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 safety recommendations to prevent their recurrence. The recommendations that arise from our investigations and safety studies are our most important product. The Safety Board cannot mandate implementation of these recommendations. However, in our 39-year history, organizations and government bodies have adopted more than 80 percent of our recommendations.

The Safety Board has recognized for many years that motor vehicle crashes are responsible for more deaths than crashes in all other transportation modes combined. 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.

The number of injuries and deaths for children in the 6-to-13 age range remains high because these children are often unrestrained, restrained in systems too advanced for their physical development, or riding in the front seat. According to data from the Fatality Analysis Reporting System (FARS), from 1995 through 2004, more than 1,800 children age 6 to age 8 were killed while riding in motor vehicles. More than 90 percent of child passengers in this age group who died had been unrestrained or placed in an adult seat belt. Over the same time period, almost 5,800 children age 6 to age 13 were killed in motor vehicle crashes; almost 43 percent were riding in the front seat.

Restraining a child makes it three times less likely that the child will be injured in a crash. Placing a child in the rear seat makes it an additional two 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 seat with a belt-positioning booster seat.

California has been a leader on child passenger safety issues, becoming one of the first States to mandate booster seats for children too big for traditional child safety seats. Since California enacted that law in 2000, however, many States have implemented more comprehensive laws. And while California is one of only 15 States to mandate back seat use for children, only the State of Washington has a law that includes all children under age 13.

Today I will discuss three key issues. First, belt-positioning booster seats are necessary to ensure proper seat belt fit for children ages 4 to 8. Second, the back seat is safer for children under age 13. Finally, a successful child passenger safety program requires legislation.

Seat Belts Do Not Provide Sufficient Protection for Children Ages 4 to 8

Because seat belts are designed to provide optimal protection for adults, they do not provide sufficient protection for children. To operate properly, seat belts depend on a person’s bone structure, 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 seat belt 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 child’s 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 crashes in which at least one vehicle contained 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 seat belts, and 65 children who were unrestrained, for a total of 194 children. The Safety Board found that none of the fatally injured children was a child who had been placed in the appropriate restraint and who had used it properly. Children inappropriately restrained by seat belts had higher overall injury severity, including five fatal injuries, than children properly restrained. Among the unrestrained children, almost 30 percent suffered moderate or worse injuries, including five fatalities. Children in high severity accidents tended to sustain injury, which makes proper restraint even more important in such accidents.

Using a seat belt 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. Because such shoulder belt positioning 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,¹ children inappropriately restrained in seat belts suffered injuries to all body regions, while there were no reported abdominal, neck/spine/back, or lower extremity injuries among children who were restrained in booster seats. Children restrained only in seat belts are 3.5 times more likely to suffer abdominal injury than children appropriately restrained with booster seats. When children use booster seats, the odds of injury are 59 percent lower than when children use only seat belts.

The Safety Board found in the 1996 study that a lap/shoulder belt would not properly fit a child less than 54 inches tall; children under this height would be safer in a booster seat. The general opinion among law enforcement has been that age is a better enforcement criterion than height. At the time of the Board’s 1996 study, the American Academy of Pediatrics age, height and weight guidelines indicated that the average 8-year-old child was 54 inches tall.² Therefore, the Board recommended enacting legislation that ensures children up to 8 years of age are required by the State’s mandatory child restraint use law to use child restraint systems and booster seats.

Back Seat Is Safer for Children Under Age 13

Another issue examined by the Safety Board in the 1996 study was seating position of children. About one-quarter of the children in the Board’s study who were seated in the back seat were not injured while only fifteen percent of children in the front seat avoided injury. The Board recommended education programs to encourage back seat use and changes to motor vehicles to make back seats more child friendly.

In March 1997, the Safety Board revisited the issue during a four-day public forum convened to address the growing public concern about air bags. Between 1993 and 1996, 38 children died because they were struck by an air bag in what would otherwise have been a survivable crash, and 23 adults were also killed by their air bags in crashes they should have survived. While air bags certainly increase the chances for survival, particularly in severe frontal crashes, it became apparent that “one size does not fit all.”

