User-driven design of child restraint information to reduce errors in use: a pilot randomised controlled trial

BackgroundIncorrect use of child restraints is a long-standing problem that increases the risk of injury in crashes. We used user-centred design to develop prototype child restraint instructional materials. The objective...

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.

Restraint in paediatrics: A delicate balance.

Patient restraint in health care is currently under intense review. There are two disparate groups that should be considered. First, infants and young children are commonly restrained while undergoing simple medical procedures such as venepuncture or immunisation, and this practice may be better framed as 'hugging' not 'holding'. Second, there is a distinct but significant group of children and adolescents with serious psychiatric or organic illness with behavioural disturbances necessitating restraint, who are the primary focus of this paper. Nevertheless, the balance between restraining any young person in health care and causing preventable harm is delicate: any form of child restraint, whether physical, chemical or seclusion, merits ethical reflection and should be undertaken judiciously. All clinicians should prioritise the dignity and privacy of the young person while weighing the vulnerability of this cohort of patients.

Cross-chest clips in child restraints: A crash testing study

Objective: Cross-chest clips are widely used in North American child restraints but are less common in other countries, partially due to concerns over anterior neck contacts in frontal crashes. They have recently been reported to be associated with lower odds of injury in real-world crashes, but there is a paucity of crash test performance information. This study aimed to compare the dynamic performance of a small child occupant in frontal crash tests with and without cross-chest clips in place.Methods: Frontal sled tests at 49 km/h were conducted to compare 2 cross-chest clip designs to nonuse of a chest clip. Tests using a P3/4 anthropomorphic test device (ATD) to represent the smallest occupant in a forward-facing child restraint were conducted with the chest clips in the recommended position and also in an incorrect lower position and with and without additional harness slack present.Results: Though contacts were observed between the chest clips and the base of the ATD’s neck, there was little difference observed in head excursion or ATD sensor loads in the presence of the chest clips. No detectable change in the neck forces or moments was detected at the time of the neck contacts. The position of the clips did not affect the results. Harness slack increased head excursion, as expected, but this effect did not differ between the tests with and without the clips.Conclusions: Cross-chest clips do not appear to greatly influence the dynamic performance of a forward-facing child restraint in a simulated frontal crash. Taken together with recent research suggesting a potential benefit in injury reduction from the clips in the real world, possibly due to maintaining the harness straps in place on a child’s shoulders, it may be appropriate to re-evaluate safety standards that prevent their use.

A rapid market survey on the availability of car seats in Qatar: Implications for child passenger safety.

Introduction: Despite the high income level in Arabian Gulf countries, people in the region need to improve their use of child restraint systems (CRSs) to reduce the incidence of preventable injuries to child automobile passengers. Anecdotal reports have attributed the resistance to using CRSs to the expense and unavailability of the systems, prompting car seat giveaway programs. Previous studies have not assessed the adoption of CRS. This study reports the results of a rapid market survey (RMS) to understand the availability, characteristics, and affordability of CRSs in Qatar and recommend future child restraint policies and legislation. Methods: The RMS identified all retail outlets that sell CRSs in Qatar and collected standard data on each restraint system: brand, model number, age/weight limits, compliance with standards, availability, and language of the owner's manual. A previously utilized metric for child safety devices was used to measure affordability. Results: The RMS showed a sufficient number (83) and variety (five types) of car seat models at 15 retail outlets, selling at a wide price range of $14–$1,399. All the car seats complied with the European standard. Only 2% showed a manufacturing or expiry date. A user manual was available for 71% of the seats and in different languages, but only 28% appeared in Arabic. The median CRS price was equivalent to the wages for less than one day of work. Conclusion: The RMS demonstrates the availability, variety, and affordability of CRSs in Qatar. Unavailability and expense cannot be cited as barriers to use CRS, and the market is prepared for legislation requiring car seats for children in Qatar. Areas for improvement include requiring user manuals for all seats, especially in Arabic; requiring that all car seats comply with globally accepted safety standards, especially for expiry/manufacturing dates, given the harsh local climate; and encouraging further varieties of CRSs in the local market.

Restraint of children

Coram Children's Legal Centre explores new guidance on restraint and restrictive interventions for children with SEND

Safe Transportation in-Spica Following Surgical Treatment of Infantile DDH: Solutions and Threats.

