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88–785 PDF 2004

S. HRG. 107–1091

BOOSTER SEATS AND THE FORGOTTEN CHILD:

CLOSING A SAFETY GAP

HEARING

BEFORE THE

SUBCOMMITTEE ON CONSUMER AFFAIRS, FOREIGN 

COMMERCE AND TOURISM

OF THE

COMMITTEE ON COMMERCE, 

SCIENCE, AND TRANSPORTATION 

UNITED STATES SENATE

ONE HUNDRED SEVENTH CONGRESS

FIRST SESSION

APRIL 24, 2001

Printed for the use of the Committee on Commerce, Science, and Transportation

(

(II)

SENATE COMMITTEE ON COMMERCE, SCIENCE, AND TRANSPORTATION

ONE HUNDRED SEVENTH CONGRESS

FIRST SESSION

JOHN MCCAIN, Arizona, Chairman 

TED STEVENS, Alaska 

CONRAD BURNS, Montana 

TRENT LOTT, Mississippi 

KAY BAILEY HUTCHISON, Texas 

OLYMPIA J. SNOWE, Maine 

SAM BROWNBACK, Kansas 

GORDON SMITH, Oregon 

PETER G. FITZGERALD, Illinois 

JOHN ENSIGN, Nevada 

GEORGE ALLEN, Virginia 

ERNEST F. HOLLINGS, South Carolina 

DANIEL K. INOUYE, Hawaii 

JOHN D. ROCKEFELLER IV, West Virginia 

JOHN F. KERRY, Massachusetts 

JOHN B. BREAUX, Louisiana 

BYRON L. DORGAN, North Dakota 

RON WYDEN, Oregon 

MAX CLELAND, Georgia 

BARBARA BOXER, California 

JOHN EDWARDS, North Carolina 

JEAN CARNAHAN, Missouri 

MARK BUSE, Republican Staff Director 

ANN CHOINIERE Republican General Counsel 

KEVIN D. KAYES, Democratic Staff Director 

MOSES BOYD, Democratic Chief Counsel 

SUBCOMMITTEE ON CONSUMER AFFAIRS, FOREIGN COMMERCE

AND TOURISM 

PETER G. FITZGERALD, Illinois, Chairman 

CONRAD BURNS, Montana 

SAM BROWNBACK, Kansas 

GORDON SMITH, Oregon 

JOHN ENSIGN, Nevada 

GEORGE ALLEN, Virginia 

BYRON L. DORGAN, North Dakota 

JOHN D. ROCKEFELLER IV, West Virginia 

RON WYDEN, Oregon 

BARBARA BOXER, California 

JOHN EDWARDS, North Carolina 

JEAN CARNAHAN, Missouri 

(III)

C O N T E N T S 

Page 

Hearing held on April 24, 2001 .............................................................................. 1

Statement of Senator Dorgan ................................................................................. 71

Statement of Senator Fitzgerald ............................................................................ 1

WITNESSES

Baloga, Tom, President, Britax Child Safety, Inc. ................................................ 81

Prepared Statement ......................................................................................... 83

Lund, Adrian K., Chief Operating Officer, Insurance Institute for Highway 

Safety .................................................................................................................... 18

Prepared statement .......................................................................................... 21

Paul, Ph.D., Heather, Executive Director, National Safe Kids Campaign ......... 72

Prepared statement .......................................................................................... 75

Quinlan, Kyran, M.D., MPH, Department of Pediatrics, University of Chicago 45

Prepared statement .......................................................................................... 47

Shelton, L. Robert, Executive Director, National Highway Traffic Safety Administration .......................................................................................................... 4

Prepared statement .......................................................................................... 6

Skeen, Autumn Alexander, Child Passenger Safety Advocate ............................ 14

Prepared statement .......................................................................................... 16

Stone, Judith Lee, President, Advocates for Highway and Auto Safety ............. 52

Prepared statement .......................................................................................... 54

Vondale, James, Director, Automotive Safety Office, Ford Motor Company ...... 78

Prepared statement .......................................................................................... 80

Weinstein, Elaine B., Acting Director, Office of Safety Recommendations and 

Accomplishments, National Transportation Safety Board ............................... 10

Prepared statement .......................................................................................... 11

Winston, Flaura Koplin, M.D., Ph.D., Assistant Professor of Pediatrics, Children’s Hospital of Philadelphia and University of Pennsylvania School of 

Medicine ................................................................................................................ 39

Prepared Statement ......................................................................................... 42

APPENDIX

The National Association of Governors’ Highway Safety Representatives, prepared statement ................................................................................................... 93

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BOOSTER SEATS AND THE FORGOTTEN 

CHILD: CLOSING A SAFETY GAP 

TUESDAY, APRIL 24, 2001

U.S. SENATE, SUBCOMMITTEE ON CONSUMER AFFAIRS, FOREIGN COMMERCE

AND TOURISM, COMMITTEE ON COMMERCE, SCIENCE, AND TRANSPORTATION, Washington, DC. 

The Subcommittee met, pursuant to notice, at 10:12 a.m. in room 

SR–253, Russell Senate Office Building, Hon. Peter G. Fitzgerald, 

Chairman of the Subcommittee, presiding. 

OPENING STATEMENT OF HON. PETER G. FITZGERALD,

U.S. SENATOR FROM ILLINOIS 

Senator FITZGERALD. I am going to call this hearing to order. 

This is the hearing of the Senate Commerce Committee, the Subcommittee on Consumer Affairs, and it is a hearing on ‘‘Booster 

Seats and the Forgotten Child: Closing the Safety Gap.’’ First, I 

will deliver my opening statement. If any other members join us, 

I will give them an opportunity to give an opening statement, and 

then we will turn to our first panel of experts. I will ask each of 

you, if you have a prepared statement, to submit your prepared 

statement for the record, to condense your remarks and, if possible, 

give them impromptu. If you do read your remarks, if you would 

try and limit them to 5 minutes, we would appreciate it. We will 

try and keep this moving so that everybody has an opportunity to 

be heard. 

Late last year, Congress passed the Transportation Recall Enhancement Accountability and Documentation, or TREAD, Act, 

which, at my insistence, included a requirement that the National 

Highway Traffic Safety Administration update its standards on 

child safety seats, including booster seats. The enactment of this 

requirement is an important step toward protecting our older child 

passengers. But I believe that we can and should do more. 

The National Highway Traffic Safety Administration, or NHTSA, 

will, I hope, expand and improve its performance standard for 

booster seats. But developing better booster seats is of limited 

value if people do not use them. It has been reported that only 

about 5 to 6 percent of children who should be in booster seats are 

using them. In the United States, there are 19.5 million so-called 

‘‘forgotten children,’’ that is children between the ages of 4 and 8; 

and we need to do a better job of protecting them. 

Those kids are too large to ride in child safety seats, but some 

experts believe that they are often too small to be properly seated 

2

in a three-point safety belt. In 1998, 495 children aged 5 to 8 were 

killed and 86,000 were injured in car crashes and collisions. Indeed, car crashes and collisions are the leading cause of death and 

serious injury in children under 10 in the United States. 

Ongoing research is providing increasingly compelling evidence 

of the need to use booster seats. Three-point shoulder and lap belts, 

even those in the back seat where it is recommended that children 

sit, currently are not made or tested for children. Children who are 

graduated at 40 pounds or so directly from their child safety seat 

to adult seat belts can suffer serious harm. 

In some crashes, the seat belts do not restrain the child or the 

child’s upper body. In others they do, but the shoulder belt that 

cuts across the small child’s neck and the lap belt that rides high 

over her abdomen cause severe internal injuries to the liver, 

spleen, intestines, and the spinal cord. 

Parents obviously want to do what is best for their children. 

Safety restraint use for children under a year old is 97 percent, and 

it is 91 percent for children ages 1 to 4. These high usage rates are 

due in large part to mandatory child restraint laws in all 50 states. 

Usage rates for booster seats, however, fall woefully short of this 

level. Although all 50 states have mandatory child safety seat laws, 

there is no similar uniform requirement for booster seat use, and 

there are very serious gaps in state laws regarding child restraints 

generally. Some states require seat belts only for children sitting 

in the front seat. Others only require children to wear seat belts 

if they are younger than 5 or 6 years old. According to NHTSA, for 

children between ages 5 and 15, restraint use is only 68.7 percent; 

and NHTSA data for 1998 shows that over 47 percent of fatally injured children ages 4 to 7 ride completely unrestrained. 

Only 3 states—Washington, California, and Arkansas—have 

adopted mandatory booster seat laws and none of them are in effect yet. Recent attempts to pass meaningful legislation in other 

states, including my home state of Illinois, have failed. A lack of 

understanding of the benefit of booster seats may account for why 

more states have not acted, but there are also unanswered questions about what booster seat laws should require that could be retarding state action. Should children be in booster seats until they 

are 4, 6 or 8 years old, 60 pounds or 80 pounds? Or should states 

not use age and weight measures and instead rely on the fit of the 

particular child in the particular vehicle? There appears to be no 

clear consensus. 

Additionally, the federal standard for booster seats currently only 

covers seats for children up to 50 pounds. NHTSA was directed in 

the TREAD Act to consider changing this standard to 80 pounds. 

In the meantime, though, what does it mean for a state law to require that children up to 60 pounds be in a ‘‘federally certified 

booster seat’’? 

At today’s hearing we will address these and other questions. 

Some of the witnesses will speak about efforts underway to address 

the ‘‘forgotten child’’, the child who has outgrown her child safety 

seat and is inappropriately placed in an adult-sized safety belt 

without an adult positioning booster seat or, worse still, left completely unrestrained. 

3

The education that these groups are providing is critical to closing the knowledge gap. A recent survey of 1,000 parents and caregivers conducted by NHTSA and Daimler-Chrysler revealed that 96 

percent of parents and caregivers did not know the correct age at 

which a child no longer requires a booster seat or a child safety 

seat. 

Education is critical and I hope to further raise public awareness. Education alone, however, is not enough. As I said before, one 

of the reasons child safety seat usage is so high is because it is 

mandated in all 50 states. People not only want to comply with the 

law for the law’s sake and for fear of being penalized; they also understand that laws codify often our knowledge or promote a desirable social end, in this case child safety. 

In the past, Congress has provided incentives for states to adopt 

responsible highway laws. We have done so to encourage states to 

adopt repeat offender and open container laws. Last year, we did 

this to encourage states to adopt .08 blood alcohol level laws. Perhaps it is still too early for federal legislation to require states to 

adopt mandatory booster seat use laws, because of the deficiency 

in the current federal standard, because comprehensive medical 

data showing the benefits of booster seats is still being developed, 

and because a lot of states have yet to adopt adequate safety belt 

laws. 

Nevertheless, I think the safety of the forgotten child is extremely important and we need to consider all of the tools at our 

disposal to advance it. One such tool is the continuation of federal 

child passenger protection education grants, the authorization for 

which expires this year. 

In closing, there is still much we do not know. We do know, however, that more needs to be done to protect many of our child passengers between the ages of 4 and 8. I look forward to working 

with my children in the U.S. Senate to develop solutions to this 

critical issue. 

With that, we are going to turn to our witnesses. On the first 

panel we have: Mr. Robert Shelton, the Executive Director of 

NHTSA; Ms. Elaine Weinstein, Acting Director, Office of Safety 

Recommendations and Accomplishments at the National Transportation Safety Board; Ms. Autumn Alexander Skeen from the state 

of Washington, a child passenger safety advocate; Dr. Flaura Winston—doctor, good to see you again—assistant professor of pediatrics at the Children’s Hospital of Philadelphia and the University 

of Pennsylvania School of Medicine; Dr. Kyran Quinlan—Dr. Quinlan is from the Department of Pediatrics at the University of Chicago in my home state of Illinois; thank you for being with us; and 

Ms. Judith Lee Stone, the President of the Advocates for Highway 

and Auto Safety. 

In addition, we have added to the first panel Dr. Adrian K. Lund, 

the Chief Operating Officer of the Insurance Institute for Highway 

Safety. I understand that Dr. Lund may have a different take on 

the whole issue and we decided to put him on the first panel so 

that we might get some give and take. 

With that, I want to start with Mr. Shelton, if he could be kind 

enough to give us his testimony. Thank you all for being here. 

4

STATEMENT OF L. ROBERT SHELTON, EXECUTIVE DIRECTOR, 

NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION 

Mr. SHELTON. Thank you, Mr. Chairman, for inviting me to testify on child booster seats. I also want to thank you, Mr. Chairman, 

for sponsoring legislation to improve child passenger safety. We are 

working hard to implement that legislation, now a part of the 

TREAD Act enacted last November. 

Traffic crashes are the leading cause of death for children. Six 

out of ten children who die in passenger car crashes are either not 

restrained at all or improperly restrained. The most effective way 

to protect children in a crash is to ensure that they are properly 

restrained in the rear seat in an appropriate restraint system on 

every trip. For the older child, generally 4 to 8 years old, booster 

seats, properly used, can help prevent injury by making adult-sized 

belts fit better. 

Booster seats help prevent injury to children between 40 and 80 

pounds. Without a belt-positioning booster seat, the lap belt can 

ride up over the stomach and the seat shoulder belt can cut across 

the neck. In a crash, this could cause serious or even fatal injuries. 

With a booster seat, the lap and shoulder belt fit correctly, reducing the risk of belt-induced injury during a crash. Correct fit also 

reduces the chance of ejection during a crash. 

Based on current data, children should be in booster seats until 

they reach about 80 pounds and a height of 4 feet 9 inches. Unfortunately, as you pointed out, few children who could benefit from 

booster seats now use them. Most studies show booster seat use 

rates below 10 percent. Survey data show that these children often 

use seat belts instead or ride totally unrestrained. 

In 1998, NHTSA included questions about booster seat use in a 

telephone survey of parents or caregivers of children under the age 

of 6. They were asked if they were aware of booster seats. While 

76 percent said they were aware of booster seats, only 53 percent 

of those who were aware said they had ever used them for their 

children. The survey confirmed that children who should be in 

booster seats often use seat belts instead. 

Premature use of seat belts by a child can cause significant injury in a crash. Many parents and caregivers do not understand 

the risks that adult seat belts can pose to children who weigh between 40 and 80 pounds. They also do not understand that booster 

seats are designed to remedy this problem. Educational efforts are 

needed to inform parents and caregivers on the benefits of booster 

seats and when to transition the child to seat belts. 

A significant barrier to the use of booster seats is gaps in state 

child passenger safety and seat belt use laws. These gaps promote 

low booster seat use rates and premature graduation of children 

from safety seats to seat belts. In many states children over 4 can 

legally ride unrestrained in the rear seat, because these laws apply 

only to front seat occupants. In most states, children older than 4 

are covered by seat belt laws, not child restraint laws, a matter 

that contributes to premature use of seat belts. 

NHTSA is taking a number of steps to improve existing standards for the performance and testing of booster seats. Federal 

Motor Vehicle Safety Standard 213, Child Restraints, establishes 

performance and structural integrity requirements for booster 

5

seats. These requirements provide for dynamic tests of the seats in 

three-point lap and shoulder belts that can restrain children weighing up to 50 pounds. 

In accordance with the TREAD Act, we are considering whether 

to amend the standard to cover restraints for children weighing up 

to 80 pounds. Though NHTSA recommends the use of booster seats 

for children up to 80 pounds and many manufacturers now recommend booster seats up to 80 pounds and higher, we currently 

test booster seats with a dummy that simulates a 6-year-old child 

weighing 47 pounds. At this time we do not have an acceptable test 

dummy larger than a 47-pound 6-year-old child dummy and smaller than a 105-pound, 5th percentile female dummy. 

NHTSA has been working with the Society of Automotive Engineers to develop a 10-year-old child dummy. We expect to have a 

prototype of this dummy to evaluate this June. Incorporation of the 

dummy’s specifications into our standards will require further testing and rulemaking. As an interim measure, however, we are assessing the approach of adding weights to the existing 6-year-old 

dummy to evaluate the performance of booster seats for larger children. 

In addition, we are conducting a study, as required by the 

TREAD Act, on the use and effectiveness of booster seats. This 

study will be completed by November. 

