Testimony of
Danielle E. Roeber
Alcohol Safety and Occupant Protection Coordinator
National Transportation Safety Board
before the
House Transportation Committe
Commonwealth of Pennsylvania
Regarding Booster Seats
August 27, 2002

I want to commend you for focusing on this issue that will so easily save children from crash-related deaths and injuries.

The National Transportation Safety Board is an independent Federal agency charged by Congress to investigate transportation accidents, determine their probable cause, and make recommendations to prevent their recurrence. The recommendations that arise from our investigations and safety studies are our most important product. The Safety Board has neither regulatory authority nor grant funds. In our 35-year history, organizations and government bodies have adopted more than 80 percent of our recommendations.

The Safety Board has recognized for many years that traffic crashes are one of this nation's most serious transportation safety problems. More than 90 percent of all transportation related deaths each year result from highway crashes. Traffic crashes are also the leading cause of death to children, and data indicate that nearly half of crashes involving children occur within 7 minutes from home. Injuries and deaths for children in the 4 to 8 age range remain high because they are either unrestrained or restrained in systems too advanced for their physical development. According to data from the Fatality Analysis Reporting System (FARS) 1, from 1994 to 2000, 3,531 children in this age group were killed while riding in motor vehicles. More than 84 percent of child passengers in this age group who died were unrestrained or in an adult seatbelt. For this age group in Pennsylvania, 97 children died while riding in motor vehicles and over 87 percent were unrestrained or in an adult seatbelt.

Simply restraining a child with a seat belt makes it 3 times less likely that the child will be injured in a crash. Placing the child in the rear seat makes it an additional 2 times less likely that the child will be injured. But the best protection for children in the 4 to 8 age range is to place the child in the rear with a belt-positioning booster seats.

Today I want to discuss 3 points. First, belt-positioning booster seats are necessary to ensure proper seatbelt fit for children ages 4 to 8. Second, a successful booster seat program requires legislation. Third, seat belts should be mandatory for those children not using child restraints.

Seatbelts Do No Provide Sufficient Protection for Children Ages 4 to 8
Because seatbelts are designed to provide optimal protection for adults, they do not provide sufficient protection for children. Seatbelts depend on the person's bone structure to operate properly, spreading the forces of a crash over the hips, shoulders, and chest, keeping the occupant in place so that the head, face, and chest are less likely to strike the inside of the vehicle. Correct seatbelt fit is not usually achieved until a child is 9 years old, the age at which the child's thigh is long enough for the child to sit against the seat back, the hips are sufficiently developed to anchor the belt, and the child's height is sufficient for the shoulder belt to fit properly over the shoulder and sternum.

In 1996, the Safety Board examined the performance and use of occupant protection systems for children. The Safety Board reviewed 120 accidents in which at least one vehicle had a child passenger younger than age 11 and in which at least one occupant was transported to the hospital. This sample included 46 children who were restrained in child restraint systems, 83 children restrained in seatbelts, and 65 children who were unrestrained, for a total of 194 children. The Safety Board found that none of the fatally injured children were children who were in the appropriate restraint and who used it properly. Children inappropriately restrained by seatbelts had higher overall injury severity, including 5 fatal injuries, than children properly restrained. Among the unrestrained children, almost 30 percent suffered moderate or worse injuries, including 5 fatalities. Children in high severity accidents tended to sustain injury, which makes proper restraint even more important in such accidents.

Using a seatbelt without a booster seat can result in serious injury to children. Without a booster seat, the lap belt can ride over a child's stomach and the shoulder belt can cut across a child's neck. As this position is uncomfortable, children frequently remove the shoulder portion of the adult seat belt, increasing their risk of head injury. According to a study by Partners for Child Passenger Safety 2, children placed in seatbelts are 3.5 times more likely to suffer significant injury and 4 times more likely to suffer head injuries. However, when children use booster seats, there is a 50 percent to 75 percent reduction in serious injuries.

A Successful Booster Seat Program Requires Legislation
Although education is an important factor in increasing booster seat use, it is not sufficient by itself for attaining higher booster seat use levels. Presently, less than 10 percent of applicable children ride in booster seats. Much of the opposition to mandating booster seats concerns the inconvenience and cost to adults to comply with booster seat laws. A backless belt-positioning booster seat costs less than $20. And the provisions of this legislation include funding for child restraints to be given to low-income families.

In her testimony before the U.S. Senate, Autumn Skeen, a mother who lost her son because he was not in a booster seat, stated that she relied on Washington state statutes in deciding to use a seatbelt for her 4-year-old son. In June 1996, Anton Skeen died when he was ejected out of his seatbelt and out of the vehicle even though his seatbelt remained buckled. Ms. Skeen's reliance on state law to determine the necessary safety requirements for their children is common among concerned parents. Parents, who participated in focus groups, stated that the only way to ensure that parents provide the optimal level of protection for their children is to have strong laws that are enforced.

Our investigations show that children are safer if placed in booster seats up to age 8. Therefore, in our 1996 safety study, the Safety Board recommended enacting legislation that ensures children up to 8 are required by the state's mandatory child restraint use law to use child restraint systems and booster seats. The value of legislation is apparent when considering the advances made in child restraint and seatbelt use after legislation was passed. Child restraint use went from 15 percent to 51 percent between 1979 and 1985 and is now above 90 percent. Seatbelt use went from 14 percent to 59 percent between 1984 and 1991, and is now about 73 percent. Within the last three years, thirteen states (Arkansas, California, Colorado, Delaware, Maine, Maryland, Nebraska, New Jersey, Oregon, Rhode Island, South Carolina, Virginia, and Washington) and the District of Columbia have mandated that children age 4 and above use booster seats.

Data from FARS covering the years 1994 to 2000 show that 585 children were riding in motor vehicles on Pennsylvania roads when they were involved in a fatal crash. Seventy-two percent of the 585 children died or suffered injuries, and almost 80 percent of those children, who died or suffered incapacitating injuries, were not in child restraints. Only 15 children, or 4 percent, were using any form of child restraint.

Seat Belts Should Be Mandatory for Children 8 Years of Age and Older

Presently, Pennsylvania law allows children 4 years and older to ride unrestrained in the rear seats. According to FARS, 3538 children age 9 through age 17 were involved in fatal crashes while riding in a motor vehicle in Pennsylvania. Almost 50 percent of these children were riding unrestrained, and 91 percent of the unrestrained children died or suffered injuries. When examining the data on children in this age range who died, more than 57 percent were riding unrestrained. In our 1996 study, the Safety Board also recommended that children 8 years and older use seat belts.

House Bill 2447 is a step in the right direction in protecting Pennsylvania's children. This bill closes the loophole and mandates that all children up to age 18 ride restrained, whether in child seats, booster seats, or seat belts. It also extends the requirement to use child restraints through age 6, adding three full years of protection.

Parents want to protect their children, but many parents do not understand that seatbelts do not provide sufficient protection for children in this age range. Belt-positioning booster seats ensure proper seatbelt fit, which means that children get the optimum level of protection from the seatbelt without the risk of injuries such as seatbelt syndrome. Passing House Bill 2447 will save lives and reduce serious injuries for Pennsylvania's youngest citizens. It would also reduce both public and private expenditures for medical care and other support that would otherwise be incurred for as long as the injured child lives.

Thank you again for inviting the Safety Board to testify about this important problem and I would be happy to answer any questions you may have.

1. Fatality information derived from FARS includes motor vehicle traffic crashes that result in the death of an occupant of a vehicle or a nonmotorist within 30 days of the crash. FARS analysts extract the information from the state's own source documents and put it in a standard format.

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