Parents Using Booster Seats -- Badly

From the WebMD Archives

Dec. 10, 2001 -- Parents, you're using booster seats more than ever before, but likely are using them incorrectly or not long enough. A study finds that the vast majority of children are not properly restrained in those seats. After age 6, very few kids are riding in boosters -- even though they still need them.

"Despite significant increases in restraint use over the past 25 years, many children are not restrained properly for their age," writes lead author Dennis R. Durbin, MD, and colleagues. Durbin is a pediatrician at Children's Hospital of Philadelphia and an epidemiologist with the University of Pennsylvania School of Medicine in Philadelphia.

His study is published in this month's issue of Pediatrics.

The importance: "Recent data have documented that young children in seat belts are over 3 times more likely to be injured in a crash than children in age-appropriate restraints," writes Durbin.

Children under 4 years old or 40 lbs. should be kept in full harness restraint, according to the American Academy of Pediatrics. After that, children should use belt-positioning booster seats until they are age 8 or a height of four feet, nine inches.

In his study, Durbin looked at data from car crashes occurring between Dec. 1, 1998, and Nov. 30, 2000, occurring in 15 different states, as reported by one insurance company. Each crash involved children between 2 and 8 years old riding in cars built in 1990 or sooner -- a total of nearly 60,000 children.

Use of restraints (including seat belts, car seats, and booster seats) was 97% overall, he reports. In fact, booster seat use among children between ages 4 and 8 increased by 74% per year during the two-year study. At the beginning of the study, only 4.6% of children enrolled were restrained in a booster seat at the time of the crash; by the study's end, 13% were restrained in the seats. Overall, 11.5% were restrained in a booster seat at the time of the crash.

Booster seat use was highest among 4-year-olds, with an increase of 80% per year, rising from 14% in 1998 to 34% in 2000. However, by age 5, seat use declined dramatically until it was "virtually nonexistent" with kids 6 and up.


Parents of 7- and 8-year-olds must be counseled in using the booster seats, writes Durbin.

Most state child occupant restraint laws are not in alignment with these recommendations, says Durbin. Only seven states have any booster seat requirement written into law. However, several states have recently passed upgraded child restraint laws that require the use of booster seats for children over age 4. Many other states are actively considering similar upgrades to their child restraint laws.

The rapid increase in booster seat use "over such a short period of time indicates a heightened interest and acceptance among parents toward optimally restraining their older children, compared to low interest levels in 1998," Durbin says in a news release. "State legislators and federal policy-makers may take notice that parents could be more receptive to booster seat legislation and other educational efforts."

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