WHEREAS, primary enforcement of legislation requiring the presence and use of restraints is the most effective method of increasing occupant restraint use and such legislation has been demonstrated to decrease deaths and serious injuries among occupants, and

WHEREAS, all motor vehicle occupants should be appropriately restrained while vehicles are in operation the specific type of restraint may depend on the individual and their situation. While lap and shoulder seat belts should generally be used for all adults and children who have outgrown booster seats, and

WHEREAS, all children younger than 13 years should be restrained in the rear seats of vehicles, and

WHEREAS, children should use a belt-positioning booster seats after outgrowing the forward-facing seat, until they are 4’9″ and between 8-12 year of age (See Child Restraint Systems Position Statement), and

WHEREAS, children should use a forward-facing seat with a harness after they outgrow their rear-facing seat and until they reach the height and weight limits specified by the child seat manufacturer. Convertible seats can be used both rear and forward facing (See Child Restraint Systems Position Statement), and

WHEREAS, infants and toddlers should ride in a rear-facing car safety seats as long as possible, until they reach the height and weight limits specified by the child seat manufacturer (See See Child Restraint Systems position statement), and

WHEREAS, it is recommended that a certified Child Passenger Safety Technician installs or confirms proper installation of child restraints.

BE IT RESOLVED that the Association for the Advancement of Automotive Medicine urges all countries to adopt and enforce legislation mandating that all passenger vehicles contain functional appropriate point restraint systems for all occupants in all seating positions,

And further

BE IT RESOLVED that the Association for the Advancement of Automotive Medicine urges all countries to adopt and fully enforce legislation requiring that all occupants of moving passenger vehicles be restrained appropriately as dictated by their age and size.

Adopted: October 2010, Revised August 2020

Rationale and Background Information

According to the World Health Organization, in 2016 1.4 million died as a direct result of injuries sustained in a motor vehicle crash.[1] However, when used correctly, adult and child occupant restraints can significantly reduce the incidence of injury and death from a motor vehicle crash. Occupant restraints, including seat belts, airbags, and child passenger restraints, help to prevent injury during a crash in five different ways: preventing ejection, shifting crash forces to the strongest parts of the body’s structure, spreading forces over a wide area of the body, allowing the body to slow down gradually, and limiting relative motion between body segments. Among vehicle systems for protecting occupants from serious injury or death in the event of a collision, seat belts and child passenger restraints (including boosters) are the simplest and least expensive.[2]

When lap and shoulder seat belts are used properly, they reduce the risk of fatal injury to adult front-seat occupants riding in passenger vehicles by at least 50% and by as much as 86%.[3],[4],[5] In the rear seating positions, lap-shoulder belts used by occupants over the age of 5 reduce the risk of fatality by 44% to 75% compared to no restraint and are 15% to 25% more effective at preventing fatal injury than lap belts alone. 4,[6],[7] Moderate to critical injuries are reduced by 50% and 65% with lap-shoulder belts use for front and rear occupants respectively.[8]

Children also benefit from the use of occupant restraints. The American Academy of Pediatrics (AAP) strongly supports optimal safety for children and adolescents of all ages during all forms of travel.9

Eighty-eight percent of developed countries have child-restraint laws in place, but are less common in low- and middle-income countries (30% and 43% respectively).5 Child restraints are not automatically installed in vehicles and must be purchased and fitted by parents, making it more challenging to achieve high usage rates, especially in low- and middle-income countries.5

Child car seats reduce the risk of injury by 71% to 82% and reduce the risk of death by 28% when compared with children of similar ages in seat belts 10,11,12 while booster seats reduce the risk of nonfatal injury among 4 to 8-year-olds by 45% compared with seat belts.12

Child car seats are 71% effective in reducing fatalities among infants (younger than 1 year old) and 54% to 80% effective for toddlers (1 to 4 years old) in passenger cars. For infants and toddlers in light trucks, the effectiveness in reducing fatalities is 58% and 59%, respectively.8  Belt-positioning booster seats lower the risk of injury in children between 4 and 8 year old and over 40 pounds by 45%- 59% compared with the use of vehicle seat belts alone.13,14

Comprehensive seat-belt laws covering all occupants are in place in 111 countries, (69% of the world’s population) and 96 countries have child restraint laws; however, only a quarter of all countries rate their seat-belt enforcement as “good” and only half collect data on seat belt use.5 In many countries where vehicle use rates are rising rapidly, not all vehicles have functioning seat belts and not all occupants use them when available. The United Nations has undertaken the responsibility to suggest standards that are adoptable by nations seeking to require functioning belts in vehicles.15

Seat belt legislation and enforcement has decreased both the number of fatalities and serious injuries among motor vehicle occupants across the globe.16,17,18,19  Effective methods used to increase belt use in higher-income countries are also successful in lower-income countries.20

[1] World Health Organization. The top ten causes of death. Available at: Accessed January 8 14, 2019.