Government regulations mandate appropriate vehicular restraints for children under 4 years of age. Patients treated for infantile developmental dysplasia of the hip (DDH) with spica casts often require special accommodations. Previous work suggests that car seat loaner programs may help achieve these goals while avoiding the need for costly ambulance transportation. The purpose of this study was to evaluate our center's experience with postdischarge transportation in a large population of DDH infants and identify future threats to our program. We performed a retrospective review of patients 4 years or younger of age who underwent closed or open reduction for DDH at our center between 2011 and 2018. Only the initial surgery of staged procedures was included. Patient demographic factors were recorded, as were procedure type, final restraint used for postdischarge transportation, and any potential discharge delays secondary to transportation issues. Costs were compared amongst transportation options. Our cohort consisted of 130 patients (mean age, 1.4±0.9 y; 98 females) treated for DDH. In total 41 children (31.5%) underwent closed reduction procedures, whereas 89 patients (68.5%) underwent open reductions. After reduction, 62 (47.7%) received 2-legged spica casts and 68 (52.3%) received 1.5-legged casts. The most common restraint was a hospital-loaned Hippo car seat (73, 55.8%) followed by family-owned car seats (27, 20.8%). Eight patients (6.2%) experienced delays in discharge while waiting for adequate restraints, 6 patients (4.6%) were transported by ambulance, and 4 patients (3.1%) left against medical advice with inadequate restraints. Following surgical treatment of DDH, over 50% of patients with a spica cast were discharged using our center's car seat loaner program. However, availability and cost can present barriers for patients, with 4.6% of patients still being transported home by ambulance and 3.1% with inadequate restraints against medical advice. Costs of car seats are significant both for patients' families intending to purchase them, as well as for hospitals maintaining loaner programs and replacing used/lost seats. Moving forward, the recent cessation of production of the most common "spica car seat" threatens the longevity of existing loaner programs and calls renewed attention to the issue of safe transportation in-spica from providers and car-seat manufacturers alike. Level III.

Evaluation of interventions to make top tether hardware more visible during child restraint system (CRS) installations

Objectives: The objective of the study is to determine whether specific child restraint system (CRS) or vehicle conditions improve top tether attachment rates during volunteer installations.Methods: A factorial randomized controlled trial was designed to evaluate 4 different experimental categories: (1) Color of tether adjuster casing (black or red), (2) labeling on tether adjuster casing (labeled with “Tether: Use for forward-facing” or unlabeled), (3) storage location of tether (bundled in a rubber band on the back of CRS or Velcroed over the forward-facing belt path), and (4) labeling in vehicle (labeled under head restraint and below anchor or unlabeled). Ninety-six volunteers were randomly assigned to one combination of conditions. One installation per volunteer was completed. The primary outcome measure was acceptable attachment of the top tether to the tether anchor. The secondary outcome measure was overall secureness of the installation. Pearson’s chi-square tests were used to identify significant predictors of acceptable outcomes and logistic regression was used to investigate interaction effects.Results: A total of 66/96 subjects (68.8%) attached the top tether in an acceptable manner, with either zero errors (n = 50) or minor errors (n = 16). A total of 30/96 subjects (31.2%) had unacceptable tether outcomes, with either major errors (n = 10) or nonuse the tether at all (n = 20). None of the 4 experimental categories significantly affected tether outcomes. Subjects who opted to install the CRS with the lower anchors (LAs) had higher rates of acceptable tether attachment compared to subjects who installed using the seat belt or those who used both LA and seat belt together (χ2 = 6.792, P = .034). Tether outcomes were not correlated with previous CRS experience, use of instruction manual(s), age, or sex. Only 15.6% of subjects produced overall correct and tight installations. Of those who used the seat belt in some manner, 70.2% neglected to switch the retractor into locking mode.Conclusions: Conditions in this study including tether color, tether labeling, storage location, and vehicle labeling did not significantly affect tether attachment rates. High rates of tether misuse and nonuse warrant further exploration to find effective solutions to this usability problem.

