title: Observational study of child restraining practice on Norwegian high-speed roads: restraint misuse poses a major threat to child passenger safety.
abstract: OBJECTIVE
  Restraint misuse and other occupant safety errors are the major cause of fatal and, severe injuries among child passengers in motor vehicle collisions. The main objectives of the present, study were to provide estimates of restraining practice among children younger than 16 years, traveling on Norwegian high-speed roads, and to uncover the high-risk groups associated with, restraint misuse and other safety errors.
  
  
  METHODS
  A cross-sectional observational study was performed in conjunction with regular traffic, control posts on high-speed roads. The seating and restraining of child occupants younger than 16, years were observed, the interior environment of the vehicles was examined, and a structured, interview of the driver was conducted according to a specific protocol.
  
  
  RESULTS
  In total, 1260 child occupants aged 0-15 years were included in the study. Misuse of restraints, was observed in 38% of cases, with this being severe or critical in 24%. The presence of restraint, misuse varied significantly with age (p<0.001), with the frequency being highest among child, occupants in the age group 4-7 years. The most common error in this group was improperly routed, seat belts. The highest frequency of severe and critical errors was observed among child occupants in, the age group 0-3 years. The most common errors were loose or improperly routed harness straps and, incorrect installations of the child restraint system. Moreover, 24% of the children were seated in, vehicles with heavy, unsecured objects in the passenger compartment and/or the trunk that were, likely to move into the compartment upon impact and cause injury. No totally unrestrained children, were observed.
  
  
  CONCLUSIONS
  This study provides a detailed description of the characteristics of restraint misuse and, the occupant's exposure to unsecured objects. Future education and awareness campaigns should, focus on children aged <8 years. The main challenges are to ensure correct routing and tightness of, harness straps and seat belts, correct installation of child restraints, and avoidance of premature, graduation from child restraints to seat belts only. Information campaigns should also advocate the use, of chest clips and address the potential risks of hard, heavy objects in the passenger compartment and, the importance of the placement and strapping of heavy objects in the trunk.
authors: Department of Forensic Pathology and Clinical Forensic Medicine, The Norwegian Institute of Public Health, Oslo, Norway. Electronic address: masr@fhi.no.
authors: Skjerven-Martinsen
authors: P A
authors: PA
authors: Naess
authors: T B
authors: TB
authors: Hansen
authors: T
authors: T
authors: Staff
authors: A
authors: A
authors: Stray-Pedersen
mesh_terms: D015998:Abbreviated Injury Scale; D000063:Accidents, Traffic; D000293:Adolescent; D000367:Age Factors; D001334:Automobile Driving / Q000706:statistics & numerical data; D001336:Automobiles / Q000706:statistics & numerical data*; D002648:Child; D057207:Child Restraint Systems / Q000592:standards / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006801:Humans; D007223:Infant; D009664:Norway; D012622:Seat Belts / Q000592:standards / Q000706:statistics & numerical data*
keywords: Child restraint system; Injury mechanism; Motor vehicle collision; Restraint misuse; Safety error