• Michael R Elliott, Michael J Kallan, Dennis R Durbin, and Flaura K Winston.
• Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA.
• Arch Pediat Adol Med. 2006 Jun 1; 160 (6): 617-21.

ObjectiveTo provide an estimate of benefit, if any, of child restraint systems over seat belts alone for children aged from 2 through 6 years.DesignCohort study.SettingA sample of children in US passenger vehicle crashes was obtained from the National Highway Transportation Safety Administration by combining cases involving a fatality from the US Department of Transportation Fatality Analysis Reporting System with a probability sample of cases without a fatality from the National Automotive Sampling System.ParticipantsChildren in tow-away [corrected] crashes occurring between 1998 and 2003.Main ExposureUse of child restraint systems (rear-facing and forward-facing car seats, and shield and belt-positioning booster seats) vs seat belts. Potentially confounding variables included seating position, vehicle type, model year, driver and passenger ages, and driver survival status.Main Outcomes MeasureDeath of child passengers from injuries incurred during the crash.ResultsCompared with seat belts, child restraints, when not seriously misused (eg, unattached restraint, child restraint system harness not used, 2 children restrained with 1 seat belt) were associated with a 28% reduction in risk for death (relative risk, 0.72; 95% confidence interval, 0.54-0.97) in children aged 2 through 6 years after adjusting for seating position, vehicle type, model year, driver and passenger ages, and driver survival status. When including cases of serious misuse, the effectiveness estimate was slightly lower (21%) (relative risk, 0.79; 95% confidence interval, 0.59-1.05).ConclusionBased on these findings as well as previous epidemiological and biomechanical evidence for child restraint system effectiveness in reducing nonfatal injury risk, efforts should continue to promote use of child restraint systems through improved laws and with education and disbursement programs.

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