Exploratory spatial analysis of traffic crashes, road mortality and morbidity in Nigeria

AbstractThis study examined the spatial distribution of road traffic crashes, mortality and morbidity in Nigeria for the period 2007–2017. The influence of exposure, road network and socio‐demographic characteristics on fatalities and injuries was analysed. Data were obtained from Federal Road Safety Corps and Annual Abstract of Statistics. Spatial statistical techniques were employed to determine the pattern of crashes, mortality and morbidity. Ordinary least squares and geographically weighted regression models were used to identify significant variables. Crashes and mortality declined by 47.9 per cent and 46.3 per cent respectively, while morbidity increased by 78.6 per cent. Crashes, mortality and morbidity were significantly clustered and high in Niger, Kaduna, FCT, Kogi and Nassarawa States. FCT recorded the highest crashes and injured persons, while Kaduna recorded the highest fatalities. Variables that significantly influenced spatial variation of mortality and morbidity were length of asphaltic concrete, surfaced dressed and earth roads, unemployment and population density. This study shows that type of road is a major factor that contributes to road crash mortality and morbidity. Crash countermeasures such as implementation of safety standards during road construction, speed reduction strategies and enforcement of seat belt use and child restraint should be implemented.

Effectiveness of Child Restraint Legislation to Reduce Motor Vehicle Related Serious Injuries and Fatalities: A National Interrupted Time Series Analysis

Background: Children that are unrestrained while travelling in a motor vehicle are more vulnerable to serious injury and death. The greatest levels of crash protection are achieved when children use the most age or size appropriate form of restraint. In this study, we aimed to examine the effectiveness of the introduction of age-appropriate child restraint legislation on serious and fatal injury in five Australian states and territories. Methods: For this interrupted time series analysis, we used a segmented regression method to assess the association between the implementation of child-restraint legislation and motor-vehicle related serious injuries and fatalities using data obtained from transport authorities in each jurisdiction. We estimated the change in annual rates after the implementation of legislation with the number of motor-vehicle accidents resulting in fatalities or serious injuries as the outcome, and the total number of injuries (minor, serious and fatal) as an offset in the model. Findings: We identified 10882 motor-vehicle related crashes resulting in fatalities (n=188), serious injuries (n=1730) and minor injuries (n=8964). In NSW and VIC, the rate ratio was statistically significant and positive, indicating an increase in the rate of serious injuries and fatalities in the period post-legislation compared to the period prior to legislation. In all other states and territories, we did not find a statistically significant effect of legislation. Interpretation: Road safety programs incorporating interventions targeted at increasing awareness of optimal restraint practices, strengthened enforcement and measures to improve the affordability of restraints are needed to support legislation. Funding Statement: The George Institute for Global Health. Declaration of Interests: The authors state: None declared. Ethics Approval Statement: The authors declare: Ethics committee approval was not needed as the data was de-identified, publicly accessible government data.

Driving while impaired by alcohol: An analysis of drink-drivers involved in UK collisions

Objective: Drink-driving represents a critical issue on international organizations’ agendas as one of the key behavioral risk factors in road traffic safety, alongside speed and nonuse of motorcycle helmets, seat belts, and child restraints. Changing road user behaviors regarding these 5 factors is a critical component in reducing road traffic injuries and casualties. The objective of this study is the identification of drivers who are more likely to contribute to crashes in the UK while impaired by alcohol to design targeted drink drive compliance campaigns.Method: To profile drivers with the factor “impaired by alcohol” assigned in collisions, an extensive data set is used, including all reported injury collisions between 2011 and 2015 in the UK (police records), merged with the Experian Mosaic Database. A multilevel mixed-effects logistic regression is conducted, utilizing the hierarchical nature of the data (drivers within Mosaic types).Results: Using multilevel mixed-effects logistic regression analysis, the finding is that some driver profiles are more likely to contribute to crashes and are assigned the contributory factor “impaired by alcohol.” Drink-related crashes are more common in some circumstances or for some crash-involved driver groups than others. For instance, alcohol-related crashes are more likely to occur on single carriageways and among males and 25- to 35-year-olds. Drink-drive-related crashes are found to be strongly associated with dark lighting conditions and, more specifically, with late night hours (the interval between 3:00 a.m. and 4:00 a.m. accounts for a third of the drink-drive-related collisions). Using the Experian Mosaic Database which divides the UK population into 66 types based on demographic, lifestyle, and behavior characteristics, the finding is that, among crash-involved drivers, some Mosaic types are significantly more likely (e.g., pocket pensions, dependent greys, streetwise singles) and others are significantly less likely (e.g., crowded kaleidoscope, cultural comfort, penthouse chic) to contribute to a drink-related crash.Conclusions: The outcome is a more nuanced understanding of drivers contributing to drink-related crashes in the UK. The study concludes by discussing the implications for governments and other interested bodies for better targeting and delivery of public education campaigns and interventions.

