Children in Car Crashes: Analysis of Data for Injury and Use of Restraints

  • Published: Pediatrics Vol. 93 No. 6 pp. 960 –965, June 1, 1994
  • Authors: Carden Johnston, Frederick P. Rivara, Robert Soderberg
  • Date Added: 09 Apr 2012
  • Last Update: 23 Jul 2013
  • Format: html


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


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.

Key Findings:

  • 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 car seats 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%). 19% of under 1 year olds who were in an appropriate restraint were injured, compared with 30% of those in an inappropriate restraint and 40% of those who were not restrained.

  • For 1 to 4 year olds, 17% of those appropriately restrained, 22% of those in a seat belt and 43% of those unrestrained were injured.

  • For 5 to 9 year olds, the relative proportions were 29%, 26% and 44% and for 10 to 14 year olds, they were 28%, 29% and 49%. Children of all ages faced a much greater chance of being injured if they were unrestrained.

  • Children who were inappropriately restrained were at greater risk than those who were appropriately restrained.

  • Unrestrained children were 1.5 to 2.5 times more likely to be injured than restrained children.

  • Use of the child 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. Injury rates of unrestrained 0 to 4 and 5 to 14 year olds were similar.

  • 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.