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Background: Road vehicle transportation is essential to support community access and participation for all children. However, little is known about the transport patterns of children with disabilities and medical conditions and their caregivers' experiences supporting them to be transported safely in road vehicles in Australia. Aim: To understand the transport needs of children with disabilities and medical conditions and the transport needs of their caregivers. Materials and Methods: A large-scale national survey was undertaken online to explore the experiences and perspectives of 193 caregivers, identifying the challenges and needs associated with providing and supporting safe road transportation for their children. Results: Caregivers believed their child was missing out on participating in everyday life due to their transportation needs, with caregivers experiencing multiple challenges and barriers to transporting their child safely. Conclusions and Significance: There is a need to provide knowledge and support to caregivers who are primarily responsible for the safe transportation of their children with disabilities and medical conditions. [ABSTRACT FROM AUTHOR]

Automobile booster seats are intended to improve belt fit for children that are too large for a harness-style child restraint, but not yet big enough to fit properly in an adult seat belt. Our objective was to prospectively study the relationship between booster seat design and interaction with the seat belt (specifically, submarining risk) for a child occupant using computer simulation of automobile crash events. Frontal-impact simulations were performed with a 6-year-old child human body model. Simplified models of booster seats were developed using an automated process designed to capture key characteristics of booster geometry, stiffness, belt guide construction, and attachment to the vehicle seat. The child model was positioned in a range of postures from upright to slouched. Our main interest was submarining, where the child's pelvis slips under the lap belt and the belt loads into the abdomen (defined based on the motion of the lower lap belt edge relative to the ASIS). Among the parameters studied, the factors that had the greatest effect on submarining risk were the booster's stiffness and the child's posture. Booster models of a low-stiffness construction (similar to an inflatable booster) nearly always resulted in submarining, regardless of the other design characteristics of the booster. A slouched posture also substantially increased the likelihood of submarining (even for high-stiffness boosters). These results suggest that booster seats of a stiffer construction, and booster seats that promote an upright posture may provide a protective benefit compared to softer boosters and boosters that are more likely to result in slouching of the child. [ABSTRACT FROM AUTHOR]

The objective of the current study was to increase scientific understanding of rear-seat passenger seating position, postures, CRS use, and belt use through a naturalistic study. A secondary objective was to compare data from vehicles used in ride-hailing with data from other vehicles. Video cameras were installed in the passenger cabins of the vehicles of 75 drivers near the center of the windshield. The video data were downloaded after the vehicles were operated by their owners for two weeks. Video frames were sampled from near the ends and in the middle of each trip, and at five-minute intervals in trips longer than 15 min. A total of 7,323 frames with second-row passengers were manually coded. A total of 444 unique second-row passengers were identified in video frames from 1,188 trips taken in 65 of the 75 vehicles in the study. Two of the vehicles that were driven for commercial ride-hailing during the study period accounted for 199 (45%) of the passengers. Considering multiple passengers in some trips, a total of 1,899 passenger-trips were identified. For passengers not using child restraint systems (CRS), the belt use rate was 65% in the non-ride-hailing vehicles versus 32% among passengers in the ride-hailing vehicles. No CRS use was observed in the ride-hailing vehicles. Among children using backless boosters, the shoulder belt was lateral to the clavicle or under the arm in 26% of frames. Among belted passengers not using CRS, the belt was lateral to the clavicle or on the neck about 6% of the time. Belted passengers not using CRS were observed leaning to the left or right about 27% of the time, with leaning away from the shoulder belt more common than leaning into the belt. This study is the first to report seating position, posture, and belt fit observations for a large naturalistic sample of second-row passengers that includes adult occupants. The data suggest that low rear seat belt use rates remain a concern, particularly in ride-hailing vehicles. Non-nominal belt placement and posture may also be common in second-row seating positions. [ABSTRACT FROM AUTHOR]

