Booster seat use increased more by carrot than stick

Booster seats significantly reduce the chance of a four to eight year old child sustaining serious injury in a car crash, but many children do not use them. Programs that aim to increase use by educating people, giving away free booster seats, or combining the two do increase use.

According to the WHO, road traffic crashes kill 1.18 million people each year, and disable or injure a further 50 million. Without a concerted drive to implement safety measures they could become the world’s third greatest cause of disability by 2020.

Booster seats are one simple measure that substantially increases the safety of children travelling in cars. The problem is that when children reach about 18 kg they outgrow toddler-sized safety seats, but are still too small to fit properly into an adult seat belt. A booster seat is designed to raise the child off the seat so that the shoulder strap comes across their chest and not across their necks.

Recommendations suggest that booster seats should be used until the child weighs 36kg, is eight years old, or reaches a height of 150 cm tall.

Some socially minded governments or local health departments might decide to fund booster seat distribution or coupons, but few governments in poorer countries are likely to be able to get free booster seats to all deserving families.

“In such situations, local health departments and traffic safety programs could try to encourage organisations like motor manufacturers, child advocacy organisations, foundations and private voluntary organisations with interest in child health to help people obtain affordable booster seats,” says lead author Associate Professor, John Ehiri who works in the Department of Maternal & Child Health in the School of Public Health at the University of Alabama at Birmingham, USA.

The Review Authors identified one study that compared enforcement of booster seat law with no intervention. It found no marked difference, suggesting that enforcement alone is unlikely to increase use. “This is only one relatively small study, so we need to be cautious before making too much of this finding,” says Ehiri.

“This review has considerable implications for research and practice relating to increased use of booster seats for four to eight year olds,” says co-author Dr. Henry Ejere of the Metropolitan Hospital Centre, New York, USA.