Booster Seats

Need for Booster Seats for Children Less than 57″ in Height (usually up to age 8 – 12)

WHEREAS, motor vehicle crashes are the second leading cause of death for children ages 4 to 10, and

WHEREAS, restraint use among children 4 to 7 years old remains at only 89%, and

WHEREAS, half of children under the age of 12 who are under the height of 54” are not using a booster seat, and

WHEREAS, even though using an adult restraint system is better than using no restraint system, passenger car seats and restraint systems are designed to accommodate adults and are not the optimal restraint suitable for children, and

WHEREAS, for children ages 4 to 8 years, use of belt-positioning booster seats reduces the risk of non-fatal injury by 45-59% compared to use of adult belts alone, and

WHEREAS, booster seats reduce the risk of fatality by 67% in 4- to 7- year-olds and by 55% in 6- to 8-year-olds compared with unrestrained adults and children, and

WHEREAS, most children will not fit properly in vehicle lap-and-shoulder belts until they have reached a height of 57”, and

WHEREAS, most children reach the height of 57” between the age of 8 and 12, and

WHEREAS, all 50 states have enacted child safety seat laws, the age at which vehicle (adult) seatbelts can be used varies between states, some allowing adult belts for children as young as 5 years, and

WHEREAS, in some states, the wording of restraint laws results in some children being covered by no law,

BE IT RESOLVED, that the Association for the Advancement of Automotive Medicine urges the prompt passage of statewide mandatory primary enforcement child restraint use laws requiring children who have outgrown forward-facing child restraints but have not yet reached the height of 57” (typically between age 8 and 12), to be restrained in a belt-positioning booster seat.

Adopted: September 2003, Updated February 2018

Background information

Motor vehicle crashes remain the leading cause of death for children and youth over age three [1], and are the second leading cause of death for children ages four to 10 in the United States [2]. Despite significant increases in restraint use for children over the past 25 years, restraint usage among children ages 4-7 remains at 89% [1]. Further, many children are not restrained properly for their age. This problem is particularly prevalent among children who have outgrown a forward-facing child restraint, yet are not big enough to use the vehicle seat belt properly. In one survey, half of the children under the age of 12 who are less than 54” in height are not using booster seats [1]. In 2013, 33% of four- to seven-year-olds were improperly restrained (either prematurely graduated to seat belts or not restrained at all) [3]. The American Academy of Pediatrics and the Children’s Hospital of Philadelphia currently recommend that children who have outgrown forward-facing child restraints be seated in a belt-positioning booster seat until they have reached a height of 57”. Most children reach this height between the ages of eight and 10 [4,5]. The National Highway Safety Administration (NHTSA) recommends that children who have reached the top height or exceeded the weight limits of their forward-facing child restraint be restrained in a booster for as long as possible until the vehicle seatbelt fits them properly [6].

Proper vehicle seatbelt fit is defined as:

  • The shoulder belt lies across the middle of the chest and shoulder, not the neck or face.
  • The lap belt is low across the hips and pelvis, not the abdomen.
  • The child is tall enough to sit against the vehicle seatback with his or her knees bent over the edge without slouching, and can stay in this position comfortably throughout the trip.
  • The child can keep his or her feet on the floor [1, 6].

The need for enforcement of proper booster seat usage is borne out in statistical surveys of injury and fatality. For children ages 4 to 8 years, use of belt-positioning booster seats reduces the risk of non-fatal injury by 45-59% compared to use of adult belts alone. Booster seats reduce the risk of fatality by 67% in 4- to 7- year-olds and by 55% in 6- to 8-year-olds compared with unrestrained adults and children [1].

Currently in the United States, all 50 states have enacted some form of child safety seat law. However, the age at which vehicle (adult) seatbelts can be used varies between states, with some beginning as young as 5 years with no secondary requirement. Most child safety laws are primary enforcement, but some still remain secondary. However, the way child safety laws are worded may lead to children being covered by no law under certain circumstances [7]. Child booster seat laws have proven effective in states with more robust guidelines and requirements. In 2012, the crash fatality rate for children ages four to eight in states with less strict laws was 13.7 per 100,000 children. In contrast, states with stricter laws had a fatality rate of 8.6 per 100,000 children. Eight of the top 10 states with the highest crash fatality rates are states with less strict booster seat laws [2]. To prevent ambiguity, eliminate the possibility of coverage gaps in child safety seat laws, and ensure children are protected by the appropriate restraint system, AAAM urges all states and nations to adopt mandatory primary enforcement child restraint use laws requiring children who have outgrown forward-facing child restraints but have not yet reached the height of 57” (typically between age 8 and 12), to be restrained in a belt-positioning booster seat.

References:

[1] Durbin DR, Committee on Injury, Violence, and Poison Prevention. Technical Report – Child Passenger Safety. Pediatrics. 2011 Apr;127(4):e1050-e1066.

[2] Safe Kids Worldwide. Buckle Up: Booster Seats, September 2014.

[3] Dunn, L., Holliday, A., & Vegega, M. (2016, March). Motor vehicle occupant protection facts – Children, youth, young adults (Fact book. Report No. DOT HS 812 251). Washington, DC:

National Highway Traffic Safety Administration.

[4] Committee on Injury, Violence, and Poison Prevention, Durbin DR. Policy Statement – Child passenger safety. Pediatrics. 2011 Apr;127(4):788-93.

[5] Children’s Hospital of Philadelphia. Car Seat Safety: 4- to 8-year-old Children. 2017. http://www.chop.edu/centers-programs/car-seat-safety-kids/car-seat-safety-by-age/4-8-year-old-children

[6] US Department of Transportation, National Highway Traffic Safety Administration. Keeping Kids Safe – A Parent’s Guide to Protecting Children in and Around Cars. 13237-091517-v4.

[7] Insurance Institute for Highway Safety, Highway Loss Data Institute. Safety Belt and Child Restraint Laws. October 2017. http://www.iihs.org/iihs/topics/laws/safetybeltuse?topicName=child-safety.