Child Passenger Protection

Child restraint systems provide specialized protection for small occupants whose body structures are still immature and growing. There is a wide variety of systems from which to choose, and different types of restraints are appropriate for children of different ages and sizes. Even with the most appropriate child restraint (CR), however, the way in which it is installed and used can have an effect on its performance. This chapter describes the theory behind the design of occupant restraint systems and applies these principles to the special needs of children. A distinction is made between child restraints, which themselves provide the restraint structure, and positioning devices, such as boosters, which help the vehicle belt fit the child. Throughout each section, current concepts of “best practice” are given, including the changes brought on by passenger airbags, and future directions are indicated.

[1]  Matthew P. Reed,et al.  Investigation of Airbag-Induced Skin Abrasions , 1992 .

[2]  S. A. Heap,et al.  The Design and Development of a More Effective Child Restraint Concept , 1968 .

[3]  Roger W. Nightingale,et al.  Biomechanical Aspects of Cervical Trauma , 2002 .

[4]  Bill Gardner,et al.  The effect of top tether strap configurations on child restraint performance , 1997 .

[5]  Phyllis F. Agran,et al.  TRAUMATIC INJURIES AMONG CHILDREN USING LAP BELTS AND LAP/SHOULDER BELTS IN MOTOR VEHICLE COLLISIONS , 1987 .

[6]  Poison Prevention,et al.  Selecting and using the most appropriate car safety seats for growing children: guidelines for counseling parents. American Academy of Pediatrics. Committee on Injury and Poison Prevention. , 2002, Pediatrics.

[7]  P C Marriner,et al.  ABDOMINAL SHIELD BOOSTER CUSHIONS IN MOTOR VEHICLE ACCIDENTS , 1995 .

[8]  Stephen Ira Halman School-age children and adult automobile restraints, an analysis of the passenger car study , 1998 .

[9]  Phyllis F. Agran,et al.  Restraint Use Among Children in Fatal Crashes , 1997 .

[10]  Kathleen Weber,et al.  REAR-FACING RESTRAINT FOR SMALL CHILD PASSENGERS: A MEDICAL ALERT. , 1995 .

[11]  Gregory Stephens,et al.  CHILDREN IN RESTRAINTS , 1994 .

[12]  Stephen W. Rouhana,et al.  Biomechanics of Abdominal Trauma , 2002 .

[13]  Donald H. Slavik CERVICAL DISTRACTION INJURIES TO CHILDREN , 1997 .

[14]  Julie Brown,et al.  A COMPARISON OF ALTERNATIVE ANCHORAGE SYSTEMS FOR CHILD RESTRAINTS IN SIDE IMPACTS , 1997 .

[15]  Michael Muller,et al.  Misuse mode and effects analysis (MMEA) - an approach to predict and quantify misuse of child restraint systems (CRS) , 1991 .

[16]  B. Kamren,et al.  SIDE PROTECTION AND CHILD RESTRAINTS - ACCIDENT DATA AND LABORATORY TEST INCLUDING NEW TEST METHODS , 1991 .

[17]  R. Lowne,et al.  Development of a sled side impact test for child restraint systems , 1998 .

[18]  Kathleen DeSantis Klinich,et al.  Injury patterns of older children in automotive accidents , 1993 .

[19]  R N Green,et al.  Fatal injuries caused by underarm use of shoulder belts. , 1987, The Journal of trauma.

[20]  Susan C. Partyka,et al.  PAPERS ON ADULT SEAT BELTS - EFFECTIVENESS AND USE. NHTSA TECHNICAL REPORT , 1988 .

[21]  Thomas Turbell,et al.  ISOFIX : A new concept of installing child restraints in cars , 1993 .

[22]  John D. States,et al.  Trauma to Children in Forward-Facing Car Seats , 1993 .

[23]  K K Christoffel,et al.  Cervical spine fractures sustained by young children in forward-facing car seats. , 1989, Pediatrics.

[24]  C Tingvall,et al.  Some aspects of the safety of children as car passengers in road traffic accidents , 1987, Acta paediatrica Scandinavica. Supplement.

[25]  Hans Norin,et al.  Child Restraints in Cars - An Approach to Safe Family Transportation , 1979 .

[26]  Michael Paine,et al.  Injuries to Restrained Children , 1994 .

[27]  L E Decina,et al.  Child safety seat misuse patterns in four states. , 1997, Accident; analysis and prevention.

[28]  Dainius J. Dalmotas,et al.  ATLANTO-OCCIPITAL FRACTURE DISLOCATION IN LAP-BELT RESTRAINED CHILDREN , 1993 .

[29]  Klaus Langwieder,et al.  Side-impact to children in cars: experience from international accident analysis and safety tests , 1996 .

[30]  Martin R. Eichelberger,et al.  Injury severity in restrained children in motor vehicle crashes , 1995 .

[31]  D. Johnson,et al.  The diagnosis and treatment of pediatric lumbar spine injuries caused by rear seat lap belts. , 1990, Neurosurgery.

