Child Safety Restraint 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...

Factors associated with booster seat use among Indigenous peoples in Canada

Objective Booster seat use among the general population remains relatively low, despite their effectiveness in preventing injury among children when involved in motor vehicle collisions. Given the prevention of injuries that booster seats provide, understanding the factors that hinder or facilitate the use of these seats is critical, particularly in communities that are often overlooked when conducting general population studies. To date, no studies have examined the prevalence and predictors of booster seat use among Indigenous peoples in Canada. The purpose of this study was to examine the use of booster seat use among Indigenous peoples across Canada and the factors that impact their use. Methods Data were collected from a survey of participants from First Nations communities and organizations serving Indigenous peoples nationwide. Hypotheses arising from known predictors of booster seat use across the general population were tested using logistic regression models. Results The strongest predictor of booster seat use, even when all other study factors were accounted for, was the reduction of barriers related to the use of booster seats, such as a child’s resistance to being placed or staying in the passive safety restraint or a parent, guardian, or other caregiver being unwilling to use or unsure of how to install/setup the booster seat. Conclusion Most Indigenous participants consistently used booster seats to safely secure children being transported in vehicles. However, this compliance rate is well below that of the general population. Accessibility and affordability of child safety restraints and/or children’s refusal to use booster seats, as well as having more than 1 child to secure, were identified as mitigating factors. Access to and the affordability of booster seats, coupled with clear and understandable information on how to use them, are critical components to compliance. Raising awareness among Indigenous peoples communities regarding the importance of using booster seats is imperative. To achieve this, Indigenous peoples must lead discussions to ensure that child safety strategies not only are based on research and best practices but are culturally connected and community driven. Through meaningful collaboration, vehicle-related injuries and mortality among Indigenous children can be significantly reduced.

Injury Patterns, Imaging Usage, and Disparities Associated With Car Restraint Use in Children.

Motor vehicle collision (MVC) is a leading cause of accidental death in children. Despite effective forms of child safety restraint (eg, car seat and booster seat), studies demonstrate poor compliance with guidelines. The goal of this study was to delineate injury patterns, imaging usage, and potential demographic disparities associated with child restraint use following MVC. A retrospective review of the North Carolina Trauma Registry was performed to determine demographic factors and outcomes associated with improper restraint of children (0-8years) involved in MVC from 2013 to 2018. Bivariate analysis was performed by the appropriateness of restraint. Multivariable Poisson regression identified demographic factors for the relative risk of inappropriate restraint. Inappropriately restrained patients were older (5.1years v. 3.6yrs, P < .001) and weighed more (44.1lbs v. 35.3lbs, P < .001). A higher proportion of African American (56.9% v. 39.3%, P < .001) and Medicaid (52.2% v. 39.0%, P < .001) patients were inappropriately restrained. Multivariable Poisson regression showed that African American patients (RR 1.43), Asian patients (RR 1.51), and Medicaid payor status (RR 1.25) were associated with a higher risk of inappropriate restraint. Inappropriately restrained patients had a longer length of stay, but injury severity score and mortality were no different. African American children, Asian children, and Medicaid insurance payor status patients had an increased risk of inappropriate restraint use in MVC. This study describes unequal restraint patterns in children, which suggests opportunity for targeted patient education and necessitates research to further delineate the underlying etiology of these differences.

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...

Association between driver and child passenger restraint: Analysis of community-based observational survey data from 2005 to 2019