Pediatric Restraint Use and Injury in New York City Taxis Compared with Other Passenger Vehicles

In New York City (NYC), as in several other U.S. cities, pediatric occupant restraint laws exempt rear-seated passengers in vehicles-for-hire from those that apply to private vehicles. This study compares rear-seated infant, child, adolescent, and teen passenger restraint use and injury in taxis compared with other passenger vehicles. New York State Department of Health Crash Outcome Data Evaluation System (CODES) was analyzed for rear-seated pediatric passengers aged 0–19 years traveling in taxis ( n = 1,631) or other passenger vehicles ( n = 21,984) involved in a crash in NYC 2011–2013. CODES is a probabilistically linked data set comprising emergency department, hospitalization, and Department of Motor Vehicle crash data. Bivariate and multivariable logistic regression odds ratios (OR) are reported with 95% CI. Taxi passenger restraint use was lower than in other passenger vehicles (51.2% vs. 86.7%, p &lt; 0.0001). Use of a child restraint for ages &lt; 8 years was low (5.9%) and one-tenth that of other passenger vehicles. Multivariable adjusted odds of restraint use was 9.80 (8.2–11.7) for other passenger vehicles compared with taxis. Compared with passengers in other vehicles, passengers in taxi crashes were twice as likely to be moderately or severely injured ( p &lt; 0.0001) and twice as likely to have traumatic brain injury ( p = 0.0070). This study documents lower restraint use and higher injury, including traumatic brain injury, for pediatric taxi passengers compared with other passenger vehicles. Improved data systems, surveillance, and enforcement are needed to improve restraint use and reduce injury in children and teens, particularly those in vehicles-for-hire.

Restraint use and injury in forward and rear-facing infants and toddlers involved in a fatal motor vehicle crash on a U. S. Roadway

BackgroundUse of appropriate child passenger safety restraints reduces injury in infants, with rear facing restraints favored over forward facing. In 2011, the American Academy of Pediatrics (AAP) began recommending that infants and children under the age of 2 years be restrained in a rear-facing seat installed in the vehicle’s rear seat. This study examines the practice of rear-facing restraints pre- and post-AAP recommendations for children under 2 years.MethodsData from the Fatality Analysis Reporting System (FARS) from 2008 to 2015 were used to examine restraint status and injuries in rear-seated infants and toddlers aged 0 to less than 2 years involved in fatal collisions (n = 4966). Subpopulation analyses were conducted on 1557 children with seat facing direction recorded. Multivariable logistic regression was used to generate odds ratios (OR) with 95% confidence intervals (CI). Covariates considered for inclusion in the multivariable model included passenger characteristics (age, gender, seating position), driver characteristics (age, gender, seat belt status, alcohol status, drug status, previous traffic violations), vehicle characteristics (vehicle type), and crash-level characteristics (day/night, weekday/weekend, rush hour, expressway/surface street, urban/rural).ResultsApproximately 6.7% (330 of 4996) of infants and toddlers were unrestrained with mortality that was approximately triple that of restrained infants (40.0% vs 13.7%, P < 0.0001). In multivariable adjusted models, predictors of an infant being unrestrained included unrestrained driver (OR: 3.17, 95% CI: 2.38–4.21), driver aged less than 20 years (OR: 2.18, 95% CI: 1.42–3.34), driver alcohol use (OR: 2.21, 95% CI: 1.42–3.44), center-seated infant (OR: 1.55, 95% CI: 1.19–2.03) and weekday crash (OR: 1.52, 95% CI: 1.12–2.01). Of all rear-seated children whose restraint status were reported (4966), rear-facing restraint use increased from 5.0% to 23.2% between 2008 and 2015 (P < 0.0001). The odds of rear-facing restraint use increased after introduction of the AAP guideline among infants aged 0 to < 1 year old (OR: 2.12, 95% CI: 1.46–3.10) and among toddlers aged 1 to < 2 years old (OR: 1.97, 95% CI: 1.03–3.79).ConclusionTrends in the use of rear-facing child restraints improved over the timeframe of this study, but remain low despite the introduction of AAP guidelines and the strengthening of child restraint laws.