It is often assumed that a child restraint with a five or six-point internal harness provides greater protection for children in frontal crashes than a booster seat with a lap-sash seat belt. However, most research comparing these restraint types has focused on protection for children aged up to approximately 3–4 years of age. Recently, harnessed child restraints for older children up to approximately 8 years of age have become available, but there is little data on their performance compared to booster seats for children over 4 years of age. This study aimed to compare frontal crash performance of a series of harnessed child restraints for children aged 4–8 years to booster seats. Four large harnessed child restraints (Type G in the Australian Standard, AS/NZS 1754:2013) and six high back booster seats (Type E in AS/NZS 1754:2013) were tested in frontal impact on a deceleration sled. Head and pelvis accelerations were recorded and head excursions were measured from high speed video. Head excursion was an average of 92 mm greater in the large harnessed child restraints than the high back booster seats. The initial position of the head in Type G restraints, an average of 58 mm further forward compared to Type E boosters, was the main contributor to the larger head excursion during impact. Conversely, peak head accelerations in the impact phase were, on average, 37.2 g lower in the large harnessed child restraints than the high back booster seats. These data suggest that recommendations for harnessed restraints and booster seats for children aged 4–8 years is not as obvious as is sometimes assumed. Harnessed restraints allow greater head excursion in frontal impacts, potentially increasing the chances of head impacts, especially in vehicles with limited clearance between the restraint and the seat in front. The likelihood, and types of, incorrect use that occur in each restraint type, the vehicle occupant space, and the restraint's crash performance under ideal conditions should be considered in recommending restraints for these older children. [ABSTRACT FROM AUTHOR]

To compare how errors in child restraint use influence crash injury risk in rearward and forward-facing restraints for a 1-year old occupant. Three convertible child restraint systems (CRS) were subjected to frontal dynamic sled tests at 56 km/h in rearward-facing and forward-facing modes in a correct use (baseline) condition and in five incorrect use conditions: loose securing belt, loose harness, partial harness use, top tether slack, and three minor errors. Excursion, head, and chest 3 ms resultant acceleration, HIC15, and neck forces and moments of a Q1 anthropomorphic test device (ATD) seated in the restraints were measured. The effect of incorrect use on each outcome and restraint type was analyzed. The influence of errors varied across different outcome variables, the three restraints tested and orientation modes. Excursion increased in four of five incorrect use conditions in both rearward and forward-facing orientations. A very loose harness increased four of five outcome variables in at least one forward-facing restraint, whereas only excursion was increased when rearward-facing. Overall, there tended to be a more negative effect of incorrect use (demonstrated through increases in outcome variables compared to the baseline) in the forward-facing orientation. Overall, errors in use tended to have a larger negative impact on forward-facing restraints than rearward-facing restraints. Given the widespread nature of errors in use, this adds further weight to arguments to keep children rearward-facing to 12 months of age and older. The results also highlight a variation in response to errors across differently designed restraints, suggesting the influence of errors may be minimized by restraint design that is more resistant to errors. [ABSTRACT FROM AUTHOR]

Background: Motor-vehicles crashes are a leading cause of death among children. Age- and size-appropriate restraint use can prevent crash injuries and deaths among children. Strategies to increase child restraint use should be informed by reliable estimates of restraint use practices. Objective: Compare parent/caregiver-reported and observed child restraint use estimates from the FallStyles and Estilos surveys with the National Survey of the Use of Booster Seats (NSUBS). Methods: Estimates of child restraint use from two online, cross-sectional surveys—FallStyles, a survey of U.S. adults, and Estilos, a survey of U.S. Hispanic adults—were compared with observed data collected in NSUBS. Parents/caregivers of children aged ≤ 12 years were asked about the child's restraint use behaviors in FallStyles and Estilos, while restraint use was observed in NSUBS. Age-appropriate restraint use was defined as rear-facing child safety seat (CSS) use for children aged 0–4 years, forward-facing CSS use for children aged 2–7 years, booster seat use for children aged 5–12 years, and seat belt use for children aged 9–12 years. Age-appropriate restraint users are described by demographic characteristics and seat row, with weighted prevalence and corresponding 95% confidence intervals (CI) calculated. Results: Overall, child restraint use as reported by parents/caregivers was 90.8% (CI: 87.5–94.1) (FallStyles) and 89.4% (CI: 85.5–93.4) for observed use (NSUBS). Among Hispanic children, reported restraint use was 82.6% (CI: 73.9–91.3) (Estilos) and 84.4% (CI: 79.0–88.6) for observed use (NSUBS, Hispanic children only). For age-appropriate restraint use, estimates ranged from 74.3% (CI: 69.7–79.0) (FallStyles) to 59.7% (CI: 55.0–64.4) (NSUBS), and for Hispanic children, from 71.5% (CI: 62.1–81.0) (Estilos) to 57.2% (CI: 51.2–63.2) (NSUBS, Hispanic children only). Conclusion and Practical Application: Overall estimates of parent/caregiver-reported and observed child restraint use were similar. However, for age-appropriate restraint use, reported use was higher than observed use for most age groups. [ABSTRACT FROM AUTHOR]

