A new study shows that many parents know that adult seat belts do not fit their older children properly, but use them anyway.

Researchers from the University of Michigan’s Child Health Evaluation and Research Unit and its Transportation Research Institute set out to determine the frequency with which drivers reported improper seat belt positioning among the Forgotten Child set – so named by the safety community, because these children have outgrown five-point child safety restraints, yet are too small for seat belts. This group of children needs the aid of a booster seat to achieve a proper belt fit, with the lap portion of the belt extended low across the hips, and the shoulder belt resting over the shoulder, rather than on the child’s neck.

The analysis, published in Academic Pediatrics, focused on caregiver responses to five questions in the phone-based 2007 Motor Vehicle Occupant Safety Survey regarding children, 4-9 years of age, and problems attributed to the lap belt, the shoulder belt or both.

Among 891 adults who drove children 4 to 9 years of age, the vast majority, 534 (60 percent) reported they always used a child safety seat. The second largest group, 241 (27percent) reported that they always used the vehicle seat belt. The remainder reported that they sometimes used either, or used no restraints at all. But the rate of child seat use steadily dropped as the children aged. By 9 years old, only 20 percent were always secured in child safety seats, compared to 61 percent of 4-6 year olds, according to parents’ responses.

Parents reported using seat belts for 334 (37 percent) of 4- to 9-year-old child passengers. And, of those, 78 percent of the drivers reported improper belt fit, with improper shoulder belt position accounting for 44 percent and improper lap belt position for 62 percent. At least one improper belt position was reported by about 78 percent of drivers, which, the researchers concluded, is the most important finding of the analysis: “Children who are prematurely restrained in an adult seat belt that does not fit properly are at increased risk of injury to the head, spine, and abdomen. Although improper lap belt positioning was more common, of greater clinical concern is that almost one-half of children were reported to have improper shoulder belt positioning. Our findings are consistent with laboratory evidence that demonstrates incorrect belt positioning is commonly the result of a mismatch between child body proportions and rear seat belt geometry. Even at age 9, most children’s thighs are too short to sit in most vehicle rear seats without slumping. The slumped postures invariably lead to poor lap belt fit. In regard to shoulder belt positioning, the discomfort associated with having the belt against the face or neck can trigger the child to put the belt under their arm or behind their back. Putting the belt under the arm or behind the back is a much more serious belt fit problem than a belt that rides close to the face or neck because these positions result in greater travel of the torso, compression of the abdomen, and stress on the spine as the body comes to a stop in a crash.”

The researchers surmised caregivers “may not be aware of proper seat belt positioning for the lap and shoulder belts or may not understand the serious and potentially permanent injuries that result from improper seat belt fit.” That confusion likely stems, at least in part, from state seat belt laws that do not address older children and “may indicate to parents that their child is ready to be transitioned from a belt-positioning booster seat to an adult seat belt before reaching the stature and maturity to ensure proper seat belt fit on every trip.” The researchers recommended that pediatricians inform their patients about the importance of seat belt fit.

ARLINGTON, VA — The Insurance Institute for Highway Safety released its latest ratings for boosters, and out of 60 models gave 15 models high marks and dinged 11 as “not recommended.” Meanwhile, a statistical analysis of the association between booster seat use and the risk of death found that boosters were no better than seatbelts alone in preventing death among 4-8-year-old children.

Researchers T.M. Rice, C.L. Anderson, and A.S. Lee of the University of California, Berkley’s Traffic Safety Center and the Center for Trauma and Injury Prevention Research at the University of California Irvine’s Department of Emergency Medicine conducted a matched cohort study (matching exposed to unexposed persons prior to outcome determination) using 1996-2006 data from the Fatality Analysis Reporting System. The sample of 6,006 vehicles included those with two or more occupants in the first two rows of seating, with one or more occupants aged 4-8 years old in which one or more occupants died.

The analysis, published in Injury Prevention, showed that seat belts, used with booster seats, were “highly effective” in preventing death among young motor vehicle occupants. In a severe crash, unrestrained children in the sample were 2.8 times more likely to die than those restrained in seat belts with boosters. The effectiveness for children 6-8 years was slightly less. But the study showed that belts alone were almost as effective: “Unrestrained children were 2.6 times more likely to suffer fatal injury than belted children. The estimated death risk ratio comparing seatbelts with boosters with seatbelts alone was 0.92.”

The researchers concluded that, in looking at the risk of death only, “booster seats do not appear to improve the performance of seatbelts.” They also noted that these results were similar to a 2002 study published in the Annual Proceedings Association for the Advancement of Automotive Medicine.

The numbers did not lead the researchers to recommend that young children use seatbelts alone because other studies show that booster seats reduce non-fatal injury severity – the abdominal and spinal injuries characteristic of seatbelt syndrome.

“Clinicians and injury prevention specialists should continue to recommend the use of boosters to parents of young children,” the study’s authors said.

