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Child Safety Seat Availability and Training


Motor vehicle traffic crashes are the leading cause of unintentional injury-related death for children ages 8 and under. In 1997, 788 children 8 and under died as occupants in motor vehicle crashes (1). The availability and proper use of child restraint systems is essential for the reduction of these preventable tragedies.

One study analyzed factors that pertain to a mother's use of child automobile restraints and found that for those mothers who did not have a car seat, cost was cited as the most frequent reason (71%) for not having one (2). Child safety seats cost from $50 to more than $120 dollars, and new child restraints are needed for each developmental (age and weight) period. Even low cost safety seats may be too expensive for some families on a limited budget.

Unrestrained children are more likely to be injured, have more severe injuries, and to die in motor vehicle crashes than children who are restrained. Further, the improper use of child restraints may reduce their protective effects in a crash (3). For this reason, many local safety-promotion groups provide safety seat "check-ups" that allow caregivers to verify that their child is properly restrained. At these "check-ups", child passenger safety experts have found that at least 75% of children are improperly restrained (4, 5).

Policy and Details

1. Fund programs to distribute age appropriate, vehicle compatible safety seats at low or no cost to families with children.

Many states are not able to provide comprehensive, statewide child safety seat programs and training due to lack of adequate resources. Public - private partnerships are a feasible alternative to this problem. For example, the Ford Motor Company has partnered with several organizations to promote and distribute booster seats for children too large for infant or toddler seats but not yet large enough for conventional safety belts. This partnership is called Boost America! It has plans to distribute more than 1 million booster seats to low income families by the end of 2001 (6).

During the late 1980s through the mid-1990s the Louisiana Office of Public Health and Governor's Highway Safety Office formed a partnership with Civitan, Lions, Rotary, and Telephone Pioneer groups in several parishes (counties) to provide safety seats and hands-on training in how to use them to families attending public health clinics. The state agencies provided personnel trained in child passenger safety; the Telephone Pioneers constructed display panels and car mock-ups; and the Rotary, Lions, and Civitan groups helped raise funds to purchase seats (7). These types of partnerships allow for increased visibility and outreach to low-income communities, not only to distribute safety seats, but to teach people about the proper use of child restraints as well.

Businesses and government agencies can benefit from providing safety seats and the proper training to families who need them. For example, a child safety seat could be an option when a "baby gift" is provided for completing prenatal or well-baby protocols. By providing low or no cost safety seats and conducting education and outreach programs, private auto and health insurers could save money by averting costly medical expenses.

Low-income families should not be put at additional risk for lifelong disabilities or even death simply because they may not be able to afford reliable car seats for their children. Programs that distribute approved car safety seats may also alleviate the problem of unsafe second hand car seats being resold.

2. Fund programs that provide training to families on how to properly install and use safety seats.

Partnerships may address training needs as well as safety seat distribution. The National Safe Kids Campaign recently entered into a five-year partnership with General Motors to promote correct car seat and safety belt usage. As part of this partnership, General Motors donated 51 minivans fully equipped to host car seat check-ups at various locations, such as day care centers and shopping malls, throughout the country (8).

DaimlerChrysler has partnered with the National Safety Council and Fisher-Price to provide a free safety seat inspection service open to all families, no matter what make or model of vehicle they drive. This project, called Fit for a Kid, was created in response to a call by the National Transportation Safety Board (NTSB) for auto manufacturers, insurance companies, states, and others to create a national system of permanent child safety seat fitting stations to help parents ensure kids are properly buckled up. Trained and certified inspectors at DaimlerChrysler dealers nationwide are available to check child safety seats - for free - to help make sure they are properly secured and that children are riding safely. Fisher-Price has donated thousands of its child safety seats to be used as loaners. Inspectors lend these seats to those who come in for an inspection with a damaged or recalled seat.

