By Kathryn Doyle
NEW YORK (Reuters Health) - Many kids are not put in car seats and booster seats as recommended, studies have shown. A new report suggests use may be particularly low among non-white children.
"We expected that differences in family income, parental education, and sources of information would explain the racial disparities in age-appropriate restraint use and they did not," lead author Dr. Michelle L. Macy told Reuters Health by email.
Certain parents may face barriers to car seat and booster seat use that researchers haven't discovered yet, Macy, a pediatrician at the University of Michigan in Ann Arbor, said. Or social norms could explain the differences between racial groups.
The new study took place in Michigan, where state law requires that children under four use a car seat and kids four to seven use a car seat or booster seat unless they are taller than 4 feet, 9 inches.
Experts generally recommend older kids under that height keep using a booster seat as well. The Centers for Disease Control and Prevention says all kids under 13 should ride only in the back seat.
The new study was based on surveys of 600 parents of kids ages one to 12.
Close to 3 percent of kids under age four ever sat in the front seat, compared to 10 percent of kids ages four to seven and 34 percent of kids ages eight to 12, according to findings published in Pediatrics.
Among four- to seven-year-olds, twice as many non-white kids sat in the front seat as white kids. For the other age groups, there was no difference based on race.
Across the board, white parents were between three and four times more likely to report using age-appropriate seats for their children than non-white parents.
Parents' education and income didn't explain the racial differences in seat use, and all parents got their child safety information from similar sources.
Parents most often learned to use car seats by reading the instruction manual or "just figuring it out." They sought child car safety information from friends, family, doctors or nurses. The most common source of information was the Internet, which was used more often by white parents.
The researchers also found that less than 30 percent of kids ages eight to 12 who should have been using a booster seat, based on height, were actually using the seat.
"Booster seats are extremely important," said Dr. Mark R. Zonfrillo of the Center for Injury Research and Prevention at the Children's Hospital of Philadelphia. Zonfrillo was not involved in the new study.
"Our previous research has shown that booster seats reduce the risk of injury in a crash by 45 to 59 percent compared to seat belts alone," he told Reuters Health.
"Motor vehicle crashes are a leading cause of death and injury for children," said Dr. Suzanne Brixey, a pediatrician at Children's Hospital of Wisconsin in Milwaukee who also didn't participate in the research. "Unfortunately, these results are not surprising and indicate that there is more work to be done to keep children safe on every trip."
Macy said she gets a lot of questions about when a child should transition from one safety seat to the next, stop using a booster seat or sit in the front seat. But there are conflicting messages.
"When I care for children injured in car crashes in the Emergency Department, parents generally thought they were doing everything they could to keep their child safe," she said. "Many parents prematurely move their child into a booster seat or seat belt based on outdated recommendations that are supported by state laws for child passenger safety."
State laws vary and don't quite line up with the best recommendations, like those published by the American Academy of Pediatrics in 2011 which emphasized child size over age, she said. Those recommendations can be found online here: http://bit.ly/1dj6SQa.
For parents, Macy stressed the importance of putting kids in the back seat when possible and not rushing to "graduate" kids to the next level of restraint before they are ready.
SOURCE: http://bit.ly/1iHEKYa Pediatrics, online January 13, 2014.