We also are examining ways to expand our educational efforts to 

raise awareness and increase the use of booster seats and give parents, caregivers and others the information they need to determine 

the correct use of all child safety seats. 

In 1998, NHTSA sponsored a blue ribbon panel of experts to recommend better ways to protect children ages 4 to 16 years old. Also 

in 1998, TEA–21 provided a new incentive grant program targeting 

specific occupant protection laws and programs. It authorized $83 

million over 5 years for a two-part program. Under the first part, 

a 5-year program, states receive grants if they demonstrate they 

have in place certain occupant protection laws and programs, such 

as a child passenger protection law that requires minors to be properly secured in an appropriate child system. 

As you mentioned, Mr. Chairman, under part two, a 2-year program which expires at the end of fiscal year 2001, states receive 

grants if they carry out child passenger protection and education 

activities, including activities on the use of booster seats. 

In 1999, to address the issue of non-use of booster seats, NHTSA 

awarded a total of $800,000 to six states and communities for pilot 

and demonstration programs to increase booster seat use for children between ages 4 and 8 and seat belt use among older children. 

In February 2000, in response to one of the blue ribbon panel’s 

recommendations, NHTSA launched ‘‘Don’t Skip a Step,’’ a national 

booster seat campaign to educate parents and caregivers not to 

skip a step as their children grow, beginning with rear-facing infant seats and progressing to forward-facing child seats, booster 

seats, and ultimately properly restrained in adult belts, in the back 

seat for all children 12 years and under. 

Also, raising booster seat awareness has been the keystone of our 

national child passenger safety week campaign for the last several 

years. 

6

We will continue to implement our booster seat initiatives by updating our legislative fact sheets, which provide technical assistance to states. In addition, we are developing a booklet, ‘‘Protecting 

America’s Children: The Case for Strong Child Passenger Safety 

Laws,’’ which will be completed this summer, to highlight the need 

to close gaps in state child passenger safety laws discussed earlier. 

NHTSA also has been a close partner in the development and refinement of the ‘‘Boost America’’ program sponsored by Ford Motor 

Company. This $30 million program, to be launched next week, will 

give away a million booster seats during the program’s first 12 

months and award $1 million in grants to local organizations to 

support grassroots booster seat advocacy and distribution efforts. 

NHTSA’s web site now contains a separate section on child safety seats, which makes it easy for the public to locate and obtain 

specific information on all child seats, including booster seats. This 

new service is designed to help families obtain the latest safety 

seat information and guide parents and caregivers to the right restraint choices for their children. The site provides one-stop shopping to those who want to learn about the correct use and installation of all child safety seats, and links the user to a list of locations 

throughout the Nation where parents and caregivers can have safety seats and booster seats inspected. Additional information on 

booster seats is also provided toll-free through our Auto Safety Hotline. 

Finally, NHTSA is currently developing a 5-year booster seat 

education strategic plan, as required by the TREAD Act. We will 

complete the plan by November of this year. 

Mr. Chairman, this concludes my statement. I will be pleased to 

answer any questions. 

[The prepared statement of Mr. Shelton follows:]

PREPARED STATEMENT OF L. ROBERT SHELTON, EXECUTIVE DIRECTOR, NATIONAL

HIGHWAY TRAFFIC SAFETY ADMINISTRATION

Mr. Chairman and Members of the Subcommittee, thank you for this opportunity 

to testify on child booster seats. I also want to take this opportunity to thank you, 

Mr. Chairman, for raising awareness about the leading killer of children in America, 

motor vehicle crashes, and for your sponsorship of legislation to improve child passenger safety. We are working hard to implement that legislation, now a part of the 

Transportation Recall Enhancement, Accountability, and Documentation (TREAD) 

Act, enacted last November. 

Traffic crashes are the leading cause of death for children of every age from 5 to 

16 years old. Six out of 10 children who die in passenger motor vehicle crashes are 

either not restrained at all or are improperly restrained. The single most effective 

way to protect children in the event of a crash is to ensure that they are properly 

restrained in the rear seat in appropriate restraint systems on every trip. For children from 4 to 8 years old, booster seats, properly used, can help prevent injury by 

making adult-sized seat belts fit correctly. 

When to Use a Booster Seat 

Booster seats are intended to be used as a transition to lap and shoulder belts 

by children who have outgrown forward-facing child safety seats. Children outgrow 

the weight and height limits of most forward-facing child safety seats at around 4 

years of age, when they weigh about 40 pounds and are about 40 inches tall. At 

that time, they should be moved to a booster seat to help the lap and shoulder belt 

fit correctly. Based on current data, NHTSA believes children should stay in booster 

seats until they reach about 80 pounds, and a height of four feet, nine inches. 

Booster seats help prevent injury to children between 40 to 80 pounds. Without 

a belt-positioning booster seat, the lap belt can ride up over the stomach and the 

shoulder belt can cut across the neck. In a crash, this could cause serious or even 

7

fatal injuries. With a booster seat, the lap and shoulder belts fit correctly, reducing 

the risk of belt-induced injury during a crash. Correct fit also reduces the chance 

of ejection during a crash. 

Why Is Booster Seat Use So Low? 

Unfortunately, few children who could benefit from booster seats use them. Most 

studies show booster seat use rates below 10 percent. Survey data show that these 

children often use seat belts instead, or ride totally unrestrained. 

In 1998, NHTSA included questions about booster seat use in a telephone survey 

of a randomly selected national sample of about 4,000 persons age 16 and older. A 

selected subgroup of this sample, parents or caregivers of children under the age 

of 6, were asked if they were aware of booster seats. While 76 percent of these participants said they were aware of booster seats, 21 percent said they had not heard 

of them and 3 percent were unsure. Of those who were aware of booster seats, 53 

percent said they had used them at some time for their children. 

The survey confirmed that children who should be in booster seats often use seat 

belts instead. While most participants thought children in rear-facing seats were expected to move on to other safety seats, 14 percent expected their older child to use 

seat belts. Slightly more than half (55 percent) said that when children outgrow a 

child safety seat they would use a different seat or booster seat while 43 percent 

answered either that the children would graduate to seat belts or that they did not 

know what would happen. 

Premature use of seat belts by a child can cause significant injury in a crash. A 

recent research project conducted for NHTSA by TraumaLink, The Children’s Hospital of Philadelphia, concludes that many parents and caregivers simply do not understand the risk that adult seat belts can pose to children who weigh between 40 

and 80 pounds. They also do not understand that booster seats are designed to remedy this problem. 

The project identified several barriers to use of booster seats, including child behavior; child discomfort; availability and cost; and gaps in state child passenger 

safety and seat belt use laws. Potential strategies to overcome these barriers focused 

on educational efforts needed to inform parents and caregivers on the benefits of 

booster seats and when to transition the child to seat belts. 

The matter of state law drew particular comment in the project report. The report 

found that gaps in state child passenger safety laws and seat belt use laws promote 

low booster seat use rates and premature graduation of children from safety seats 

to seat belts. For example, in many states, children over the age of 4 can legally 

ride unrestrained in the rear seat because these laws apply only to front seat occupants. 

Since 1985, all 50 states and the District of Columbia have adopted child restraint 

laws. All of these laws are primary laws (which means that a law enforcement officer may stop a vehicle solely for restraint law violations) and require that young 

children be properly secured in a child safety seat. Though child restraint laws have 

helped to increase the use of child restraints, they often fail to conform to current 

best practices. For example, some states permit children as young as two years of 

age to be restrained in a seat belt if the child is in the rear seat, while others have 

no restraint requirements for any rear-seat occupants other than for children under 

a specified age. In most states, children older than 4 are covered by seat belt laws 

(most of which are secondary enforcement laws), not child restraint laws-a matter 

that contributes to premature use of seat belts. 

The project also found that parents and caregivers rely on state child restraint 

laws for instruction and guidance. They believe that these laws are an accurate 

guide for what is recommended to be safe for their children; but, many state laws 

do not provide such a guide. To date, only two states, California and Washington, 

require the use of booster seats. These laws require booster seat use only for children to age 6 or 60 pounds. 

Late last year, NHTSA provided technical assistance to the DaimlerChrysler Corporation for a survey on parental attitudes and expectations about state child restraint laws. Among the survey’s conclusions—released early this month—was the 

finding that parents are confused about when children may safely ride in an adult 

safety belts and the exact purpose of booster seats. The survey’s findings have reinforced the continuing need to make the purpose, use and details of booster seats a 

top agency priority. 

What NHTSA Is Doing: Motor Vehicle Safety Initiatives 

NHTSA is taking a number of steps to improve existing standards for the performance and testing of booster seats. Federal Motor Vehicle Safety Standard 

(FMVSS) 213, ‘‘Child Restraints,’’ establishes performance and structural integrity 

8

requirements for booster seats. These requirements provide for dynamic tests of the 

seats in 3-point lap and shoulder belts that can restrain children weighing up to 

50 pounds. 

In accord with the TREAD Act, we are considering whether to amend the Standard to cover child restraints for children weighing up to 80 pounds. Though NHTSA 

recommends the use of booster seats for children up to 80 pounds, and many child 

restraint manufacturers now certify booster seats up to 80 pounds and higher, we 

currently test booster seats with a dummy that simulates a 6-year-old child. At this 

time, we do not have an acceptable test dummy larger than our 47-pound 6-yearold dummy and smaller than our 95- 105-pound 5th percentile female dummy. 

To acquire a test dummy suitable for evaluating booster seats designed for larger 

children, NHTSA has been working with the Society of Automotive Engineers (SAE) 

to develop a 10-year-old child dummy, which would be approximately 4-feet 6-inches 

tall and weigh 71 pounds. We expect to have a prototype of the 10-year-old dummy 

to evaluate by June 2001, but incorporation of the dummy’s specifications into our 

standards will require further testing and rulemaking. As an interim measure, we 

are assessing the approach of adding weights to the existing 6-year-old dummy to 

evaluate the performance of booster seats for larger children. However, the primary 

concern for older children is head excursion which is influenced by the height of the 

dummy. Thus, adding weight to a 6-year-old dummy is not a satisfactory long-term 

solution. 

NHTSA is currently conducting a study, as required by the TREAD Act, on the 

use and effectiveness of booster seats. This study is hampered, however, by the lack 

of use of booster seats by older children, which makes it hard to find enough crash 

cases with booster seats to give reasonable estimates of their effectiveness. This 

study will be completed this November. 

In addition to setting and maintaining federal motor vehicle safety standards, 

NHTSA conducts compliance tests to assure that the standards are met. We generally test every child restraint model available on the market each year for compliance with FMVSS No. 213. From 1996 to the present, NHTSA has conducted compliance tests on 63 models of booster seats. In 1998, we sent a letter to all child 

safety seat manufacturers urging them to manufacture child seats so that they ‘‘perform well beyond the minimum requirements of our standard.’’ We can also conduct 

investigations and seek a recall if there is evidence that these restraints contain a 

safety-related defect. 

What NHTSA Is Doing: Education and Information Initiatives 

In addition to NHTSA’s motor vehicle safety initiatives to improve booster seats, 

we are continually examining ways to expand our educational efforts to give parents, caregivers and others the information they need to determine the correct use 

of all child safety seats. These efforts include initiatives to raise awareness and increase the use of booster seats. 

The agency has four strategies that have been determined to be especially effective in meeting child passenger safety goals: public education; high visibility law enforcement; public-private partnerships; and strong legislation. 

In1998, NHTSA sponsored a ‘‘Blue Ribbon Panel’’ of experts to recommend better 

ways to protect children passengers 4 to16 years old. In March 1999, the panel presented recommendations for these children in three areas:

• Marketing and Public Education—Educate parents and caregivers on the importance of booster seats for children who have outgrown child safety seats; generate peer programs for increasing seat belt use among older children.

• Legislation and Enforcement—Close gaps in the child passenger safety and seat 

belt laws that leave children ages 4 to 16 unprotected; encourage high visibility 

enforcement of child passenger safety laws.

• Product Design and Implications—Improve booster seat design for safety and 

comfort; develop recommendations for the use of aftermarket products.

Also in 1998, the Transportation Equity Act for the 21st Century (TEA–21) added 

a new incentive grant program to our occupant protection efforts. Beginning in FY 

1999, TEA–21 authorized $83 million over 5 years for a two-part program to target 

specific occupant protection laws and programs. Under part one, a 5-year program 

beginning in FY 1999, states receive grants if they demonstrate that they have in 

place certain occupant protection laws and programs, such as a child passenger protection law that requires minors to be properly secured in an appropriate restraint 

system. Under part two, a 2-year program in FY 2000 and 2001, states receive 

grants if they carry out child passenger protection and education activities, including activities on the use of booster seats. 

9

Since 1998, NHTSA and AAA have jointly published a brochure, Buying a Safer 

Car for Child Passengers, designed to help consumers make an informed decision 

when purchasing a family vehicle. The brochure, which is updated annually to include safety features available on new model year vehicles, highlights information 

on booster seats. 

In 1999, to address the issue of non-use of booster seats, NHTSA awarded a total 

of $800,000 to six states and communities (NY, RI, TX, WA, AZ, ND) for pilot and 

demonstration programs to increase booster seat use for children between age 4 and 

8 years old and seat belt use among older children. Using final reports on these programs, due at the end of 2001, NHTSA will develop ‘‘best practices’’ strategies and 

educational materials for the use of the states and our national partner organizations. 

In February 2000, in response to one of the Blue Ribbon Panel’s recommendations, NHTSA launched Don’t Skip a Step, a national booster seat campaign to educate parents and caregivers not to skip any step as their children grow: beginning 

with rear-facing infant seats and progressing to forward-facing child safety seats, 

booster seats, and properly restrained in an adult belt in the back seat for all children 12 and under. As part of the campaign, NHTSA has distributed campaign brochures to enlist the support of child safety advocates, health care providers, law enforcement personnel and others to help spread the booster seat safety message 

across the country. An expanded booster seat education program is planned for later 

this year. In addition, raising booster seat awareness has been the centerpiece of 

NHTSA’s ‘‘National Child Passenger Safety Week’’ campaign for the last several 

years. 

We will continue to implement our booster seat initiatives by updating NHTSA’s 

legislative fact sheets, which provide technical assistance to the states. In addition, 

we are developing a booklet, Protecting America’s Children: The Case for Strong 

Child Passenger Safety Laws, which will be completed this summer, to highlight the 

need to close gaps in state child passenger safety laws discussed earlier. In January 

2001, the National Committee on Uniform Traffic Laws and Ordinances developed 

a model law on occupant protection that provides coverage for all occupants in all 

seating positions. 

NHTSA has been a close partner in the development and refinement of the ‘‘Boost 

America!’’ program sponsored by Ford Motor Company. This $30-million program, 

to be launched at the end of this month, will give away a million booster seats during the program’s first 12 months, and award $1 million in grants to local organizations to support grassroots booster seat advocacy and distribution efforts. In addition, the program will distribute pre-school and elementary school educational materials promoting booster seat use. NHTSA plans to continue to work with child safety 

seat manufacturers and retailers to raise consumer awareness of booster seats. 

NHTSA’s web site, www.nhtsa.dot.gov, now contains a separate section on ‘‘Child 

Safety Seats,’’ that makes it easy for the public to locate and obtain specific information on all child seats, including booster seats. This new Internet-based service, 

launched last month by Secretary Mineta, is designed to help families obtain the 

latest child safety seat information and guide parents and caregivers to the right 

restraint choices for their children. When a user clicks on the icon, ‘‘Child Safety 

Seats,’’ the user is linked to a comprehensive source of information, tips and recommendations. Dozens of full-color photos of the different types of child safety seats 

are provided, together with step-by-step installation guidelines. This site provides 

one-stop shopping to those who want to learn about the correct use and installation 

of all child safety seats, and includes: (1) a current listing of all new child safety 

seats available; (2) a list of model year 2001 vehicles with child safety seat features; 

(3) a description and list of various features available on the restraints that may 

make them easier to use and install; and (4) a child safety seat dictionary of terms. 

The site also has links to a comprehensive list of locations throughout the country 

where parents and caregivers can have child safety seats and booster seats inspected, and to the brochure, Buying a Safer Car for Child Passengers, mentioned 

earlier. 