To examine the effect of age on the dynamic performance of child restraint systems in frontal crashes. A sample of used (3-269 months from manufacture) and newly purchased child restraints were subjected to frontal crash simulations of more than 56 km/h and peak deceleration approximately 33 g on a deceleration sled. Restraints were monitored for evidence of damage before and after each impact. Anthropometric test device (ATD) head and chest responses and peak head excursions were recorded for rearward facing restraints using the Q1 ATD and for forward facing restraints and booster seats using the Q6 ATD. The influence of restraint age on peak 3 ms head acceleration, HIC15, head excursion, peak 3 ms chest acceleration and restraint damage were analyzed. In all impacts, the ATD remained within the restraint and secured to the test bench demonstrating the crash protection offered by the old and used restraints. There was no apparent relationship between ATD responses and restraint age for any restraint type. Older forward facing restraint systems had a very modest increase in forward head excursion (R2 = 0.59, p = 0.001) of 0.27 mm for each month of age (95% CI, 0.13 mm − 0.42 mm). This equates to a 0.7% increase in the minimum measured excursion per year of restraint age. There was also a small increased likelihood of critical damage to the restraints in the simulated crashes per month of restraint age (OR 1.031, 95% CI 1.010-1.069). Overall, degradation in restraint dynamic performance in older restraints, including some that are much older than the currently recommended 10-year lifetime, is minimal. However newer restraints may provide better protection due to marginal improvements in restraint design over time. Furthermore, the results of this study confirm previous recommendations that restraints should not be re-used after crash involvement. [ABSTRACT FROM AUTHOR]

We modified the Child Safety Seat (CSS) Hassles Scale to characterize CSS hassles in a diverse population and test for associations between hassles and caregiver-reported child passenger safety behaviors. Secondary analysis of a 2-site survey of caregivers seeking emergency care for their ≤10-year-old child in 2015. Caregivers answered questions regarding CSS hassles, child passenger safety behaviors, and demographics. Size-appropriate restraint use was defined by the American Academy of Pediatrics (AAP) 2011 Guidelines for Child Passenger Safety. We tested for associations between the number of hassles and adherence to AAP guidelines (including the consistent use of a size-appropriate CSS, travel in a back seat, and never traveling unrestrained). There were 238 caregivers included in analyses. Overall, caregivers endorsed a median of 5 hassles (interquartile range 2, 8). Half (50.8%) of caregivers endorsed child passenger safety behaviors that were nonadherent to AAP guidelines. Compared with caregivers reporting no hassles, there was an increased odds of not adhering to AAP child passenger safety guidelines for each additional hassle reported (adjusted odds ratio [aOR] 1.11; 95% confidence interval [CI] 1.03, 1.19). In addition, a higher number of hassles was associated with the inconsistent use of a size-appropriate CSS (aOR 1.15; 95% CI 1.06, 1.25) and as sometimes traveling unrestrained (aOR 1.13; 95% CI 1.03, 1.23). Caregivers who reported more CSS hassles were more likely to report behaviors that were not adherent to AAP guidelines. Addressing CSS hassles may provide solutions for nonadherence of AAP child passenger safety guidelines. [ABSTRACT FROM AUTHOR]

