Child Safety Restraint Use Research Articles

Childhood opportunity and appropriate use of child safety restraints in motor vehicle collisions

ObjectivesSafety restraints reduce injuries from motor vehicle collisions (MVCs) but are often improperly applied or not used. The Childhood Opportunity Index (COI) reflects social determinants of health and its study...

Child safety restraint patterns in Moldova

Objective The Republic of Moldova has one of the European region’s highest road traffic injury rates and also has an increase in motorization and exposure of children as vehicle passengers. This study describes child restraint use, and parents’ knowledge and attitudes toward child restraint based on observations in Chisinau, the country’s capital and largest city. The study aims to describe the use of child restraints and to compare data with existing standards of good practice. Methods An observational study on child safety restraint use was conducted in 2018. Observational sites included 22 early education institutions, where drivers (n = 611) and child passengers (n = 710) were observed. Observations were conducted as motor vehicles parked or pulled to a stop near the early education institutions and included a driver survey on knowledge and attitudes toward restraint legislation and child safety behavior. Results Of the 710 child passengers observed, 462 (65.1%) were appropriately restrained, 145 (20.4%) were seated in restraints inappropriate for the child and 103 (14.5%) of children were unrestrained. Younger children (0-3 year-old) were 7 times more likely to be properly restrained compared with children with ages between 4 and 6 (OR 1.92, 95% CI 1.15 to 3.22). Two-thirds out of 609 observed drivers with full study data, N = 431 (70,8%), knew about the mandatory legislation on using child safety restraints in the Republic of Moldova. The drivers using child safety restraints responded that they used them because of their safety features, and the major reason for nonuse was high price/affordability. Conclusion This study, the first to document child safety restraint use among children, indicates that much progress has been made, in that the majority of children are restrained and most drivers of children are aware of safety policies. However, progress can be made to increase knowledge and motivation to safely transport children, and to ensure safety seats are affordable and available. These data will be an important foundation on which to advocate for increased safety activities, child restraint policies, educational approaches in Moldova and to monitor progress over time.

Improper Restraint Use in Pediatric Patients Involved in Motor Vehicle Collisions

Motor vehicle collisions (MVCs) are the leading cause of unintentional death among children and adolescents; however, public awareness and use of appropriate restraint recommendations are perceived as deficient. We aimed to investigate the use of child safety restraints and examine outcomes in our community. We retrospectively queried a level 1 trauma registry for pediatric (0-18y) MVC patients from October 2013 to December 2018. Demographic and clinical variables were recorded. Data regarding appropriate restraint use by age group were examined. Four hundred thirty-four cases of pediatric MVC were identified. Overall, 53% were improperly restrained or unrestrained. Sixty-two percent of car seat age and 51% of booster age children were improperly restrained or unrestrained altogether. Fifty-nine percent of back seat riding, seatbelt age were improperly restrained/unrestrained, with 26% riding in the front. Fifty-one percent of seatbelt-only adolescents were not belted. Black, non-Hispanic children were more often improperly restrained/unrestrained compared to Hispanics (63% versus 48%, P=0.001). Improperly restrained/unrestrained children had higher injury severity (10% versus 4% Injury Severity Score > 25, P=0.021), require operative/interventional radiology (33% versus 19%, P=0.001), and be discharged to rehabilitation or skilled nursing facility (5.2% versus 1.5%, P=0.033). Mortality in adolescents was higher among those unrestrained (5.2% versus 0.8%, P=0.034). Although efforts to improve adherence to restraint regulations have greatly increased in the last decade, more than half of children in MVC are still improperly restrained. Injury prevention services and community outreach is essential to educate the most vulnerable populations, especially those with infants and toddlers, on adequate motor vehicle safety measures in our community.

Child restraint use in motor vehicles in Shanghai, China: a multiround cross-sectional observational study

ObjectivesWhile appropriate child restraint use in motor vehicles can reduce the risk of injuries or deaths, few previous studies have assessed child restraint practice in China. We aim to describe...

Safety seat and seat belt use among child motor vehicle occupants, Cluj-Napoca, Romania

BackgroundUse of seat belts and car seats for children are among the most effective interventions to reduce injury severity when a crash occurs. The use should be enforced in order...

A comparative analysis of child passenger restraint use in China and the United States.

