title: Observed child restraint misuse in a large, urban community: Results from three years of inspection events.
abstract: OBJECTIVE
  Child restraints (CRs) are vital for optimizing child passenger safety and reducing the risk of pediatric injury and fatality in motor vehicle crashes. However, most CRs are installed improperly.
  
  
  METHODS
  This present study was an assessment of observed instances of CR misuse. Participants were recruited through advertisements for CR inspection events in Los Angeles County, California. Child Passenger Safety Technicians collected information about each child passenger, vehicle, and aspects of CR selection and installation.
  
  
  RESULTS
  Of 693 CRs installed upon arrival, only 3.8% were used with no instances of misuse. The most common misuses were inappropriate use of the top tether and failure to secure the seatbelt in locked mode.
  
  
  CONCLUSIONS
  The majority of observed CRs were installed with instances of misuse. CRs in newer vehicles were less likely to be installed in front of airbags and more likely to have the seatbelt routed inappropriately compared to those in older vehicles. Older children were more likely to be prematurely restrained in the front vehicle seat.
  
  
  CONCLUSIONS
  The majority of CRs are installed improperly. We identified specific instances of CR misuse that are common in a large, urban community and present recommendations to improve child passenger safety practices and education.
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: Shelby L
authors.initials: SL
authors.lastname: Bachman
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: Garrett A
authors.initials: GA
authors.lastname: Salzman
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Rita V
authors.initials: RV
authors.lastname: Burke
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: Helen
authors.initials: H
authors.lastname: Arbogast
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: Pearl
authors.initials: P
authors.lastname: Ruiz
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. Electronic address: jupperman@chla.usc.edu.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Upperman
mesh_terms: D017278:Air Bags; D002140:California; D002648:Child; D057207:Child Restraint Systems / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D012306:Risk; D012622:Seat Belts
keywords: Car seat; Child passenger safety; Child restraint system; Installation; Misuse