PEDIATRICS Vol. 93 No. 6 June 1994, pp. 960-965
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Children in Car Crashes: Analysis of Data for Injury and Use of Restraints

Carden Johnston MD1, Frederick P. Rivara MD1, and Robert Soderberg BS1

1 Harborview injury Prevention and Research Center and Department of Pediatrics, School of Medicine, University of Alabama at Birmingham

Objective. To determine the effect of car restraints on motor vehicle injury rates for children aged 0 to 14 years.

Methods. A probability sample of all police-reported car crashes in the United States in 1990 and 1991 was analyzed for injury rates of passengers aged less than 15 years in relation to restraint usage, age, and seating position.

Results. Optimal restraint usage (defined as car seats for children 0 to 4 years old and lap shoulder belts for children 5 to 14 years old) was 40%. The use of the car seat was 76% for infants (0 to 12 months old) and 41% for toddlers (1 to 4 year olds). The non use of a restraint was highest for 10 to 14 year olds (43%).

The rate of involvement in car crashes for all children was 21.4 (per 1000/yr). The highest rate was the 14 year olds with 29.6 followed by 2 year olds with 26.5.

Injury rates were 4.76 (per 1000/yr) for all children. The lowest rate was 2.91 for infants but increased to 4.78 for 3 year olds. The single strongest risk factor for injury was the non use of a restraint. (Adjusted odds ratio 2.7; 95% CI 2.4 to 3.0.) The risk factor for injury for the front seat was 1.5 (95% CI 1.4 to 1.7).

Use of the car seat reduced injuries by 60% for 0 to 4 year olds, whereas the lap shoulder harness was only 38% effective for 5 to 14 year olds (P le .001) Injury rates of unrestrained 0 to 4 and 5 to 14 year olds were similar.

Conclusions. Greater involvement in car crashes and less use of car restraints explains the 64% higher rate of injury for 3 year olds than for infants. It is time to target the toddlers.

Restraints designed for adults are not as effective for the school age child as car seats are for the preschool child. A better restraint for the school age child should be designed and evaluated. Meanwhile, increased usage of current restraints must be encouraged, as they substantially reduce injuries.

Submitted on November 15, 1993
Accepted on November 19, 1993


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