When used correctly, child restraint systems (CRS) effectively reduce the risk of serious injury and death to child passengers in motor vehicle crashes. However, error rates in CRS use among caregivers are extremely high. Consultation with child passenger safety technicians (CPST) reduces misuse rates, but access to CPST is limited, particularly in rural areas. Remote consultation via interactive virtual presence (IVP) may increase access to CPST. One hundred and fifty caregivers in Southeast Montana completed remote consultation with CPST via IVP. Errors in CRS selection, installation, and child positioning were coded at baseline and postintervention in a within-subjects, pretest–posttest design. The proportion of caregivers making one or more errors in CRS selection (McNemar's test p <.001) and installation (McNemar's test p <.001), but not child positioning, significantly decreased following remote consultation. IVP is a promising mobile health (mHealth) strategy for providing remote consultation with CPST to improve rates of correct CRS use and mitigate child injury risk. [ABSTRACT FROM AUTHOR]

Objective: Estimates of child restraint misuse rates in the United States range from 49% to 95%, but not all misuse modes have similar consequences in terms of restraint effectiveness. A series of laboratory sled tests was conducted to determine the effects of common misuses and combinations of misuses, including loose harness, loose installation, incorrect installation angle, incorrect belt path, loose/no tether, and incorrect harness clip usage.Methods: Three commercial convertible child restraint models were loaded with the Hybrid III 3-year-old anthropomorphic test device (ATD) and secured by either LATCH or seat belt on a modified FMVSS No. 213 bench. Tests were conducted in forward-facing (FF) and rear-facing (RF) modes. The response variables included ATD accelerations, excursions, and restraint kinematics. Belt/LATCH loads, tether loads, ATD kinematics, and restraint structural response data were also documented. A fractional factorial test design on 8 factors was used to define an initial series of 32 tests. The first series also included 4 tests of correct CRS, 2 forward facing and 2 rearward facing. The analysis of those data determined the selection of conditions for the remaining 20 tests to focus on factors and interactions of high interest and significance.Results: In the RF condition, misrouting the LATCH belt or seat belt through the incorrect belt path was the only misuse that significantly affected outcomes of interest and was associated with high levels of undesirable CRS rotation. In FF tests, loose installation and tether misuse had large adverse effects on 3 of 4 key response variables.Conclusion: The study provides strong evidence for prioritizing tight restraint installation and proper tether use for FF restraints. In particular, use of the tether helped offset the adverse effects of loose installation or loose harness. Because the results show that performance of a RF child restraint system (CRS) installation is less affected by user error, they also provide support for extended RF restraint use. In addition, packaging convertible child restraints with the LATCH belt routed through the RF belt path could help prevent the most consequential RF CRS misuse. [ABSTRACT FROM AUTHOR]

Objective: Cross-chest clips are widely used in North American child restraints but are less common in other countries, partially due to concerns over anterior neck contacts in frontal crashes. They have recently been reported to be associated with lower odds of injury in real-world crashes, but there is a paucity of crash test performance information. This study aimed to compare the dynamic performance of a small child occupant in frontal crash tests with and without cross-chest clips in place. Methods: Frontal sled tests at 49 km/h were conducted to compare 2 cross-chest clip designs to nonuse of a chest clip. Tests using a P3/4 anthropomorphic test device (ATD) to represent the smallest occupant in a forward-facing child restraint were conducted with the chest clips in the recommended position and also in an incorrect lower position and with and without additional harness slack present. Results: Though contacts were observed between the chest clips and the base of the ATD's neck, there was little difference observed in head excursion or ATD sensor loads in the presence of the chest clips. No detectable change in the neck forces or moments was detected at the time of the neck contacts. The position of the clips did not affect the results. Harness slack increased head excursion, as expected, but this effect did not differ between the tests with and without the clips. Conclusions: Cross-chest clips do not appear to greatly influence the dynamic performance of a forward-facing child restraint in a simulated frontal crash. Taken together with recent research suggesting a potential benefit in injury reduction from the clips in the real world, possibly due to maintaining the harness straps in place on a child's shoulders, it may be appropriate to re-evaluate safety standards that prevent their use. [ABSTRACT FROM AUTHOR]

