Does Your Child Need a Booster Seat?

From the WebMD Archives

April 24, 2001 (Washington) -- Booster seat advocates call 19.5 million kids the "forgotten" children. They're too big for child safety seats and too small for regular seat belts.

These kids are the prime candidates for booster seats, which raise children so they are more properly positioned into seat belts.

A congressional hearing focused Tuesday on increasing the use of the boosters, as an association of crash injury experts separately issued recommendations to require the use of these seats for children.

The leading cause of death for children aged 5-16 is traffic wrecks. In the 1990s, about 16 kids between 4 and 8 were killed each week in motor vehicle accidents. In 1999, more than 70% of the children who died were totally unrestrained.

All 50 states have mandatory child restraint laws, but most do not have laws mandating booster seats for children who have outgrown car seats. Kids too big for child seats can, in a crash, be tossed out of a loose-fitting adult belt or can suffer injuries from the belt itself.

Dennis Durbin, MD, a child injury prevention expert, tells WebMD, "Booster seats do offer a distinct advantage over seat belts [alone]."

Durbin helped plan this week's booster seat meeting of the Association for the Advancement of Automotive Medicine, which backed the mandatory use of boosters. He says, "There is now coming a body of scientific evidence that booster seats in real-world crashes in fact are better than seat belts alone for these young kids." Durbin is an assistant professor of pediatrics at the Children's Hospital of Philadelphia.

But only three states -- California, Washington, and Arkansas -- currently require the use of booster seats. And none of these laws are yet in effect.

Other states have legislation pending, but objections including "parents' rights" arguments have blocked action in states including Illinois and Maryland.

At Tuesday's congressional hearing, Sen. Peter Fitzgerald (R, Ill.) said he is considering legislation that would hinge federal transportation funding to states upon their willingness to require booster seats.

According to the National Highway Traffic Safety Administration, most studies show that booster seats are used with fewer than 10% of kids. The agency also did a recent survey that found that more than 20% of parents of young kids had not heard of booster seats.


What should parents do? Durbin tells WebMD, "Beginning at birth, all children should be placed in a rear-facing car safety seat, until they are at least one year of age and at least 20 pounds." Once the child has reached both of these points, he says, "You are ready to turn the child around in a forward-facing car safety seat."

"When they outgrow that forward-facing safety seat, this is the critical transition where many parents now put their child in a seat belt," Durbin says. "There is a better transition -- to the belt-positioning booster seat." This simply rests on the existing auto seat, better positioning the child for the car's lap and shoulder belts.

According to Durbin, the child should stay in that seat until he or she properly fits in the car's seat belt. This will depend on the child's height, weight, and the size of vehicle, but it could be as late as 10 years of age.

There is no federal standard for certifying which booster seats would benefit which children. Moreover, so-called "shield" booster seats are considered unsafe but are still available in the U.S., Durbin and other experts say. Federal regulators have yet to develop a 10-year-old-child-size dummy for crash-testing the seats.

That's why the Insurance Institute for Highway Safety told Congress that "emphasizing boosters is a misplaced priority." Instead, it said, "The first order of business is to get older children in restraints regardless of what type of restraint is used."

In other words, let's focus just on assuring the use of seat belts. The institute's Susan Ferguson, PhD, said, "We don't want to have parents even more confused than they already are."

But Durbin tells WebMD that it's time to move ahead. "The message for several decades has been 'buckle up,' and that was a very successful message." He says that evidence now clearly suggests that booster seats are better than seat belts alone, although seat belts are certainly better than no restraints at all.

Judith Lee Stone, president of Advocates for Highway and Auto Safety said that states should pass laws to encourage booster seat use, even if there is no clear definition yet of the ideal seat.


Others note that consumers need to make their voices heard to automakers, some of whom have -- with little fanfare or apparent demand -- begun to make built-in booster seats available with new cars.

"The car-buying public should start to ask questions," said traffic safety researcher Hugo Mellander.

WebMD Health News
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