During the forum, the National Highway Traffic Safety Administration (NHTSA) presented evidence, based on a 1996 evaluation that the negative effects of a passenger-side air bag outweighed the benefits for occupants below age 13. Participants from many countries and organizations also voiced support for a back seat requirement. The Safety Board agreed and recommended that all States amend their laws to require children under age 13 to be in the back seat when a back seat is available.

Although today's technology can tailor the deployment of the air bag according to the crash severity, size and posture of the occupant, seat belt use or non-use, and the occupant's proximity to the air bag, motor vehicles with older air bags remain in circulation. As long as children continue to ride in these vehicles and given that frontal collisions remain the most common type of crash (with the back seat therefore the farthest seating position from the point of impact), children under age 13 are safer if they ride in back.

A Successful Child Passenger Safety 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. A 2003 survey conducted by NHTSA revealed that 85 percent of parents and caregivers had heard of booster seats, but only 60 percent of those who knew about booster seats had used them at some point. The survey also revealed that just 21 percent of children ages 4 to 8 had traveled on at least one occasion in a booster seat. Among the State Farm insured population participating in the ongoing Partners for Child Passenger Safety study, 62 percent of children between the ages of 4 and 8 were placed only in adult seat belts.³

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 had relied on Washington State statutes in deciding to use a seat belt for her 4-year-old son. In June 1996, Anton Skeen died when he was ejected out of his seat belt and the vehicle, even though his seat belt remained buckled. Ms. Skeen’s reliance on State law to determine the necessary safety requirements for her child is common among concerned parents. In focus groups conducted by Partners for Child Passenger Safety, many parents who used seat belts to restrain their children justified their actions with their States’ child passenger safety laws.

One concern about mandating booster seats is the additional cost, particularly for low-income families. Booster seats, however, are the least expensive type of child restraint, costing as little as $15. Also, many child restraints are convertible from a forward-facing child safety seat to a booster seat. Parents may have already purchased a restraint that can become a booster seat, but they may not realize it. In addition, the California Highway Patrol, Office of Traffic Safety funded programs, and SAFE KIDS Coalitions throughout the State, in conjunction with their extensive education programs, can help provide booster seats to those who otherwise cannot purchase them.

California recognized the value of legislation when it became one of the first States to upgrade its child passenger safety law. California requires child safety seats and booster seats for children under age 6 and requires those children to ride in the back seat. This law clearly has had an affect; in 1995, only 8.5 percent of children age 4 to age 6 involved in fatal crashes were using child restraints. As of 2004, more than 42 percent of children in this age range involved in fatal crashes were in child restraints. In 1995, more than 35 percent of children under age 6 and involved in fatal crashes were riding in the front seat. Now, only 7.5 percent of children in this age range and involved in fatal crashes are in the back seat.

Children remain at risk, however, because California’s law does not fully implement the Safety Board’s recommendation. From 1995 through 2004, 145 children age 6 and 7 were killed while riding in motor vehicles in California; 84 percent were unrestrained or improperly restrained in adult seat belts. During this same time period, 500 children age 6 through age 12 were killed in motor vehicle crashes; more than 36 percent of those killed were riding in the front seat. While California has seen an increase in child restraint use for 6- and 7-year-olds and back seat use for 6- through 12-year-olds, the changes have been nowhere near as substantial as for the applicable younger populations.

Assembly Bill 2108 fully satisfies the Safety Board’s recommendation on the use of child restraints and complies with best practices by requiring children to use child restraints until they are 8 years old and be in the back seat until they are 13 years old.

Parents want to protect their children, but many parents do not understand that seat belts do not provide sufficient protection for children in this age range and that the front seat remains a risk for children under age 13. Belt-positioning booster seats ensure proper seat belt fit, which means that children get the optimum level of protection from the seat belt without the risk of head or abdominal injuries. Placing children in the back reduces a child’s risk of injury by one-third. Passing Assembly Bill 2108 will save lives and reduce serious injuries for California’s youngest citizens.

Thank you again for inviting the Safety Board to testify about this important problem. I 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 5-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.

2. The source of the American Academy of Pediatrics’ guidelines has always been the Centers for Disease Control and Prevention.

3. Partners for Child Passenger Safety, CPS Issue Report, July 2004.