Parents: Don't Use Shield-Style Booster Seats

Forward-Facing Car Seats With Seat Belt, Harness Advised

From the WebMD Archives

March 1, 2004 -- There's more evidence against shield-style child booster seats. Children are at nearly eight times higher risk of serious injury when riding in these seats, a new study shows.

Shield-style booster seats are equipped with a horizontal, padded, pop-down restraint bar in line with the child's mid-torso that is supposed to replace the protection of a safety belt. In some studies and lawsuits, they have been linked to serious injuries in crashes. Many car seat makers have stopped selling them.

The study is a warning flag for parents: Invest in a new model of car seat that meets recent federal guidelines. Don't use an older model that's been handed down or that you've found in a thrift shop. Don't even use a new model of shield booster seat; one manufacturer still produces them, but they are not considered by many experts to be safe. It is marketing them for children between 30 and 40 pounds.

Forward-facing car seats that secure the child with a five-point seat belt and harness are advised by the National Highway Traffic Safety Administration.

"Shield booster seats no longer have any role in child passenger safety," writes researcher Elizabeth A. Edgerton, MD, MPH, an emergency medicine and trauma specialist at Children's National Medical Center in Washington, D.C.

Her paper appears in the current issue of Pediatrics.

Federal investigations of shield booster seats have demonstrated the lack of safety. A series of rollover crash tests showed that dummies weighing less than 40 pounds were more likely to be ejected if they rode in these seats.

Also, crash investigations have reported that babies riding in shield booster seats had greater trauma to the baby's upper body, abdomen, and head.

"On the basis of these studies, the American Academy of Pediatrics has discouraged the use of shield booster seats, stating that they do not provide the best protection to children who are involved in motor vehicle collisions," she writes.

Nevertheless, there is concern about older models of the seat that are still in circulation.

Investigating Car Crash Injuries

In her study, Edgerton investigated 46 car crash victims who were admitted to pediatric trauma centers between 1991 and 2003. She compared the outcomes of children in shield booster seats with those in forward-facing car seats.

Of children restrained in shield booster seats, 62% had severe injuries, especially to the head, chest, and abdominal/pelvic area. They had longer hospitals stays, often in intensive care units, and often required rehabilitation, she reports.

Of children in forward-facing seats, 16% had serious injuries, but their hospital stays were shorter.

Shield booster seats "accounted for all the abdominal and pelvic injuries and a significantly greater proportion of head and chest injuries," writes Edgerton.

Parents must be careful to use car seats that meet current federal guidelines and that are appropriate for the child's age and weight, she explains.

SOURCE: Edgerton, E. Pediatrics: March 2004; vol 113: pp 153-158.