title: Safe restraint of the child passenger.
abstract: OBJECTIVE
  The aim of this study was to understand the need for, and use of, booster seats in the 4-12 years age group and to identify risk factors for booster seat-non-use.
  
  
  METHODS
  A cross-sectional sample of 1101 children aged 4-12 years travelling in 663 privately owned vehicles was taken from the Auckland region. Auckland is New Zealand's largest population centre, with a population of over 1.5 million. Information was gathered using a short questionnaire followed by direct inspection to identify those children using booster seats. The SafetyBeltSafe USA '5-step rule' was used to look at those children not using a booster seat to determine whether one was still required.
  
  
  RESULTS
  While booster seat use has improved significantly in younger children since a similar study in 1992, only 40% of sampled children requiring a booster seat were using one. Booster seat use by children requiring them declined sharply as age increased. While 93% of 5- to 8-year-olds required a booster, only 30% were using one. The requirement for booster seats fell dramatically to 34% of 9- to 12-year-olds, but only 3% were using one.
  
  
  CONCLUSIONS
  The high rate of need for booster seats and the lack of use of booster seats in children aged 5-8 years is a strong argument for legislation and education programmes targeting this age group. While the proportion of 9- to 12-year-olds needing a booster drops sharply, there would likely be benefits from educating parents on the '5-step rule' or similar method to help identify the 30% of these older children that would continue to benefit from a booster seat. Rear seating should be promoted alongside booster seat use in the age group 4-12 years.
authors.affiliation: Emergency Department, Starship Hospital, Auckland, New Zealand. matt.lee@xtra.co.nz
authors.forename: Leanne
authors.initials: L
authors.lastname: Cameron
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Segedin
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Nuthall
authors.forename: John
authors.initials: J
authors.lastname: Thompson
mesh_terms: D001334:Automobile Driving / Q000706:statistics & numerical data*; D001827:Body Height; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009520:New Zealand; D010290:Parents / Q000523:psychology; D011482:Protective Devices / Q000706:statistics & numerical data*; D012307:Risk Factors; D012622:Seat Belts / Q000706:statistics & numerical data; D012959:Socioeconomic Factors