Testimony of Vice-Chairman Carol Carmody
before the Maryland House of Delegates,
Committee on Commerce and Government Matters
on Child Booster seats
March 6, 2002

Good afternoon Chairman Wood and members of the Committee on Commerce and Government Matters. I am glad to be here in Annapolis to talk about belt-positioning booster seats.

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 created 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, 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), 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 Maryland, 45 children died while riding in motor vehicles and 82 percent were unrestrained or in an adult seatbelt.

Simply restraining a child 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 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 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 Safety1 , 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 as a nation, what value do we want to place on a child's life?

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 through age 7. Therefore, in our 1996 safety study, the Safety Board recommended enacting legislation that ensures children up through age 7 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. Eight States (Arkansas, California, New Jersey, Oregon, Rhode Island, South Carolina, Tennessee, and Washington) have mandated booster seat use. At least 19 States, including Virginia, are considering booster seat legislation.

FARS data from 1994 - 2000 show that 282 children were riding in motor vehicles on Maryland roads when they were involved in a fatal crash. Fifty-seven percent of the 282 children died or suffered incapacitating injuries, and 82 percent of those children, who died or suffered incapacitating injuries, were not in child restraints. Only 8 children, or 5 percent, were using any form of child restraint.

Partners for Child Passenger Safety found in Maryland that 80 percent of children ages 4 to 8 were restrained by a seatbelt. Only 14 percent of the children in this age range were appropriately restrained in a booster seat. More than 90 percent of the children in the study who were seriously injured were not restrained in a booster seat, and 80 percent of the serious injuries to Maryland children were to the head or face.

House Bill 699 is a step in the right direction in protecting Maryland's children. It extends the requirement to use child restraints through age 6, adding three 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 House Bill 699 will save lives and reduce serious injuries for Maryland'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 will try to answer any questions you may have.

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.