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 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."

           SHIELD BOOSTER SEATS vs. BELT-POSITIONING BOOSTER SEATS

    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 hillsu@email.chop.edu.