A quick show of hands–who thinks it’s easier to buckle a kid into a booster than it is to buckle a kid into a harnessed car seat?  I think many parents think it’s easier to buckle a child into a booster and that’s why we see the early transition into boosters from harnessed seats.  There are other factors as well for moving a child into a booster seat: it’s less a “baby” seat, the child has outgrown a small/short harnessed seat, the parent is only willing to follow minimum legal safety requirements, it’s easier to move from vehicle to vehicle, the child is more likely able to buckle himself into the seat, there’s less chance for user error.  Or is there?

We’re making headway with keeping kids rear-facing past age 1 and 20 lbs. and in harnesses past 40 lbs. in seats designed for higher weights, but our booster-aged kids are still being left behind.  Depending on the study you choose, the percentage of children riding in boosters is still pretty low.  In the first ever observational study done by NHTSA, 41% of 4-7 year olds were riding in boosters.  However, in a study done in Indiana by the Riley Children’s Hospital, they found only 16% of 4-8 year olds were in boosters.  It depends on area law, educational programs, and who conducts the study how high those numbers go.

A few years ago, the Children’s Hospital of Philadelphia (CHOP) found that boosters reduce the risk of injury by 59% in the 4-7 year old age group when used properly.  When used properly, let me emphasize those words.  We’re doing our best to get parents and caregivers to use boosters, but then we assume they know how to use them.  Who can screw up a booster, right?  It’s so easy to use.  Shoulder belt goes through this red thing here, lap belt goes over this red thing here.  Voilà, you’re done.  I’ve seen many parents just open the vehicle door, let the child crawl in, and close the door behind him.  They drive off seconds later, barely long enough for the parent to buckle up, let alone a child who has less dexterity than an adult and has to maneuver a seat belt around a booster armrest.

The brutal fact is that parents and kids aren’t using boosters correctly.  Joseph O’Neil with Riley Hospital, in his observational study of booster seat use, found a 64.8% misuse rate with many of those having more than one misuse.  O’Neil wasn’t alone in his findings; other studies confirm these multiple misuses with boosters.  What are they finding kids doing in boosters?

The shoulder belt is mispositioned on the shoulder.  Remember the old CPS adage: pick the car seat that fits your vehicle, fits your child, and fits your budget?  That holds true for booster seats as well.  Not every booster will fit every vehicle or child.  The D-ring position (we’re talking vehicle shoulder belt anchorage here, not rear-facing tethering) in vehicles varies so much that it’s important to find a booster that will work with the shoulder belt in your vehicle to make the belt fit comfortable and safe on your child.

The shoulder belt guide on the booster isn’t used at all.  It’s there for a reason.  Use the feature.

The shoulder belt is placed under the arm.  Yep, it’s still happening.  Even with boosters.

The vehicle belt is placed over the armrest of the booster instead of under it.  Parents don’t understand that the armrests act as false hips for the child since the child doesn’t have the bony hip structure until adolescence to keep the lap portion of the vehicle belt down low on the thighs.  Some combination seats have bizarre design gaps between the armrests and the back of the car seat where the seat belt must lay across the child which I’m sure must add to the confusion.  *Every* booster instruction manual has a drawing showing proper use and as a bonus, all booster manuals are very short in length!  I think the longest may be 15 pages, so no excuses about the manual being too long or complicated to read.

The seat belt isn’t tight.  The child buckles the seat belt but doesn’t pull the seat belt tight across the hips.  It takes a lot of coordination to first buckle a seat belt, then pull the slack out.  You have to know which part of the seat belt to pull on to get the slack out and that’s a pretty heavy duty task for a 4 year old to tackle.  Plus, when a lot of children sit down in their seats, their pants bunch up around their hips and that makes it hard to get the seat belt tight across their thighs.

I dare say a lot of these misuses could be corrected with a little parental supervision.  First, we need to teach parents how to use booster seats correctly, then parents need to teach their children how to sit properly in their booster seats.  We can’t expect a child to go from sitting in a harnessed seat with very little freedom built in to it to sitting in a booster seat where the child can lean to the side or climb completely out of the seat very easily.  It shouldn’t be easier to switch to a booster seat from a harnessed seat because it should still take time to place the seat belt correctly on the child and to buckle the seat belt.  This process could take months until the child feels comfortable doing it himself.  It all boils down to adult supervision.  We can teach kids independence with buckling, but as adults, we still have the duty to make sure our children are riding safely and correctly in their safety seats.

 

What should a belt positioning booster do?  It should position the seat belt on a child for optimum safety and comfort.  The lap belt should fit low across the hips, touching the thighs, and the shoulder belt should fit across the middle of the shoulder or closer to the neck so the shoulder can’t slide out from under the belt.