Children should always use a booster seat until they are big enough to fit in a seat belt properly. (Joshua & Amber/Flickr)
Children should always use a booster seat until they are big enough to fit in a seat belt properly. (Joshua & Amber/Flickr)

By Brian Lau, MD

Many studies have shown that parents don’t always use carseats and booster seats, and their kids could be at increased risk in a crash. A new study published this week shows that non-white children have particularly low use.

Researchers from The University of Michigan surveyed 601 parents about their car seat usage for 1 to 12-year-old children that received treatment at the emergency room. They found that non-white parents were nearly four times less likely to use appropriate child car restraints than white parents.

Doctors and policy makers have known of this disparity and attributed it to socioeconomic variables. But the new study shows that differences remained even after accounting for education and income.

“People have suggested that racial disparities in restraint use are due to differences in socioeconomic status,” said lead author Dr. Michelle Macy, a pediatrician at the University of Michigan, in an email. “Our results demonstrate the answer is more complicated than that.”

In the study, the authors noted that because race continues to be a “significant predictor” of appropriate car seat usage,  “suggests that modifiable factors not measured in our study, such as parental knowledge, motivation, barriers, and sociocultural norms, may contribute to disparities.”

Others point out that income and education are not the only factors when accounting for differences in racial and socio-economic disparities.

“Injury prevention often suffers with greater social stress,” said Dr. Lee Sanders, co-director of Stanford’s Center for Policy, Outcomes and Prevention. “Factors like single-parent families and greater number of kids can make it difficult to keep up with changes from kid to kid.” Both of these factors are associated with lower socio-economic status and were not directly accounted for in the study.

Laws on injury prevention vary from state to state which may make it difficult for anyone, but particularly adults with greater social stressors, to track what kind of car seat is appropriate at what age.

“State laws generally fall short of ‘optimal’ child passenger safety recommendations,” said Dr. Macy. This may be due in part to state legislators lagging behind recent changes to the American Academy of Pediatric guidelines released in March 2011 that place greater emphasis on child size than child age when determining when to transition from car seats, booster seats, and ultimately the front seat.

“Keep kids in a rear seat whenever possible,” said Dr. Macy, “using a rear-facing car seat beyond 1 year and until the child outgrows the car seat’s rear-facing weight or height limit.” She added that children should be in a booster seat from the time they outgrow their forward-facing car seat — until an adult seat belt fits properly.

Having the proper car seat and knowing how to use it is one thing, but getting your kids to stay in them is another.

“One of the most effective methods is to tell the kids that you won’t start the car until they are safely in their seat,” said Dr. Sanders, “and don’t let the kid trying to get out of their seat or complaining, fool you into thinking they are safe without their child seat.”

Regardless of race, proper child passenger restraint use is known to save lives. California has been one of the leaders in keeping its guidelines up-to-date with the American Academy of Pediatrics.

Minority Parents Less Likely to Use Appropriate Car Seat, Study Finds 17 January,2014State of Health

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