Few published studies have examined child passenger safety practices across countries. This study compared the prevalence and associated factors of child passenger restraint use among children, aged 0 to 17 in the state of Iowa in the United States, and the city of Shantou in China. Child restraint use observations were conducted in Iowa and in Shantou in 2012, respectively, among child passengers. Observations in Iowa were conducted at randomly selected gas stations, while in Shantou observations were completed at randomly selected schools or medical clinics. Research observers approached the driver, observed restraint use, and collected brief survey data. A total of 3049 children from Iowa and 3333 children aged 0 to 17 years from Shantou were observed. For children aged 0 to 3 years, only 0.1% were compliantly restrained in Shantou as compared to 95.9% in Iowa. The proportion of children who were compliantly restrained in Shantou increased with age, but generally decreased with age in Iowa. In Shantou, 36.0% of children aged 0 to 3 were sitting in the front seat as compared to only 1.7% of children of the same age in Iowa. Driver seat belt use was significantly associated with child restraint in both Iowa and Shantou; the association was stronger in Iowa than Shantou for all age groups. A significantly higher prevalence of children who were not appropriately restrained was observed in Shantou than in Iowa. Our findings support the need of mandatory child safety restraint use legislation in China.

Restraint Usage Characteristics and Other Factors Associated with Safety of Children Involved in Motor Vehicle Crashes

Involvement in road traffic crashes as vehicle occupants is a leading cause of death and serious injury among children. The objective of this study was to investigate crash severity factors and child safety restraint use characteristics in order to identify effective countermeasures to increase children's highway safety. Characteristics and percentages of restraint use among child passengers aged 4~13 years were examined using highway crash data from Kansas. The association between restraint use, injury severity and characteristics of children involved in crashes were investigated using OR (odds ratios) and a logistic regression model, which was used to identify risk factors. RESULTS showed that children, who were unrestrained, were seated in the front seat, traveling with drunk drivers and on rural roads, and traveling during nighttime was more vulnerable to severe injury in the case of motor vehicle crashes. The most frequent contributing causes related to crashes involving children included driver's inattention while driving, failure to yield right-of-way, driving too fast, wet roads and animals in the road. Based on identified critical factors, general countermeasure ideas to improve children's traffic safety were suggested, including age-appropriate and size-appropriate seat belt restraints and having children seated in the rear seat. Parents and children must gain better education regarding these safety measures in order to increase child safety on the road. Language: en

Child safety restraint usage in Romania - an observational study design

Background Romania presently has limited policies and capacity to prevent child and adolescent injuries but also little data to document the consequences of not using appropriate child passenger restraint. Our aim was to document child safety restraint use and identify factors associated with proper child restraint in a motor vehicle. Methods An observational study on child safety restraint was conducted in Cluj-Napoca, Romania, between 2013 and 2014. Observational sites included 38 schools and kindergartens …

Hospital-based program to increase child safety restraint use among birthing mothers in China.

ObjectiveTo evaluate a hospital-based educational program to increase child safety restraint knowledge and use among birthing mothers.MethodsA prospective experimental and control study was performed in the Obstetrics department of hospitals. A total of 216 new birthing mothers from two hospitals (114 from intervention hospital and 102 from comparison hospital) were recruited and enrolled in the study. Intervention mothers received a height chart, an 8-minute video and a folded pamphlet regarding child safety restraint use during their hospital stay after giving birth. Evaluation data on the child safety seat (CSS) awareness, attitudes, and use were collected among both groups before and after the intervention. An additional phone interview was conducted among the intervention mothers two months after discharge.ResultsNo significant differences existed between groups when comparing demographics. Over 90% of the intervention mothers found the educational intervention to be helpful to some extent. A significantly higher percentage of mothers in the intervention than the comparison group reported that CSS are necessary and are the safest seating practice. Nearly 20% of the intervention mothers actually purchased CSS for their babies after the intervention. While in both the intervention and comparison group, over 80% of mothers identified the ages of two through five as needing CSS, fewer than 50% of both groups identified infants as needing CSS, even after the intervention.ConclusionThe results indicated that child safety restraint education implemented in hospitals helps increase birthing mothers' overall knowledge and use of CSS. Further efforts are needed to address specific age-related needs to promote car seats use among infants.

Parents’ experience with child safety restraint in China

BackgroundChild safety restraints are effective measures in protecting children from an injury while traveling in a car. However, the rate of child restraint use is extremely low in Chinese cities. Parent drivers could play an important role in promoting child safety restraint use, but not all of them take active responsibility.MethodsThis study used a qualitative approach and included 14 in-depth interviews among parents with a child, under the age of 6, living in Shantou City (7 child safety restraint users and 7 non-users). Purposive sampling was used to recruit eligible parent drivers who participated in a previous observation study. Interview data were collected from March to April 2013. The audio taped and transcribed data were coded and analyzed to identify key themes.ResultsFour key themes on child safety restraint emerged from the in-depth interviews with parents. These included 1) Having a child safety restraint installed in the rear seat with an adult sitting next to the restrained child is ideal, and child safety restraint is seen as an alternative when adult accompaniment is not available; 2) Having effective parental education strategies could help make a difference in child safety restraint use; 3) Inadequate promotion and parents’ poor safety awareness contribute to the low rate of child safety restraint in China; 4) Mandatory legislation on child safety restraint use could be an effective approach.ConclusionInadequate promotion and low awareness of safe traveling by parents were closely linked to low child safety seat usage under the circumstance of no mandatory legislation. Future intervention efforts need to focus on increasing parents’ safe travel awareness combined with CSS product promotion before the laws are enacted.

