A progress report on reducing deaths and injuries among four to eight year old child passengers has just been released from the National Highway Traffic Safety Administration (NHTSA). Although traffic crashes are still the leading cause of death for children ages 3 through 19, progress has been made in some areas. The report states that restraint use is at the highest levels ever recorded for infants and toddlers (98 percent for infants and 93 percent for toddlers), and crash-related child fatalities have dropped steadily to the lowest number since record keeping began in 1975. Unfortunately, similar progress has not been achieved where older-child passengers are concerned. Booster seat use, estimated at only 10 to 20 percent nationwide, remains unacceptably low.

Since 1996, there has been more focus on children who have outgrown their forward-facing child safety seats. These children, ages four to about eight, are often referred to as “Forgotten Children” because after they outgrow their child safety seats, if they are restrained at all, they are generally placed in lap and shoulder belts that are made for adults and do not fit them properly. Moving a child to a safety belt too early greatly increases risk of injury. Children who are prematurely graduated to safety belts are four times more likely to suffer a serious head injury in a crash than those restrained in booster seats.

In 2002 NHTSA developed a “4 Steps for Kids” program to promote the correct use of child safety seats at different stages in a child’s development. The third, and most frequently underused, step is Booster Seats, which should be used from about the age of four and approximately 40 pounds to at least age eight, unless 4’9” tall. A child placed in an adult safety belt is at grave risk for abdominal, spinal, head, facial, neck, and other injuries. A booster seat offers optimal protection for children until they are large enough to use vehicle safety belts properly.

From 2000 to 2003, the percentage of children four to eight who died while traveling unrestrained in passenger vehicles dropped two percentage points (from 51 percent to 49 percent). While this trend is clearly a positive one, much work remains to be done to reduce these tragic incidents. Booster seat use has increased, but still remains far too low.

According to the report, as of November 1, 2005, 33 States and the District of Columbia had enacted provisions in their child restraint laws requiring the use of an appropriate device or booster seat by children who have outgrown their child safety seats but are still too small to use an adult safety belt correctly. Specific provisions vary widely from state to state. All laws include age limits, but some states also emphasize weight limits, while others also stipulate height requirements. Focus groups of parents, caregivers, and police officers will be conducted in states with both upgraded and non-upgraded child restraint laws to determine the influence of booster seat use requirements on parental practices.

NHTSA continues to promote booster seat use and has joined forces with an array of partners to work on booster seat promotional efforts. The full article can be downloaded from http://www.nhtsa.dot.gov/people/injury/childps/BoosterSeatProgress/index.htm.