[32]  Martin R. Eichelberger,et al.  Injuries to children restrained in 2- and 3- point belts , 1998 .

[33]  John Gane,et al.  Usability Trials of Alternative Child Restraint Attachment Systems , 1997 .

[34]  Kathleen Weber Comparison of car-bed and rear-facing infant restraint systems , 1989 .

[35]  M. Bull,et al.  Premature infants in car seats. , 1985, Pediatrics.

[36]  Xavier Trosseille,et al.  INITIAL CONCLUSIONS OF AN INTERNATIONAL TASK FORCE ON CHILD RESTRAINING SYSTEMS , 1991 .

[37]  B A Winkelstein,et al.  Epidemiology, classification, mechanism, and tolerance of human cervical spine injuries. , 1995, Critical reviews in biomedical engineering.

[38]  Dainius J. Dalmotas,et al.  Investigation of Dummy Response and Restraint Configuration Factors Associated with Upper Spinal Cord Injury in a Forward-Facing Child Restraint , 1993 .

[39]  Kaye Sullivan,et al.  Where Are All the Children Seated and When Are They Restrained , 1997 .

[40]  D F Huelke,et al.  Infants and children in the adult world of automobile safety design: pediatric and anatomical considerations for design of child restraints. , 1969, Journal of biomechanics.

[41]  R. Lowne,et al.  A COMPARISON OF THE PERFORMANCE OF DEDICATED CHILD RESTRAINT ATTACHMENT SYSTEMS (ISOFIX) , 1997 .

[42]  Anders Kullgren,et al.  The Protective Effects of Rearward Facing CRS: An Overview of Possibilities and Problems Associated with Child Restraints for Children Aged 0-3 Years , 1993 .

[43]  C Morgan,et al.  EFFECTIVENESS OF LAP/SHOULDER BELTS IN THE BACK OUTBOARD SEATING POSITIONS , 1999 .

[44]  Richard L. Stalnaker,et al.  Spinal cord injuries to children in real world accidents , 1993 .

[45]  C. P. Waslewski Children in car crashes: Analysis of data for injury and use of restraints: Johnston C, Rivara FP, Soderberg R Pediatrics 93:960–965 Jun 1994 , 1994 .

[46]  Robert Bell Misuse test panels: A technique for the identification and prevention of misuse of child restraints , 1991 .

[47]  Michael A. Lumley Child Restraint Tether Straps - A Simple Method of Increasing Safety for Children , 1997 .

[48]  A. Lund,et al.  Reductions in deaths in frontal crashes among right front passengers in vehicles equipped with passenger air bags. , 1997, JAMA.

[50]  Klaus Langwieder,et al.  Development of a Sled-Based Impact Test for Child Restraints in Side Collisions , 1997 .

[51]  John W. Melvin,et al.  Performance of child restraints in serious crashes , 1980 .

[52]  L K Sullivan,et al.  EVALUATION OF DEVICES TO IMPROVE SHOULDER BELT FIT. , 1994 .

[53]  Claude Tarriere,et al.  NECK INJURY CRITERIA FOR CHILDREN FROM REAL CRASH RECONSTRUCTIONS , 1993 .

[54]  Harold J. Mertz,et al.  Anthropomorphic Test Devices , 2002 .

[55]  Richard L Stainaker INCONSISTENCIES IN STATE LAWS AND FEDERAL REGULATIONS REGARDING CHILD RESTRAINT USE IN AUTOMOBILES , 1993 .

[56]  Å. Nygren,et al.  An epidemiological study of injuries to children as car passengers in road traffic accidents , 1987 .

[57]  Julie Brown,et al.  The performance of tethered and untethered forward facing child restraints , 1995 .

[58]  L Evans,et al.  The effectiveness of safety belts in preventing fatalities. , 1986, Accident; analysis and prevention.

[59]  C J Kahane,et al.  EVALUATION OF CHILD PASSENGER SAFETY: THE EFFECTIVENESS AND BENEFITS OF SAFETY SEATS. SUMMARY , 1986 .

[60]  Julie Brown,et al.  Child restraint performance in side impacts with and without top tethers and with and without rigid attachment (canfix) , 1995 .

[61]  Annemarie Shelness,et al.  OBSERVED MISUSE OF CHILD RESTRAINTS , 1983 .

[62]  Albert I. King,et al.  Injury to the Thoraco-Lumbar Spine and Pelvis , 1993 .

[63]  S A Ferguson,et al.  Seating positions and children's risk of dying in motor vehicle crashes , 1998, Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention.

[64]  Maryvonne Dejeammes,et al.  Exploration of Biomechanical Data Towards a Better Evaluation of Tolerance for Children Involved in Automotive Accidents , 1984 .

[65]  G. Stürtz,et al.  Biomechanical Data of Children , 1980 .

[66]  C. Got,et al.  From Three-Years-Old to Adult Size - How to Ensure Child Protection in Automobile Accidents , 1983 .

[67]  R J Lehman,et al.  Child anthropometry for restraint system design , 1985 .

