After car booster seat laws, child deaths fell

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U.S. states with laws requiring kids to ride in car booster seats have had fewer child deaths in accidents, especially among 6- and 7-year-olds, researchers reported Monday.

Nearly all U.S. states require that children who have outgrown traditional car seats use a car booster seat, which raises a child high enough so that seatbelts can be positioned properly - with the shoulder strap across the shoulder (not the neck), and the lap belt across the hips.

Florida and South Dakota are the only states that don't mandate booster seats. But the other states vary in their age requirements, and many don't require booster seats for 6- and 7-year-olds.

But in the new study, researchers found that after states began passing booster seat laws, fewer children ages 4 to 7 died in car accidents - and the biggest differences were seen in older kids.

Between 1999 and 2009, states that started requiring booster seats had an 11 percent lower risk of child traffic deaths compared with states without a law. When the booster law included 6- and 7-year-olds, deaths dropped by about one-quarter, versus states with no booster seat mandate.

"I think parents may think that as kids get older, they need booster seats less," said senior researcher Dr. Lois K. Lee of Children's Hospital Boston.

"But this shows that it's kids at the upper end of the age range who could benefit the most," Lee said in an interview.

Already, the American Academy of Pediatrics (AAP) says that children should ride in car seats with a harness until they are 4 years old, or have outgrown the seat. After that, they should use a booster seat until they're between 8 and 12 years old, or have reached 4 feet, 9 inches in height.

Based on the current findings, Lee said, "I think states should consider extending their age limits to match the AAP guidelines."

Tell your child it's the law

The findings, which appear in the journal Pediatrics, are based on data from the National Highway Traffic Safety Administration (NHTSA) for 1999 through 2009. In 1999, no U.S. state had a car booster seat law; by 2009, nearly all had passed one.

Among states that passed a law, traffic deaths among 4- and 5-year-olds fell from an average of 5.7 per 100,000 before the law, to 4.2 per 100,000.

The researchers then looked at states whose laws covered 6-year-olds. The average death rate among kids that age dipped from 2.3 to 1.5 per 100,000.

In states that covered 7-year-olds -- 16 of them in 2009 -- the average death rate among those kids did not decline. But when the researchers accounted for other factors, like other new driving laws, booster seat laws were linked to a one-quarter lower death rate among 7-year-olds.

Lee said that regardless of what your state law is, the best way to keep your child safe in the car is to follow the AAP guideline on booster seats.

Of course, getting your 8-year-old to agree to get in a booster seat can be a challenge, Lee acknowledged. "That's one way legislation helps parents," she noted. "They can tell their child it's the law."

For booster seats to work, they do have to be installed and used correctly. And research has found that families often make mistakes, such as improperly positioning or latching the seatbelts.

Parents who need advice on using booster seats can go to online sources like the NHTSA website ( and Safe Kids USA (

The NHTSA site also lets parents search for local inspection stations where they can get help installing and using car safety seats.