Car Seat Safety -Why are Children Still at Risk of Injury and Death? Literature Review Open Access

Merchant, Juliette Marie (2015)

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The Centers for Disease Control and Prevention (CDC) lists motor vehicle crashes as the leading cause of death among children in the United States. Each year nearly 250,000 children in the United States are injured in motor vehicle crashes, and approximately 2000 die from their injuries (NHTSA 2013, Bae, Anderson et al. 2014). From 2000 to 2013 a staggering 32,044 children from birth to 15 years of age were killed in traffic fatalities (WISQARS 2015). School aged children between the ages of 4 to 8 years old are particularly at risk for injury as passengers in motor vehicles because they are often too big for a car seat but too small for a seat belt. Seat belts don't fit children properly until they are at least 57" (4'9") tall and weigh between 80 and 100 pounds. Booster seats are designed to improve belt fit by altering the seated position of the child by changing the belt routing. CDC recommends using age and size appropriate child restraints systems (CRS) in the back seat until they are large enough to safely fit into an adult seat belt properly. This means the lap belt lays across the upper thighs, not the abdomen, and the shoulder belt lays across the shoulder and chest, not the neck or face (Sauber-Schatz, West et al. 2014). When installed and used properly, CRS can prevent injuries and save lives. Although laws and public awareness campaigns have increased the use of restraints, many children continue to be unrestrained or improperly restrained. This systematic review of literature will investigate potential reasons children are still at risk for injury and death as occupants of motor vehicles. What is the most effective way to education parents of school age children about the critical importance of booster seats? The examination of the literature will focus on child passenger policy and legislation; booster seat interventions for school age children between 4 to 8 years old; education program strategies and technology implications affecting child restraint use.

Table of Contents

Chapter I Introduction 1

Definition of Terms 4

Chapter II Review of Literature 6

Figure 1: Child passenger restraint laws 9

Figure 2: U.S. states engaged in legislative activities 15

Table 1: First Ten Adopter States for Child Passenger Safety Laws 16

Table 2: Georgia Passenger Vehicle Occupant Fatalities Age 5 and Above 21

Table 3: Passenger Vehicle Occupants Killed by Age Group and Restraint Use 24

Table 4: Estimated Number of Lives Saved by Restraint Systems 25

Figure 3: Improper vs. Proper Positioning of a Lap Belt 27

Figure 4: Five Popular Booster Seat Types 28

Figure 5: Regression Analysis Comparing of Six Booster Seat Types 29

Figure 6: Motor vehicle occupant deaths birth to 12 2002-2011 29

Figure 7: Proportion of unrestrained child motor vehicle deaths by age/year 31

Figure 8: : Booster Seat Use, National Estimates 34

Table 6: Distribution of Restraint Types Among Children 35

Figure 9: Child Restraint Use by Age and Race/Ethnicity in 2013 36

Chapter III Methodology 40

Chapter IV Results 42

Figure 10: Diagram of Search Query Results of Research Articles 42

Figure 11: Sub Classification of Selected Research Articles 43

Table 7: Child Restraint Policy/Legislation 44

Table 8: Booster Seat >3 yrs 47

Table 9: Education 51

Table 10: Technology 56

Chapter V Conclusions 59

References 65

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