Belt-Positioning Booster Seats for Children - National Perspectives from Emergency Physicians and Parents

Motor vehicle collisions (MVCs) are the leading cause of death in children after the first year of life.1 On average, 5 children under age 15 are killed in MVCs each day in the United States (US).2 In 2008, an estimated 172,047 children under age 15 received treatment in US hospital emergency departments (EDs) for non-fatal injuries sustained as occupants in MVCs.1 Proper child restraint has been shown to decrease the risk of death and serious injury in MVCs for children of all ages. Advances in child passenger safety seats have led to specific recommendations for proper restraint of children of various age and size ranges.3, 4 While car seats are used for over 90% for infants and toddlers, children between 4 and 8 years of age are much less likely to be properly restrained.5 Research has shown 4 to 8 year olds are safest when restrained in a belt positioning booster seat, reducing their risk of serious injury by nearly 50% when compared with children in seat belts alone.6 Despite strong evidence supporting the benefit of belt positioning booster seats, 22% of children 4 to 5 years old and 52% of children 6 to 7 years old are prematurely placed solely in seat belts.5 Not using a booster seat has been associated with the child riding in multiple cars and the presence of multiple passengers in the car. 7-9 However practical barriers to booster seat use have not been examined in a national sample of parents. Following an MVC, parents, especially those who present to the ED for evaluation, may be more receptive to educational messages about child passenger safety. This so called "teachable moment"10, 11 places emergency physicians in a unique position to increase proper restraint use for child passengers. While the American College of Emergency Physicians has created policy statements regarding the role of emergency physicians in injury prevention and control12, emergency physician knowledge of child safety seats has not previously been examined. Emergency physician attitudes and beliefs about the use of the ED visit as an opportunity to provide parents with child safety seat information are also unknown. Surveys of primary care physicians suggest that knowledge of proper child restraint decreases for children over 1 year of age and training on child passenger safety is limited.13, 14 The proposed study consists of two components. In component 1 we will conduct a national survey of emergency physicians who have, and who have not, undergone dedicated pediatric training to determine their knowledge of current child passenger restraint recommendation as children transition from car seats to booster seats to seat belts. In order to understand knowledge related to these transition points, we will include questions about restraint use for children from 2 to 10 years of age. General emergency physicians, in addition to specialized pediatric emergency physicians, will be included in the survey as they provide care to more than 90% of children seen in EDs.15 Objective 1: To evaluate emergency physician knowledge of proper child restraint for children 2 to 10 years of age. Hypothesis 1: Emergency physicians with dedicated pediatric training will have greater knowledge of proper child restraint compared with emergency physicians without dedicated pediatric training. Objective 2: To examine emergency physicians' attitudes, beliefs, and perceptions of self-efficacy about their role in MVC-related injury prevention during the ED visit. Hypothesis 2: Pediatric emergency physicians will be more likely than general emergency physicians to view a role for child passenger safety as a part of their clinical work. The second component will focus on booster seat use in vehicles with multiple child passengers. We will conduct a national survey of parents of 4 to 8 year old children using the C.S. Mott Children's Hospital National Children's Health Poll to determine the extent to which 4 to 8 year old children are transported in car pools and to explore parental opinions and experiences related to booster seats when transporting multiple 4 to 8 year old children. Objective 1: To describe, in parents of 4 to 8 year old children, the frequency with which parents drive multiple children and their experiences and opinions related to booster seat use when car pooling. Hypothesis 1: Parents who infrequently drive multiple 4 to 8 year old children will be more likely to use a booster seats for those children compared with parents who car pool often.


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  • Status: Active
  • Contract Numbers:


  • Sponsor Organizations:

    Center for Advancing Safe Transportation Throughout the Lifespan

    University of Michigan, Ann Arbor
    Ann Arbor, MI  United States  48109-2150

    Research and Innovative Technology Administration

    Department of Transportation
    1200 New Jersey Avneue, SE
    Washington, DC  United States  20590
  • Performing Organizations:

    University of Michigan Emergency Medicine

    300 North Ingalls Building
    Room 6D09
    Ann Arbor, MI  United States  48109-5456
  • Principal Investigators:

    Macy, Michelle

  • Start Date: 20100101
  • Expected Completion Date: 0
  • Actual Completion Date: 20110131
  • Source Data: RiP Project 26168

Subject/Index Terms

Filing Info

  • Accession Number: 01461507
  • Record Type: Research project
  • Source Agency: Center for Advancing Safe Transportation Throughout the Lifespan
  • Contract Numbers: F024569
  • Files: UTC, RiP, USDOT
  • Created Date: Jan 3 2013 1:47PM