Additional information on booster seats also is available toll-free through 

NHTSA’s Auto Safety Hotline, 1–888–DASH–2–DOT. Our Hotline operators are 

available to answer questions from 8 a.m. to 10 p.m., Eastern time, Monday through 

Friday. Messages can be left on tape 24 hours a day. 

NHTSA currently is developing a 5-year booster seat education strategic plan, as 

required by the TREAD Act, to reduce deaths and injuries caused by failure to use 

the appropriate booster seat in the 4- to 8-year-old age group by 25 percent. Booster 

seat use will be monitored using NHTSA’s databases. We will complete the plan by 

November of this year. 

10

In closing, I would like to note that NHTSA staff have been active participants 

at the Association for the Advancement of Automotive Medicine’s (AAAM) Conference on ‘‘Booster Seats for Children,’’ taking place this week in Washington, DC. 

This conference has brought together international experts in pediatric restraint 

science from Canada, Sweden, the United States, the United Kingdom and Germany 

to review the current state of the art in child booster seat design, materials, tolerances and child riding behavior. The proceedings of the conference will be published 

to serve as a guide to future research in child safety engineering, provide recommendations for the medical community, and address the formulation of effective 

restraint laws for 4- to 8-year old children. 

Mr. Chairman, this concludes my statement. I will be pleased to answer any questions.

Senator FITZGERALD. Mr. Shelton, thank you very much. 

Ms. Weinstein. 

STATEMENT OF ELAINE B. WEINSTEIN, ACTING DIRECTOR,

OFFICE OF SAFETY RECOMMENDATIONS AND

ACCOMPLISHMENTS, NATIONAL TRANSPORTATION SAFETY 

BOARD 

Ms. WEINSTEIN. Good morning, Mr. Chairman. It is a pleasure 

to represent the National Transportation Safety Board this morning on this very important issue. 

According to the National Highway Traffic Safety Administration, in the decade of the 1990s, 8,600 children between the ages 

of 4 and 8 died in motor vehicle crashes. Highway crashes are the 

leading cause of death for children in this country, Mr. Chairman, 

and we applaud you for holding this much-needed hearing. 

The Centers for Disease Control and Prevention have stated that 

children who have outgrown child safety seats should ride in a 

booster seat that positions the shoulder belt across the chest, with 

the lap belt low across the upper thighs. Without a booster seat, 

a child can slouch and slide forward, causing the vehicle lap belt 

to ride up into the child’s abdomen, resulting in serious or fatal injuries. 

The Safety Board agrees with that position, and in 1996 we recommended that the states require children up to 8 years old to use 

child restraint systems and booster seats. As you mentioned, in the 

4 years since our recommendation was issued only 3 states—Washington, California, and Arkansas—have enacted some form of 

booster seat legislation. 

Another problem identified in the Safety Board’s 1996 study was 

that there are children who exceed the 60-pound weight limit established by most child restraint manufacturers for booster seats, 

but these children are still too short to properly use lap and shoulder belts. In addition, the NHTSA standard only covers child restraints for children up to 50 pounds. Also 4 years ago, the Safety 

Board asked NHTSA to establish performance standards for booster seats that can restrain children up to 80 pounds, but today there 

are still no such standards. 

Safety advocates often tell parents that the safest place for their 

children in the car is the center of the back seat, because it is the 

farthest away from a side or frontal crash. Parents have been listening. Today 46 percent of back seat occupants in crashes seated 

in the center seat are under the age of 13. But to use one of the 

booster seats on the market today, you need a lap and a shoulder 

belt in the center rear seat position. Except few minivans and 

11

SUVs, which are today’s family car, many vehicles now have lap 

and shoulder belts in the center rear seat position. 

The Safety Board believes that the back seat of the car should 

be designed with children in mind, and we have issued several recommendations to the automobile manufacturers to make the back 

seats of the cars more child-friendly. 

In December of last year, the Safety Board sponsored a meeting 

with safety advocates and representatives of industry and government to identify immediate, short-term and long-term actions that 

can be taken to ensure that all children are equally protected when 

they are traveling on our nation’s roadways. We were particularly 

concerned about low income and minority children. 

Some of the solutions identified by participants include more 

products, including booster seats that are compatible with lap-only 

belts, more education of parents of 4 to 8 year old children about 

the need to use booster seats, incentives such as store-manufacturer coupons to purchase low-cost booster seats, more availability 

of booster seats in stores that reach low income and minority families, and retailer education to ensure that booster seats are available. 

Mr. Chairman, too many parents buckle their children into adult 

restraints in their automobiles and think that their child is safe. 

We know that that is not the case. The Safety Board believes that 

action must be taken by the states, the automobile manufacturers 

and NHTSA to ensure that there is one level of safety for all children. 

That completes my statement, Mr. Chairman. I would be happy 

to answer any questions. 

[The prepared statement of Ms. Weinstein follows:]

PREPARED STATEMENT OF ELAINE B. WEINSTEIN, ACTING DIRECTOR, OFFICE OF

SAFETY RECOMMENDATIONS AND ACCOMPLISHMENTS, NATIONAL TRANSPORTATION

SAFETY BOARD

Good morning Mr. Chairman and Members of the Subcommittee. It is a pleasure 

to represent the National Transportation Safety Board before you today regarding 

child passenger safety, particularly the use of booster seats by children between the 

ages of 4 and 8 years old. 

Americans understandably react with horror at random acts of violence that take 

the lives of innocent children, and they demand that action be taken when a child 

is killed in a school firearm incident. In 1998, 121 children under age 10 died as 

a result of unintentional firearm-related actions, according to the National Safe Kids 

Campaign. That same year, 922 children under age 10 died as passengers in motor 

vehicle crashes, according to the National Highway Traffic Safety Administration’s 

(NHTSA) Fatality Analysis Reporting System (FARS). Although highway crashes 

are the leading cause of death for children in this country, we do not hear a nationwide outcry every time a young girl or boy dies in a traffic crash. Mr. Chairman, 

the Safety Board applauds you for holding this hearing to bring much needed attention to this important issue. 

According to NHTSA, in the decade of the 1990s, over 90,000 children died in 

motor vehicle crashes, and over 9 million were injured. Eight thousand six hundred 

of the children who died were between the ages of 4 and 8. That equals about 16 

children between the ages of 4 and 8 killed each week in motor vehicle crashes. 

More than 70 percent of the 778 children age 4-to-8 killed in automobile accidents 

in 1999 were totally unrestrained (546 children), and 13 percent (105 children) were 

in lap/shoulder belt restraint systems designed for adults. 

The Safety Board has for some time been concerned about the dangers to our children when riding in an automobile. In 1996, the Safety Board adopted a study on 

the performance and use of child restraint systems, seatbelts, and air bags for children in passenger vehicles. 

12

In part, the Board’s 1996 report concluded that:

• Children (especially those properly restrained) in the back seats of vehicles are 

less likely to sustain injury than those seated in the front seats;

• Children of all ages need to be properly restrained and should be covered by 

the states’ child restraint and seatbelt use laws;

• More than two-thirds of the children in the Safety Board’s study sample were 

not in the appropriate restraint for their age, height, and weight;

• Children tended to be in restraint systems too advanced for their development, 

such as moving from child restraint systems to seatbelts rather than using 

booster seats; and

• Booster seats that restrain children who weigh more than 50 pounds are not 

subject to any performance standards; however, booster seats are necessary for 

some children above that weight.

Two years ago, to focus attention on our 1996 safety recommendations, the Safety 

Board implemented a comprehensive campaign regarding children passenger safety. 

We met on several occasions with automobile and child safety seat manufacturers, 

participated at child safety seat fitting stations and check points, testified at legislative hearings, spoke at and attended numerous conferences and symposia, and held 

several meetings. As a direct result of the Board’s work, we have seen many improvements regarding child passenger safety, especially related to increasing proper 

use of child safety seats. For instance:

• NHTSA developed a guidebook for states to use in establishing and operating 

fitting stations;

• Many states have set up fitting stations at health centers or in police, sheriff, 

or fire stations;

• DaimlerChrysler established Fit for A Kid, a nationwide program of permanent 

fitting stations, at selected dealerships. Fit for a Kid is now in all 50 states, 

and much of the U.S. population is less than an hour’s drive from a Fit for a 

Kid location;

• General Motors established mobile fitting stations in every state in partnership 

with the National Safe Kids Campaign; and

• Ford Motor Company established the ‘‘Boost America’’ program to provide support for existing community fitting stations, to conduct child safety seat inspections, and to implement a campaign to give away booster seats to needy families.

Mr. Chairman, it is unfortunate that booster seats are still not recognized or understood by the public as the next step in child passenger protection after a child 

outgrows a child restraint system. 

Seatbelt Fit for 4-to-8-year-old Children 

Once children outgrow child restraint systems, they often use the vehicle seatbelts. In the crashes investigated for the Safety Board’s 1996 study, 73 children 

should have been in booster seats according to their age, height, and weight, but 

only 11 children were restrained in booster seats. Fifteen children in our study cases 

were improperly restrained by the vehicle seat belt. Fourteen of those children 

should have been in booster seats, and the other one should have been in a child 

safety seat. 

Vehicle seat belts, like air bags, were designed to protect adults. Poor shoulder 

belt fit was reported in 8 seatbelt misuse cases by children in our sample as the 

reason for wearing the shoulder belt under the arm or behind the back. Moderate 

to severe injuries were sustained by 9 of the children; all but 1 were involved in 

high severity crashes. Five children in the study who sustained no or minor injuries 

were involved in low to moderate severity crashes. Improper use of the lap/shoulder 

belt decreased as the child’s height increased above 50 inches, resulting in a better 

fit of the shoulder portion of the belt. 

According to the Centers for Disease Control and Prevention, children who have 

outgrown their child safety seats should ride in a booster seat that positions the 

shoulder belt across the chest, and with the lap belt low across the upper thighs. 

Without a booster seat, a child can slouch and slide forward, causing the vehicle 

lap belt to ride up on to the child’s abdomen, resulting in serious or fatal injures. 

The Safety Board believes that children of all ages need to be properly restrained 

and should be covered by the states’ child restraint and seatbelt use laws. AccordVerDate 0ct 09 2002 12:13 Nov 30, 2004 Jkt 088785 PO 00000 Frm 00016 Fmt 6633 Sfmt 6621 S:\WPSHR\GPO\DOCS\88785.TXT JACK PsN: JACKF
13

ingly, on October 31, 1996, the Safety Board recommended to the Governors and 

Legislative Leaders of the 50 states and U.S. Territories, that children up to 8 years 

old be required by the state’s mandatory child restraint use law to use child restraint systems and booster seats. In the over five years since the safety recommendation was issued, only three states—Washington, California, and Arkansas—have enacted some form of booster seat law. 

Another problem identified in the Safety Board’s 1996 study was that there were 

22 children who exceeded the 60-pound weight limit established by most child restraint manufacturers for booster seats, but were too short (all of these children 

were less than 59 inches tall) for lap/shoulder belts according to the age, height, and 

weight classification system used by the Board. NHTSA’s own research confirms 

that ‘‘the minimum size child in this study who could use three-point belts alone 

had a sitting height of 74 cm [29.6 inches], standing height of 148 cm [59.2 inches], 

and weight of 37 kg [82 pounds].’’ On September 20, 1996, the Safety Board asked 

NHTSA to establish performance standards for booster seats that can restrain children up to 80 pounds. NHTSA responded to the Board’s recommendation with a letter to the child restraint manufacturers asking them if they had plans to produce 

booster seats for older children and if there was a need for federal standards. 

NHTSA subsequently convened a Blue Ribbon Panel on older children in 1998 

which recommended a number of actions similar to what the Safety Board asked 

for in it’s 1996 recommendations. 

Mr. Chairman, when discussing child passenger safety there are two additional 

areas that need to be discussed—child-friendly back seats and children in low income families. 

Child-Friendly Back Seats 

The Safety Board believes that the back seat of vehicles should be designed with 

children in mind. We have issued safety recommendations to the automobile manufacturers to design child-friendly back seats by having center lap/shoulder belts in 

the rear seats of new vehicles, lap/shoulder belts in the rear outboard seating positions that fit older children, and built-in child safety seats. 

The Safety Board first asked manufacturers to consider installing center lap/

shoulder belts in all newly manufactured passenger vehicles following a 1986 safety 

study on the performance of lap belts in frontal crashes. Although more vehicles 

have lap and shoulder belts in the center rear seat position today than in 1986, few 

minivans or sport utility vehicles—today’s family car—have lap/shoulder belts available for children in all back seat positions. 

Safety advocates often tell parents that the safest place for their children is the 

center position in the back seat because it’s the farthest away from a side or frontal 

crash. Parents have been listening. NHTSA’s FARS data show that 46 percent of 

all back seat occupants seated in the center position are under the age of 13, and 

75 percent of them are under the age of 21. Vehicle occupants seated in the center 

rear seat position should be afforded the same level of protection as other occupants 

of the back seat. 

The Board has also recommended that lap/shoulder belts in the rear outboard 

seating positions should fit older children comfortably and securely. Manufacturers 

have argued that the adjustable upper shoulder belt anchorages, now standard in 

the front seat, aren’t feasible in the back seat because the back seat’s design renders 

the anchorage ineffective. If that is true, the Safety Board has suggested that manufacturers put their design teams to work looking for alternative solutions. 

Lastly, the Board recommended that vehicles should have built-in child safety 

seats. Few manufacturers offer a built-in safety seat. It is almost solely an optional 

equipment item, and often is not marketed well. Auto manufacturers have suggested that built-in child seats are a tough sell. Many people who have children 

young enough to use them are not in the market for a new car, and car dealers do 

not want to stock vehicles with integrated seats. 

Children in Low Income Families 

A concern recently expressed by the Safety Board involves the use of booster seats 

in older vehicles. Booster seats currently on the market are, with one exception, designed for use with lap and shoulder belts. However, lap/shoulder belts have only 

been required in the outboard seating position of vehicle back seats since 1990. That 

means that about 34 percent of all cars (some 43 million vehicles) still in use today 

have lap belts in all back seat positions. Shoulder belts still are not required in the 

center back seat position, and many current model vehicles, including sport utility 

vehicles, only have lap belts in the center rear seat position. When Board representatives participated in child safety seat fitting stations and check points, we were 

told that it is difficult to find booster seats for use in vehicles with lap-only belts. 

14

According to the 1995 National Personal Transportation Survey, conducted for the 

Federal Highway Administration, the average age of vehicles owned by low-income 

households is 11 years. Therefore, it is reasonable to assume that low-income families with children between the ages of 4 and 8 years old are likely to own a vehicle 

with lap-only belts in the back seat. The Safety Board is concerned that adequate, 

affordable protection is not readily available for these children when they are transported in cars. 

In December 2000, the NTSB sponsored a meeting with safety advocates and representatives of industry and government to identify immediate, short-term, and 

long-term actions that can be taken to ensure that all children are equally protected 

when they are traveling on our nation’s roadways. Some of the solutions identified 

by the participants include:

• More products, including lap-only belt compatible restraints;

• More education of parents of 4-to-8-year old children about the need to use 

booster seats;

• Incentives, such as store/manufacturer coupons, to purchase low cost booster 

seats and more availability of booster seats in stores that reach low-income and 

minority families; and

• Retailer education to ensure that booster seats are available.

As a result of the Safety Board’s meeting, representatives of the Departments of 

Transportation, Health and Human Services, and the Safety Board’s Chairman 

signed a Letter of Intent to work together to increase the availability of child safety 

seats and booster seats for low-income families. 

Mr. Chairman, too many parents buckle their children into adult restraints in 

their automobiles and think their child is safe. We know that is not the case. The 

Safety Board believes that action must be taken by the states, the automobile manufactures, and NHTSA to ensure that there is one level of safety for all children. 

That completes my statement, and I will be happy to respond to any questions 

you may have.

Senator FITZGERALD. Ms. Weinstein, thank you very much. 

Ms. Autumn Alexander Skeen from Walla Walla, Washington. 

Thank you very much for being here. 

