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National Child Passenger Safety Week -- February 14-20, 1999.

In 1997, 1791 U.S. children aged <15 years were killed and 282,000 were injured while riding in motor vehicles (1). National Child Passenger Safety Week, February 14-20, 1999, will highlight safety recommendations for children aged >4 years and weighing >40 lbs who have outgrown their child safety seats.

Children who are too large for child safety seats often are restrained improperly or not at all. A recent observational study in four states indicated that, of children weighing 40-60 lbs, 75% were improperly restrained, and 19% were unrestrained (2). Of passengers aged 5-9 years in fatal crashes in 1997, 46% were unrestrained (1).

For proper restraint, children who have outgrown child safety seats require booster seats used with vehicle lap/shoulder belts. Lap/shoulder belts usually do not fit children properly until they are 58 inches tall, have a sitting height of 29 inches, and weigh 80 lbs (3). Therefore, children aged <10 years probably will not be big enough to use a lap/shoulder belt without a booster seat. When smaller children restrained with only a lap belt or a poorly fitting lap/shoulder belt become involved in a crash, the belt tends to ride up onto the abdomen, allowing the pelvis to slide under the belt. This places pressure directly on the abdominal organs and may lead to the child flexing over the belt above the hips, resulting in abdominal and/or spinal injuries (4).

Children should remain in their convertible child safety seats as long as they fit well. Convertible seats are the appropriate restraints for children until their ears reach the top of the back of the safety seat and their shoulders are above the top strap slots, or until they reach the upper weight limit of the seat. To help prevent deaths and injuries among young passengers who have outgrown their child safety seats, CDC recommends the following:

* Belt-positioning booster seats should be used until lap/shoulder belts fit properly (5). Belt-positioning boosters raise children so that the safety belt fits correctly (Figure 1) and should always be used with a lap/shoulder belt. Booster seats with high backs are recommended for vehicles with seat backs that do not support a child's head. Shield boosters, which have a plastic shield in front of the child, do not provide as much upper-body protection and are no longer certified for children weighing >40 lbs. The American Academy of Pediatrics recommends that shield boosters not be used for children weighing <40 lbs, even if they are labeled for use at a lower weight (6). Shield boosters should only be used with their shields removed so they can function as belt-positioning booster seats with lap-shoulder belts.

* Lap/shoulder belts should fit properly (Figure 1). A child cannot ride comfortably and remain properly restrained until tall enough for the knees to bend over the edge of the seat when the child's back is resting firmly against the seat back.

* Whenever possible, child passengers should be placed in the back seat.

The National Transportation Safety Board recommends that states upgrade their child passenger protection laws to require age-appropriate child restraint systems and booster seats for children aged <8 years and has asked automobile manufacturers to redesign the back seats of cars to be more accommodating to children (7). Additional information on child passenger protection is available on the World-Wide Web from the American Academy of Pediatrics at, the Society of Automotive Engineers at, the National Highway Traffic Safety Administration at, the National Transportation Safety Board at http//, and CDC's National Center for Injury Prevention and Control at


1. US Department of Transportation, National Highway Traffic Safety Administration. Children: traffic safety facts 1997. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1998.

2. Decina LE, Knoebel KY Child safety seat misuse patterns in four states. Accid Anal Prey 1997;29:125-32.

3. Klinch KD, Pritz HB, Beebe MS, et al. Study of older child restraint/booster seat fit and NASS injury analysis. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, November 1994; report no. DOT-HS-808-248.

4. Lane JC. The seat belt syndrome in children. Warrendale, Pennsylvania: Society of Automotive Engineers, 1993:159-64. (SAE no. 9330981.

5. American Academy of Pediatrics, Committee on Injury and Poison Prevention. Selecting and using the most appropriate car safety seats for growing children: guidelines for counseling parents. Pediatrics 1996;97:761-2.

6. American Academy of Pediatrics. 1998 family shopping guide to car seats. Elk Grove Village. Illinois: American Academy of Pediatrics, 1998.

7. National Transportation Safety Board. The performance and use of child restraints, seatbelts, and air bags for children in passenger vehicles. Washington, DC: US Department of Transportation, 1996; document no. NTSB/SS-96/01.
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Publication:Morbidity and Mortality Weekly Report
Article Type:Brief Article
Date:Feb 5, 1999
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