Objective: Traffic crashes have high mortality and morbidity for young children. Though many specialized child restraint systems improve injury outcomes, no large-scale studies have investigated the cross-chest clip's role during a crash, despite concerns in some jurisdictions about the potential for neck contact injuries from the clips. This study aimed to investigate the relationship between cross-chest clip use and injury outcomes in children between 0 and 4 years of age.Methods: Child passengers between 0 and 4 years of age were selected from the NASS-CDS data sets (2003-2014). Multiple regression analysis was used to model injury outcomes while controlling for age, crash severity, crash direction, and restraint type. The primary outcomes were overall Abbreviated Injury Score (AIS) 2+ injury, and the presence of any neck injury.Results: Across all children aged 0-4 years, correct chest clip use was associated with decreased Abbreviated Injury Scale (AIS) 2+ injury (odds ratio [OR] = 0.44, 95% confidence interval [CI], 0.21-0.91) and was not associated with neck injury. However, outcomes varied by age. In children <12 months old, chest clip use was associated with decreased AIS 2+ injury (OR = 0.09, 95% CI, 0.02-0.44). Neck injury (n = 7, all AIS 1) for this age group only occurred with correct cross-chest clip use. For 1- to 4-year-old children, cross-chest clip use had no association with AIS 2+ injury, and correct use significantly decreased the odds of neck injury (OR = 0.49; 95% CI, 0.27-0.87) compared to an incorrectly used or absent cross-chest clip. No serious injuries were directly caused by the chest clips.Conclusions: Correct cross-chest clip use appeared to reduce injury in crashes, and there was no evidence of serious clip-induced injury in children in 5-point harness restraints. [ABSTRACT FROM AUTHOR]

Seat belt and child restraint use is noted to be poor in developing countries such as Ghana. An unobstructive observational survey guided by the Theory of Planned Behaviour was therefore conducted to assess seat belt and child restraint use in the Cape Coast Metropolis, Ghana. The observational survey was carried out at the entrances of four nursery schools in medium and high class residential areas in the Metropolis to determine seat belt use by drivers and accompanied child being transported/dropped off in school. The results revealed that a total of 1922 vehicles comprising 826(43.0%) cars, 350(18.2%) SUV, 644(33.5%) taxis and 102(5.3%) mini buses with 3844 vehicle occupants comprising 1922 drivers and child apiece were successively observed. The majority of the drivers (53.1%) did not use the seat belt with 13.2% of the children been restrained. The gender of the driver has a relationship with the seat belt use. The vehicle type has a relationship with the child restraint use and the gender of the driver has a significant relationship with child restraint use. The enforcement of the Road Traffic Act 2004 and Road Traffic Regulation 2180 by the officials of Motor Transport and Traffic Department(MTTD) of the Ghana Police Service in collaboration with National Road Safety Commission (NRSC) can establish social norms that may have a greater potential to enhance seat belt and child restraint use in the Metropolis. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to investigate vehicle factors associated with child restraint tether use and misuse in pickup trucks and evaluate 4 labeling interventions designed to educate consumers on proper tether use.Methods: Volunteer testing was performed with 24 subjects and 4 different pickup trucks. Each subject performed 8 child restraint installations among the 4 pickups using 2 forward-facing restraints: a Britax Marathon G4.1 and an Evenflo Triumph. Vehicles were selected to represent 4 different implementations of tether anchors among pickups: plastic loop routers (Chevrolet Silverado), webbing routers (Ram), back wall anchors (Nissan Frontier), and webbing routers plus metal anchors (Toyota Tundra). Interventions included a diagram label, Quick Response (QR) Code linked to video instruction, coordinating text label, and contrasting text tag.Results: Subjects used the child restraint tether in 93% of trials. However, tether use was completely correct in only 9% of trials. An installation was considered functional if the subject attached the tether to a tether anchor and had a tight installation (ignoring routing and head restraint position); 28% of subjects achieved a functional installation. The most common installation error was attaching the tether hook to the anchor/router directly behind the child restraint (near the top of the seatback) rather than placing the tether through the router and attaching it to the anchor in the adjacent seating position. The Nissan Frontier, with the anchor located on the back wall of the cab, had the highest rate of correct installations but also had the highest rate of attaching the tether to components other than the tether anchor (seat adjustor, child restraint storage hook, around head restraint). None of the labeling interventions had a significant effect on correct installation; not a single subject scanned the QR Code to access the video instruction. Subjects with the most successful installations spent extensive time reviewing the vehicle manuals.Conclusion: Current implementations of tether anchors among pickup trucks are not intuitive for child restraint installations, and alternate designs should be explored. Several different labeling interventions were ineffective at achieving correct tether use in pickup trucks. [ABSTRACT FROM AUTHOR]

