Press Coverage

June 4, 2003
Study Finds Children's Car Booster Seats Safer Than Seat Belt

by Matthew L. Wald
The New York Times

WASHINGTON — In a car crash, a child in a booster seat has less than half the risk of injury of a child wearing only an adult seat belt, a study of more than 3,600 crashes has found.

But children in the study's age group, 4 to 7, are not covered by the child safety laws of most states. The seats are called belt-positioning boosters because they raise the child's torso to a level that makes the adult lap and shoulder belts safer, but the study found few children were using them.

The study, being published on Wednesday in The Journal of the American Medical Association, covered more than 4,200 children who were too big for child car seats but too short for adult seat belts. In accidents, their injuries occur in a pattern doctors call seat belt syndrome, which includes abdominal and spinal cord damage from being bent forward over the lap belt as well as injuries to the face and brain from the head hitting the knees.

Wearing an adult seat belt cut a child's risk of injury by 38 percent, but using a booster seat with a belt cut it by 78 percent, said the study's lead author, Dr. Dennis R. Durbin of the Children's Hospital in Philadelphia. The risk reduction between using an adult seat belt and using such a belt with a booster seat was 59 percent, Dr. Durbin said.

The study was based on 1998 to 2002 data from the State Farm Insurance Company. Although the number of children who used booster seats was small, the researchers said there were enough children to make the results statistically significant.

They adjusted for the fact that children in seat belts are more likely to sit in the front seat and to be in cars driven by younger drivers.

Of the children in the cars that crashed, 1.81 percent sustained injuries; for children wearing adult seat belts, the figure was 1.95 percent, as against 0.77 percent for
those in belt-positioning booster seats. Use of booster seats eliminated injuries to the abdomen, neck, spine, back and lower extremities. The study group included five deaths; none of those children were in booster seats.

The authors said the results would probably hold true for children who are 8 as well because average height increases only two inches from ages 7 to 8. But the authors added that there were too few 8-year-olds who use booster seats
to make a statistically valid comparison.

In a telephone interview, Dr. Durbin said the rate of booster seat use fell off sharply with age, with only about 4 percent of the 6- and 7-year-olds using them. Still, he
added, "There's no evidence booster effectiveness declines with age."

He said it would be difficult for parents whose children were now in adult belts, often tucking the shoulder portion behind them, to persuade them to sit in booster seats.

All 50 states have laws requiring that babies ride in car seats. But legislatures in only 19 states have passed laws requiring age-appropriate restraints for children over 4.

Those laws were all passed in the last three years, said Judy Stone, president of Advocates for Highway and Auto Safety, a nonprofit group here. Of children who are 4 to 7, Ms. Stone added, "We call that age group the forgotten children."