Preventing Child Passenger Injury

What to know

  • Many serious crash injuries and deaths can be prevented with proper use of car seats, booster seats, or seat belts that are appropriate for a child's age/size.
  • Child passenger safety technicians (CPSTs) are trained to provide education and hands-on assistance for all types of car seats and booster seats.
Young child in car seat

Overview

Parents and caregivers can reduce the risk of serious injuries and death by making sure children are properly buckled in car seats, booster seats, and seat belts that are appropriate for their age and size.

  • Car seat use reduces the risk for injury in a crash by 71–82% for children, when compared with seat belt use alone.12
  • Booster seat use reduces the risk for serious injury by 45% for children ages 4–8, when compared with seat belt use alone.3 Also, a more recent study found that the effectiveness of booster seats may be even higher than 45%. The newer study also found that booster seats help prevent moderate and serious crash injuries among children ages 7–8.4
  • Seat belt use reduces the risk for death and serious injury by about half for older children and adults.56

Community prevention methods

Communities, organizations, and agencies can prevent motor vehicle crash injuries in child passengers

  • Car seat and booster seat distribution plus education programs can increase restraint use.789 These programs help parents and caregivers get new, unused car seats or booster seats and learn how to properly install and use them.789 These programs often include hands-on demonstrations which can help increase proper installation and use.
    • Incentive and education programs reward parents or children with coupons or other prizes for correctly using car seats and offer educational print materials and videos for parents and caregivers.7810
  • Child restraint laws require children riding in vehicles to be buckled up in approved restraints such as car seats, booster seats, or seat belts appropriate for their age, weight, and height. These laws are effective for increasing restraint use and reducing child deaths and injuries.71011
  • Strengthening current laws with booster seat provisions that require children who have outgrown car seats to use booster seats until at least age 9 helps reduce injuries and deaths.12131415161718
    • Children ages 4–8 years in states with booster seat laws were over four times as likely to be using age-appropriate restraints and were 20% less likely to die in crashes than children in states without booster seat laws.
    • A study among children (including booster seat age children) involved in crashes found that restrained children were 66% more likely to be buckled in appropriate restraints if their state law followed best practice recommendations.
    • Observed booster seat use among children ages 4–7 years increased from 24% to 43% after booster seat laws were implemented in Milwaukee County, Wisconsin.
    • The crash death rate among 7-year-olds was 25% lower for children in states with booster seat laws covering 7-year-olds compared with states without booster seat laws covering 7-year-olds.
    • The rate of children using car seats and booster seats increased nearly three-fold in five states that increased the booster seat use age requirement to 7 or 8 years. The rate of children who sustained fatal or incapacitating injuries decreased by 17% in these states.
    • Multiple studies in Canada also demonstrate the effectiveness of strengthening current child restraint laws with booster seat provisions.1718
    • As of September 2023
  • Short-term, high-visibility enforcement programs can enhance the effectiveness of child restraint laws, especially if they include broad media coverage.192 These programs are often similar to or conducted in combination with seat belt use programs like Click It or Ticket.

Prevention tips

Infographic showing the 4 stages of booster seats by age and includes the text Make sure your child is always buckled in a car, booster, seat, or seat belt that is appropriate for their age and size.
Child passenger safety guidelines for parents and caregivers

Know the stages

CDC provides guidance to ensure children are properly buckled in a car seat, booster seat, or seat belt—whichever is appropriate for their age, weight, and height.

Stage 1. Rear-facing car seat: Birth until age 2–4.

Infants and toddlers should be buckled in a rear-facing car seat with a harness, in the back seat, until they reach the maximum weight or height limit of their car seat. This offers the best possible protection.2021 Check the car seat manual and labels on the car seat for weight and height limits.

Never place a rear-facing car seat in the front seat. Front passenger air bags can injure or kill young children in a crash.

Stage 2. Forward-facing car seat: After outgrowing their rear-facing car seat and until at least age 5.

When children outgrow their rear-facing car seat, they should be buckled in a forward-facing car seat with a harness and a top tether, in the back seat. They should stay in their forward-facing car seat until they reach the maximum weight or height limit of their seat. Check the car seat manual and labels on the car seat for weight and height limits.

Stage 3. Booster seat: After outgrowing their forward-facing car seat and until the seat belt fits properly.

