Booster Seat Effectiveness Among Older Children: Evidence From Washington State

Abstract

Introduction The American Academy of Pediatrics has recommended that children as old as 12 years use a booster seat when riding in motor vehicles, yet little is known about booster seat effectiveness when used by older children. This study estimated the association between booster use and injuries among children aged 8–12 years who were involved in motor vehicle crashes. Methods Researchers analyzed data on all motor vehicle crashes involving children aged 8–12 years reported to the Washington State Department of Transportation from 2002 to 2015. Data were collected in 2015 and analyzed in 2016. Children who were in a booster seat were compared with children restrained by a seat belt alone. Logistic regression was used to adjust for potential confounders. Results In unadjusted models, booster use was associated with a 29% reduction in the odds of experiencing any injury versus riding in a seat belt alone (OR=0.709, 95% CI=0.675, 0.745). In models adjusted for potential confounders, booster use was associated with a 19% reduction in the odds of any injury relative to riding in a seat belt alone (OR=0.814, 95% CI=0.749, 0.884). The risk of experiencing an incapacitating/fatal injury was not associated with booster use. Conclusions Children aged 8–12 years involved in a motor vehicle crash are less likely to be injured if in a booster than if restrained by a seat belt alone. Because only 10% of U.S. children aged 8–12 years use booster seats, policies encouraging their use could lead to fewer injuries.

Epidemiological Characteristics of Road Traffic Injuries Involving Children in Three Central American Countries, 2012–2015

“…A specific preventative intervention in pediatric MVC-related injuries is the implementation of CRSs. Studies have demonstrated that the correct use of CRSs reduces mortality and injury frequency and severity in infants and children and consequently reduces injuryrelated sequelae and disability in this vulnerable group [7][8][9]16,20]. While Costa Rica has implemented legislation mandating the use of CRSs [21], Panama and Guatemala, lack specific legislation for CRS in compliance with international standards.…”

“…Because CRS use depends on implementation by caregiving adults, interventions educating caregivers have demonstrated a reduction of almost 50% in the number of children not riding in a CRS [8]. Correct implementation and use of CRSs in vehicles reduces MVC mortality by 71% in under-1-year-olds, by between 54% and 80% in 1-to 4-year-olds [5][6][7], and by 19% in 8to 12-year-olds [9]. However, although there are international consensus statements on the use of CRSs [1, 2,10], local regulations for their use vary widely among Latin American countries.…”

Are Booster Seats More Effective than Child Safety Seats or Seat Belts at Reducing Traffic Fatalities among Children?

“…Moreover, the existing booster seat studies come with significant drawbacks. For instance, they either use crash data from only one state (Anderson et al 2017), are restricted by a small sample size (Ma et al 2013), rely on older data from periods when booster seat use was rare (Durbin et al 2003) 8 , or focus only on trafficrelated injuries (Durbin et al 2003;Arbogast et al 2009;Anderson et al 2017). 9 Given the limitations of these papers, credible estimates of the relationship between booster seat use and the probability of fatality remain absent from the literature.…”

“…found that primary seatbelt laws reduced traffic fatalities among individuals 14 to 18 years of age by approximately 8 percent.7 Economists have studied a wide array of policies that influence traffic fatality rates. For example, research has focused on alcohol and drug policies(Dee 2001;Carpenter and Dobkin 2009;Grant 2010;Anderson et al 2013), automobile insurance and accident liability laws(Cohen and Dehejia 2004), graduated driver licensing laws(Dee et al 2005), minimum wage laws(Adams et al 2012;Sabia et al 2014), smoking bans(Adams and Cotti 2008), and texting bans (Abouk and Adams 2013).8 Durbin et al (2003) observed only 4 percent of 6-and 7-year-olds riding in booster seats in their data.9 Due to a relatively small number of fatalities in their data,Anderson et al (2017) considered a serious injury category that combined incapacitating and fatal injuries.…”

“…Given these differences, one should hesitate before interpreting estimates based on the FARS as applicable to all crash types. For a detailed description of the Washington State DOT data, seeAnderson et al (2017).15 Based on the definition of "light trucks" from the FARS, this category includes vehicles such as SUVs, utility station wagons, vans, compact pickup trucks, and standard pickup trucks. Roughly 90 percent of children 2 to 9 years of age in the data were occupants of a passenger car or a light truck.…”