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Child Passenger Safety Laws, Child Safety Seat Distribution Programs, Education and Enhanced Enforcement

According to NHTSA's annual National Occupant Protection Use Survey, seat belt use has steadily increased since 1994, with the record high of 86% in 2012 representing a 2% increase over the previous year. However, motor vehicle injuries are a leading cause of death among children in the United States. Of the children who died in motor vehicle crashes in 2011, 33% were not buckled up, according to CDC. Of the teens (aged 13–20 years) who died in crashes in 2012, approximately 55% were not wearing a seat belt at the time of the crash (CDC, 2014). Child passenger restraint laws require children to travel in age- and size-appropriate child restraints, such as car seats or booster seats, until adult seat belts fit them properly. Use of age- and size-appropriate car seats, booster seats, and seat belts for child passengers reduces their risk for death and serious injury in a crash. Child safety seat use reduced the risk for death to infants (aged <1 year) by 71% and to toddlers (aged 1–4 years) by 54% in passenger vehicles (Durbin, 2011). Booster seat use reduces the risk for serious injury by 45% for children aged 4–8 years when compared with seat belt use alone (Arbogast et al, 2009).

  • In 2013, according to CDC, 12 states had child passenger restraint laws that required child safety seat/booster seat use by children aged ≤5 years, 36 states and the District of Columbia had laws requiring child safety seat/booster seats use by children through either age 6 or 7 years, and two states had laws requiring child safety seat/booster seat use by children through at least age 8 years. As a result, in 2013, only 2% of children in the United States lived in states with a child passenger restraint law that required child safety seat/booster seat use by children through at least age 8 years (CDC, 2014).

Child safety seat distribution programs provide child safety seats and education on proper use and installation of seats. Effective interventions can increase restraint use among child motor vehicle occupants and help limit or prevent crash-related fatalities and injuries (Sauber-Schatz, West, Bergen, 2014). Evidence has demonstrated that child passenger restraint laws, incentive and distribution programs, and education programs are effective in increasing use of car seats and booster seats and decreasing child deaths and injuries, especially when these programs are combined (Eichelberger AH, Chouinard AO, Jermakian JS, 2009).

Related Transportation and Heath Tool Indicators

How can this strategy result in health benefits?

  • Improve safety
  • Reduce motor vehicle-related injuries and fatalities

How has this worked in practice?

Wisconsin’s booster seat law: education and enforcement

In Wisconsin, children must be in a car seat until they reach age 4 years and 40 pounds, and in a booster seat until they reach age 8 years, more than 80 pounds in weight, or more than 4 feet, 9 inches in height. To enforce the law in cases of non-compliance of booster seat use, variable penalties are applied through citations. Citations have been given by law enforcement officers since January 2007. A 6-month grace period preceded that, during which written warnings were given in lieu of citations for first offenses of the original booster seat law. The Wisconsin Department of Transportation and advocacy groups publicized the new law. They also developed an information sheet about it for law enforcement personnel and the public. The Wisconsin branch of the American Automobile Association, along with Safe Kids Worldwide, held car seat checks around the state. A 2012 study reviewed police-reported crash data from five states, including Wisconsin, to understand population-based injury rates among children before and after booster seat laws. The study found that booster seat laws were associated with “a 5% reduction in the per capita rate of children who sustained injuries of any severity and a 17% reduction in the per capita rate of children who sustained fatal or incapacitating injuries” (Eichelberger, 2012).

Corazón de mi vida child passenger safety campaign

Corazón de mi vida was developed in 1999 by the National Latino Children’s Institute (NLCI) in partnership with NHTSA and corporate sponsors. Corazón means heart in Spanish. NLCI notes that the initiative name translates to “You are the center of my life” and serves as the core for the program’s public information messages and culturally-based outreach strategies.

According to NHTSA, motor vehicle crashes are the leading cause of death for Hispanic children ages 1 year and older, and child fatality rates are higher for Hispanic than non-Hispanic children. This is because of lower levels of restraint use, including child safety seats, booster seats, and seatbelts.

