September 1, 2026
Key Takeaways
- New research from The Ohio State University College of Medicine finds that more than half of children injured in vehicle crashes were either improperly restrained or not restrained at all.
- The study links car seat and seat belt misuse to more severe injuries and deaths among children ages 1 to 13.
- Researchers say targeted education is needed to help families know when children should use car seats, booster seats and seat belts.
COLUMBUS, Ohio – Despite decades of efforts to improve car seat and seat belt habits, more work needs to be done to protect children in motor vehicle crashes, according to new research from The Ohio State University College of Medicine.
The Injury Biomechanics Research Center study explored the use of car seats and seatbelts among children involved in traumatic vehicle crashes. Data showed that more than half of children injured in car crashes were not restrained or used the wrong type of restraint for their age, height or weight, resulting in more serious injuries.
“Many families are still not using car seats, booster seats and seat belts correctly,” said Gretchen Baker, PhD, lead author and research assistant professor in the School of Health and Rehabilitation Sciences. “This puts children at greater risk of injury and highlights the importance of more education about appropriate restraint use.”
The research, recently published in Traffic Injury Prevention, reviewed American College of Surgeons Trauma Quality Program Participant Use File data from 2018 – 2022. The TQP PUF includes information on pediatric and adult patients admitted to trauma centers across the United States.
The study team filtered the trauma registry data by motor vehicle crashes with occupants ages 1 – 13 years. There were 39,993 children who met the criteria to be included in the study.
Key study findings
- Thirty-nine percent of children in this sample did not use any type of restraint.
- Another 19% used the wrong restraint type based on age, height or weight.
- The rate of inappropriate child restraint use increased with each year of age from 6% at age 1 to 39% at age 7. It fell to 1% at age 13.
- The percentage of unrestrained children also increased with child age, ranging from 33% at age 1 to 50% at age 13.
“As children get older, they are more likely to be in the wrong type of restraint or none at all,” said Julie Mansfield, PhD, study co-author, research associate professor at the School of Health and Rehabilitation Sciences and co-director of the Center for Child Injury Prevention Studies. “These children likely transitioned to a booster seat or lap and shoulder belt before reaching the recommended age or size thresholds or stopped using them all together.”
Children suffered a total of 182,157 injuries in the 5-year dataset. Head injuries were the most common, accounting for 46% of all injuries. Injuries to the arms and legs were next at 26%. About 41% of children suffered serious injuries. There were 1,008 deaths among the children in this dataset.
“The increased odds of severe injuries and fatalities for improperly and unrestrained children emphasizes the critical importance of car seats, boosters and seat belts,” Baker said. “We especially need targeted education about the right time to transition to and from boosters to improve the safety of older children riding in cars.”
Other Ohio State researchers involved in this study are Angela Harden, PhD, and Mary Cole, PhD.
Caregivers who have questions about car seat or booster safety can find up-to-date recommendations from the National Highway Traffic Safety Administration and the American Academy of Pediatrics.
Media Contact
Serena Smith, Ohio State Wexner Medical Center Media Relations, Serena.Smith@osumc.edu