IIHS’s second annual recommended booster seat list attempts to help parents and caregivers select the booster seats “most likely to provide good lap and shoulder belt fit in a range of vehicles,” the institute said in a news release about rankings. In its first year, the institute evaluated 41 seats. This latest round covers nearly all models sold in the United States. Eventually, IIHS plans to structure its booster seat ratings like its Top Safety Pick awards, evaluating new models as they are released to the public.

Institute engineers assess each model by measuring how lap shoulder belts fit a “specially outfitted” 6-year-old crash test dummy under “four conditions spanning the range of safety belt configurations in vehicle models. Each booster gets four scores for lap belt fit and four for shoulder belt fit. The overall rating for each booster is based on the range of scores for each measurement,” the news release said.

The IIHS’s best-rated boosters are: the Combi Dakota backless with clip, Recaro Young Sport highback (combination seat), Recaro Vivo highback, Maxi-Cosi Rodi XR dual-use highback, Evenflo Big Kid Amp backless with clip, Eddie Bauer Auto Booster dual-use highback, Cosco Juvenile Pronto dual-use highback, Britax Frontier highback.

The Institute did not recommend: Harmony Secure Comfort Deluxe backless with clip, Combi Kobuk dual-use highback, Evenflo Express highback (combination), Eddie Bauer Deluxe highback (combination), and Evenflo Sightseer highback. Also on the list are 3-in-1s including the Safety 1st Alpha Omega Elite, Alpha Omega Elite, Eddie Bauer Deluxe 3-in-1, Safety 1st All-in-One, Alpha Omega Luxe Echelon, and Alpha Omega.

Half of the boosters that aren’t recommended are 3-in-1s that leave the lap belt too high on the abdomen and the shoulder belt too far out on the shoulder. One seat, the Harmony Secure, has armrests that push the lap belt away from the hips, way out on a child’s thighs. Shoulder belt fit is the main problem for the rest — the Combi, 2 Evenflos, and the Eddie Bauer Deluxe.

Dorel Juvenile Group, the largest US children’s gear distributor, makes three of the most highly recommended boosters and seven of those that aren’t recommended. Dorel seats sell under the names Cosco, Dorel, Eddie Bauer, Maxi-Cosi, and Safety 1st.

These recent developments contradict, in part, earlier findings by researcher Suzanne Tylko of Transport Canada, who reported three years ago that a five-point restraint system is the safest option for children.

Transport Canada measured the performance of booster seats with child Hybrid III dummies representing a 10- and 6-year-olds in full frontal rigid barrier and frontal offset deformable barrier tests. The 6-year-old dummy was restrained in a belt-positioning booster and the 10-year-old was restrained with either a booster or a three-point belt. Tylko and her colleague Dainius Dalmotas tested 77 passenger cars, cross-over vehicles, minivans and SUVs from the 2003-2005 model years, paired with low-back and high-back boosters, high-back boosters with a harness latch and tether and a lap and shoulder belt.

In the tests involving the six-year-old dummy in a lap and shoulder belt, the belt would either slide up into the neck or down to the shoulder, as the dummy pitched forward. In the latter case, some dummies rolled out of the belt entirely—particularly if there was any offset component to the crash—causing the head and chest to hit its lower extremities. Tylko found little difference among booster seats. All of them – unlike three-point belts alone – effectively kept the lap portion of the belt in the pelvic region, and prevented it from traveling into the abdominal cavity. But boosters didn’t do much to protect the child’s chest region, failing to keep them properly positioned in an adult three-point belt.

WASHINGTON, D.C.—NHTSA’s regulatory dance card is mighty full for the next five months, with a clutch of substantive rulemakings that includes developing a performance standard for full and partial ejection mitigation, restraints on motor coaches, boosters for older children and a rearward visibility standard – nearly all mandated by Congress.

The agency’s official shortlist, published in the Federal Register on July 1, contains several significant areas for immediate rulemaking ranging from occupant protection to regulations that would reduce deaths and injuries to children in and around vehicles. In the future, the agency will turn its attention toward possible rulemakings for crash avoidance technology, such as lane departure warning systems and automatic braking in advance of an impending crash.

Of course, making the list, which covers this year through 2011, doesn’t mean NHTSA will actually make it happen, but we’ve summarized the highlights below:

Rules for Children

Of the rulemakings regarding children, three were required by the Cameron Gulbransen Kids and Cars Safety Act of 2007. This measure, adopted after five years of intense lobbying, compels NHTSA to develop a rearward visibility standard, mandate a brake-to-shift-interlock and require power windows to have an automatic reverse feature. The bill was named after 2-year-old Cameron Gulbransen, who was killed when his father, a pediatrician from Long Island, inadvertently backed over him, because the blindzone behind his SUV made the toddler impossible to see.

In March, NHTSA published an Advanced Notice of Proposed Rulemaking on establishing a rearward view standard in March. It did not outline a possible performance standard, but presented the research it had done to date and sought answers to 52 different questions in seven different areas, including the scope of the problem, technologies for improving rear visibility, effectiveness, driver behavior, options for measuring rear visibility and countermeasure performance. It expects to publish an NPRM this year, with a Final Rule in 2011.

