Testimony of Carol J. Carmody,
Vice Chairman
National Transportation Safety Board
before the Senate Transportation Committee
Commonwealth of Virginia
regarding Child Safety Booster Seats
January 24, 2002

Good afternoon Chairman Williams and members of the Committee on Transportation. It is my pleasure to be here in Richmond, Virginia to talk about belt-positioning booster seats. With me today are Elaine Weinstein and Danielle Roeber.

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 33-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. 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), in 2000, 470 children in this age group were killed while riding in motor vehicles. More than 50 percent of child passengers in this age group who died were unrestrained. For this age group in Virginia, 5 children died while riding in motor vehicles.

Today I want to discuss 2 key issues. 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.

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 appropriately restrained children in low to moderate severity accidents sustained less serious injuries than the inappropriately restrained children. 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. However, when children use booster seats, there is a 50 percent to 70 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. 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. Also testifying before the Senate, Dr. Kyran Quinlan, a pediatrician at the University of Chicago, explained that legislation would help medical professionals persuade parents of the value of booster seats.

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 seatbelt use went from 14 percent to 59 percent between 1984 and 1991. Five States (Arkansas, California, New Jersey, Oregon, and Washington) have mandated booster seat use. At least 9 States, including Maryland, are considering booster seat legislation.

FARS data show that among all children injured or killed while riding in motor vehicles on Virginia roads, none were using a child restraint or booster seat. Seventy-five percent of these children died or suffered incapacitating injuries.

Partners for Child Passenger Safety1 found in Virginia that 86 percent of children ages 4 to 8 were restrained by a seatbelt. Only 4 percent of the children in this age range were appropriately restrained in a booster seat. More than 90 percent of the children in this age group who were seriously injured were not restrained in a booster seat, and 55 percent of the serious injuries to Virginia children were to the head or face.

Senate Bill 395 is a step in the right direction in protecting Virginia's children. It extends the requirement to use child restraints through age 5, adding two full years of protection.

In the 1990s, 8,600 children ages 4 to 8 died in traffic crashes. 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 Senate Bill 395 will save lives and reduce serious injuries for Virginia'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 or my staff would be happy to answer any questions you may have.

1 The Children's Hospital of Philadelphia and The University of Pennsylvania, with support from The State Farm Insurance Companies, has undertaken a five-year research project to study child occupant protection. The central goal of this project is to save children's lives by increasing the fund of knowledge about children in motor vehicle crashes.

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