STATEMENT OF AUTUMN ALEXANDER SKEEN,

CHILD PASSENGER SAFETY ADVOCATE 

Ms. SKEEN. Mr. Chairman and Senators: I am Autumn Alexander Skeen of Washington state. Thank you for allowing me to 

testify. It is seemly that this opportunity would come less than 2 

weeks after my son’s birthday. Spring and Easter are the most 

painful times now, their message of new life and green glory underscoring what Anton has lost. He would have been 9 years old this 

year, just like your son. 

But Anton was 4 years old and a good-sized lad when he, his sister and I came home from Japan for summer vacation in June 

1996, leaving my husband at his post in Tokyo as the Pacific editor 

of Stars and Stripes. We were to have a whole summer at our family cabin in central Oregon. 

My parents live in Seattle and for the summer I borrowed their 

SUV, a 1988 Dodge Raider. In the whirl of travel, my mind quickly 

touched upon the basics of transport. The front seats were where 

the only lap and shoulder belts were in this vehicle, and of course 

it had no air bags. Washington state law said you could buckle children Anton’s size and weight, nearly 50 pounds and too big for a 

child car seat, into seat belts. I concluded he should be up front 

with the best seat belts. 

I am a journalist. I had researched the law in 1993, writing on 

the lack of child passenger safety laws on Indian reservations. So 

15

I felt knowledgeable about the law. I was a mom who played by 

the rules: bike helmets, limited TV time, brush teeth and bed time 

by 8:30. 

Anton’s grandmother remembers buckling him into the seat that 

morning when we left Seattle. ‘‘I get to ride up in front with 

mommy,’’ he crowed to her. He was a sunny child, loving, smart, 

healthy—everything a parent could want. 

He and I headed toward central Washington, planning to visit 

friends there before driving on to Oregon. My daughter Geneva was 

to follow us the next day with my sister, her aunt. Two and a half 

hours into our drive, we were traveling approximately 65 miles an 

hour on I–82, crossing a high desert steppe, a desolate place used 

by the Army as a firing range. Anton’s head leaned against the 

window as he fell asleep in the warm sun. 

When the noon news faded, I reached for the car radio, which 

was positioned exceptionally low, just over the car’s hump. At the 

same time, we passed a semi truck in the right-hand lane, and basically that is all I remember. At the same time I leaned over, we 

apparently hit a gust of wind, drifting onto the shoulder, which had 

no rumble strips. I must have startled when I realized where we 

were and overcorrected. The wheels bit into the volcanic ash and 

sand, tripping the vehicle into a triple roll. 

They found me unconscious in the car, critically injured, but 

nonetheless alive. The seat belt held me in, saving my life. But 

next to me they found no one. When the Washington State Patrol 

examined the car, they found Anton’s seat belt still clicked shut, 

but Anton was in the median, dead from massive head injuries. 

The seat belt had failed to hold him in and he was thrown out, only 

to have the car roll over him, and just that fast this beautiful boy 

was gone, never to be seen nor held by me again. 

Anton did get to the cabin in Oregon in the end, but as ashes, 

ashes we spread in the cold Metolius River. I have a river since 

then, too, for the pain of missing him and the pain of knowing 

what he has missed is an insurmountable sorrow for his father and 

me. 

I realize, however, one mother’s broken heart alone is not enough 

to change a nation’s behavior. But Anton’s death was no anomaly. 

Some 500 children in Anton’s age group bloody the road sides of 

America and die. Thousands more are hurt for life. Since this last 

Thanksgiving, within a 50-mile radius of my house, in separate incidents a 51⁄2 year old boy in an adult seat belt was partially 

thrown out in a rolling pickup truck and died, a 6 year old girl in 

an adult seat belt was thrown out in a crash and died. Last week, 

in a three-car collision another 6 year old was injured by the adult 

seat belt itself. These are just the recent ones I know about in 

rural southeast Washington state. 

These are not statistics who suffer or die. These are worlds that 

die: Tonka trucks and teddy bears packed away, Dr. Seuss and Curious George stories boxed up, hollow birthdays celebrated only 

with prayers and burning candles. The start of the school year only 

signals more sadness for us parents, mentally graduating lost children along: first grade, second grade, and now third grade. 

16

Because many of these deaths are preventable, guilt and blame 

drive divorce, chemical dependency, family dysfunction, and, yes, 

suicide, to fill the empty silhouette of a child. 

I was fortunate in one way. My marriage and psyche have survived this catastrophe. Nonetheless, almost equal to my sorrow is 

my rage, at myself and at the other elements of this horror—foremost, the lack of regulation in regard to safety practices and safety 

equipment for passengers smaller than 170-pound males. Where 

have our governments been? Even though car crashes are the number one killer of children, apparently there has not been enough 

dead youngster data to set off a commensurate alarm. 

Yet people in safety and automotive circles have known about 

this problem of poor fit for the post-car seat aged child since the 

late 1980’s. Safety equipment in a car is no guarantee, but it does 

imply a chance. Perhaps Anton would not have survived the crash 

forces, but we will never know, because his seat belt did not, could 

not, deliver. 

Too late, in retrospect I see how ludicrous it was to think its ill 

fit would suffice. But I extrapolated then that if the law said it was 

OK, someone somewhere had tested the engineering. Adult seat 

belts are better than nothing. Nonetheless, they present an illusion 

of safety, a lie in effect to these children who trust us with their 

very lives, the same way I naively trusted the law. 

I am not the only one. Parents are awash in health and safety 

messages. Their priority filters tell them that if a warning is not 

law the potential is not life-threatening. Nothing could be further 

from the truth when it comes to car crashes. 

In our commuter society, children travel more than a thousand 

car trips a year, and yet they are subjected to the capricious nature 

of state child passenger safety laws, all of which, even Washington 

and California’s new improved ones, fall short of best practice. But 

parents do not realize this. 

These treasured children are Americans first. They carry American passports, not state passports. They deserve a uniform standard of regulatory protection coast to coast, whether that involves 

auto design or booster seats or both. As citizens, it is their birth 

right to come of age. We all failed Anton. Good conscience and good 

government demand we not fail another vulnerable young spirit. 

This ends my testimony. I will answer any questions. Thank you. 

[The prepared statement of Ms. Skeen follows:]

PREPARED STATEMENT OF AUTUMN ALEXANDER SKEEN, CHILD PASSENGER SAFETY

ADVOCATE

Mr. Chairman and Senators of the Committee, I am Autumn Alexander Skeen of 

Washington state. 

Thank you for allowing me to testify. It is seemly that this opportunity would 

come less than two weeks after our son’s birthday. Spring and Easter are the most 

painful times now, their messages of new life and green glory underscoring what 

Anton has lost. He would have been nine years old this year, just like your son, Senator Fitzgerald. 

But Anton was four years old and a good-size lad, when he, his sister and I came 

home for summer vacation in June 1996, leaving my husband at his post in Tokyo 

as the Pacific editor of Stars and Stripes. We were to have a whole summer at our 

family cabin in Central Oregon. 

My parents live in Seattle and for the summer I borrowed their SUV, a 1988 

Dodge Raider. In the whirl of travel, my mind quickly touched upon the bases of 

transport: The front seats were where the only lap-shoulder belts were in this vehiVerDate 0ct 09 2002 12:13 Nov 30, 2004 Jkt 088785 PO 00000 Frm 00020 Fmt 6633 Sfmt 6621 S:\WPSHR\GPO\DOCS\88785.TXT JACK PsN: JACKF
17

cle. And of course, it had no air bags. Washington state law said you could buckle 

children Anton’s size and weight—nearly 50 pounds and too big for a child carseat—

into seatbelts. I concluded he should be up front with the best seatbelts. I’m a journalist; I had researched the law in 1993, writing on the lack of child passenger safety laws on Indian reservations, so I felt knowledgeable about the law. I was a mom 

who played by the rules—bike helmets, limited TV time, brushed teeth and bedtime 

by 8:30. 

Anton’s grandmother remembers buckling him into the seat that morning we left 

Seattle: ‘‘I get to ride up in front with Mommy!’’ he crowed to her. He was a sunny 

child, loving, smart, healthy—everything a parent could want. 

He and I headed toward Central Washington, planning to visit friends there before driving on to Oregon. My daughter Geneva was to follow us the next day with 

my sister, her aunt. Two and a half hours into our drive, we were traveling approximately 65 miles an hour on I82, crossing a high desert steppe, a desolate place used 

by the army as a firing range. Anton’s head leaned against the window as he fell 

asleep in the warm sun. 

When the noon news faded I reached for the car radio, which was positioned exceptionally low, just over the car’s hump. At the same time, we passed a semi-truck 

in the right-hand lane. And basically that’s all I remember. At the same time I 

leaned over, we apparently hit a gust of wind, drifting onto the shoulder, which had 

no rumble strips. I must’ve startled when I realized where we were and overcorrected. The wheels bit into the volcanic ash and sand, tripping the vehicle into a 

triple roll. 

They found me, unconscious in the car, critically injured, but nonetheless alive. 

The seatbelt held me in, saving my life. 

But next to me, they found no one. When the Washington State Patrol examined 

the car, they found Anton’s seatbelt still clicked shut, but Anton was in the median, 

dead from massive head injuries. The seatbelt had failed to hold him in, and he was 

thrown out, only to have the car roll over him. 

And just that fast, this beautiful boy was gone, never to be seen nor held by me 

again. 

Anton did get to the cabin in Oregon in the end but as ashes, Senators, ashes 

we spread in the cold Metolius River. I have wept a river since then, too, for the 

pain of missing him and the pain of knowing what he has missed is an insurmountable sorrow for his father and me. 

I realize, however, one mother’s broken heart alone is not enough to change a nation’s behavior, but Anton’s death was no anomaly. Some 500 children in Anton’s 

age group bloody the roadsides of America and die; thousands more are hurt for life. 

Since this past Thanksgiving, within a 50-mile radius of my house in separate incidents, a 51⁄2 year old boy in an adult seatbelt was partially thrown out in a rolling 

pick up and died; a 6-year-old-girl in an adult seatbelt was thrown out in a crash 

and died, last week in a three-car collision another 6-year-old was injured by the 

adult seatbelt itself. And those are just the ones I know about in rural southeast 

Washington. 

These aren’t statistics who suffer or die, these are worlds that die: toy trucks and 

teddy bears packed away; bedtime stories boxed up; hollow birthdays celebrated 

only with prayers and burning candles. The start of the school year only signals 

more sadness for parents—mentally graduating lost children along: first grade, second grade, and now third grade. Because most of these deaths are preventable, guilt 

and blame drive divorce, chemical dependency, family dysfunction and yes, suicide 

to fill the empty silhouette of the child. 

I was fortunate in one way—my marriage and psyche have survived this catastrophe. Nonetheless, almost equal to my sorrow is my rage—at myself and at the 

other elements of this horror, foremost the lack of regulation in regard to safety 

practices and safety equipment for passengers smaller than 170-pound males. 

Where have our governments been? Even though car crashes are the #1 killer of 

children, apparently there hasn’t been enough dead-youngster data to set off a commensurate alarm. Yet, people in safety and automotive circles have known about 

this problem of poor fit for the post-carseat age child since the late 1980’s. Safety 

equipment in a car is no guarantee, but it does imply a chance. Perhaps Anton 

would not have survived the crash forces, but we’ll never know because his seatbelt 

did not, could not deliver. Too late, in retrospect I see how ludicrous it was to think 

its ill fit would suffice. But I extrapolated then that if the law said it was OK, someone somewhere had tested the engineering. Adult seatbelts are better than nothing, 

nonetheless they present an illusion of safety, a lie in effect, to these children who 

trust us with their very lives, the same way I naively trusted the law. 

18

I’m not the only one. Parents are awash in health and safety messages. Their priority-filters tell them that if a warning is not law, the potential is not life threatening. Nothing could be further from the truth when it comes to car crashes. 

In our commuter society, children travel more than 1,000 car trips a year and yet 

they are subjected to the capricious nature of state child passenger safety laws, all 

of which, even Washington and California’s new improved ones, fall short of best 

practice. But parents don’t realize this. 

These treasured children are Americans first; they carry American passports, not 

state passports. They deserve a uniform standard of regulatory protection coast to 

coast, whether that involves auto design, or booster seats or both. As citizens, it’s 

their birthright to come of age. We all failed Anton; good conscience and good government demand we not fail another vulnerable young spirit.

Senator FITZGERALD. Ms. Skeen, I want to thank you for that 

very powerful and compelling testimony and thank you and applaud you for your courage in coming forward with that, and for 

all the good work and advocacy you have been doing in this area. 

We will work so that there are not other parents what have to undergo the suffering that you have endured, and we will keep Anton 

in our memories. Thank you very much for your courage in coming 

forward with that powerful testimony. 

Mr. Lund, the Chief Operating Officer of the Insurance Institute 

for Highway Safety, thank you for being here. 

STATEMENT OF ADRIAN K. LUND, CHIEF

OPERATING OFFICER, INSURANCE INSTITUTE FOR

HIGHWAY SAFETY 

Dr. LUND. Thank you, Mr. Chairman. The Insurance Institute for 

Highway Safety is a nonprofit research and communications organization that identifies ways to reduce motor vehicle crashes and 

crash losses. 

Senator FITZGERALD. Mr. Lund, could you just pull that microphone a little bit closer to you. I would appreciate it. Thank you. 

Dr. LUND. I am the Institute’s Chief Operating Officer and I am 

here to discuss the issue of child occupant protection, in particular 

the advisability of requiring booster seats. With me today are 

Michele Fields, General Counsel for the Institute, and Shelly Martin, our Government Affairs Representative, who will help me at 

various stages. 

To begin, I want to emphasize that the Institute believes that the 

main issue with regard to child occupant protection is the fact that 

so many children ride unrestrained. Although child restraint use is 

up markedly since the 1970’s and 1980’s, only one in three children 

killed in motor vehicle crashes in 1999 were restrained. 

When it comes to protecting infants and children in motor vehicles, the key issue is whether a restraint system is used. It is not 

the type of restraint or whether it is installed precisely as the manufacturer intended. Although these can be important, it is not the 

main issue. Research indicates that even when restraints are misused, they do often provide good protection. We should not lead 

parents to assume that the belt provides no protection. 

When the Institute evaluated child restraint laws around the nation last year, we did not consider what kind of restraint a law requires for children or how extensively it defined proper use of the 

restraint. Instead, the principal concern was whether the laws included provisions that we know from data maximize the use of 

19

some kind of restraint. Our emphasis throughout was to ensure 

that all children in all vehicle seats are restrained all the time. 

In this situation, where do boosters come in? Restraint use is a 

particular concern among those children who are graduating from 

child restraints and for whom boosters are being recommended. Research shows that restraint use declines precipitously among children ages 3 to 6 compared with their zero to 2 year old. It declines 

from around 95 percent to around 40 to 50 percent in rear seats. 

We do not know why this decline occurs, but it means these children are at increased risk of injury in crashes. 

Are boosters the answer? The fact is boosters can help. A child 

should use a lap belt that fits over the upper legs or pelvis and not 

the stomach. The shoulder belt should cross the center of the chest. 

It should not come across the neck and face. For some children, 

this optimal level of restraint may not be achievable without a 

booster seat. However, the Institute believes that requiring boosters is a misplaced priority at this time. 

First, requiring boosters complicates the first priority in protecting child occupants, which is to get kids buckled up in the first 

place. It means that we must convince parents not only to buckle 

their children, but also to have booster seats available for all the 

children they might carry. A parent who buckled their child into 

a vehicle’s lap-shoulder belt alone would become a law-breaker 

even if no booster were required to achieve a good fit. 

Now, a second concern at the Institute is that booster seats are 

not all the same. They do not fit all cars or all kids the same. To 

get a handle on this, the Institute has examined how different 

booster seats fit two different children in three different vehicles. 

Our finding is that booster seats sometimes improve belt fit and 

sometimes have no effect or can make things worse. 

I have asked Shelly to help us look at some exhibits here. I 

would like to start with this picture of 6 year old Laura in the rear 

seat of a Honda Accord. As you can see, the adult lap-shoulder belt 

fits Laura in this vehicle reasonably well without a booster. Now, 

she still might benefit from a booster in perhaps another vehicle 

with different belt geometry. But in this vehicle, when we looked 

at different booster seats we saw that they were as likely to worsen 

belt fit for her as to improve it. 