I love my baby even unto death: child safety restraint use among drivers in Gaborone, Botswana

This study examined the use of child safety restraints by drivers transporting children in Gaborone, Botswana. We observed 518 vehicles (329 male drivers, 189 female drivers) carrying children at four different locations in Gaborone over four days. A team of 2-4 trained observers recorded whether the child was restrained or not, where they were seated in the car, the type of vehicle (private or commercial) and model of vehicle. Children were restrained in 111 (21.4%) of the observed vehicles and unrestrained in 407 (78.6%) of the observed vehicles. Additionally, male drivers were more likely than female drivers to have an unrestrained child (chi-square = 4.465, P=.04); commercial vehicles were more likely than private vehicles to have an unrestrained child (chi-square= 7.387, P=.01); SUVs were more likely to have a restrained child (chi-square = 17.499, P=.00); and children in the back seat of the vehicle were less likely to be restrained than children located in the front seat (chi-square = 49.036, P=.00). There was also a noted difference based on location (chi-square= 19.405, P=.00), indicating socioeconomic factors at play. Most drivers in Gaborone are not restraining children in vehicles. There seems to be a general lack of knowledge among drivers about the importance of child safety restraints. It is recommended that stakeholders work to raise awareness, enforce legislation and offer incentives and subsidies for car seat use in order to improve the safety of child passengers on Botswana’s expanding and developing roads.

An exploratory study of parents' use and knowledge of car safety seats in Beijing, China

As the number of vehicles in China rapidly increases and there is no child safety seat law, the issue of road safety for children is a growing concern. The purpose of this study was to examine parents' use and knowledge of car safety seats in Beijing, China. Using a convenience sample of 843 parents, survey results showed that only 64.8% of parents used a safety restraint for their children; the remaining 35.2% of children, of which most were toddlers or school-aged children, travelled unrestrained in vehicles. Among parents who used a safety restraint, only 24.2% were using it correctly based on the child's age (for infants), weight and height. Common reasons for not using a safety seat included difficulty finding safety seats (56.6%), cost (26.1%), and a preference to hold the child (18.1%). Moreover, a large proportion of parents prematurely transitioned their child from a safety seat to seat belt. The results highlight the need to develop injury prevention interventions that communicate the benefits and encourage the use of child safety restraints in China.

Comparison of motor vehicle collision and non-motor vehicle collisions related child restraint seat injuries in British Columbia: 1997-2002

In Canada, as in many other countries, the mandatory use of child safety restraints (CSRs) over the past two decades has resulted in a drastic reduction in child mortality attributed to motor vehicle collisions (MVCs) (Snowdon, Polgar, Patrick, & Stamler, 2006). However, the ease of using CSRs outside of a vehicle has led to unexpected deleterious consequences to younger children. In this study, we looked at all injuries sustained by children (0-9 years) which involved a CSR and compared injuries which related to MVCs to those which occurred in other locations. Out of a total of 107 cases, 95 (88.8%) were not motor vehicle collision related (non-MVC) and the majority of these (87/95; 91.6%) occurred among children under 12 months of age. Children injured while in a CSR outside of a vehicle were also more likely to suffer from a head injury than those involved in an MVC (Odds Ratio 23.3). This study highlighted the importance of the continued education of parents to the unexpected hazard of placing children on elevated surfaces while in a CSR. Furthermore, it demonstrated the need to place additional pressure on manufacturers to ensure that design modifications address this consistent pattern of injury. Language: en

Changes in child safety restraint use and parental driving behaviours in Italy

To evaluate the changes in prevalence of child-restraint correct use, level of parental information and parental driving behaviours in a population of North-Eastern Italy 2 years after a previous survey. A mail survey of 514 families with children <12 years. We examined the prevalence of child restraint correct use, level of parental information, parental driving behaviours and the concordance between the responses to the current and previous survey. Multivariable logistic regression was used to identify factors influencing correct restraint use. Habitual restraint use was reported for 92.5% of children. The frequency of habitual use decreased with increasing child's age (p = 0.0143). Among children 3-7 years, correct restraint use was lower than in the previous survey (p = 0.0039). Increased child's age was associated with decreased likelihood of correct restraint use. Previous correct restraint use and parental information on child restraints, and current parental seat belt use were positively associated with correct use. In the last 2 years, only 17.5% of families have received information on transport safety. Most parents declared to comply with traffic regulations. In our study area, the use of child restraints is common, although non-habitual use is reported, especially among older children. The information on transport safety is insufficient. Law enforcement and information campaigns could further enhance parental compliance with traffic regulations.