The focus of the Corazón de mi vida initiative is to inform and educate Latino families about the importance of correctly placing their young children in child safety restraints and buckling up. Promotional and educational information is organized for use by community coordinators in planning events and campaigns in their communities. The Corazón de mi vida program was piloted in 11 cities over the course of a year, in coordination with existing community-based organizations. Participating organizations received training and materials and implemented several of the program elements, including parent gatherings to distribute information on child safety and correct child safety seat installation, press conferences, and safety seat clinics to test the installation, distribute, and approve child safety seats. Results released in 2001, demonstrated that the program addressed core safety needs by inspecting and correcting improper safety seat installation, distributing needed child safety seats, and educating Hispanic community members. Nearly half of the families at the safety seat clinics did not have installed safety seats in their vehicles. Of the slightly more than half who had safety seats installed, 99% failed the safety seat inspection and learned techniques and how to check for proper installation. Surveys of participants showed that a strong majority (86%) would be willing to participate in future events, and two-thirds would bring a relative to a future event.

Where can I learn more?

The CDC web page on Child Passenger Safety provides information about motor vehicle-related deaths among children, including risk and protective factors, and guidelines for caregivers on the proper use of child safety restraints.

The National Highway Traffic Safety Administration (NHTSA) Parents Central site offers consumer information for keeping kids safe at all ages. The site can help users locate a car seat inspection station to ensure their car seat is installed properly and teach proper installation, learn about the registration of car seats and any recalls, and get involved in a car seat campaign. NHTSA provides funding to states to assist communities in ensuring that children are able to ride in age appropriate restraints; information may be found at state Highway Safety Offices.

The American Academy of Pediatrics site provides information for parents on types of child restraints and their proper use.

The CDC Parents Are the Key to Safe Teen Drivers campaign helps parents, pediatricians, and communities keep teen drivers safe on the road. The web site offers effective ways for parents to get involved with their teen’s driving, key steps for pediatricians in helping families address safe teen driving, and how the community and businesses can help prevent teen driving crashes, injuries, and deaths.

Evidence base

Arbogast KB, Jermakian JS, Kallan MJ, Durbin DR. Effectiveness of belt positioning booster seats: an updated assessment. Pediatrics 124;1281–6. 2009.

Durbin, DR Technical report—Child passenger safety. Pediatrics 2011;127(4).

Ehiri JE, Ejere H, Magnussen L, Emusu D, King W, Osberg SJ. Interventions for promoting booster seat use in four to eight year olds travelling in motor vehicles. Cochrane Database Systematic Reviews 2006.

Eichelberger AH, Chouinard AO, Jermakian JS. Effects of booster seat laws on injury risk among children in crashes. Traffic Injury Prevention 2012;13:631–9.

Goodwin A, Sandt B, Hall W, Thomas L, O’Brien N, Summerlin D. Countermeasures that work: A highway safety countermeasure guide for state highway safety offices, 7th edition. Washington, DC: NHTSA, U.S. DOT. 2013.

Injury Prevention & Control Motor Vehicle Safety. Atlanta (GA): Centers for Disease Control and Prevention; Child Passenger Safety: Fact Sheet; 2014.

National Highway Traffic Safety Administration. Washington (DC): U.S. Department of Transportation; Traffic Safety Facts: 2012 Children; 2014.

National Highway Traffic Safety Administration. Washington (DC): U.S. Department of Transportation; Traffic Safety Facts: 2012 Occupant Protection; 2014.

National Highway Traffic Safety Administration. Washington (DC): U.S. Department of Transportation; Tween seat belt campaign; 2015.

Sauber-Schatz EK, West BA, Bergen G. Vital Signs: Restraint Use and Motor Vehicle Occupant Death Rates Among Children Aged 0–12 Years — United States, 2002–2011. Morbidity and Mortality Weekly Report (MMWR); 2014:63(05):113-118. 

The Guide to Community Preventive Services (The Community Guide). What Works to Promote Health. Motor vehicle-related injury prevention: Use of child safety seats; 2014.

Zaza S, Sleet DA, Thompson RS, Sosin DM, Bolen JC. Reviews of evidence regarding interventions to increase use of child safety seats. American Journal of Preventive Medicine 2001;21(4 Suppl):31‑47.