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Children in states with booster seat laws more likely to be appropriately restrained in car crashes
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Children age 4 to 7 in states with booster seat laws appear more likely to be appropriately restrained during car crashes than children in states without booster seat laws, according to a report in the March issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

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Motor vehicle accidents are one of the leading causes of injury and death in school-aged children, killing 350 children age 4 to 7 in 2004, according to background information in the article. “Belt-positioning booster seats (boosters) are an inexpensive, easy-to-use and effective method for reducing injuries from crashes in these children,” the authors write. Before 2000, the use of child restraints and booster seats in children age 4 through 8 was less than 10 percent. Since then, several states have enacted booster seat laws, which aim to ensure the appropriate child restraints in motor vehicles.

Flaura K. Winston, M.D., Ph.D., of The Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, and colleagues analyzed data collected through insurance claims records and a telephone survey of those involved in a motor vehicle crash. Data from a probability sample of 5,198 vehicles in crashes involving 6,102 children were collected from December 1998 through December 2004. “Qualifying crashes were limited to those that occurred in 16 states and the District of Columbia, representing four regions of the United States (East, Midwest, South and West),” the authors note.

Seven of those states, along with the District of Columbia, have booster seat laws that went into effect during the study and nine of the states did not have any booster seat laws. Children age 4 to 5 made up 53 percent of the sample, while children age 6 to 7 constituted 47 percent. “Between the first six months of 1999 and the last six months of 2004, appropriate restraint use increased from 21.5 percent to 74.8 percent for children aged 4 to 5 years and from 3 percent to 22.9 percent for children aged 6 to 7 years,” according to the study. Children age 4 to 7 in states with booster seat laws were 39 percent more likely to be appropriately restrained in crashes than were children in states with no booster seat laws.

The researchers found that for 4- to 5-year-olds, the increase in appropriate restraint was greater when the law applied to only that age group than when it applied to children 4 through 7. For children age 6 to 7, appropriate restraint use was greater when the law included those age 4 to 7 than when it included 4- to 5-year-old children.

“Our data suggests that booster seat provisions for children aged 4 through 7 years will have some effect on all children in this age range,” the authors conclude. “Given the current greater use of appropriate restraints for 4- to 5-year-olds compared with older children, future upgrades to child restraint laws should target all children through at least age 7 years to achieve the greatest effect on overall child restraint use.”
(Arch Pediatr Adolesc Med. 2007;161:270-275. Available to the media pre-embargo at

Editor's Note: This study was supported by State Farm Mutual Automobile Insurance Co. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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