Introduction: Crash data suggest an association between driver seatbelt use and child passenger restraint. However, community-based restraint use is largely unknown. We examined the association between driver seatbelt use and child restraint using data from a state-wide observational study. Methods: Data from Iowa Child Passenger Restraint Survey, a representative state-wide survey of adult seat belt use and child passenger safety, were analyzed. A total of 44,996 child passengers age 0–17 years were observed from 2005 to 2019. Information about driver seatbelt use and child restraint was directly observed by surveyors and driver age was reported. Logistic regression was used to examine the association between driver seatbelt use and child restraint adjusting for vehicle type, community size, child seating position, child passenger age, and year. Results: Over the 15-year study period, 4,114 (9.1%) drivers were unbelted, 3,692 (8.2%) children were completely unrestrained, and another 1,601 (3.6%) children were improperly restrained (analyzed as unrestrained). About half of unbelted drivers had their child passengers unrestrained (51.8%), while nearly all belted drivers had their child passengers properly restrained (92.3%). Compared with belted drivers, unbelted drivers had an 11-fold increased odds of driving an unrestrained child passenger (OR = 11.19, 95%CI = 10.36, 12.09). The association between driver seatbelt use and child restraint was much stronger among teenage drivers. Unbelted teenage drivers were 33-fold more likely (OR = 33.34, 95%CI = 21.11, 52.64) to have an unrestrained child passenger. Conclusion: These data suggest that efforts to increase driver seatbelt use may also have the added benefit of increasing child restraint use. Practical applications: Enforcement of child passenger laws and existing education programs for new drivers could be leveraged to increase awareness of the benefits of seatbelt use for both drivers themselves and their occupants. Interventions aimed at rural parents could emphasize the importance of child safety restraints.

An investigation of awareness, perceptions, and usage of child car seats in Pakistan

IntroductionThe objectives of this study were to investigate the level of awareness and usage of child car seats in Pakistan, identify problems that influence non-usage among the knowledgeable parents, as well as to explore the need and interventions for conducting effective awareness campaigns or educational programs for parents in the country. MethodsTotal 375 vehicles with children occupants and 622 children were observed at several schools, day-care centers, pediatric departments in hospitals, and children recreational places within 3 cities of Pakistan. Child safety restraints usage was almost negligible in the study sample. Out of the total 375 vehicles, 318 parents/drivers participated in the interview survey. ResultsAlmost half of the participants were found to be unaware of child car safety restraints. Those who knew, most commonly expressed unavailability, time taken in child car seat installation, and absence of law as the reasons behind not using the child car seats while another common reason was their misperception about the children age group for using child car seats. Driver's education level was found to be the most significant (p < 0.0001) demographic characteristic associated with the driver's awareness on child car seats as well as support towards their usage, initiation of awareness campaigns, and law implementation. ConclusionsThe findings of the study indicate a great need and potential for child car seat educational programs as well as market for such devices especially among educated and affluent parents. The findings of the study also identify parents’ behaviors and attitudes, existing problems, and highlight several challenges and recommendations for planners, policy makers, transportation safety specialists, pediatricians, law enforcement agencies, as well as manufacturers for promoting children road safety.

Road vehicle transportation of children with physical and behavioral disabilities: A literature review

Background: A literature review in 2001 found that children with disabilities were frequently transported in unsafe conditions and further research was required to investigate the gap between regulations, standards and actual transportation practices.Objectives: To synthesize available evidence on the transportation of children with disabilities in road vehicles.Methods: Four databases were systematically searched: CINAHL; Medline; National Transport Library Catalogue (Sweden); and Transport Research International Documentation.Results: Nineteen studies ranging in methodological quality from poor to excellent were included in the review. The findings are presented under the following six major themes: child safety restraints, wheelchairs, vehicles, travel habits, parental and professional knowledge. The results are mapped onto two groups of children, those with behavioral problems and those with physical disabilities.Conclusion: The literature reflected little change across the six major themes since the previous review. Children with disabilities continue to be inappropriately restrained in vehicles, constituting an ongoing road safety problem. There is a strong need to increase parent knowledge, upskill health professionals and provide families with financial assistance to enable them to ensure the safe transportation of children with disabilities to minimize the risk of injury and fatalities on the road, and enhance their participation in the community.

