title: Driver report of improper seat belt position among 4- to 9-year-old children.
abstract: OBJECTIVE
  To determine the frequency with which drivers report improper seat belt positions among children 4-9 years of age and the frequency with which reported problems were attributable to the lap belt, shoulder belt, or both.
  
  
  METHODS
  Analysis of driver responses to 5 questions related to seat belt positioning from the cross-sectional, phone-based 2007 Motor Vehicle Occupant Safety Survey. Belt position problems categorized as related to (1) shoulder belt and (2) lap belt. Improper belt position was compared across age groups (4-6 years, 7-8 years, and 9 years) and use of a child safety seat with χ(2) statistics or Fisher exact tests as appropriate.
  
  
  RESULTS
  Seat belt use was reported for 334 of 891 (37%) 4- to 9-year-old child passengers, and 261 (78%) drivers reported improper belt fit among these child passengers. Improper shoulder belt position (44%) was less common than improper lap belt position (62%). At least one improper belt position was reported by 78% of drivers of 4- to 6-year-old children, 77% of 7- to 8-year-old children, and 79% of 9-year-old children (P = .87). There were no significant differences in report of improper belt position among children who never and those who occasionally use a child safety seat were compared.
  
  
  CONCLUSIONS
  Drivers frequently report improper lap and shoulder belt positions for their 4- to 9-year-old child passengers yet persist in restraining children by the use of seat belts alone. Clinicians can promote the use of size-appropriate child passenger restraint systems, including car seats and booster seats, to overcome the improper belt positions identified in this study.
authors.affiliation: Department of Emergency Medicine, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, MI 48109-5456, USA. mlmacy@umich.edu
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Macy
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Reed
authors.forename: Gary L
authors.initials: GL
authors.lastname: Freed
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D057207:Child Restraint Systems / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004868:Equipment Failure / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D012622:Seat Belts / Q000592:standards / Q000706:statistics & numerical data*; D014481:United States; D014947:Wounds and Injuries / Q000517:prevention & control; D055815:Young Adult