Children restrained in belt-positioning booster seats less likely to get injured

The Children's Hospital of PhiladelphiaOct 20 2009

Boosters especially effective in side impact crashes

A study released today in Pediatrics by The Children's Hospital of Philadelphia offers updated evidence that children ages 4 to 8 who are restrained in the rear seat of a car in a belt-positioning booster seat are 45 percent less likely to be injured in a crash compared with children using a seat belt alone. Furthermore, the study showed there was no difference in the level of protection offered by backless versus high back booster seats. Of those riding in booster seats, children involved in side-impact crashes saw the greatest reduction in injury risk.

Researchers at The Children's Hospital of Philadelphia's Center for Injury Research and Prevention studied more than 7,000 children ages 4 to 8 involved in real-world crashes between 1998 and 2007.

"We wanted to take a fresh look at booster seats' effectiveness to reduce injury among this age group, because when we first evaluated the protective benefits of booster seats in 2002, most children using them were 4 and 5 years old," explains lead researcher Kristy Arbogast, Ph.D., Director of Engineering at CHOP's Center for Injury Research and Prevention. "Since then, usage rates among older kids ages 6- to 8 have tripled, and we wanted to be sure these older kids were as well-protected by booster seats as the younger ones, now that we had more data. We found that injury reduction offered by booster seats remains significant even when a greater proportion of older children are included in the study."

Researchers attribute the sharp increase in booster seat use among older children, in part, to many states passing upgrades to their child restraint laws that require booster seats for children older than age 4. The upper age limit of these booster laws varies by state and ranges from 6 through 8 years. Passage of these laws is associated with a nearly 40% increase in child restraint use among children up to age 8. While 47 states have booster seat laws, only 25 states and the District of Columbia require booster seats for children up to at least age 8. Florida, Arizona, and South Dakota have no booster seat law. The CHOP researchers recommend policymakers work to close these gaps in the laws to cover children to at least age 8 so that parents have the best information to protect their children.

"Based this new analysis of a decade's worth of data on children involved in crashes, policymakers, pediatricians and health educators should continue to recommend as best practice the use of belt-positioning booster seats once a child outgrows a harnessed based child restraint until he/she is at least 8 years of age," says Dennis Durbin, M.D., M.S.C.E., Co-Scientific Director of The Center for Injury Research and Prevention and study co-author. "Additionally, these results can give confidence to parents and health educators that choosing between a high back versus a backless booster seat for their child does not represent a compromise in safety."