Motor vehicle injuries are the leading cause of injury-related death for Canadian children. While action must be taken to reduce the risk of crashes, it is essential that steps be taken to reduce the risk of injury when a crash occurs. Motor vehicle collisions can cause multiple serious injuries. In particular, head injuries are a risk for children, especially when they are not restrained properly.1, 2 The risk of injury can be reduced by protecting children with the right kind of restraint for their age and size and using it correctly.3, 4 To achieve this, a number of approaches need to be pursued in tandem to make roads safer for children.

Safe Kids Canada logoAn integral part of the solution is the use of appropriate passenger restraints. According to a recent analysis of severe injuries of child passengers, 92% of infants, 74% of toddlers, and 96% of school-aged children were not using the appropriate restraint at the time of the crash.5 To be properly protected at all times, children should move through 4 stages of passenger restraints, based on their age and weight:

  1. Rear-facing car seats until at least age 1 and at least 22 pounds (10 kg).
  2. Forward-facing car seats until at least 40 pounds (18 kg), which is normally reached between ages 4 and 5.
  3. Booster seats until at least 80 pounds (36 kg) and 57 inches tall (145 cm), which are not usually reached until at least age 9.
  4. Seat belts.

To be effective, child restraints must be used correctly. Proper use allows the car seat straps or seat belt to be positioned over the parts of a child’s body that are best able to absorb the forces of a crash.6 Moving children from one stage of car seat use to another too early or skipping a stage entirely can be dangerous. For example, a baby moved to a forward-facing car seat too soon is too small for the seat and may therefore be at increased risk of being ejected.7 Children are also frequently moved directly from a car seat to a seat belt, completely skipping the use of a booster seat. Putting a child in a seat belt before they are big enough puts them at risk for serious injuries or death in a crash. ‘Seat belt syndrome’ is how doctors describe the severe injuries to the spine and internal organs that can happen to children who are too small for a seat belt.

When used correctly, proper passenger restraints can significantly reduce the rates of injuries and fatalities in children:

  • Car seats can reduce the risk of death by 71 per cent for infants under age 1 and 54 per cent for children ages 1 to 4.8
  • Car seats reduce the risk of hospitalization by 67 per cent for children age 4 and under.9
  • Booster seats provide 59 per cent more protection than seat belts alone.10

In efforts to increase children’s safety on the road, legislation makes a difference.11 In the 1970s and 1980s, the number of motor vehicle deaths and serious injuries convinced legislators to implement seat belt laws. In the case of children, similarly observed statistics were soon followed by car seat laws. Legislation has a direct impact on behavior. Research shows that approximately 90% of Canadians now use seat belts,12 and at least 75% use car seats.13

Currently, similar legislative efforts are needed in the area of booster seats. Nearly three-quarters of Canadian children between ages 4 to 9 are not protected by booster seats.14 As already noted, booster seats provide 59 percent more protection than seat belts alone.15 Although a number of provinces have booster seat legislation in place, including British Columbia, Ontario, Quebec, Nova Scotia, New Brunswick, Prince Edward Island, and Newfoundland and Labrador, Safe Kids Canada welcomes the introduction of booster seat legislation in those provinces lacking in this important area of child passenger safety without delay.

In tandem with legislation and enforcement, educational campaigns are needed throughout Canada to communicate the message that appropriate child restraints are fundamental to the safety of children on the road. Likewise, increased government investment in child passenger safety, including investment in research related to the design and use of car seats is also needed. Child passenger safety is a key issue in injury prevention, and as such, child restraint safety needs to be considered a priority within preventive healthcare.

The severity of motor vehicle injuries to children can be mitigated through a coordinated approach that views safety as a key priority. A multi-pronged approach that includes legislation, education and enforcement is the best way to make roads safer for children.

Source: Pamela Fuselli, Executive Director, Safe Kids Canada


1
Muszynski C, Narayan Y, Pintar F, Gennarelli T. “Risk of Pediatric Head Injury After Motor Vehicle Accidents.” Journal of Neurosurgery (Pediatrics 4) 2005; 102:374-379.
2
Durbin D, Elliott M, Winston F. “Belt-Positioning Booster Seats and Reduction in Risk of Injury Among Older Children in Vehicle Crashes.” Journal of the American Medical Association 2003; 289(21):2835-2840.
3
Inbed.
4
Weber K. “Crash Protection for Child Passengers: A Review of Best Practice.” UMTRI Research Review. Sept 2000, 1-28, 31.
5
Chouinard A, Hurley R. Towards the Development of a National Restraint Survey. Transport Canada. Paper presented at the Canadian Multidisciplinary Road Safety Conference, XV, Fredericton, New Brunswick, June 2005.
6
Weber, K. “Crash Protection for Child Passengers: A Review of Best Practice.” UMTRI Research Review. Sept 2000, 1-28, 31.
7
Howard A, McKeag A, Rothman L, Reid D, Letts M, Comeau J, Monk B, German A. Ejections from Child Restraint Systems in Rollovers: Observations from Read World Collisions. Presented at the Canadian Multidisciplinary Road Safety Conference XII, London, Ontario, June 2001.
8
National Highway Traffic Safety Administration. Research note: revised estimates of child restraint effectiveness. Washington, D.C: US Department of Transportation. National Highway Traffic Safety Administration, 1996. Report No. 96.855. www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/RNotes/1996/childest.pdf
9
Kahane C. An Evaluation of Child Passenger Safety: The Effectiveness and Benefits of Safety Seats. Washington, DC: US Department of Transportation. National Highway Traffic Safety Administration, 1986. Report No. 806 890. www.nhtsa.dot.gov/cars/rules/regrev/Evaluate/806890.html
10
Durbin D, Elliott M, Winston F. “Belt-Positioning Booster Seats and Reduction in Risk of Injury Among Older Children in Vehicle Crashes.” Journal of the American Medical Association 2003; 289(21):2835-2840.
11
Peden M, et al (editors). World Report on Road Traffic Injury Prevention. World Health Organization. 2004.
12
Canadian Council of Motor Transport Administrators. Road Safety Vision 2010: Making Canada’s Roads the Safest in the World. 2002 Annual Report.
13
Transport Canada. Child Restraint Use in Canada: 1997 Survey Data. Ottawa. www.tc.gc.ca/roadsafety/
14
Safe Kids Canada. National Child Passenger Safety Survey Results. 2004.
15
Durbin D, Elliott M, Winston F. “Belt-Positioning Booster Seats and Reduction in Risk of Injury Among Older Children in Vehicle Crashes.” Journal of the American Medical Association 2003; 289(21):2835-2840.