Objective: The research objective was to quantify the influence of child restraint lower attachment method on head kinematics, head impact potential, and head, neck, and thorax injury metrics for a child occupant secured in a forward-facing child restraint system (FFCRS) in oblique side impacts.Methods: Fifteen sled tests were conducted with a Q3s seated in an FFCRS secured to the center position on a production small SUV bench seat. Three lower attachment methods were evaluated: rigid ISOFIX, a flexible single loop lower anchors and tethers for children (LATCH) webbing routed through the vehicle belt path of the FFCRS, and dual flexible LATCH webbing attachments on either side of the FFCRS. All were tested with and without a tether with one repeat test in each test condition. The same model FFCRS was used for all tests; only the attachment method varied. The vehicle bench seat was fixed on the sled carriage at 80° (from full frontal). The input pulse was the proposed FMVSS 213 side impact pulse scaled to a 35 km/h delta-v. Two-way analysis of variance (ANOVA) was used to evaluate the effect of lower attachment and tether use on 3 outcome metrics: lateral head excursion, neck tension, and neck lateral bending. Data included anthropomorphic test dummy (ATD) head excursions, head linear accelerations and angular velocities, neck loads and moments, thoracic accelerations, lateral chest deflections, lower anchor loads, and tether webbing loads. ATD head kinematics were collected from 3-dimensional motion capture cameras.Results: Results demonstrated a reduction in injury measures with the rigid ISOFIX and dual webbing attachment compared to the single webbing attachment with decreased lateral head excursions (331, 356, and 441 mm for the rigid ISOFIX, dual webbing, and single webbing systems, respectively, P <.0001), neck tension (1.4, 1.6, and 2.2 kN, P <.01), and neck lateral bending (31.8, 38.7, and 38.0 Nm, P =.002). The tether had a greater influence on lateral head excursion for the FFCRS with flexible webbing attachments than those with the rigid attachment, with the tether forces being highest with the single webbing attachment. Lateral head excursions were significantly lower and lateral neck bending moments were significantly higher with tether use (P <.0001) across all lower attachments. The effect of tether on neck tension was mixed, only showing an increased effect with the rigid ISOFIX system.Conclusion: The CRS lower attachment system influenced occupant kinetics. The results indicate that CRS attached to the vehicle via rigid and dual webbing systems exhibit improved kinematics by reducing the rotation and tipping seen with the single webbing attachment. This leads to reduced lateral head excursions and neck tension values. The advantages of the tether in reducing lateral head excursion in side impacts are most pronounced with the flexible webbing attachments. With tether use low in the United States, a dual webbing type FFCRS attachment system may be a better attachment method than single webbing and provide a simpler engineering solution than rigid ISOFIX attachment. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to identify factors that predict restraint use and optimal restraint use among children aged 0 to 13 years.Methods: The data set is a national sample of police-reported crashes for years 2010-2014 in which type of child restraint is recorded. The data set was supplemented with demographic census data linked by driver ZIP code, as well as a score for the state child restraint law during the year of the crash relative to best practice recommendations for protecting child occupants. Analysis used linear regression techniques.Results: The main predictor of unrestrained child occupants was the presence of an unrestrained driver. Among restrained children, children had 1.66 (95% confidence interval, 1.27, 2.17) times higher odds of using the recommended type of restraint system if the state law at the time of the crash included requirements based on best practice recommendations.Conclusions: Children are more likely to ride in the recommended type of child restraint when their state's child restraint law includes wording that follows best practice recommendations for child occupant protection. However, state child restraint law requirements do not influence when caregivers fail to use an occupant restraint for their child passengers. [ABSTRACT FROM AUTHOR]