NHTSA also expects to publish a Notice of Proposed Rulemaking to consider requiring power windows to automatically reverse direction when, upon closing, the window detects an obstruction, to prevent children and others from being trapped, injured, or killed. Under the language of the law, the agency would have 18 months to initiate the process and 30 months to establish the standard. But, the provision allows the Secretary of Transportation to decline to make a rule requiring the feature, if the secretary determines “that no additional safety standards are reasonable, practicable, and appropriate.”

The brake to shift interlock (BTSI) is a safer regulatory bet. In 2006, the major automakers who comprise the Association of International Automobile Manufacturers, Inc. attempted to head off legislation by announcing that its members had voluntarily committed to installing brake-to-shift interlocks by 2010. Safety advocates, however, were disturbed by the loopholes in the agreement. For one, manufacturers with new entries into the market, from China for example, would have no obligation to include a BTSI. Further, the agreement did not require the brake-to-shift interlock to work regardless of the key position, meaning that the BTSI might not work when the key is in the accessory position. Finally, advocates criticized the agreement because consumers wouldn’t know which vehicles did not have a BTSI. An NPRM is slated to be published this year.

The fourth rulemaking that could improve automotive safety for children is a scheduled Supplemental Notice of Proposed Rulemaking to add requirements to FMVSS 213 Child Restraint Systems for booster seats for older children, and add a 10-year-old crash test dummy to the regulation. The agency has been working on this for four years. The most recent rulemaking was in January 2008, when NHTSA published an SNPRM that proposed seating procedures for positioning the Hybrid III 10-year-old child dummy and the HIII 6-year-old child dummy in booster seats when the dummies are used in the FMVSS 213 compliance tests.

Safety for the Rest of Us

The Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU) Act required the agency to publish a final rule establishing performance standards to reduce complete and partial ejections of vehicle occupants from outboard seating positions by October 1, 2009. The first phase of the agency’s effort was amending FMVSS 214 Side Impact in September 2007, to include a side-impact pole test. This rule had the effect of requiring side air curtains, at least for front seat passengers. According to an earlier plan, the second phase is to establish occupant containment performance requirements, which included the development of a test methodology to evaluate the performance of ejection mitigation systems, including side curtain airbags and improved glazing. The third phase is to establish performance requirements for rollover sensors, to ensure that the air bags will deploy in a rollover crash. The agency describes the rule thus: “This proposed standard would reduce the partial and total ejection of vehicle occupants through side windows in crashes, particularly rollover crashes.” There were few hints on how that would be accomplished.

After decades of buying the Motor Coach industry’s rap at retail, the agency is about to get serious about motor coach safety. Bus manufacturers have fended off regulations for decades, arguing that occupants were adequately protected from crash forces by compartmentalization – the space around them enclosed by the seat backs behind and in front of them and the side structure. The compartment, however, was open on three sides. The large picture windows tended to fail in a crash, leading to fatal ejections. In rollovers, occupants and their possessions are tossed right out of their compartments and sustain injuries from contact with the roof and other occupants. Performance standards for motor coaches in various crashes has been on the National Transportation Safety Board’s list for at least 11 years, but the agency has shown little interest beyond gathering the players for conferences in which industry representatives defended the status quo. At one such event, in 2002, then-Associate Administrator for Safety Standards Stephen Kratzke assured the industry that the agency wouldn’t promulgate any regulations – “just to do something.” Proposals would be based on “solid data,” he promised.

In the Future, We Just Won’t Crash

Looking ahead, NHTSA sees crash avoidance as the next frontier. It intends to focus its research on developing performance criteria and tests for systems that automatically apply the brakes when the vehicle senses an impending crash, lane departure warning systems and vehicle to vehicle communications systems. The pre-crash warning and brake assist technology is already offered on some Honda, Mercedes-Benz, Volvo, Toyota and Ford vehicles. These systems use radar sensors to monitor the traffic in front of the vehicle, and if the distance between the vehicle and the one in front of it is too small, the driver receives a warning and the brakes may be primed for maximum power, or automatically applied. Other systems tighten the seat belts and activate the airbags, as well.

NHTSA has already developed a performance test for New Car Assessment Program that will debut for the 2011 model year. The agency expects to decide if it will require automatic crash-imminent braking.

Similarly, the agency plans to establish performance criteria and tests for lane departure warning systems, which have also debuted on Toyota, GM, Nissan, Honda and Mercedes vehicles. Again, NHTSA has already developed a performance test for the NCAP to apply to the 2011 model year. The next agency decision, scheduled for 2011, will be whether to require them.

Further into the future, NTSA is contemplating a technologically advanced automotive environment, in which vehicles communicate with one another to avoid collisions. Some prototype vehicle-to-vehicle communications systems send out speed, GPS location and braking information for crash avoidance, speed management, intersection collision avoidance and traffic congestion. These systems are in development among the major manufacturers. Vehicle-to-vehicle systems only work if a critical mass of the fleet is so-equipped. Last year, the European Union laid the groundwork of a widespread vehicle-to-vehicle communications landscape by reserving an EU-wide frequency band for automotive use. NHTSA forecasts that its next agency decision will be in 2013.