Nearly 70% of U.S. children in car crashes with a fatality were not using proper child passenger restraints, study finds

Despite national guidelines, state laws and known safety benefits of child passenger restraint systems (CRS), suboptimal practices were found in nearly 70% of children under 13 years old who were involved in car crashes with a fatality from 2011 to 2021, according to a study published in the journal Traffic Injury Prevention.

“Given the continued problem of suboptimal child passenger safety practices among children across the country, there is a need for innovative, targeted programs to promote correct and consistent use of age-appropriate car seats, restraints and seating locations,” said lead author Arthi Kozhumam, MScGH, a Ph.D. candidate in the Medical Scientist Training Program in the Macy Lab at Stanley Manne Children’s Research Institute at Ann & Robert H. Lurie Children’s Hospital of Chicago.

An average of three child fatalities and an estimated 429 child injuries occur each day as the result of motor vehicle crashes in the United States.

The study found that inappropriate child passenger safety practices were more common in children who were 4–7 and 8–12 years old, traveling with drivers from under-resourced communities (i.e., with low or very low Child Opportunity Index), and across 75 county-level hotspots throughout the country.

“A novel contribution of this research is our finding of geographic concentrations of suboptimal child passenger safety practices. These areas can be targeted for interventions, especially in the most vulnerable age groups,” said senior author Michelle Macy, MD, MS, Director, Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center at Manne Research Institute at Lurie Children’s and Professor of Pediatrics (Emergency Medicine) at Northwestern University Feinberg School of Medicine.

“The Child Opportunity Index may also provide a lens for targeted prioritization of educational interventions and deployment of passenger safety resources,” added Dr. Macy.

The study analyzed passenger safety practices in 50,000 children involved in a car crash with at least one fatality recorded in the national Fatality Analysis Reporting System (FARS) database—the largest available dataset. Researchers found that 36% of these children were prematurely transitioned to a less protective restraint, 20% were riding unrestrained and 15% were riding in the front seat. Additionally, 9% of children sitting in the front seat were also unrestrained.

The study furthermore revealed that stricter CRS laws and larger fines for first seat belt offenses are significantly associated with lower odds of suboptimal child passenger safety practices.

“In addition to identifying individual factors and geographic areas that can be targeted for interventions, we show that state policy makes a huge difference in promoting safer transportation practices for child passengers,” said Dr. Macy.

Dr. Macy holds the Mary Ann and J. Milburn Smith Research Professorship for the Director of Child Health Research at Lurie Children’s.