Injuries related to motor vehicle collisions are the leading cause of injury-related death for Canadian children. Motor vehicle collisions can cause a number of serious injuries such as damage to the spine and internal organs. Children are also at a higher risk for head injuries when they are not restrained properly.1
It is essential that parents and caregivers use car seats, booster seats, and seatbelts as intended. Often cited older research indicates that when used correctly, car seats reduce the risk of death by 71 per cent for infants under one year of age and 54 per cent for children aged one to four.2 More recent research demonstrates similar findings, with the risk of death or serious injury reduced by as much as 74 per cent when children are correctly installed in appropriate car seats.3, 4 Regarding booster seats specifically, data indicates that they can provide 60 per cent more protection than seatbelts alone.5 Child restraints are effective because the car seat harness or vehicle seat belt is positioned over the parts of a child’s body that are best able to absorb the force of a crash.4
It is clear that the risk of injury can be significantly reduced by protecting children with the appropriate car seat or booster seat for their age, height and weight and by using it correctly.4, 5
It is estimated that between 44 per cent and 81 per cent of car and booster seats are not used correctly, putting children at risk for increased injury.6, 7 According to a 2005 analysis of severe injuries to child passengers, 92 per cent of injured infants, 74 per cent of injured toddlers, and 96 per cent of injured school-aged children were not using the appropriate restraint at the time of the crash.8 Until car seats are engineered and designed to be installed with a perception of ease, parent education is paramount to successful car seat installation and compliance.
Research indicates that children 12 years of age and under who are restrained in the back seat of a vehicle have a substantially lower risk of dying in a fatal crash and have a lower risk of serious injury compared to children in other seating positions.9, 10 It is also important to note that while newer designs of front passenger airbags have reduced the prior risk (84 per cent) of injury to children, a moderate increased risk still exists for non-fatal injury to children exposed to an activated air bag.11 Airbags are designed to protect adult bodies.
Current data indicates that only 30 per cent of Canadian children between four and eight years of age are using booster seats despite existing booster seat laws in the majority of Canadian provinces.12 The remaining children in this age range (1.8 million) are in jeopardy of suffering severe internal injuries during a crash, as a result of using a seatbelt too early in their development. Labelled “seatbelt syndrome”, injuries can include bowel perforations and spinal fractures. Recovery is rarely complete and many children suffer permanent paralysis.13
While we continue to advocate for all provinces and territories to introduce booster seat legislation, it is vital to encourage parents to use a booster seat for their child when they have outgrown their forward-facing car seat, even if their province does not currently have a law in place.
Existing laws in Canada vary slightly due to provincial variables. Generally, children must use a rear-facing car seat until at least one year of age and at least 10 kilograms (22 pounds), and then may transition to a forward-facing car seat until at least 18 kilograms (40 pounds). It is important to note that just because a child has reached these minimum weight requirements, it doesn't mean they should be rushed to the next stage. A booster seat should then be used until a child is at least 36 kilograms (80 pounds) and 145 centimetres (57 inches) tall, measures which are not typically reached until at least age nine years of age. Children can transition to a seatbelt alone once it rests in the correct position on their body. Experts agree that premature graduation to a car seatbelt alone jeopardizes a child’s safety significantly.14
Legislation, education and enforcement in combination can increase the correct use of child restraints. Research has shown that a combination of strategies can reduce child passenger injuries.15
To read about the current Car Seat and Booster Seat legislation across Canada, download our Car Seat Legislation Chart.
1 Muszynski CA, Yoganandan N, Pintar FA, Gennarelli TA. Risk of pediatric head injury after motor vehicle accidents. Journal of Neurosurgery (Pediatrics) 2005;102:374-9.
2 National Highway Traffic Safety Administration. Research note: Revised estimates of child restraint effectiveness. Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration; 1996. (96.855).
3 Biagioli F. Proper use of child safety seats. Am Fam Physician 2002;65(10):2085-90.
4 Weber K. Crash protection for child passengers: a review of best practice. UMTRI Research Review 2000;31(3):1-27.
5 Durbin DR, Elliott MR, Winston FK. Belt-positioning booster seats and reduction in risk of injury among children in vehicle crashes. Journal of the American Medical Association 2003;289(21):2835-40.
6 Canadian Paediatric Society. Transportation of infants and children in motor vehicles. Paediatr Child Health 2008;13(4):313-27.
7 Morris SD, Arbogast KB, Durbin DR, Winston FK. Misuse of booster seats. Inj Prev 2000(6):281-4.
8 Chouinard A, Hurley R. Towards the development of a national child restraint survey. In: Canadian Multidisciplinary Road Safety Conference XV, 2005; Frederiction, BC.
9 Braver ER, Whitefield R, Ferguson SA. Seating positions and children's risk of dying in motor vehicle crashes. Inj Prev 1998;4:181-7.
10 Berg MD, Cook L, Corneli HM, Vernon DD, Dean JM. Effect of seating position and restraint use on injuries to children in motor vehicle crashes. Pediatrics 2000;105(4 Pt 1):831-5.
11 Arbogast KB, Durbin DR, Kallan MJ, Elliott MR, Winston FK. Injury risk to restrained children exposed to deployed first- and second-generation air bags in frontal crashes. Arch Pediatr Adolesc Med 2005;159(4):342-6.
12 Safe Kids Canada, Decima Reseach Inc. National child passenger safety survey results. 2004.
13 Durbin DR, Arbogast KB, Moll EK. Seat belt syndrome in children: a case report and review of the literature. Pediatr Emerg Care 2001;17(6):474-7.
14 Winston FK, Durbin DR, Kallan MJ, Moll EK. The danger of premature graduation to seat belts for young children. Pediatrics 2000;105(6):1179-83.
15 World Health Organization. World report on road traffic injury prevention. Geneva: World Health Organization; 2004.