Objective Although child safety seats are highly effective in preventing injuries, they are frequently misused. Experts have identified two leading “critical misuses”: (1) loose harness straps and (2) loose vehicle attachment at the base. We designed an innovative child safety seat system that educates, instructs, and alarms participants of safety seat errors. The system includes both the Cellular Car Seat (CCS) smartphone app and a network of car seat sensors. Our objective was to determine if CCS system users had fewer child safety seat misuses than users with a child safety seat manual alone. Methods During the study visit, 92 participants completed three safety seat scenarios using a mock vehicle setup, test doll, and a convertible child safety seat: A) fully install a convertible safety seat, B) recognizing/correcting loose harness straps in a seat with intentionally loose straps, and C) recognizing/correcting loose attachment to the vehicle seat at the base in a seat with intentionally loose attachment. Intervention participants (n = 46) were asked to use the CCS app during each scenario and control participants (n = 46) were given only the paper child safety seat manual. For each scenario, researchers determined errors/misuses present at the end of the scenario, time to complete scenario, and tension achieved on the harness straps (collected via load cell). Results Compared with controls, intervention participants had significantly fewer errors and higher average harness tensions for all three scenarios; furthermore, a greater portion achieved a harness tension of 4 newtons. During Scenario A, the rate of loose harness strap errors was more than three times higher for controls and loose base attachment errors almost six times higher. We observed similar trends in Scenario B, with harness strap errors more than double for controls. In Scenario C, the rates of both critical misuse errors were four times higher for controls compared to the intervention group. Conclusions The innovative CCS system was highly effective at reducing child safety seat use errors, especially critical misuses. Reducing critical misuses will decrease injuries and fatalities among crash-involved children. The CCS system can alert families to everyday harnessing and installation errors and provide families and caregivers with ongoing, accessible support.
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