Background: State laws regarding child passenger protection vary substantially.Objectives: The objective of this study was to develop a scoring system to rate child passenger safety laws relative to best practice recommendations for each age of child.Methods: State child passenger safety and seat belt laws were retrieved from the LexisNexis database for the years 2002-2015. Text of the laws was reviewed and compared to current best practice recommendations for child occupant protection for each age of child.Results: A 0-4 scale was developed to rate the strength of the state law relative to current best practice recommendations. A rating of 3 corresponds to a law that requires a restraint that is sufficient to meet best practice, and a rating of 4 is given to a law that specifies several options that would meet best practice. Scores of 0, 1, or 2 are given to laws requiring less than best practice to different degrees. The same scale is used for each age of child despite different restraint recommendations for each age. Legislation that receives a score of 3 requires rear-facing child restraints for children under age 2, forward-facing harnessed child restraints for children aged 2 to 4, booster seats for children 5 to 10, and primary enforcement of seat belt use in all positions for children aged 11-13. Legislation requiring use of a "child restraint system according to instructions" would receive a score of 1 for children under age 2 and a 2 for children aged 2-4 because it would allow premature use of a booster for children weighing more than 13.6 kg (30 lb).Conclusions: The scoring system developed in this study can be used in mathematical models to predict how child passenger safety legislation affects child restraint practices. [ABSTRACT FROM AUTHOR]

Abstract Objectives : To examine changes in child car restraint practices in low socioeconomic areas following the introduction of mandatory child car restraint legislation in New South Wales (NSW), Australia. Methods : Data from two cross‐sectional studies of child car restraint use at pre‐schools, early childhood centres and primary schools before and after the introduction of legislating mandatory age‐appropriate car restraint use for children up to the age of seven years was used in this analysis. All included observations were from local government areas with socioeconomic status in the lowest 30% of urban Sydney. Children aged 2–5 years were observed in their vehicles as they arrived at observation sites (107 pre‐legislation, 360 post‐legislation). Multilevel logistic regression was used to examine changes in observed age‐appropriate and correct use of car restraints. Results : Age‐appropriate car restraint use was higher post‐legislation than pre‐legislation. After controlling for child's age, parental income, language spoken at home and adjusting for clustering, the odds of children being appropriately restrained post‐legislation were 2.3 times higher than in the pre‐legislation sample, and the odds of them being correctly restrained were 1.6 times greater. Conclusions : Results indicate an improvement in car restraint practices among children aged 2–5 in low socioeconomic areas after introduction of child restraint laws. Implications : Despite improvements observed with enhanced legislation, further efforts are required to increase optimal child car restraint use.

Objective: Suboptimal child restraint use includes incorrect and/or inappropriate restraint use and increases the risk of injury. Comfort has been suggested as an important factor impacting on optimal use of restraints by children. This article aims to examine the relationships between parent reported comfort and restraint misuse and age-appropriate restraint choice.Methods: This is an analysis of data from a cross sectional observation study of child restraint use in New South Wales. Logistic regression was used to model the relationship between parent-reported comfort and restraint misuse and age-appropriate restraint choice.Results: There was no significant relationship between either parent-reported comfort and restraint misuse or parent-reported comfort and age-appropriate restraint choice.Conclusions: Parent perceptions of comfort of children in child restraints do not appear to be associated with incorrect child restraint use or age appropriate restraint choice. It is possible that the actual comfort of the child may be related to incorrect use but this remains to be tested. Further investigation of the relationship between parent-perceived comfort and the actual comfort of the child, as well as the impact of child comfort on optimal child restraint use is warranted. [ABSTRACT FROM AUTHOR]

