title: Child restraint system misuse and/or inappropriate use in Australia.
abstract: OBJECTIVE
  Motor vehicle crashes are one of the leading causes of child death and acquired disability. Child restraint systems (CRS) for vehicles are designed to provide specialized protection for child occupants in the event of a crash. However, the effectiveness of a CRS is critically dependent on: correct installation of the CRS in the vehicle, the correct harnessing of the child in the CRS, and use of an appropriate CRS. The current study aimed to investigate the incidence misuse and/or inappropriate use of CRS through a CRS inspection program in the Australian states of New South Wales (NSW), Victoria (VIC), Queensland (QLD), South Australia (SA), Western Australia (WA), and Tasmania (TAS).
  
  
  METHODS
  Participants were recruited through an advertisement for free CRS inspections displayed at childcare centers, kindergartens, community centers, hospitals, and child expos. At each inspection, the CRS fitting specialist inspected and reported to the owner of the CRS on the installation of the child restraint(s) and/or system(s) and any fitting faults and/or concerns with the fitting and/or use if the child restraint(s) and or system(s).
  
  
  RESULTS
  The following results are based on the inspection of 1386 vehicles, in which there were 1995 restraints. Of all the restraints inspected, the majority (79%) were reported as having at least one instance of misuse. The most common forms of misuse included harness strap errors such as the straps being adjusted, faulty, twisted, and/or incorrectly positioned (38%); seat belt errors such as the seatbelt being incorrectly routed, twisted, and/or incorrectly adjusted (32%); missing or incorrect fitting of gated buckle/locking clip (23%); the need for a missing sash guide (8%); tether errors such as the tether being incorrectly routed and/or adjusted (7%); inappropriate use of a CRS for the size of the child (6%); anchor errors such as the anchor was fitted incorrectly or not the correct type (5%); and the H Harness(1) being used incorrectly (5%). In addition, there were significant differences across restraint types in terms of the proportion of restraints with CRS misuse or fitment errors, chi(2) (2) = 51.42, p < 0.001. The rate of misuse was highest for the forward-facing CRS (88%), compared to infant seats (67%) and booster seats or cushions (63%).
  
  
  CONCLUSIONS
  The results show that CRS misuse and fitment errors are widespread in Australia. Based on the findings of this study, it is recommended that educational and awareness materials and programs that provide information on the safety benefits associated with correct CRS use (as well as the injury risk associated with CRS misuse) be developed for both parents and children.
authors.affiliation: Monash University Accident Research Centre, Monash University, Victoria 3800, Australia. Sjaanie.Koppel@muarc.monash.edu.au
authors.forename: Sjaanie
authors.initials: S
authors.lastname: Koppel
authors.forename: Judith L
authors.initials: JL
authors.lastname: Charlton
mesh_terms: D001315:Australia; D001336:Automobiles; D002675:Child, Preschool; D004867:Equipment Design; D004868:Equipment Failure / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D015370:Infant Equipment / Q000592:standards*; D012622:Seat Belts