The second exhibit——

Senator FITZGERALD. Dr. Lund, could I stop you for a second and 

ask you how much that young girl who you said was 6 years old 

weighed? 

Dr. LUND. She weighs 62 pounds. 

Senator FITZGERALD. 62 pounds. 

Dr. LUND. So she’s just over the 60-pound limit, but well under 

the 80-pound limit. 

Senator FITZGERALD. How tall would she have been? 

Dr. LUND. She is 52 inches. 

Senator FITZGERALD. 52 inches, and she does look like she fits 

into that. 

Dr. LUND. Yes. 

Now, the second exhibit shows a different story. This is 5 year 

old Camron in the rear seat of a Hyundai Excel. Without benefit 

of a booster, we see two problems with the belt fit. First, the belt 

20

does lie across Camron’s neck and face. But most importantly, we 

see that the belt crosses his stomach rather than lying down on his 

thighs or across his pelvis. 

Now, if we go to the next exhibit, we see Camron in a Britax 

Star-Riser booster seat. This is not an ad for Britax, but there are 

other boosters that do this as well. But we see that with this Britax 

seat a good improvement in the belt fit. We see that the belt has 

been re-routed across the chest and, most importantly, the arms on 

this seat are keeping the lap belt low on the thighs and pelvis. 

That is what you want to do to avoid abdominal injuries. 

Now, if we go to the next exhibit, here is the problem that we 

see. This is the Jupiter Comfort Rider GTX booster. It does not 

help so much. The belt fit is somewhat better as it passes over the 

shoulder, but it achieves this by lengthening the amount of shoulder belt that is out. That means that in a frontal crash this seat 

is going to rotate further in that crash, allowing the head to go further forward. We know that in real world crashes a problem for 

kids is head injuries, even restrained kids. 

More importantly in my view in this case, though, is the fact that 

if you look at that lap belt fit on the child, you see that the lap 

belt is still in the stomach, threatening abdominal injuries in a severe frontal crash. 

Thus, our research is indicating that booster seats do not necessarily improve belt fit. Whether they do depends on the specific 

child, the specific booster seat, and the specific car model in which 

the two are positioned. 

That leads me to the final point that I would like to make. Booster seats are not well defined. In general, a booster seat raises a 

child up for a better fit. But does this mean a firm cushion qualifies as a booster seat? What about a phone book? We note that the 

National Highway Traffic Safety Administration sets forth extensive testing requirements for infant and child seats, and all states 

require the use of federally approved seats. These seats have been 

tested and approved. 

But these requirements do not apply to booster seats for children 

who weigh more than 50 pounds. It makes no sense in our view 

to require the use of special restraint devices that have not been 

tested or approved for the children that they are required for. 

Given these observations, the Institute has the following recommendations for improving child occupant protection at this time. 

The very first order of business is to get older children into restraints. Lap-shoulder belts may have limitations, but they still 

greatly improve the likelihood that children will survive in crashes. 

State legislatures are already moving to remove the loopholes in restraint legislation that are partly responsible for the decline in restraint use by elder children. The next step is we have got to get 

the police enforcing those laws as well. 

At the same time, though, we must recognize that these belts do 

not fit all children well. Research should proceed to document the 

benefits that booster seats can and cannot provide. We need to understand not only the potential limitations of lap-shoulder belts, 

but also the aspects of booster seats that help or do not help. 

We do not yet—I go back to my point that not all boosters are 

the same, and our problem is we do not know which differences are 

21

1Williams, Allan F. 1976. Observed child restraint use in automobiles. American Journal of 

Diseases of Children 130:1311–17. 2 National Highway Traffic Safety Administration. May 1999. National occupant protection 

use survey, 1998, controlled intersection study (draft). Research Notes. Washington, D.C. U.S. 

Department of Transportation. 3Melvin, John W.; Weber, Kathleen; and Lux, Paula. Performance of child restraints in serious crashes. Proceedings of the 24th Annual Conference of the American Association for Automotive Medicine, 117–31. Morton Grove, IL: American Association for Automotive Medicine. 4 Insurance Institute for Highway Safety. 2000. How state laws measure up. Status Report

35:10. 

the most important. We need research. At a minimum, before we 

require booster seats we need a federal definition of booster seats 

that is based on science and test requirements that are standard 

and realistic. 

That concludes my testimony, Mr. Chairman. 

[The prepared statement of Dr. Lund follows:]

PREPARED STATEMENT OF ADRIAN K. LUND, CHIEF OPERATING OFFICER, INSURANCE

INSTITUTE FOR HIGHWAY SAFETY

The Insurance Institute for Highway Safety is a nonprofit research and communications organization that identifies ways to reduce motor vehicle crashes and 

crash losses. I am the Institute’s chief operating officer, and I am here to discuss 

the issue of child occupant protection—in particular, the advisability of requiring 

booster seats. 

Main Issue is Whether Restraints are Used 

The proportion of children who ride restrained has increased markedly since the 

early 1980s,1,2 but too many children still ride unrestrained. The results are deadly. 

In 1999, more than 1,300 child passengers (12 and younger) died in crashes. Only 

36 percent of them were restrained. Another 14 percent were either improperly restrained (in all likelihood, gross misuse of the child seat or safety belt) or restraint 

use was unknown. Fifty percent of the children who died were unrestrained. Thus, 

nearly two of every three child deaths probably involved a failure to use an available restraint system. Among the older children in this group, restraint use was 

lower than among the infants and youngest children (0–3 years old). 

CHILDREN KILLED IN PASSENGER VEHICLES, 1999

Age Count 

Unrestrained Unknown/Improper Restraint Restrained 

NO. Percent NO. Percent NO. Percent 

0–3 years 451 172 38% 80 18% 199 44%

4–6 years 281 148 53% 37 13% 96 34%

7–8 years 215 119 55% 33 15% 63 29%

9–12 years 362 212 59% 33 9% 117 32%

TOTAL 1,309 651 50% 183 14% 475 36%

Source: Fatality Analysis Reporting System 

So, when it comes to protecting infants and children in motor vehicles, the key 

issue is whether a restraint system is used—not what type of restraint or whether 

it is installed precisely as the manufacturer intended (research indicates that, even 

when restraints are misused, they often provide good protection).3 What matters is 

that so many children still are riding unprotected by any kind of restraint. 

Ratings of State Laws Based on Likelihood of Increasing Restraint Use 

The Insurance Institute for Highway Safety always has placed the highest importance on enacting and enforcing laws that require restraint use by all children sitting in all vehicle seats. Last year the Institute rated selected traffic safety laws 

in every state, based on research indicating the extent to which the laws enhance 

highway safety (attachment).4 To evaluate laws protecting child passengers, the Institute considered the comprehensiveness of both child restraint and adult belt use 

laws, which cover older children. The laws that earn the highest ratings provide primary coverage for all children 12 and younger in all vehicle seats. (Primary coverage means police may stop and ticket motorists for restraint violations alone. All 

22

5Ferguson, Susan A.; Wells, JoAnn K.; and Williams, Allan F. 2000. Child seating position 

and restraint use in three states. Injury Prevention 6:24–28. 6 National Highway Traffic Safety Administration. 2001. www.nhtsa.dot.gov/people/injury/

childps/Boosterseat/talking.html. Washington, D.C. U.S. Department of Transportation. 

child restraint laws are primary, but most adult belt laws are secondary, which 

means motorists have to be stopped for some other violation first.) Laws with low 

ratings allow some children to ride unrestrained. 

Children too old to be covered under the child restraint laws in 11 states (Alabama, Arizona, Idaho, Illinois, Indiana, Iowa, Minnesota, Mississippi, New Jersey, 

Ohio, and Pennsylvania) are protected by adult belt laws that apply only to people 

riding in the front seat. Thus, it is perfectly legal in these states for children to ride 

unrestrained in rear seats. This makes no sense. The back seat is where we tell parents it is safest for their children to ride, so restraint laws should cover the kids 

who sit there. Closing such loopholes in the laws should be our highest priority. 

In rating the laws, the Institute did not consider what kind of restraint a law requires for children of various ages. Adults could buckle children into rear-facing infant restraints, forward-facing child restraints, or adult lap/shoulder belt systems, 

as appropriate. This reflects the Institute’s major concern, which is to ensure that 

all children in all vehicle seats are restrained all the time. 

Restraint Use Declines After Age Two 

The problem of children riding unrestrained is not uniform from infant through 

preteen years. Restraint use declines after age two, according to recent Institute 

surveys conducted in three states. In particular, restraint use drops off precipitously 

among children ages 3–6 compared with 0–2 year-olds.5 We do not know why this 

is happening, but it means these children are at unnecessary injury risk in crashes. 

PERCENT OF CHILDREN RESTRAINED 

FRONT SEAT

(in percent) 

REAR SEAT

(in percent) 

MICHIGAN 

younger than 1 82 96

1–2 years 69 98

3–6 years 56 44

7–12 years 69 39

NORTH CAROLINA 

younger than 1 89 94

1–2 years 83 96

3–6 years 66 57

7–12 years 79 39

TEXAS 

younger than 1 77 89

1–2 years 64 92

3–6 years 55 42

7–12 years 73 37

Source: Ferguson, Susan A.; Wells, JoAnn K.; and Williams, Allan F. 2000. Child seating position and restraint use in three states. Injury Prevention 6:24–28. 

Are Booster Seats the Answer? 

There is merit in the idea of booster seats for some children who have outgrown 

their child restraints. Experts agree that a child should use a lap belt that fits over 

the upper legs or pelvis (not the stomach) and a shoulder belt that crosses the center of the chest (not the face or neck). The knees should bend at the edge of the 

vehicle seat so the child is not encouraged to slouch down for comfort, displacing 

the lap belt up over the stomach or perhaps even allowing the child to slide out from 

under the belt system. 

For some children, this level of restraint may not be achievable without a booster 

seat, so some people would like to require boosters. The idea is that adult belts will 

fit better, more 3–6 year olds will ride restrained, and these children will be better 

protected than in adult belts alone. Three states already have passed booster seat 

requirements covering children to age 6 or 60 pounds: Arkansas, California, and 

Washington. States also are considering legislation that would extend booster seat 

requirements to children who weigh less than 80 pounds or are shorter than 57 

inches, as recommended on the National Highway Traffic Safety Administration’s 

website.6

23

The Institute believes emphasizing boosters is a misplaced priority. One problem 

is that it complicates the task of complying with the law. Parents have to buy boosters and have them available for any children they might take along in their cars. 

A parent who buckles a child into a vehicle’s lap/ shoulder belt alone would become 

a lawbreaker, even if no booster were needed to achieve a good belt fit. Adding 

booster seat requirements for 4–6 year olds without also extending the coverage of 

child restraint laws to 7–12 year-olds still would leave substantial numbers of children unprotected. 

Booster seat requirements still might be a good idea if the boosters were to greatly improve the fit of adult safety belts. But it is not clear that they do. Institute 

researchers have tried to get a handle on this by buckling two children (a 6-yearold girl 52 inches tall weighing 62 pounds; a 5-year-old boy 45 inches tall weighing 

42 pounds) into 6 different booster seats positioned in 3 different passenger vehicles 

(a small car with contoured seats, a midsize car with bench seats, and a passenger 

van with captain’s chairs). For comparison, the researchers conducted the same 

placements with a Hybrid III dummy representing a 6-year-old boy (50th percentile 

height at 45 inches tall; 75th percentile weight at 52 pounds). Sixty-three different 

placements were assessed, including ones in which no booster seats were used (adult 

belt systems only). 

One finding is that some booster seats are very good—that is, they route the adult 

lap/shoulder belt correctly—while others provide only marginal improvement in belt 

fit. Getting a good one does not necessarily mean buying the most expensive one. 

The Britax Star-Riser is a good choice at $100. Evenflo’s Right Fit is another good 

booster seat costing only $20.


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Adult safety belts alone (above left) do not fit some children, like 5-year-old 

Camron who weighs 42 pounds. The shoulder belt cuts across his face and neck, 

while the lap belt is much too high across his stomach instead of lower on his upper 

legs or pelvis. Plus his knees do not bend at the edge of the vehicle seat, so he is 

likely to scoot forward. The right booster seat can help. The key is to get the right 

one. The Jupiter Komfort Rider GTX (above middle) does not help much. The shoulder belt is routed better than with an adult belt alone, but the lap belt still is positioned too high. A better fit is in the Britax Star-Riser (above right), which routes 

both the lap and shoulder portions for a correct fit. But not every child 4-8 years 

old needs a booster seat. Laura (below), who is nearly 7 and weighs 62 pounds, fits 

reasonably well in an adult belt system without a booster.


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The main finding of this research is that booster seats enhance belt fit in some 

configurations. In others, a booster makes no difference or results in a poorer fit. 

All of this variability makes it difficult, if not impossible, to generalize about which 

groups of children would benefit from a booster seat requirement. It depends on the 

specific child, the specific booster seat, and the specific car model in which the two 

are positioned. 

An even more basic problem with requiring booster seats is that we in the United 

States do not have a clear definition of what boosters for older children are. In general, a booster seat raises a child up for a better fit in an adult belt system. Does 

this mean a firm cushion would qualify as a booster seat? What about a phone book? 

Kids, even when they are the same age, vary widely in height and weight. Booster 

seats vary in size and shape. Vehicle seats vary from bench-type to contoured. Safety belt systems also vary from car model to model. So which boosters work best in 

which vehicles? Which children need booster seats in what vehicle models? For how 

long? The answers vary from child to child and vehicle to vehicle. There is too much 

variability to apply a single booster seat requirement to all kids of specified ages 

(or heights or weights) in all cars. 

Another issue involves testing. The National Highway Traffic Safety Administration sets forth extensive testing requirements for infant and child restraints. All 

states require the use of federally approved seats. But these requirements do not 

apply to booster seats for children who weigh more than 50 pounds. It makes no 

sense to promote, let alone require, the use of devices for older children that have 

not been tested or approved. 

Recommendations 

The first order of business is to get older children in restraints regardless of what 

type of restraint is used. Lap/shoulder belts may have limitations, but they still 

greatly improve the likelihood that children will survive in crashes. State legislators 

already are extending child restraint laws to cover older children, which accomplishes two objectives. It closes loopholes that once allowed some children to ride 

unrestrained, and it extends primary enforcement of restraint laws to more children. (All child restraint laws are primary, but most adult belt laws are secondary.) 

At the same time, government and other researchers are proceeding with studies 

to document the benefits that booster seats can and cannot provide. These studies 

should continue. We need to understand not only the limitations of lap/shoulder 

belts for children but also the aspects of booster seats that help remedy such limitations. Not all booster seats are the same, and we do not yet know which differences 

are the important ones. At a minimum, we need a federal definition of booster seats 

based on science and test requirements that are standard and realistic. 

26


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State Traffic Laws Rated Good to Poor, Revealing Nation’s Best and Worst 

Ratings Based on Likelihood Laws Will Enhance Traffic Safety by Influencing Driver 

Behavior 

Traffic safety laws are on the books in every state to reduce deaths and injuries 

in crashes by changing driver behavior. The idea is to deter dangerous behavior like 

driving while impaired by alcohol and encourage beneficial habits like buckling up 

safety belts. 

How do these laws compare from state to state? Overall the strongest laws in the 

United States are in California, the District of Columbia, and Maryland. The weakest traffic safety laws are those in Montana, South Carolina, and South Dakota. 

Research has repeatedly shown the benefits of good traffic safety laws that are 

enforced. This has been established as the only way to achieve high belt use rates, 

for example. The starting point is to put a good law on the books, which is why the 

Institute has conducted a comprehensive assessment of key traffic safety laws in all 

50 states and the District of Columbia. 

‘‘We didn’t evaluate every law by any stretch,’’ says Institute senior vice president 

Allan Williams. ‘‘We looked at provisions of selected laws that research shows have 

improved driver behavior. Clearly some states do a better job than others of getting 

good traffic safety laws on the books.’’