Improvement in booster seat use in Tennessee.

Tennessee enacted an enhanced child safety restraint law in July 2004, which included new requirements for booster seat use among 4- to 8-year-old children. The goal of this study was to evaluate the appropriate use of child safety restraints and knowledge of the enhanced law before and after its implementation. On-site child safety restraint assessments and brief driver interviews for cars with passengers 0 to 8 years of age were conducted at 34 sites in 3 urban counties in Tennessee. Assessments were conducted 2 to 3 months before implementation of the law and 1 year after implementation of the law. Appropriateness of restraint use was defined on the basis of language in the enhanced law. Data were obtained for 1247 child passengers transported by 1191 drivers; 333 of the children were 0 to 3 years of age, and 914 were 4 to 8 years of age (the primary age group targeted by the enhanced law). Significant improvement in appropriate booster seat use was seen for 4- to 8-year-old passengers after implementation (39%), compared with use before implementation (29%). There was no improvement in the rate of appropriate restraint use for younger children (<4 years of age) after implementation. Black passengers 4 to 8 years of age were twice as likely as white child passengers to be unrestrained, before and after implementation. Seventy-nine percent of drivers reported awareness of the new restraint law after implementation; the majority of drivers obtained information from television advertisements. Improvements in booster seat use were seen after adoption of an enhanced state law requiring use; however, racial differences in restraint use persisted among 4- to 8-year-old passengers. Additional study of barriers to booster seat use among drivers of black child passengers and unrestrained children is warranted.

181: Emergency Department Screening for Improper Child Safety Restraint Use—Parent Confidence Versus Practice

We hypothesized that a survey designed to measure the confidence of parents regarding appropriate safety restraint use would help to identify children improperly restrained in automobiles.

The use of child safety restraints with nursery furniture.

In Australia, nursery furniture is associated with just over 6% of all injuries to children between birth and 3 years of age and 19% (or almost one in five) of all injuries in the first year of life. In the case of injury associated with prams or strollers and high chairs, the vast majority of injuries occur as the result of falls (75 and 83% respectively). Interviews with parents whose children suffered an injury as a result of a fall from a pram or stroller or from a high chair indicate that only a small proportion of the children (28 and 25% respectively) were wearing any form of safety restraint prior to their injury despite the fact that, in both samples, the percentage of safety restraints fitted was about 80%. The potential for serious injury from such falls is great as most injuries in both groups (96 and 75% respectively) were to the head. One death associated with a stroller and one death as a result of a fall from a high chair have been recorded for Victoria between 1985 and 1988. In the absence of mandatory requirements for the design and manufacture of nursery furniture, there is a need to provide information about nursery furniture safety to parents and care-givers through nursery furniture retailers and through maternity hospitals and child health centres. In particular, the promotion of the correct use of an appropriate and effective child restraint is a relatively simple and inexpensive measure that could prevent up to 80% of all injuries associated with the three items of nursery furniture most often related to injury: strollers or prams, high chairs and change tables.

Studies of child safety restraint use in motor vehicles—Some methodological considerations

Despite the effectiveness of safety restraints in reducing the risk of death or injury in motor vehicle accidents, many children still travel unrestrained. Two methodological issues related to child restraint studies which had not been adequately addressed were identified: firstly, the accuracy of parental self-reports of restraint use with their children; and secondly, the consistency of observational data over time. These issues were investigated in the present research. The data indicate that parents' report is inaccurate, suggesting that if self-report measures are used, there is a need to compare them with direct observational measures to obtain information on reporting bias. A single observation of a child's restraint use appears to provide an accurate reflection of restraint use on other occasions in the same setting.

Sociocultural Perspective on Child Occupant Protection

During the past decade substantial effort has been devoted to increasing the use of child safety restraints. This has involved educational programs and, more recently, legislation mandating restraint use by children. Neither of these approaches has had major documented effects on proper restraint use. Misuse is currently high and use decreases dramatically among toddlers and older children. It is maintained that the complexity of the problems of nonuse and misuse has not been fully recognized. A more comprehensive perspective on the issue is presented, focusing on the social and cultural issues involved in attempting to change parental behavior regarding their children's use of restraints. A structured approach to programs for the promotion of safety restraint use suggested by this perspective is presented, highlighting actions that are already being taken and those that need to be taken to develop a comprehensive attack on both nonuse and misuse of safety restraints.