The State and Territorial Injury Prevention Directors' Association and the Association of State and Territorial Health Officers have each endorsed formalized policies that encourage the distribution of infant or child car safety seats to all children. These policy statements also recommend funding for training in the proper use of safety seats (9, 10). The National Highway Traffic Safety Administration (NHTSA) offers four-day training courses for child passenger safety professionals while Operation Kids, Buckle Up Kids, and Mobilizing America to Buckle Up Children offer courses for law enforcement and fire and rescue personnel.


Child safety seats are extremely effective when correctly installed and used in passenger cars. Research on the effectiveness of child safety seats has found that they reduce the risk of fatal injury by 69 percent for infants (less than 1 year old) and by 47 percent for toddlers (1-4 years old) (11). If all child passengers ages 5 and under were properly restrained, it is estimated that an additional 183 lives could have been saved in 1997 alone (12).

Low-income parents are less likely to own a child safety seat than other parents, but those who do own child safety seats use them at the same rate as other parents (13). Clearly, parents from low-income families want to protect their children from injuries. These children should not be placed at greater risk for injuries simply because their families cannot afford safety seats. A bulk-purchased safety seat and instruction on its proper use may be delivered for about $50. Each seat can avert an estimated $100 in medical costs and $360 in other direct monetary costs (14). Thus, increased availability of child safety seats and training in their use will save lives and avoid unnecessary medical spending, by both the government and other private sources.


David Lawrence, Center Director
Center for Injury Prevention Policy and Practice
San Diego State University
6505 Alvarado Road, Suite 208
San Diego, CA 92120
Phone: (619) 594-3691
Fax: (619) 594-1994


1. Office of Statistics and Programming, National Center for Injury Prevention and Control, CDC. 1997, United States MV traffic, Occupant Deaths and Rates per 100,000. Available ONLINE:, April 11, 2000.

2. Radius SM, McDonald EM, Bernstein L. Influencing Car Safety Seat Use: Prenatal and Postnatal Predictors. Health Values, 15 (4): 29-38, 1991.

3. Winston F, Bhatia E, Durbin D. Initial Results from Partners for Child Passenger Safety, Part 2: patterns of inappropriate restraint usage. Presented at: Ambulatory Pediatric Association 39th Annual Meeting; May 2, 1999; San Francisco, California. As referenced in Winston F, Durbin D. Buckle Up! Is Not Enough: Enhancing Protection of the Restrained Child. JAMA, 281 (22): 2070-2072, June 9, 1999.

4. National Highway Traffic Safety Administration. Patterns of Misuse of Child Safety Seats. DOT HS 808 440, January 1996.

5. Sachs MD and Tombrello SM. Car Seat Safety: Buckling Up Isn't Always Enough. Pediatric Basics, 90. Winter 2000.

6. Boost America! Raising Kids with Safety in Mind. Available online:, June 6, 2000.

7. Lawrence DW. Project KISS, presentation to Louisiana Advisory Council on Disability Prevention, April 1993.

8. Safe Kids. Safe Kids Buckle Up Program Goes Mobile-General Motors to Provide the Wheels. Press release, January 18, 2000. Available ONLINE:, May 31, 2000.

9. The State and Territorial Injury Prevention Directors' Association. Child Safety Seat Availability and Training. Available ONLINE: , February 21, 2000.

10. Association of state and Territorial Health Officers, Executive Committee. Recommendations from the Injury Prevention Task Force and ASTHO Prevention Policy Committee. ASTHO Report 7(19), p. 5, 1999.

11. National Highway Traffic Safety Administration. Traffic Safety Facts 1997: Children. DOT HS 808 765.

12. National Highway Traffic Safety Administration. Traffic Safety Facts 1997: Occupant Protection. DOT HS 808 768.

13. Mayer, M and LeClere, FB. Injury prevention measures in households with children in the United States, 1990. Advance data from vital and health statistics; no 250. Hyattsville, Maryland: National Center for Health Statistics, 1994.

14. Miller, T and Levy, D. Cost-Outcome Analysis in Injury Prevention and Control: 84 Recent Estimates for the United States. Medical Care, 38(6):562-582, 2000.

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Last modified: 3-Aug-2000.