Even if a law includes strong provisions, enacting it isn’t sufficient to influence 

the behavior of many drivers. The necessary next step to maximize a law’s effectiveness is to publicize and enforce it. ‘‘People don’t usually comply with traffic laws because they think doing so will prevent crashes or save lives. People comply if they 

believe there’s a real chance of getting a ticket or points on their license if they 

don’t. This is why we didn’t give high marks to laws that are on the books but are 

hard to enforce,’’ Williams explains. 

Institute researchers assessed alcohol-impaired driving laws, young driver licensing laws, safety belt use laws, child restraint use laws, motorcycle helmet use laws, 

and laws allowing camera enforcement of red light violations. A rating of good, acceptable, marginal, or poor is assigned to each law, or set of related laws, in each 

state (see pp. 32–33). These ratings reflect how well the provisions of a given law 

can be expected to improve safety, based on research identifying what works and 

doesn’t work to achieve such improvements.

28

DUI/DWI laws: ‘‘There used to be a lot of high-profile activity to reduce alcohol-impaired driving. But lately people seem to believe we’ve solved this problem, so 

the push to strengthen laws and enhance enforcement has waned,’’ Williams 

says. The Institute has evaluated four separate DUI/DWI laws in all states and 

the District of Columbia. 

1. Under administrative license revocation laws, the license of every driver arrested for DUI/DWI is automatically revoked for a specified time. The success of 

such laws in reducing fatal crashes has been documented since the late 1980s (see 

Status Report, March 14, 1988). The best administrative license revocation laws require driver’s license removal for at least 30 days with few or no exceptions for 

hardship. 

‘‘Administrative license revocation is the cornerstone of an effective DUI or DWI 

program,’’ Williams says. Yet Kentucky, Michigan, Montana, New Jersey, Pennsylvania, Rhode Island, South Carolina, South Dakota, and Tennessee still don’t have 


424lund2.eps
29

such laws on the books. Another 17 states don’t require revocations lasting at least 

30 days. 

2. Under the laws in 21 jurisdictions, it’s illegal to drive with a blood alcohol concentration, or BAC, at or above 0.08 percent (elsewhere it’s usually 0.10 percent). 

Research indicates that 0.08 laws have reduced fatal crashes in which alcohol is a 

factor. 

3. Across the United States, it’s illegal for people younger than 21 to drive with 

any measurable BAC. All jurisdictions have such laws, dubbed zero tolerance, because in 1998 the federal government began withholding highway funds from states 

without the provisions. But the laws are far easier to enforce in some states than 

others. Institute researchers found that laws in Massachusetts, Nevada, New Jersey, New Mexico, North Dakota, Rhode Island, and Tennessee are virtually unenforceable because police must suspect a young driver has a high BAC before administering a breath test to check for violations of the zero tolerance law, under which 

any measurable BAC constitutes a violation (see Status Report, March 11, 2000; on 

the web at www.highwaysafety.org). 

4. High-profile sobriety checkpoints are effective ways to deter alcohol-impaired 

driving. They increase drivers’ perceptions that apprehension is likely to follow the 

offense. Yet checkpoints aren’t permitted in Idaho, Iowa, Michigan, Minnesota, Montana, Oregon, Rhode Island, Texas, Washington, Wisconsin, or Wyoming. 

Graduated licensing laws: The newest drivers are the most hazardous because 

they’re not only inexperienced but also immature. Teenage drivers have the highest 

crash risk of any group, and 16 year-olds pose a much greater risk than older teens. 

This is why graduated licensing is being embraced by state legislators. Its purpose 

is to protect beginners by phasing in full driving privileges so teenagers graduate 

to unrestricted licenses over at least a year (see Status Report, March 11, 2000; on 

the web at www. highwaysafety.org).

30

Beginning with Florida in 1996, ‘‘graduated licensing has caught on rapidly,’’ Williams points out. ‘‘An impetus has been media attention on young driver crashes, 

especially fatal crashes. This attention has kept the issue in the forefront and 

helped make state legislators receptive to graduated licensing.’’

Now only nine states (Alabama, Arizona, Hawaii, Kansas, Montana, Nevada, 

Oklahoma, Texas, and Wyoming) fail to include any of the key provisions of graduated licensing. In the other 42 jurisdictions, there’s wide variation in the strength 

of the provisions. 

Williams explains that ‘‘the most important aspect of graduated licensing is to restrict driving once a beginner gets a license.


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GOOD LAWS 

ALCOHOL 

Alabama 

California 

Florida 

Hawaii 

Kansas 

New Hampshire 

Utah 

Vermont 

YOUNG DRIVERS 

California 

District of Columbia 

Massachusetts 

New Jersey 

Oregon 

Tennessee 

Washington 

SAFETY BELT USE 

California 

District of Columbia 

Oregon 

CHILD RESTRAINT USE 

Alaska 

California 

Colorado 

Connecticut 

Delaware 

District of Columbia 

Georgia 

Hawaii 

Kansas 

Louisiana 

Maryland 

Michigan 

Missouri 

New Hampshire 

New York 

North Carolina 

North Dakota 

Oklahoma 

Oregon 

Rhode Island 

Tennessee 

Texas 

Utah 

Vermont 

Virginia 

Washington

32


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HOW LAWS ARE RATED 

Alcohol Laws 

GOOD: an administrative license revocation law that mandates at least a 30-day 

revocation for a violation with few or no exceptions for hardship; a law under which 

it’s illegal to drive with a blood alcohol concentration (BAC) at or above 0.08 percent; a readily enforceable law under which it’s illegal for anyone younger than 21 

to drive with any measurable BAC (enforcement is impeded in some states because 

police must suspect that a young driver has a high BAC before administering an 

alcohol test to check for any measurable BAC); and sobriety checkpoints must be 

permitted 

ACCEPTABLE: an administrative license revocation law (not necessarily including 

a 30-day revocation) or a law under which it’s illegal to drive with a BAC at or 

above 0.08 percent plus at least one of the other provisions listed above (see GOOD) 

MARGINAL: a readily enforceable law under which it’s illegal for anyone younger 

than 21 to drive with any measurable BAC plus no limitations on conducting sobriety checkpoints 

POOR: one or none of the four provisions listed above (see GOOD) 

Young Driver Licensing Laws 

GOOD: minimum 6-month learner’s phase; once licensed, beginners are subject to 

restrictions beginning at 10 p.m. or earlier and extending to 5 a.m. and/or a restriction that allows no more than one passenger when driving unsupervised; and beginners must wait until age 17 for their unrestricted licenses 

ACCEPTABLE: law includes the late evening/night driving restriction and/or passenger restriction listed above, and beginners must wait until age 17 for their unrestricted licenses; or law includes a minimum learner’s phase (any length) plus some 

restrictions on driving hours and/or passengers, and beginners must wait until age 

161⁄2 for their unrestricted licenses 

MARGINAL: law includes a minimum learner’s phase (any length) plus, once a beginner is licensed, some restrictions on driving hours and/or passengers; or law includes only a learner’s phase lasting a minimum of 6 months; or law includes only 

restrictions on driving hours and/or passengers once a beginner is licensed 

POOR: minimum learner’s phase shorter than 6 months and no restrictions on driving by beginners 

Safety Belt Use Laws 

GOOD: law allows primary enforcement (police may stop and ticket motorists for 

belt law violations alone); fines and/or license points are imposed for violations; and

law applies to occupants in rear as well as front seats 

ACCEPTABLE: law allows primary enforcement but doesn’t require belt use in rear 

seats 

MARGINAL: law allows secondary enforcement (police must stop motorists for other 

violation before enforcing belt law) 

POOR: either no belt use law or law doesn’t impose any fine or license points 

Child Restraint Use Laws 

GOOD: all children younger than 13 in all vehicle seats are required to ride in infant restraints, child seats, or safety belts; enforcement is primary (see above for 

definition of primary enforcement) 

MARGINAL: all children younger than 13 in all seats are required to ride in infant 

restraints, child seats, or safety belts; enforcement under adult belt laws may be 

secondary (see above for definition of secondary enforcement) 

POOR: some children younger than 13 aren’t required to be restrained 

Motorcycle Helmet Use Laws 

GOOD: all motorcycle riders must wear helmets 

POOR: either no helmet use law or law covers only some riders 

Red Light Camera Enforcement Laws 

GOOD: law grants specific statewide authority for camera enforcement 

ACCEPTABLE: operational camera enforcement without specific state authority 

MARGINAL: law restricts authority for camera enforcement to specific communities 

only 

POOR: no law grants authority for camera enforcement and no operational camera 

enforcement

35

GOOD LAWS 

MOTORCYCLE HELMET USE LAWS 

Alabama 

California 

District of Columbia 

Georgia 

Maryland 

Massachusetts 

Michigan 

Mississippi 

Missouri 

Nebraska 

Nevada 

New Jersey 

New York 

North Carolina 

Oregon 

Pennsylvania 

Tennessee 

Vermont 

Virginia 

Washington 

West Virginia 

RED LIGHT CAMERA ENFORCEMENT 

California 

Colorado 

Delaware 

District of Columbia 

Hawaii 

Maryland

36

States accomplish this by prohibiting unsupervised driving in high-risk situations 

like at night or with passengers. The tougher these restrictions are and the longer 

they last past a beginner’s 16th birthday, the higher we rated a state’s licensing law 

covering young drivers. Also important is an initial learning phase lasting six 

months or longer when only driving under supervision is allowed.’’

Safety belt use laws: In 1984, New York enacted the nation’s first law requiring 

motorists to buckle up. Within 2 years, 22 jurisdictions had such laws, and now all 

but New Hampshire does. But the provisions vary widely. 

For example, most states still don’t allow police to stop motorists solely for belt 

violations (primary enforcement). Enforcement is secondary, which means motorists 


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have to be stopped for some other violation first. This impedes enforcement and explains, in part, why belt use is significantly lower in the United States than in Canada and elsewhere. The laws in only 17 U.S. states and the District of Columbia 

allow primary enforcement, and even in these states the laws don’t always cover 

people riding in rear seats. 

‘‘One thing we know from repeated research conducted since the early 1980s is 

that belt law effectiveness depends on publicity and enforcement,’’ Williams says 

(see Status Report, Jan. 15, 2000; on the web at www. highwaysafety.org). ‘‘It’s 

harder to enforce a secondary law. This is why, when we rated state belt use laws, 

we considered whether the provisions for enforcement are primary or secondary. We 

also considered whether all occupants are covered.’’

Child restraint laws: To evaluate these, the Institute assessed not only the comprehensiveness of state laws covering very young children but also the adequacy of 

adult belt laws, which cover older children. What matters most is whether these 

laws together provide primary coverage for all children younger than 13 in all seats 

or allow some children to ride unrestrained. 

For example, children too old to be covered under the child restraint laws in 14 

states are protected by adult belt laws that apply only to people riding in the front 

seat. Thus, it’s perfectly legal for children to ride unrestrained in rear seats. 

‘‘This makes no sense,’’ Williams says. ‘‘The back seat is where we tell parents 

it’s safest for their children to ride, so restraint laws should cover the kids who sit 

there.’’

Motorcycle helmet use laws: By the 1970s, helmet laws had been enacted in 

virtually all states. All riders were covered, and injuries among cyclists were reduced. (Wearing a helmet reduces the risk of death in a motorcycle crash by about 

onethird). But by 1980 most states had abandoned their motorcycle helmet laws or 

substantially weakened them by applying them only to riders younger than a specified age, usually 18. 

Now all riders are covered in only 21 jurisdictions. Helmet laws aren’t on the 

books in Colorado, Illinois, or Iowa, and they’re watered down in another 27 states. 

‘‘You might as well not have a law that doesn’t apply to all riders,’’ Williams says, 

‘‘because so few motorcyclists are the younger riders covered under the weak laws. 

Helmet use rates in states with limited laws are about the same as in states without any laws at all’’ (see Status Report, April 4, 1998; on the web at 

www.highwaysafety. org). For this reason, the Institute assigned poor ratings to the 

laws in all states where helmet laws don’t apply to all riders. 

Red light camera enforcement: Running red lights is a good example of ‘‘everyday’’ aggressive driving. It’s less spectacular but a lot more common than the occasional headline-grabbing instances of aggressive driving known as road rage. 

Until a few years ago, red light violators had to be apprehended and ticketed one 

by one. The odds of this were so small that offenders found little reason to change 

their ways. But now they do, at least where red light cameras have been installed 

to snap photos of vehicles whose drivers deliberately run red lights. Then the violators are ticketed by mail. 

Such programs reduce red light running by about 40 percent (see Status Report,

July 11, 1998; on the web at www.highwaysafety. org), but there’s a problem. Relatively few red light camera programs are operational, in many cases because state 

laws haven’t been enacted to authorize them. In only six jurisdictions (California, 

Colorado, Delaware, the District of Columbia, Hawaii, and Maryland) is camera enforcement specifically authorized for use statewide. 

‘‘Cameras shouldn’t merely be permitted in the United States. They should be in 

wide use, as in other countries,’’ Williams says. ‘‘Red light running kills hundreds 

of people every year, more than half of them struck by the signal violators. To make 

a dent in this toll, we’ve got to encourage the use of the camera technology we know 

will deter the would-be violators.’’

For more information: Specific provisions of selected traffic safety laws in all 

50 states and the District of Columbia are detailed at www.highwaysafety.org. Click 

on ‘‘safety facts’’ and then choose ‘‘state laws.’’

38


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39

Senator FITZGERALD. Dr. Lund, thank you very much. 

Dr. Flaura Winston, the assistant professor of pediatrics at the 

Children’s Hospital of Philadelphia. Thank you, Dr. Winston, for 

being here. 

STATEMENT OF FLAURA KOPLIN WINSTON, M.D., PH.D.,

ASSISTANT PROFESSOR OF PEDIATRICS,

CHILDREN’S HOSPITAL OF PHILADELPHIA AND UNIVERSITY 

OF PENNSYLVANIA SCHOOL OF MEDICINE 

Dr. WINSTON. Good morning, Mr. Chairman, Members of the 

Committee. Thank you for the opportunity to speak. My name is 


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Dr. Flaura Koplin Winston. I am a biomechanical engineer as well 

as a board-certified pediatrician and the mother of two young boys, 

Zachary and Andrew. I head a pediatric injury research center at 

the Children’s Hospital of Philadelphia and the University of Pennsylvania. 

Together with State Farm Insurance Companies, we have created the world’s largest surveillance system for children in motor 

vehicle crashes, Partners for Child Passenger Safety. We now have 

hard data on which to base policy—not simply fitting children in 

booster seats, not opinions, but hard data on 137,000 children in 

real crashes. Based on these numbers, more than 1.5 million U.S. 

children are passengers in motor vehicle crashes annually. 

Today more than 750 children will be injured. Nearly 100 of 

these children will be seriously injured or killed. Unfortunately, the 

most common serious injuries are to the brain. I understand that 

in most cases, restraints will save a child’s life. That has been demonstrated many times. But many children will still be seriously injured if they are inappropriately restrained. Many of these serious 

injuries will be to the brain. 

As a physician, I know the brain is the organ least able to recover. These injuries to the brain tend to be the most devastating 

to families and it is essential to prevent these injuries. 

In a nutshell, my research shows that most parents have gotten 

the message to place their youngest children in car seats in the 

rear of the vehicle. My research bears out that these properly restrained children are the least likely to sustain devastating injuries. But at the same time, it is glaringly obvious that most parents 

have not gotten the message that children under age 9 are too 

small for adult seat belts and require car seats or belt-positioning 

booster seats. 

This lack of awareness has led to devastating injuries that could 

be prevented. My research points to the need for ensuring a more 

consistent message to parents about appropriate restraint, backed 

up by consistent laws and their enforcement. Preventable injuries 

occur every day. 

Let me demonstrate the safety advantages of a belt-positioning 

booster seat. This is a simulation that was based on multiple crashes that we investigated. The above simulation shows a 6 year old 

child properly restrained in a belt-positioning booster seat. This 

child barely moves during the 35 mile per hour crash. 

In the below simulation, the same child is improperly restrained 

in a seat belt. This child dummy demonstrates what many children 

will do with an uncomfortable seat belt that falls over their neck. 