Assignment of Weights to Indexes in Evaluating Usability of Child Safety Chairs Based on AEMV Synthetic Weighting Method

Usability is a decisive factor of any child safety restraint (child-safety chair) in assessing its functions, making purchase decision, and using it properly and effectively. The article takes advantage of well-developed child chair evaluation regulations and processes worldwide, itemizes and discusses every correlation between usability evaluation index and misuse, and thus formulates usability evaluation indexes system consisting of symbol usability, usability of user manual, usability of child protection and usability of chair installation; builds AEMV synthetic weight assignment modeling combining AHP method, Entropy method and Mean Variance method, on account of usability evaluation that can be subjectively biased, and index weighting that can not be decided properly, in consideration of expertise and objective test data; and calculates any index weight assigned to child chair usability evaluation based on the present synthetic weight assignment modeling, and justifies the scientific strength and objectivity of the weights assignment method in question by means of result comparison and analysis.

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...

The Impact of Child Safety Restraint Status and Age in Motor Vehicle Collisions in Predicting Type and Severity of Bone Fractures and Traumatic Injuries.

Although morbidity and mortality in children increases in motor vehicle collisions (MVC) if child restraints are not used, no data exist correlating specific injuries with proper or improper use of safety restraints or age. The purpose of this study was to evaluate correlations between childhood MVC injuries, age, and restraint status. A medical record search for pediatric patients involved in a MVC was conducted at a pediatric hospital (level 1 trauma). Charts were reviewed for demographics and injury-specific information. Patients were grouped by age, restraint use, and injuries. Nine hundred sixty-seven patients ≤12 years (average age 6.39 y) were identified. Being properly restrained was most common in all age groups except the 4- to 8-year age group in which being improperly restrained was most common. Unrestrained patients were most commonly found in the 9- to 12-year age group. A statistically significant difference was not observed for orthopaedic injuries among the restraint groups, but internal thoracic injuries, open head wound, and open upper extremity wounds were significantly more common in improperly or unrestrained patients. Improperly restrained infants had a significantly higher rate of intracranial bleeds and abrasions than those properly restrained. Unrestrained and improperly restrained 9- to 12-year olds had significantly more open head, open upper extremity, and vascular injuries. When comparing injury types with age groups, upper extremity fractures, femoral fractures, dislocations, and spinal fractures were found to be significantly higher in older children. Preventing orthopaedic injuries in older children may be accomplished by changes in regulations or automotive safety equipment. Rear-facing child safety seats could possibly be improved to prevent head trauma in the youngest patients. There is a continued need to reinforce the importance of proper use of child safety devices to parents. Knowledge of the patient's age, along with restraint status, might aid in diagnosis of less obvious MCV injuries. Level III.

Knowledge, attitudes, and behaviors related to child safety restraint in citizens of Shenzhen Municipality, China, and the associations between these factors

ABSTRACTObjective: A child safety restraint (CSR) is an effective measure to reduce the risk of child injury from traffic collisions. This study aims to explore knowledge, attitudes, and behaviors regarding CSRs in a Chinese population.Methods: A cross-sectional survey regarding CSR use was conducted from April to May 2014 in Shenzhen municipality. Respondents were parents who had at least one child 0 to 6 years of age and owned a car. These parents provided a self-report of demographic characteristics as well as information about their knowledge, attitudes, and behaviors toward CSR use.Results: Most respondents had a fair level of knowledge about CSRs, with higher mean knowledge scores demonstrated among the respondents who were male, had an advanced degree, had a higher income, owned an expensive car, had an older child, drove frequently with children, and routinely drove greater distances with children. In addition, most respondents had a more positive attitude toward CSR use, with a higher mean attitude score among those who had an advanced degree, owned an expensive car, drove frequently with children, and routinely drove greater distances with children. However, some myths regarding CSR use also existed (e.g., parents can effectively protect their children in a car collision by holding them, they are not required to purchase the CSR for child safety if there is no mandatory provision by law, among others). Among 3,768 respondents who had at least one child and a car, 27.8% (1,047) had a CSR and 22.9% (864) used the CSR. A logistic regression model showed the likelihood of CSR ownership to be higher if respondents drove frequently or greater distances and was dependent on both the education level of the respondents and the age of the children. The frequency of CSR use increased as the age of children decreased (P = .0274). Respondents who owned a CSR and those who frequently used CSRs had higher mean knowledge and mean attitude scores.Conclusions: This observational study found that although the majority of respondents had fair levels of knowledge and positive attitudes, they had lower rates of CSR ownership and use. Therefore, efforts at developing opportunities to expand public awareness of CSR use should be made to improve child passenger safety practices and eliminate child injury caused by traffic collisions.