[2] National Highway Traffic Safety Administration. Safety belts save lives. Available at: Accessed August 14, 2009.

[3] Rivara FP, Koepsell TD, Grossman DC, Mock C. Effectiveness of automatic shoulder belt systems in motor vehicle crashes. JAMA. 2000 Jun 7;283(21):2826-8.

[4] Kahane C. Fatality Reduction By Safety Belts For Front-Seat Occupants Of Cars And Light Trucks. National Highway Traffic Safety Administration, Department of Transportation.  DOT HS 809 199.  Accessed 6/6/2018.

[5] World Health Organization. Global status report on road safety 2018.

[6] Morgan, C.  Effectiveness of Lap/Shoulder Belts in the Back Outboard Seating Position.  National Highway

Traffic Safety Administration. DOT HS 808 945. 1999.

[7] Zhu M, Cummings P, Chu H, Cook L (2007) Association of rear seat safety belt use with death in a traffic crash: a matched cohort study. Injury Prevention 13:183-185.

[8] National Highway Transportation Safety Administration (NHTSA). Traffic Safety Facts. 2016 Data, Occupant Protection in Passenger Vehicles. DOT HS 812 494.

9 Durbin D, Hoffman B. Child passenger safety. American Academy of Pediatrics, 2018;142(5).

10 Arbogast KB, Durbin DR, Cornejo RA, Kallan MJ, Winston FK. An evaluation of the effectiveness of forward facing child restraint systems. Accid Anal Prev. 2004;36(4):585–589pmid:15094411.

11 Zaloshnja E, Miller TR, Hendrie D. Effectiveness of child safety seats vs safety belts for children aged 2 to 3 years. Arch Pediatr Adolesc Med. 2007;161(1):65–68pmid:17199069.

12 Elliott MR, Kallan MJ, Durbin DR, Winston FK. Effectiveness of child safety seats vs seat belts in reducing risk for death in children in passenger vehicle crashes. Arch Pediatr Adolesc Med. 2006;160(6):617–621

13 Arbogast KB, Jermakian JS, Kallan MJ, Durbin DR. Effectiveness of belt position booster seats: an

updated assessment. Pediatrics 2009; 124:1281-86.

14 Durbin DR, Elliott MR, Winston FK. Belt-positioning booster seats and reduction in risk of injury among children in vehicle crashes. JAMA. 2003;289(21):2835-40.

15 UNECE. Regulation No. 16, Revision 8, 26 May 2014. Uniform provisions concerning the approval of I: Safety-belts, restraint systems, child restrains systems and ISOFIX child restraint systems for occupants of power-driven vehicles. II: Vehicles equipped with safety-belts, safety-belt reminders, restrain systems, child restraint systems and ISOFIX child restraint systems and i-Size child restraint systems. Accessed 6/6/2018.

16 US Government Accounting Office.Safety Belt Use Laws Save Lives and Reduce Costs to Society, May 1992  Accessed 4/19/10.

17 Ashton SJ, Mackay M, Thomas PD, Galer MD, Harms P, The Effects of Mandatory Seatbelt Use in Great

Britain, Proceedings, Tenth International Technical Conference on Experimental Safety Vehicles, Oxford, July 1985.

18 Allen MJ, Barnes MR, Bodiwala GG, The effect of seat belt legislation on injuries sustained by car occupants, Injury,1985: 16: 471-476.

19 Norin H, Carlsson G, Korner J, Seat Belt Usage in Sweden and Its Injury Reducing Effect, SAE 840194.

20 Stevenson M, Yu J, Hendrie D, Li L-P, Ivers R,Zhou Y, Su S,  Norton R. Reducing the burden of road traffic injury: translating high-income country interventions to middle-income and low-income countries. Inj. Prev. 2008;14;284-289.