Objective: Restraint performance is evaluated using anthropomorphic test devices (ATDs) positioned in prescribed, optimal seating positions. Anecdotally, humans-children in particular-assume a variety of positions that may affect restraint performance. Naturalistic driving studies (NDSs), where cameras and other data acquisition systems are placed in a vehicle used by participants during their regular transportation, offer means to collect these data. To date, these studies have used conventional video and analysis methods and, thus, analyses have largely been qualitative. This article describes a recently completed NDS of child occupants in which their position was monitored using a Kinect sensor to quantify their head position throughout normal, everyday driving trips.Methods: A study vehicle was instrumented with a data acquisition system to measure vehicle dynamics, a set of video cameras, and a Kinect sensor providing 3D motion capture at 1 Hz of the rear seat occupants. Participant families used the vehicle for all driving trips over 2 weeks. The child occupants' head position was manually identified via custom software from each Kinect color image. The 3D head position was then extracted and its distribution summarized by seat position (left, rear, center) and restraint type (forward-facing child restraint system [FFCRS], booster seat, seat belt).Results: Data from 18 families (37 child occupants) resulted in 582 trips (with children) for analysis. The average age of the child occupants was 45.6 months and 51% were male. Twenty-five child occupants were restrained in FFCRS, 9 in booster seats, and 3 in seat belts. As restraint type moved from more to less restraint (FFCRS to booster seat to seat belt), the range of fore-aft head position increased: 218, 244, and 340 mm on average, respectively. This observation was also true for left-right movement for every seat position. In general, those in the center seat position demonstrated a smaller range of head positions.Conclusions: For the first time in a naturalistic setting, the range of head positions for child occupants was quantified. More variability was observed for those restrained in booster seats and seat belts than for those in FFCRS. The role of activities, in particular interactions with electronic devices, on head position was notable; this will be the subject of further analysis in other components of the broader study. These data can lead to solutions for optimal protection for occupants who assume positions that differ from prescribed, optimal testing positions. [ABSTRACT FROM AUTHOR]

Pedestrian and motor vehicle-related injuries are leading causes of morbidity and mortality in children. Trauma centers have specialized resources to conduct interventions that improve the safety of whole communities. In the present study, we evaluated the effectiveness of a school-hospital partnership in increasing knowledge of pedestrian and motor vehicle safety among students and parents in a large, urban community. Staff from a Level I pediatric trauma center conducted educational interventions in an urban public school district. Elementary school students participated in a pedestrian safety program, middle school students completed a community safety program, and high school students learned about the dangers of drunk and distracted driving. Students completed pre- and post-tests. Parents in the neighboring community received child passenger safety education at two child restraint (CR) inspection events. A total of 2203 students participated at a total of nine schools. Post-test scores were significantly higher than pre-test scores for students in all three age groups and within each grade level. At CR inspection events, 67 CRs were inspected, 49 (73 %) of which were replaced with new age- and weight- appropriate CRs. The most common instance of improper CR use was loose CR fit in vehicle seat (33 %). All 120 observed instances of misuse were corrected by a certified Child Passenger Safety Technician. Educational interventions effectively increased knowledge of pedestrian and motor vehicle safety among students and parents. We have demonstrated the utility of a school-hospital partnership for furthering knowledge of safety in an urban community. [ABSTRACT FROM AUTHOR]

Background: Child restraints provide maximum protection when used appropriately, but seat orientation (rear‐ or forward‐facing) according to child development is often misunderstood, and the information provided can be inaccurate. This study examined the accuracy of information in Japanese on seat orientation found on the Internet. Methods: We searched websites in Japanese on Google regarding information on recommended seat orientation for young children and examined the first 50 sites based on the search rankings for the criteria on when to allow children to ride in forward‐facing seats. Results: None of the examined websites included information that was consistent with the recommendation of the Japan Pediatric Society (i.e. age must be at least 1 year old and weight, at least 10 kg). The most common mistake was that weight alone could determine timing. Conclusions: More vigorous efforts are needed to disseminate evidence‐based information about seat orientation to protect child passengers. [ABSTRACT FROM AUTHOR]