When children outgrow their forward-facing car seat, they should be buckled in a belt-positioning booster seat with a seat belt, in the back seat. They should continue to use a booster seat until the seat belt fits properly without a booster seat. A seat belt fits properly when the lap belt is across the upper thighs (not the stomach) and the shoulder belt is across the center of the shoulder and chest (not across the neck or face, and not off the shoulder). This usually occurs when children are between 9 and 12 years old.

Stage 4. Seat belt: When the seat belt fits properly without a booster seat.

Children no longer need to use a booster seat when the seat belt fits them properly. A seat belt fits properly when the lap belt is across the upper thighs (not the stomach) and the shoulder belt is across the center of the shoulder and chest (not across the neck or face, and not off the shoulder). This usually occurs when children are between 9 and 12 years old.

  • Seat belts can fit differently in each vehicle your child rides in, so check seat belt fit in each vehicle to decide when a booster seat is needed. Sometimes a child might need a booster seat in one vehicle but not in a different vehicle.
  • Keep children properly buckled and in the back seat until age 13 for the best possible protection.13

Car seat, booster seat, and seat belt tips

  • Install and use car seats and booster seats properly on every trip. Check the car seat or booster seat manual and the vehicle owner's manual for instructions.
    • Be sure to check for:
      • A correct recline angle for rear-facing car seats.
      • A tight installation for all car seats.
        • Installed car seats should move no more than one inch from front-to-back and from side-to-side at the belt path.
      • A tight harness that is not behind the child's arms, legs, or back for all car seats.
        • Do the "pinch test" to ensure the harness is tight enough. If you can pinch the harness straps between your fingers at the child's shoulders, this means that the harness is too loose.
      • A harness chest clip that is at the child's armpit level.
      • Proper seat belt fit for children using booster seats or the seat belt alone.
        • Make sure the lap belt is across the upper thighs (not the stomach) and that the shoulder belt is across the center of the shoulder and chest (not across the neck or face, and not off the shoulder).
  • Help is available! Get help installing car seats and booster seats from certified child passenger safety technicians. They are trained to provide education and hands-on assistance for all types of car seats and booster seats. These services are usually free.
  • Don't seat children in front of an air bag. Air bags can kill young children riding in the front seat. Never place a rear-facing car seat in front of an air bag.
  • Buckle children in the middle of the back seat when possible.6 This is generally the safest position in the vehicle since it is the farthest point from an impact coming from any direction.
    • If the middle seating position contains only a lap belt, older children using booster seats or seat belts should sit in a different seating position in the back seat where they can use both a lap and shoulder belt.
    • Most rear-facing and forward-facing car seats can be safely installed in the middle seating position using the lap belt only.
  • Use the top tether with forward-facing car seats.2223
    • A top tether can reduce a child's head movement in a crash by about 4–6 inches.2223
    • A top tether should be used regardless of whether the forward-facing car seat is installed with the lower anchors or with the seat belt.
  • Ensure that children are properly buckled in the back seat until age 13.
  • Always make sure that older children who use booster seats or seat belts are buckled with both the lap and shoulder belt. Both the lap and shoulder belt are needed for proper protection.
  • Use proper restraints on every trip.
    • Buckle children in car seats, booster seats, or seat belts on every trip—no matter how short the trip may be.
  • Parents and caregivers can set a good example by always wearing a seat belt.

Considerations for children with special needs

  • The American Academy of Pediatrics offers guidance on transporting children with special health care needs.
  • Some child passenger safety technicians (CPSTs) receive additional training to provide education and assistance for transporting children with special needs.
    • Find a CPST with this training by selecting the "Special Needs" option in the "Extra Training" search box.
  • Some large hospitals and other health care facilities have CPST staff members who have received special needs training and are available to help.

Learn how to prevent hot car deaths among children

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  2. Zaloshnja E, Miller TR, Hendrie D. Effectiveness of child safety seats vs safety belts for children aged 2 to 3 years. Arch Pediatr Adolesc Med. 2007;161(1):65–68. doi:10.1001/archpedi.161.1.65
  3. Arbogast KB, Jermakian JS, Kallan MJ, Durbin DR. Effectiveness of belt positioning booster seats: an updated assessment. Pediatrics. 2009;124(5):1281–1286. doi:10.1542/peds.2009-0908
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