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.

Parental practice of child car safety in Enugu, Southeast Nigeria.

Child safety restraints and seat belts are regarded as the most successful safety and cost-effective protective devices available to vehicle occupants, which have saved millions of lives. This cross-sectional descriptive study evaluated the practice and use of child car restraints (CCRs) among 458 purposively selected respondents resident in two local government areas in Enugu State, Nigeria. Self-administered questionnaires were sent to parents of children attending private schools who owned a car. Chi-square and multivariate analyses were used to assess the determinants of the use of car restraints in children among respondents. In all, 56% and 45% of adults and children, respectively, used car restraints regularly. The awareness of child safety laws and actual use of age-appropriate CCRs among respondents was negatively and weakly correlated (r=−0.121, P=0.310). Only respondent’s use of seat belt during driving (P=0.001) and having being cautioned for non-use of CCRs (P=0.005) maintained significance as determinants of the use of CCRs in cars on multivariate analysis. The most frequent reasons given for the non-use of CCRs included the child being uncomfortable, 64 (31%); restraints not being important, 53 (26%), and restraints being too expensive, 32 (15%). Similarly, for irregular users, exceptions for non-use included the child being asleep (29%), inadequate number of CCRs (22%), and the child being sick (18%). There is a need for a strategy change to enforce the use of CCRs in Nigeria.

The impact of child safety restraint legislation on child injuries in police-reported motor vehicle collisions in British Columbia: An interrupted time series analysis.

Motor vehicle collisions (MVCs) remain a leading cause of death and serious injury in Canadian children. In July 2008, British Columbia introduced child safety seat legislation that aimed to reduce the number of children killed or injured in MVCs. This legislation upgraded previous child seat legislation (introduced in 1985) and affected children zero to three and those four to eight years of age. The objective of the present study was to evaluate the effectiveness of this legislation. Deidentified police reports for all MVCs involving zero- to 14-year-olds (2000 to 2012) were used to compare injury rates, booster seat use, and seating position among children before and after booster seat laws. An interrupted time series design was used to estimate the effect of the new law on injuries among children zero to three and four to eight years of age. Estimates were adjusted using children nine to 14 years of age as controls. The booster seat law was associated with a 10.8% (95% CI 2.7% to 18.9%) reduction in the monthly rate of injuries in four- to eight-year-old children (P=0.01). This was equivalent to a decrease of 14.3 injuries per 1,000,000 children. Similarly, the monthly injury rate among children zero to three years of age decreased by 13.0% (95% CI 1.5% to 24.6% [9.8 injuries per 1,000,000]; P=0.03). The results provide evidence that British Columbia's new child safety restraint law was associated with fewer injuries among children covered by the new laws.

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 …

Don׳t learn safety by accident: A survey of child safety restraint usage among drivers in Dansoman, Accra

ObjectiveThe study surveyed child safety restraints use among drivers transporting children to school in Dansoman, Accra. MethodEmploying a naturalistic observational method, the following were observed: sex of the driver, vehicle model, child characteristics, child location in the vehicle, whether child was restrained and how they were restrained, whether the driver was belted and the presence of other vehicle occupants. In total 126 vehicles were observed. ResultsThe study revealed low child restraints use among the observed drivers; children in new vehicles were more likely to be restrained; children seated in the back seat were more likely to be unrestrained; and child occupants were more likely to be unrestrained where there were other vehicle occupants. ConclusionThe study maintained that a collaborated effort by road safety stakeholders in terms of education/awareness creation and subsequent strict enforcement of child restraints use laws were required.

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.