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Eduard Zaloshnja, PhD; Ted R. Miller, PhD; Delia Hendrie, MA, GradDip (Road Safety)

Arch Pediatr Adolesc Med. 2007;161(1):65-68.

Objective  To compare the effectiveness of child safety seats and lap-shoulder belts in rear passenger vehicle seats for 2- to 3-year-old crash survivors.

Design  Cohort study.

Setting  The January 1, 1998, to December 31, 2004, US data on a nationally representative sample of crashes that resulted in at least 1 vehicle being towed away.

Participants  Toddlers who were sitting in rear vehicle seats and using lap-shoulder belts or child seats when involved in highway crashes.

Intervention  Child safety seat vs safety belt.

Outcome Measure  Presence of any injury after a crash.

Results  The adjusted odds of injury were 81.8% lower (95% confidence interval, 58.3%-92.1% lower) for toddlers in child seats than belted toddlers.

Conclusions  Child safety seats seem to be more effective rear seat restraints than lap-shoulder safety belts for children aged 2 to 3 years. Laws requiring that children younger than 4 years travel in child safety seats have a sound basis and should remain in force.

Author Affiliations: Pacific Institute for Research and Evaluation, Calverton, Md (Drs Zaloshnja and Miller); and School of Population Health, University of Western Australia, Crawley (Ms Hendrie).