Seating patterns and corresponding risk of injury among 0- to 3-year-old children in child safety seats

Pediatrics. 2008 May;121(5):e1342-7. doi: 10.1542/peds.2007-1512.


Objective: Current guidelines for optimal restraint of children in motor vehicles recommend the center rear seating location for installing a child-restraint system. However, recent research on child occupants in child-restraint system has brought this into question. The objective of this study was to describe seating position patterns among appropriately restrained child occupants aged 0 to 3 years in the rear row of vehicles. In addition, we determined the association between rear row seating location and risk of injury.

Methods: We studied data collected on child occupants from December 1, 1998, to December 31, 2006, via insurance claim records and a validated telephone survey. The study sample included child occupants aged 0 to 3 years seated in a child-restraint system in the rear row of the vehicle, model year 1990 or newer, involved in a crash in 16 states. Children were classified as injured if a parent or driver reported an injury corresponding with Abbreviated Injury Scale scores of > or = 2.

Results: Seating position distribution for child occupants was as follows: left outboard (31%), center (28%), and right outboard (41%). There was an inverse relationship between the center position and increasing child age (39% for occupants < 1 year old versus 18% for occupants 3 years old), independent of the number of additional row occupants. Child occupants seated in the center had an injury risk 43% less than children seated in either of the rear outboard positions.

Conclusions: The most common seating position for appropriately restrained child occupants in a child-restraint system is the right rear outboard. The center rear seating position is used less often by children restrained by a child-restraint system as they get older. Children seated in the center rear have a 43% lower risk of injury compared with children in a rear outboard position.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidents, Traffic*
  • Child, Preschool
  • Humans
  • Infant
  • Infant Equipment*
  • Risk Factors
  • Wounds and Injuries / etiology
  • Wounds and Injuries / pathology
  • Wounds and Injuries / prevention & control*