Four-to-9-year-old children are a special group with respect to motor vehicle occupant restraints. Having outgrown child safety seats, they are often placed in adult seat belts. This study was undertaken to examine patterns of injury among restrained 4- to 9-year-old by seat location and crash impact site. The data were obtained from an ongoing hospital-based monitoring system. Seventy percent of the sample sustained a head or face injury. Upper-torso and extremity injuries were infrequent. Lower torso injuries occurred primarily in frontal impacts in both the back and front seats. Frontal impacts resulted in a greater proportion of serious injuries than rear impacts. The most serious injuries, however, occurred to children seated on the side of impact in lateral collisions. Questions must be raised regarding the appropriateness of the present restraint system for young children. Recommendations, given current seat belt systems, are provided. However, technological improvements in vehicle design and belt systems are needed to improve protection, particularly in lateral impacts.