Significant Rate of Misuse of Child Booster Seats May Put Toddlers And Pre-Schoolers at Increased Risk in Auto Accidents, Say Researchers At The Children's Hospital of Philadelphia


PHILADELPHIA, March 29 /PRNewswire/ -- Shield booster seats are more than three times as likely to be misused compared to belt-positioning booster seats, according to researchers at The Children's Hospital of Philadelphia. Overall, their study showed that more than half of all booster seats are used incorrectly, which may put toddlers and pre-schoolers at greater risk of injury in automobile accidents.

The study is the first to describe booster seat misuse patterns and is based on a sample of 227 parents who voluntarily attended car seat checkpoints held in Pennsylvania and southern New Jersey between April 1997 and January 1999. The findings, published in the December, 2000 issue of Injury Prevention, were based on research conducted through TraumaLink: The Interdisciplinary Pediatric Injury Control Research Center at the Children's Hospital of Philadelphia.

Two types of booster seats were evaluated: shield boosters, and belt- positioning boosters. Shield boosters have a plastic shield that rests over the child's abdomen and is secured to the vehicle with the vehicle seat belt. Belt-positioning boosters are high-back or backless platforms that rest on the vehicle's seat to raise the child up so that the lap and shoulder portions of the vehicle's seat belt fit properly.

"Just as parents need to purchase age-appropriate toys, children need to be placed in car seats designed to safely restrain their growing bodies," said Shannon Morris, the study's lead author and project coordinator for Partner's for Child Passenger Safety Study at the hospital. "When a child has outgrown his or her forward-facing convertible car seat, the safest option is to graduate the child into a belt positioning booster seat."

Overall, 56 percent of the booster seats evaluated at the car seat checkpoints demonstrated at least one form of misuse. An alarming majority (64%) of children using booster seats weighed less than 40 pounds. Yet guidelines established by the National Highway Traffic Safety Administration (NHTSA) call for children to remain in forward-facing convertible car seats up to this weight. At that point, NHTSA recommends that children be graduated to a belt-positioning booster seat until they are 80 pounds and a height of 4 foot 9 inches -- typically around 8 years of age.

Shield booster seats have failed crash tests for children over 40 pounds and, therefore, have been decertified by NHTSA for children in this weight category. In this study, almost a third of the children who weighed more than 40 pounds were in a shield booster seat. "Kids who are restrained in a shield booster and weigh more than 40 pounds are at greater risk for forward head movement upon impact in a crash," stated Morris. "This may lead to serious head or brain injuries, and in some cases may lead to ejection of the child out of the seat."

Parents and caregivers who own a vehicle with lap-only seat belts are faced with a difficult situation. Belt-positioning booster seats, the recommended booster seat, can only be used with a lap/shoulder seat belt. "Safety advocates recommend that families with older model cars equipped with lap-only seat belts have the car retrofitted with shoulder belts," said Morris. "This would permit use of the safer, belt-positioning booster seats for children who have outgrown their convertible child safety seat."


Data from this study showed that 68 percent of shield booster seats were misused compared to 20 percent misuse with the belt-positioning booster seats. Most common misuses in shield booster seats were not using a locking clip correctly or at all when needed (78%) and not tightly securing the shield booster seat to the vehicle (73%).

"Shield boosters are more complex to use than belt-positioning booster seats because they require tight installation to the vehicle by the vehicle's seat belt. In contrast, belt-positioning boosters simply rest on the vehicle seat while the lap shoulder belt is used in its regular manner," said Morris. "Incompatibilities between the shield booster, vehicle seat and seat belt may contribute to the inability to install the shield booster tightly -- a problem frequently experienced with infant or convertible seats."

In contrast, belt-positioning booster seats are less likely to be misused because of their simplicity. They simply rest on the vehicle seat and are secured by a regular lap and shoulder belt, which fits over the child's shoulder and snugly across the hips restraining both the upper and lower body regions. The most common misuse of these seats (in 14 percent of the cases) involved incorrect placement of the shoulder belt across the child's body.

The Children's Hospital of Philadelphia is home to TraumaLink: The Interdisciplinary Pediatric Injury Control Research Center. TraumaLink studies include the Partners for Child Passenger Safety Study (PCPS). Funded by State Farm Insurance Companies, The University of Pennsylvania, and Children's Hospital, PCPS is the largest single research project in the country devoted exclusively to pediatric motor vehicle injury.

Founded in 1855 as the nation's first pediatric hospital, The Children's Hospital of Philadelphia is ranked today as the best pediatric hospital in the nation by a comprehensive Child Magazine survey. One of the leading research facilities in the world, Children's Hospital has fostered discoveries that have benefited children worldwide through its pediatric research program, which is among the largest in the country and ranks second in National Institutes of Health funding. As a teaching hospital, Children's Hospital is responsible for training new generations of pediatric healthcare professionals. Its unique family-centered care and public service programs have brought the 381-bed hospital recognition as a leading advocate for children and adolescents from before birth through age 19.

CONTACT: Suzanne Hill of The Children's Hospital of Philadelphia, 215-590-1417, or