The child would move the seat belt behind her back. As you can 

see, she is thrown forward dramatically without the torso protection. 

Our data indicate that inappropriately restrained children can 

strike their head, making them four times more likely to suffer 

brain injuries than children in booster seats. Further, children in 

adult seat belts, as you all very well know, suffer intestinal, liver, 

spleen, and spinal cord injuries, all due to the excessive bending 

during a crash from being in a seat belt rather than a belt-positioning booster seat. 

41

Now, please look at this graph of recommended restraint use. I 

am defining recommended restraint in that children under 4 need 

to be in car seats and children 4 to 8 year olds need to be in booster seats. What you can see is an alarming dip in recommended restraint between the ages of 3 and 8. More than 80 percent of children through age 2 are appropriately restrained in car seats, according to our study. This is good news. 

Beginning at age 3, appropriate restraint use drops to 52 percent. Nearly half of 3 year old children are not in car seats. By age 

4, the most prevalent form of restraint is, inappropriately, the 

adult seat belt and virtually no 7 or 8 year old children are in beltpositioning booster seats. 

Instead of using car seats or belt-positioning booster seats, many 

children between ages 3 and 8 are inappropriately restrained in 

adult seat belts. It is important to note that many children older 

than 8 are too small for adult seat belts and may benefit from beltpositioning booster seats. 

Existing laws have been very effective in getting those youngest 

children into car seats. But the laws as they currently stand are 

a patchwork that differ widely and fail to incorporate current best 

practice guidelines. This serves as a source of confusion for parents. 

We have conducted extensive focus groups to actually ask about 

this and the parents in our study suggested that strong laws that 

are enforced are important for sending clear, consistent messages 

regarding child passenger safety. Parents, much like Ms. Skeen, 

look to the law. 

The responsibility for the safe transportation of children must be 

shared, though, by educators, regulators, legislators, manufacturers, and the parents. All of us must share responsibility for America’s children. Clearly, we must ensure that all children are restrained. I agree with that. That will save lives. 

But this is not enough. We want the best protection for our children, and we now know that children over 40 pounds are seriously 

injured when they are improperly restrained. We want the best. 

We need to determine evidence-based uniform guidelines for appropriate restraint for all children. We need to consistently incorporate 

these guidelines into state laws and enforce them. We need to ensure that high quality, low cost, user friendly, comfortable restraints are available for all children in all vehicles. 

I am happy to say that State Farm Insurance Companies and the 

Children’s Hospital of Philadelphia are doing their part. We have 

collaborated in many efforts to get the appropriate restraint message to parents, doctors, advocates, legislators, enforcement agencies, and manufacturers, and now have produced the nation’s first 

in-school curriculum to educate young children about booster seats. 

Efforts such as these have resulted in an increased booster seat 

awareness. Our data are showing a trend of increased booster seat 

use. But overall, appropriate restraint use remains very, very low. 

Partners for Child Passenger Safety is here to help you in your 

important work and we commend all the hard work that you have 

been doing. If there is any way that we can provide additional 

data, we will be glad to do that. 

Mr. Chairman, I am ready to respond to any questions you might 

have. 

42

[The prepared statement of Dr. Winston follows:]

PREPARED STATEMENT OF FLAURA KOPLIN WINSTON, M.D., PH.D.,

ASSISTANT PROFESSOR OF PEDIATRICS, CHILDREN’S HOSPITAL OF

PHILADELPHIA AND UNIVERSITY OF PENNSYLVANIA SCHOOL OF MEDICINE

Good morning, Mr. Chairman, Members of the Committee. Thank you for the opportunity to speak. 

My name is Dr. Flaura Koplin Winston. I am a practicing pediatrician at The 

Children’s Hospital of Philadelphia, a faculty member at the University of Pennsylvania School of Medicine, a biomechanical engineer, a clinical researcher, and a 

mother of two boys, Zachary and Andrew, who inspire my research to make every 

ride safe for children. The Children’s Hospital of Philadelphia is a Level One Pediatric Trauma Center, designated to care for the most seriously injured children, but 

much of our work is devoted to preventing injury. We realize that the best way to 

care for our children is to keep them safe, avoiding the physical and emotional pain 

and suffering that accompany every childhood injury. 

I am the Principal Investigator of Partners for Child Passenger Safety, the world’s 

largest surveillance system for children in automobile crashes. Begun in 1997, Partners for Child Passenger Safety, a collaboration between State Farm Insurance 

Companies, the University of Pennsylvania, and The Children’s Hospital of Philadelphia, is the first comprehensive research study of how and why children are injured or killed in motor vehicle crashes. 

Each day the Partners research team receives information, with privacy safeguards, from State Farm on nearly 200 children involved in crashes in 15 states 

(AZ, CA, DE, IL, IN, M.D., MI, NC, NJ, NY, NV, OH, PA, VA, and WV) and the 

District of Columbia. The research team conducts in-depth telephone interviews and 

on-site crash investigations in order to estimate the number of children in crashes; 

identify specific safety problems for children in motor vehicles; suggest solutions to 

those problems; and evaluate real-world effectiveness of vehicle and restraint system features. 

In this testimony, I will describe the national problem of children in motor vehicle 

crashes in terms of the number of crashes involving children and the number of 

children who are injured in these crashes. I will also describe the high proportion 

of children who are inappropriately restrained for their age and size and the mechanism of injuries due to inappropriate restraint. The key message is that the vast 

majority of parents across the country are not adequately protecting their 4-to-8-

year-old children in crashes. These parents can do a better job by appropriately restraining these children in belt-positioning booster seats in the rear seat of their vehicles on every ride. 

With just two years of data collection, Partners for Child Passenger Safety has 

collected information on more than 90,000 crashes involving roughly 137,000 children under age 16. Based on these numbers, we estimate that each year in the 

United States, more than 1.5 million children are passengers in motor vehicle crashes. More than 750 children will be injured today, nearly 100 of these children will 

be seriously injured. Unfortunately, the most common serious injuries are to the 

brain, which can lead to devastating long-term disabilities. 

Motor vehicle crashes are very violent events that occur in milliseconds, in the 

blink of an eye. Our data indicate that nearly half of crashes involving children 

occur within seven minutes from home. All it takes is a split second for an errand, 

a car pool, or a family outing to turn into tragedy. 

Last summer we learned of a tragic case in which a 7-year-old, we’ll call him 

Jared, was the only fatality. On a warm June evening in Arizona, Jared’s father 

swerved and crossed the center line of the highway and struck a pickup truck headon. There were no airbags in the vehicle, yet Jared’s father survived this serious 

crash without brain, spinal cord, or organ injury. Jared, unfortunately, was inappropriately restrained in a lap-shoulder belt in the front seat of his father’s mid-size 

sedan. During the crash, his sub-optimal restraint allowed him to move forward and 

strike the windshield. Jared suffered a lethal injury to his cervical spine—a fracture 

with complete dislocation. If Jared had been restrained in a belt-positioning booster 

seat in the back seat of his father’s car, he likely would have survived. His younger 

siblings in the rear seat survived the crash. A simple action—using the appropriate 

restraint and placing the child in the rear seat—could have likely prevented a family’s lifetime of mourning. 

Just a few months ago, I learned of another preventable tragedy. At 7:00 in the 

morning, a 5-year old girl from Ohio, let’s call her Latasha, was the only passenger 

injured in a moderate severity crash. Her 22-year old mother was driving their fullVerDate 0ct 09 2002 12:13 Nov 30, 2004 Jkt 088785 PO 00000 Frm 00046 Fmt 6633 Sfmt 6621 S:\WPSHR\GPO\DOCS\88785.TXT JACK PsN: JACKF
43

size sedan when another vehicle made a left turn into the path of their vehicle, impacting the right side. Latasha’s mother, who was wearing her lap and shoulder 

belt, was uninjured. Latasha’s 18-month-old sister, who was appropriately restrained in her child safety seat in the rear seat, was uninjured. Latasha, who was 

sitting in the right rear seat next to her sister, was inappropriately restrained in 

a lap-shoulder belt. Latasha suffered bilateral severe kidney damage. Our investigation indicated that the inappropriate restraint caused the serious injuries known as 

‘‘seat belt syndrome.’’ If Latasha had been restrained in a belt-positioning booster 

seat, she would likely have been uninjured. 

Preventable injuries such as these occur every day. 

Our data indicate that most parents ensure that their children are restrained. 

The simple act of restraining a child makes it three times less likely that that child 

will be injured in a crash. Many parents further protect their children by placing 

them in the back seat, thereby making it an additional two times less likely that 

their children will be injured in most vehicles. Further, most parents ensure that 

their youngest children are restrained in child safety seats. Accordingly, these children have the lowest chance of getting injured of any age group. 

However, I am particularly concerned with children between age 3 and 8 years. 

That is where our data show an alarming decrease in recommended restraint use 

[refer to recommended restraint use chart—Attachment A]. Note the u-shape in this 

graph of recommended restraint use by age. More than 80 percent of children 

through age 2 years are appropriately restrained. Beginning at age 3, appropriate 

restraint drops to 52 percent. By age 4, the most prevalent form of restraint is the 

adult seat belt. Only 24 percent of children age 4 are in booster seats. By age 7, 

virtually no children are in booster seats. Instead of using car seats or belt-positioning booster seats, many children ages 3-to-8 years old are inappropriately restrained in adult seat belts. For optimal protection during crashes, children should 

ride in child safety seats with full harness until the seat is completely outgrown 

based on manufacturer height and weight limits. This is usually around 4 years old 

and 40 pounds, at which point children should be placed in belt-positioning booster 

seats. They should remain in the belt-positioning booster seat until they are big 

enough for the adult seat belt to fit correctly. Correct adult seat belt fit is not 

achieved until a child is at least 4 feet 9 inches tall and 80 pounds, often around 

the age of nine. 

Last June, Partner’s for Child Passenger Safety published an article in the journal Pediatrics about the risk of premature graduation of children to adult seat belts. 

We found that 2-to-5-year-old children who were placed in adult seat belts were 3.5 

times more likely to suffer significant injury and four times more likely to suffer 

head injury when compared to children in the same age group who used car or 

booster seats. There is a 50 to 75 percent reduction in serious injuries to child passengers who are placed in belt-positioning booster seats rather than seat belts alone. 

Why are booster seats so much more effective than adult seat belts in protecting 

4 to 8-year-olds in car crashes? Standard equipment vehicle seat belts are designed 

for adults. During a crash, adult seat belts spread the forces of the crash over the 

strong, hard bones—the hips, shoulders, and chest—and keep the occupant in place 

so that the head, face and chest are less likely to strike the inside of the vehicle. 

An adult seat belt fits correctly when the lap portion of the belt rides low over the 

hips and the shoulder portion of the belt crosses the sternum and shoulder. Correct 

seat belt fit is not usually achieved until a child is 9 years old, the age at which 

the child’s thigh is long enough for the child to sit against the back of the seat, the 

hips are sufficiently developed to anchor the belt, and the child’s sitting height is 

sufficient for the shoulder belt to fit properly over the shoulder and sternum. 

When a child is ‘‘prematurely graduated’’ to an adult seat belt, the lap portion 

of the belt rides up over the soft abdomen and the shoulder portion crosses the neck 

or face, causing many children to move the shoulder belt behind their back or under 

their arm. Incorrect fit of the vehicle belt places the child at risk for ‘‘submarining’’ 

or sliding out of the lap belt during a crash. Rapid, ‘‘jack-knife’’ bending around a 

poorly positioned vehicle adult seat belt increases the risk of intra-abdominal and 

spinal cord injuries, also known as ‘‘seat belt syndrome’’ and brain injury due to impact of the head with the child’s knees or the vehicle interior. 

Our data indicate that the majority of the injuries to children prematurely graduated to seat belts are to the head, likely due to excessive head excursion. In addition, Partners data show that children in adult seat belts suffered the only reported 

cases of abdominal injuries, including intestinal, liver, and spleen injuries. 

Let me demonstrate the safety advantage of a belt-positioning booster seat by this 

crash simulation. [Booster seat crash simulation computer model] The above simulation shows a 6-year-old child properly restrained in a belt-positioning booster seat. 

This child barely moves during the 35 m.p.h. crash. This same child is represented 

44

in the below simulation of the same crash. She is improperly restrained in an adult 

seat belt. Like many children, she has slipped the shoulder portion of the belt behind her back. As you can see, she is thrown forward dramatically. The inappropriate fit of the adult seat belt and lack of upper body restraint puts the child at 

risk for severe head, spine, abdominal and brain injury. 

What is at stake is the safety of our children. Under contract to the National 

Highway Traffic Safety Administration, we conducted focus groups and in-depth discussions with parents about the barriers to using belt-positioning booster seats. 

There are many reasons parents give for prematurely placing their child in vehicle 

seat belts. Some parents are unaware of the likelihood of crashes and the injuries 

that can result. Others are not awareof current best practice regarding child passenger safety. Still others do not realize that children are actually more comfortable 

in belt-positioning booster seats rather than in adult seat belts alone. Clearly, education is needed. 

Parents with older vehicles face additional challenges in finding a child restraint 

compatible with vehicles that only have lap belts in the rear seat. Clearly, there is 

a role for new technologies. 

However, many parents of 4-to-8-year-old children are aware of the risks of crashes, are aware of the injuries, know that belt-positioning booster seats can reduce the 

risk of injuries, and have vehicles that can accommodate belt-positioning booster 

seats in the rear. Yet, they fail to use these devices. According to parents in our 

focus groups, the only strategy to ensure that these parents are optimally protecting 

their children is through strong laws that are enforced. 

Our current laws are not in alignment with best practice recommendations from 

the National Highway Traffic Safety Administration and the American Academy of 

Pediatrics and this serves as a source of confusion for parents. Much of the opposition to closing the gaps in child passenger restraint laws concerns the inconvenience 

and cost to adults to comply with these laws. My question to you, Senators, is this: 

What value do we, as a nation, place in the life of a child? A backless belt-positioning booster seat costs less than $20 at my local retailer. 

I am happy to say that State Farm Insurance Companies and The Children’s Hospital of Philadelphia are doing their part. We have collaborated in many efforts to 

get the appropriate restraint message to parents and have now collaborated to 

produce the nation’s first in-school curriculum, called Safe Cruisin’ with the Good 

Neigh Bear, to educate young children about booster seats. We regularly share our 

study data with doctors, advocates, regulatory agencies, and manufacturers. In 2001 

we will be producing state-specific fact sheets on each state involved in the Partners 

study to aid advocates in their educational efforts. But there is much more to be 

done. 

Efforts such as these have resulted in an increased awareness of booster seats. 

For the first time, Partners data is showing a trend of increased booster seat use. 

Maybe the climate is right for closing the gap in occupant restraint laws to require 

booster seats for older children. 

If parents continue to restrain their young children in vehicle seat belts or, worse, 

not restrain them at all, we will continue to have tragic, preventable, costly injuries 

to our children, our most precious resource. As a pediatrician, pediatric injury researcher, and mother of two young children, I am here to provide a voice for children, all children. They need our protection. They need appropriate restraint on 

every ride. 

Mr. Chairman, I am ready to respond to any questions the Committee might 

have. 

45

Senator FITZGERALD. Thank you, Dr. Winston. 

Dr. Quinlan from the Department of Pediatrics at the University 

of Chicago. Thank you for being here. 

STATEMENT OF KYRAN QUINLAN, M.D., MPH,

DEPARTMENT OF PEDIATRICS, UNIVERSITY OF CHICAGO 

Dr. QUINLAN. Thank you. Good morning, Mr. Chairman. My 

name is Kyran Quinlan. I am a board-certified pediatrician on the 

faculty at the University of Chicago. I am an injury epidemiologist, 

trained at the National Center for Injury Prevention and Control 

at the Centers for Disease Control and Prevention, and I have a 

master’s in public health in epidemiology. I am a child passenger 

safety researcher, a clinician, and a fellow in the American Academy of Pediatrics. I also have personal experience caring for children who have suffered preventable crash injuries. I regularly 

counsel parents in my practice on the need for belt-positioning 

boosters and I was a part of the recent unsuccessful attempt for a 

booster law in the chairman’s home state of Illinois. 

