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Can booster seats save lives?

Most parents realize that infants belong in car seats whenever they ride in a car or truck. But what about older children age four to eight who are too large for these car seats? New studies show that these children who are placed in adult seat belts are at increased risk for injury, but parents are often reluctant to use booster seats or may not know they are required. What can be done to increase their use?

That question was addressed recently by a group of researchers from Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine. They wanted to find out whether parents:

• Knew that children ranging in weight from 40 to 80 pounds and under 4 feet 9 inches should be in special seats, not adult seat belts; and
• Would be willing to use such devices once they knew they were needed.

Their findings, which described barriers to booster seat use and ways to increase their use, were published in the October 2002 issue of Pediatrics.

Finding out why
At present, booster seat use remains low. About 85 percent of children who should be in car seats or belt positioning booster seats are wrongly placed in seat belts meant for adults. If an accident occurs, an incorrectly restrained child has 3.5 times the risk of being injured over a properly restrained child.

To learn more about why parents and children did or did not use the seats, the team conducted focus groups and performed follow-up discussions with parents and children. The Phase I focus group consisted of 46 parents and eight children who were asked to identify reasons why they did not use or like booster seats. The second group consisted of 57 parents who were asked via telephone survey to name any additional barriers to booster seat use and ways to increase their use. In several instances, follow-up telephone calls were made to further explore suggestions raised.

The majority of participants in the two groups were:

• White (77% and 83%)
• Female (71% and 69%)
• Ages 35 to 44 (phase I, 52%) and 25 to 34 years (phase II, 56%)
• Attended some college (81% and 78%)

The children were between ages four and seven.

What they found
The researchers identified several themes.

Uninformed parents
Many parents did not realize that children should remain in booster seats until the recommended weight, height and age. Some felt that booster seats served no real safety purpose and simply boosted up the child. Others commented that since the law in their state did not require booster seats, they did not use them. Other obstacles included having extra passengers in the vehicle and viewing the booster seats as inconvenient.

Parents with a false sense of safety
Parents who used seat belts (and not booster seats) said their children were safe because the parents were safe drivers. They felt confident the seat belt provided enough protection. They complained they had a hard time getting their children to use booster or safety seats. They believed booster seats were not safe. When these parents were told of the importance of using booster seats, many did not intend to change their child's restraint. Children who did not use booster seats said they felt the seats were uncomfortable.

Informed parents
Parents who used booster seats were more concerned that their child could be injured in a crash. Overall, these parents were more aware of the design and installation of booster seats and child passenger safety laws, in part because they actively sought out this information. Using a booster seat was "non-negotiable," with parents insisting children use them every time.