[68]  K. Christoffel,et al.  Safe Transportation of Premature Infants , 1991, Pediatrics.

[69]  Lotta Jakobsson,et al.  Trends and Effects of Child Restraint Systems Based on Volvo's Swedish Accident Database , 1997 .

[70]  B G Conry,et al.  Cervical spine fractures and rear car seat restraints. , 1987, Archives of disease in childhood.

[71]  D. Diekema,et al.  Odontoid fracture in a child occupying a child restraint seat. , 1988, Pediatrics.

[72]  R. Rutledge,et al.  The spectrum of abdominal injuries associated with the use of seat belts. , 1991, The Journal of trauma.

[73]  Donald F. Huelke,et al.  Car Crashes and Non-Head Impact Cervical Spine Injuries in Infants and Children , 1992 .

[74]  K. Weber,et al.  INJURY POTENTIAL WITH MISUSED CHILD RESTRAINING SYSTEMS , 1983 .

[75]  N. Feles Design and Development of the General Motors Infant Safety Carrier , 1970 .

[76]  J. Melvin,et al.  Accidental Injury: Biomechanics and Prevention , 1993 .

[77]  Michael Griffiths,et al.  Adult seat belts: how safe are they for children? , 1996 .

[78]  P. F. Gloyns,et al.  A Population Study of UK Car Accidents in Which Restrained Children Were Killed , 1993 .

[79]  F. Rivara,et al.  Children in car crashes: analysis of data for injury and use of restraints. , 1994, Pediatrics.

[80]  Richard Kaplan,et al.  EFFECTIVENESS OF CURRENT AND FUTURE RESTRAINT SYSTEMS IN FATAL AND SERIOUS INJURY AUTOMOBILE CRASHES. DATA FROM-ON-SCENE FIELD ACCIDENT INVESTIGATIONS , 1979 .

[81]  J A Newman THE RESTRAINT OF SCHOOL-AGE CHILDREN IN AUTOMOBILES; A LITERATURE REVIEW , 1979 .

[82]  Elisa R. Braver,et al.  Risk of Death Among Child Passengers in Front and Rear Seating Positions , 1997 .

[83]  David F. Clement,et al.  Technological Evolution of the Airbag Safe Infant Seat , 1999 .

[84]  Claude Tarriere,et al.  Protection of children on board vehicles: influence of pelvis design and thigh and abdomen stiffness on the submarining risk for dummies installed on a booster , 1996 .

[85]  M J Cynecki,et al.  THE INCIDENCE AND FACTORS ASSOCIATED WITH CHILD SAFETY SEAT MISUSE , 1984 .

[86]  R. Nelson,et al.  Risk of hypoventilation in premature infants in car seats. , 1986, The Journal of pediatrics.

[87]  Mary L. Chipman,et al.  The effectiveness of safety belts in preventing fatalities and major injuries among school-aged children , 1995 .

[88]  John W. Melvin,et al.  Injury Assessment Reference Values for the CRABI 6-Month Infant Dummy in a Rear-Facing Infant Restraint with Airbag Deployment , 1995 .

[89]  Thomas G. Molnar,et al.  A New Concept in Child Restraint Design , 1979 .

[90]  Kathleen Weber CHILD RESTRAINT AND AIRBAG INTERACTION: PROBLEM AND PROGRESS , 1993 .

[91]  John W. Melvin,et al.  Review of biomechanical impact response and injury in the automotive environment. Task B final report , 1991 .

[92]  Sue A. Ferguson,et al.  PRELIMINARY REPORT: INITIAL ESTIMATES OF REDUCTIONS IN DEATHS IN FRONTAL CRASHES AMONG RIGHT FRONT PASSENGERS IN VEHICLES EQUIPPED WITH PASSENGER AIRBAGS , 1996 .

[93]  W. Cole,et al.  The paediatric cervical seat belt syndrome. , 1993, Injury.

[94]  D C Herbert,et al.  CHILDREN WEARING APPROVED RESTRAINTS AND ADULTS' BELTS IN CRASHES , 1981 .

[95]  J. Graham,et al.  Reducing Risks to Children in Vehicles With Passenger Airbags , 1998, Pediatrics.

[96]  Alan Cantor,et al.  BOOSTER-WITH-SHIELD CHILD RESTRAINT CASE STUDIES , 1997 .

[97]  John W. Melvin,et al.  Abdominal Intrusion Sensor for Evaluating Child Restraint Systems , 1986 .

[98]  F P Rivara,et al.  The epidemiology of seatbelt-associated injuries. , 1991, The Journal of trauma.

[99]  D N Castillo,et al.  Comparison of motor vehicle occupant injuries in restrained and unrestrained 4- to 14-year-olds. , 1992, Accident; analysis and prevention.

[100]  Newborn,et al.  Safe Transportation of Premature and Low Birth Weight Infants , 1996, Pediatrics.

[101]  J C Lane,et al.  THE SEAT BELT SYNDROME IN CHILDREN , 1994 .