Thank you for this opportunity to discuss this important issue. 

I am here today with two recommendations: First, that Congress 

promote booster laws in each state; and second, that Congress support the National Highway Traffic Safety Administration to lead an 


424wins.eps
46

intensive and sustained public education campaign to promote beltpositioning boosters. 

Motor vehicle trauma is the leading threat to the health of our 

children. While most age groups have experienced recent significant declines in crash deaths, the unchanging annual count of 500 

dead and nearly 90,000 injured has clearly established the 4 to 8 

year age range as the forgotten children in traffic safety. 

These children are real. There was the 5 year old boy who was 

brought to our hospital recently after a crash. He was small for a 

5 year old and, despite being buckled in a lap-shoulder belt, he was 

ejected from his family’s car. Unconscious and bloody, he lay motionless in the street with a broken skull, pelvis, thigh, and shin 

bones. He lived and his bones will mend, but he will have a long 

road back with rehabilitation for his severe brain injury. 

Then there was the 8 year old boy we recently treated. He had 

put the shoulder belt behind his back to keep it from rubbing and 

cutting across his neck. In the instant he was thrown violently forward in the crash, the poorly fitting lap belt crushed his soft internal organs and then fractured his spine, leaving him paralyzed. 

Multiple abdominal surgeries were successful at repairing the injuries to his intestines and other internal organs. Much less successful, however, have been the attempts to bring him out of the growing depression from realizing that, while only 8 years old, he will 

never walk again. 

Too big for a car seat, not big enough for seat belts made for 

adults, these children need belt-positioning booster seats. But few 

families are using them. Data from Partners for Child Passenger 

Safety, from Dr. Winston, tell us that in our state specifically, Mr. 

Chairman, that at most 20 percent of the 4 to 5 year olds are using 

boosters, just a handful of 6 year olds do, and virtually no 7 or 8 

year olds are currently using booster seats. 

This fits with what I see in my practice on the South Side of Chicago. I recently saw a family with a 4 year old who had outgrown 

her car seat, her forward-facing car seat, and was using just a seat 

belt. I discussed the need for a belt-positioning booster and advised 

the family to get her one. The next time I saw them, they had not 

gotten a booster seat. The mom said: I remember what you told me, 

I remember you told me that my daughter’s back could break in 

a crash and that she could be paralyzed, but I just have not gotten 

around to it yet. 

Being able to say that riding without a booster is against the law 

would help me to persuade parents to use one. 

So I recommend first that Congress promote booster laws in each 

state. The laws should require children to be in belt-positioning 

boosters from the time they outgrow a forward-facing car seat and 

until they are large enough to sit safely using the vehicle lap-shoulder belt. So far just three states—Washington, California, and Arkansas—have passed booster laws. Many other states, including 

our own home state, Mr. Chairman, have introduced booster bills, 

but have not been successful in passing them. 

Booster laws will protect children. Fewer children will be injured 

and fewer will be killed when it becomes illegal to ride without one. 

Second, Congress should support NHTSA to lead an intensive 

and sustained public education campaign to promote belt-posiVerDate 0ct 09 2002 12:13 Nov 30, 2004 Jkt 088785 PO 00000 Frm 00050 Fmt 6633 Sfmt 6601 S:\WPSHR\GPO\DOCS\88785.TXT JACK PsN: JACKF
47

tioning booster seats. Related to this is the section 2003[b] of TEA–

21, that is the child passenger protection education grants which 

fund innovative demonstration projects. Funding for section 

2003[b] should be extended. 

While a huge undertaking, safety promotion on this scale has 

been done successfully before. 25 years ago, just a handful of infants and toddlers used car seats. Today usage in these two groups, 

as you mentioned, is over 90 percent. We can promote belt-positioning boosters and we will see an increase in their use. How 

quickly that happens will depend in part on the degree of different 

investment in promoting them now and promoting reasonable laws 

regarding their use. 

This is an exciting and historic time in child passenger safety, 

similar in many respects to 1977, when Tennessee passed the first 

car seat law. By 1985, just 8 years later, all states had one and 

putting an infant in a car seat started to become just what you do. 

Seeing the day that belt-positioning booster seats are in common 

use will require laws supported by sustained public education. 

Thank you for the opportunity to testify here today. I would be 

happy to answer any questions that you have. 

[The prepared statement of Dr. Quinlan follows:]

PREPARED STATEMENT OF KYRAN QUINLAN, M.D., MPH, DEPARTMENT OF

PEDIATRICS, UNIVERSITY OF CHICAGO

Good morning Mr. Chairman and Members of the Subcommittee. My name is 

Kyran Quinlan. I am a pediatrician on faculty at the University of Chicago. I am 

a clinician, a child passenger safety researcher and a member of the American Academy of Pediatrics. Thank you for this opportunity to discuss this important issue. 

We are talking today about how to better protect our children from the greatest 

threat to their health. In the United States, nothing kills more children than motor 

vehicle crashes. Each year, about 500 of our children aged 4–8 years die and another 90,000 are injured while riding in a motor vehicle. With most occupant safety 

attention focused on younger child passengers, this older group of what has been 

termed ‘‘forgotten children’’ has not experienced any real decrease in their occupant 

fatality rates over the last 20 years. 

These children are real. I could tell you about the 5-year-old boy who was brought 

to the University of Chicago recently after being in a crash. He was small for a 5-

year-old. Despite being buckled up in a lap/shoulder belt, he was ejected from his 

family’s car. Unconscious and bloody, he lay motionless in the street with a broken 

skull, pelvis, thigh and shin bones. He lived, and his bones will mend, but he will 

have a long road back with rehabilitation for his severe head injury. Or I could tell 

you about the 8-year-old boy who was recently cared for at our hospital after being 

in a crash. He put the shoulder belt behind his back to keep it from rubbing and 

cutting across his neck. In the instant he was thrown violently forward in the crash, 

the only thing that stopped him was the poorly-fitting lap belt. After crushing his 

soft internal organs, the lap belt then found and fractured his back bone leaving 

him paralyzed. Multiple abdominal surgeries were successful at repairing the injuries to his intestines and other internal organs. Much less successful however, have 

been the attempts to bring him out of the growing depression from realizing that 

while only 8, he will never walk again. 

These children are too big for a car seat, but are not big enough to fit safely in 

the seat belts of the car. They need booster seats to raise them up so that the lap 

belt fits low and snug across their upper thighs and the shoulder belt crosses their 

collarbone and not their neck. Not using a booster seat puts these children at unnecessary risk. As you have just heard from Dr. Winston, there is good evidence that 

boosters protect children, but few families are using them. In Illinois specifically, 

Dr. Winston’s system tells us that at most about 20 percent of the 4–5-year-olds use 

boosters, just a handful of 6-year-olds do, and virtually no 7- or 8-year-olds do. 

This fits with what I see on the south side of Chicago. I recently saw a family 

with a 4-year-old who had outgrown her car seat and was using just a seat belt. 

I discussed the importance and need for a booster and advised them to get one for 

48

her. At the next visit, they told me they had not gotten a booster. I frankly told 

them I was interested to know if there was something I could have said that would 

have been more persuasive the first time. The mom said, ‘‘no, I remember what you 

said. You told me that without a booster, my daughter’s back could break and she 

could become paralyzed in a crash, but I just hadn’t gotten around to it.’’ I could 

use help to convince parents to use boosters. Being able to say that riding without 

a booster is against the law would certainly help. 

So there’s a real problem here. We’re dealing with the leading killer of children, 

and we know that boosters protect children, but changing the way people buckle 

their children up is difficult. 

What do I think Congress can do? 2 main things:

1. Congress should promote booster laws in each state. These laws should require children to be in boosters from the time they outgrow a forward-facing 

car seat until they are large enough to sit safely using the vehicle lap/shoulder belt. So far, just three states, Washington, California, and Arkansas have 

booster laws. Many other states have introduced booster bills but have not 

been successful. I was part of the recent unsuccessful effort to pass booster 

legislation in Illinois. Congress should consider providing incentives to the 

states to pass booster laws. Tying the receipt of state highway funds to passing a booster law is one mechanism. Booster laws will protect children. Less 

children will be injured and less children will be killed when it becomes illegal to ride without a booster.

2. Congress should support the National Highway Traffic Safety Administration 

to lead an intensive and prolonged public education campaign to promote 

booster seats. The recent booster promotion efforts by NHTSA and the National SAFE KIDS campaign have been significant, but much more needs to 

be done. We are talking here about changing a social norm, changing the way 

virtually everyone buckles up this group of children. While it is a huge undertaking, safety promotion on this scale has been done successfully before. 

Twenty five years ago, just a handful of infants and toddlers used car seats. 

Today, usage in these two groups is over 90 percent. We can promote boosters, and we will see increased use of boosters. How quickly that happens will, 

in part, depend on the degree of federal investment in promoting boosters 

now.

Thank you, Mr. Chairman, for the opportunity to testify here today. I look forward to the day when parents would not think of taking a trip without their child 

in a booster. Getting booster use to be that common can be achieved through booster 

laws and intensive and sustained public education. I would be happy to answer any 

questions you and the members of the Subcommittee may have. 

MMWR (Morbidity and Mortality Weekly Report) 

February 25, 2000/49(07);135–7

Motor-Vehicle Occupant Fatalities and Restraint Use Among Children Aged 

4–8 Years—United States, 1994–1998

In the United States, more children aged 4–8 years die as occupants in motorvehicle—related crashes than from any other form of unintentional injury (1). To reduce the number of deaths and injuries caused by motor-vehicle-related trauma, 

child passengers in this age group should be restrained properly in a vehicle’s back 

seat (2). To characterize fatalities, restraint use, and seating position among occupants aged 4–8 years involved in fatal crashes, CDC analyzed 1994–1998 data from 

the Fatality Analysis Reporting System (FARS), which is maintained by the National Highway Traffic Safety Administration (NHTSA). This report summarizes the 

results of that analysis, which indicate that during 1994–1998, little change occurred in the death rate, restraint use, and seating position among children aged 

4–8 years killed in crashes. 

Motor-vehicle occupants who died in crashes during 1994–1998 were included in 

the analysis of FARS data. FARS is a census of traffic crashes in which at least 

one occupant or nonmotorist (e.g., pedestrian) died within 30 days of a crash on a 

public road within the 50 states, District of Columbia, and Puerto Rico. FARS includes information about restraint use and seating position derived from police 

crash reports. Restraint use (e.g., seat belts, child-safety seats [CSSs], and belt-positioning booster seats) was reported as used or not used. Seating position was designated as front, back, other, or unknown. Injury death rates per 100,000 population 

were calculated using annual estimates from the Bureau of the Census. 

49

During 1994–1998, 14,411 child occupants aged 4–8 years were involved in crashes where one or more fatalities occurred; of these, 2549 (17.7 percent) died. Approximately 500 child occupants died each year during the study period; the average annual age-specific death rate was 2.6 per 100,000 population (Table 1). In 1994, restraint use among fatally injured children was 35.2 percent (177 of 503); in 1998, 

restraint use was 38.1 percent (201 of 527). The proportion of fatally injured children seated in the back seat of a vehicle involved in a crash was 50.1 percent (252 

of 503) in 1994 and 53.7 percent (283 of 527) in 1998. 

Reported by: Div of Unintentional Injury Prevention, National Center for Injury 

Prevention and Control, CDC.

TABLE 1. Number of deaths, death rate,* restraint use, and seating position among fatally 

injured motor-vehicle occupants aged 4–8years—United States, 1994–1998

Year No.

deaths 

Death

rate 

No.

restrained 

Restrained

(in percent) 

No. seated

in back 

Seated in back

(in percent) 

1994 503 2.65 177 35.2 252 50.1

1995 498 2.58 168 33.7 208 41.8

1996 499 2.55 188 37.7 250 50.1

1997 522 2.64 198 37.9 257 49.2

1998 527 2.66 201 38.1 283 53.7

Total 2549 2.61 932 36.6 1250 49.0

*Per 100,000 age-specific population. 

Source: Fatality Analysis Reporting System, National Highway Traffic Safety Administration. 

Editorial Note: During 1994–1998, child occupant death rates did not decrease, 

restraint use among fatally injured child occupants changed little, and the proportion of fatally injured children seated in the back seat of a motor vehicle involved 

in a crash remained fairly constant. Children aged 4–8 years represent a special 

population for motor-vehicle occupant protection. Having outgrown CSSs designed 

for younger passengers, children aged 4–8 years frequently sit unrestrained or are 

placed prematurely in adult seat belt systems. Public health and traffic safety organizations recommend that children in this age group be restrained properly in booster seats (3). This study found that nearly two thirds of fatally injured children were 

unrestrained at the time of the crash. Only 4%–6% of children aged 4–8 years used 

booster seats when riding in motor vehicles (4,5). 

Belt-positioning booster seats raise a child so that the shoulder belt fits securely 

between the neck and arm and the lap belt lies low and flat across the upper thighs. 

Children do not fit in adult lap/shoulder belts without a booster seat until they are 

58 inches tall and weigh 80 lbs (3,6). Children should ride in a booster seat from 

the time they graduate from their forward-facing CSS until approximately age 8 

years or until they are tall enough for the knees to bend over the edge of the seat 

when the child’s back is resting firmly against the seat back. 

Despite recommendations for children to ride in the back seat whenever possible 

to reduce risk for injury in a crash, approximately one fourth of child passengers 

ride in the front seat (7). Riding in the back virtually eliminates injury risk from 

deployed front-seat passenger air bags and places the child in the safest part of the 

vehicle in the event of a crash. As of January 1, 2000, 35 children aged 4–8 years 

have died while seated in front of air bags. Of these children, 31 (89 percent) were 

either unrestrained or improperly restrained (8). Riding in the back seat is associated with at least a 30 percent reduction in the risk for fatal injury (9). Approximately half of those children in this study who were fatally injured were sitting in 

the back seat. 

The 50 states, District of Columbia, and Puerto Rico have child-passenger safety 

laws; however, substantial gaps in coverage exist for child passengers aged 4–8 

years. For example, in 19 states, children this age can ride unrestrained in the back 

seat of a motor vehicle. In most states, children as young as age 4 years may use 

an adult seat belt. No state requires the use of booster seats for children who have 

outgrown their CSSs (10). Three states have laws requiring that children be seated 

in the back seat of passenger vehicles. The ages of the children covered by these 

laws vary by state. 

The findings in this study are subject to at least three limitations. First, police 

crash reports overestimate restraint use; therefore, restraint use may be lower for 

children in this age group. Second, vehicle miles traveled have increased during 

1994–1998; consequently, improvements in fatality rates may be masked by increased exposure to travel. Finally, increases in restraint use and resulting changes 

50

in occupant fatalities may require many years of investigation before they become 

apparent. 

Reducing fatalities among motor vehicle occupants aged 4–8 years will require 

finding effective strategies to promote booster seat use and placement of children 

in the back seat. Public health and traffic safety efforts should be accelerated to increase appropriate occupant protection among children aged 4–8 years as a primary 

means to reduce fatal motor-vehicle—related injuries. Efforts are under way by CDC 

and others to determine the best ways to encourage booster seat use and to increase 

the prevalence of properly restrained children riding in the back seat. 

References 

1. National Center for Health Statistics. Annual mortality tapes. Hyattsville, 

Maryland: US Department of Health and Human Services, CDC, 1994–1998. 

2. National Transportation Safety Board. Safety recommendation. Washington, 

DC: National Transportation Safety Board, 1997. 

3. CDC. National Child Passenger Safety Week—February 14–20, 1999. MMWR 

1999;48:83–4. 

4. Winston FK, Durbin DR, Bhatia E, Werner J, Sorenson W. Patterns of inappropriate restraint for children in crashes. Joint session organized by the European Vehicle Passive Safety Network, AAAM, and IRCOBI. London, England: 

Professional Engineering Publishing Limited, 1999. 

5. Decina LE, Knoebel KY. Child safety seat misuse patterns in four states. Accid 

Anal Prev 1997;29:125–32. 

6. American Academy of Pediatrics Committee on Injury and Poison Prevention. 

Selecting and using the most appropriate car safety seats for growing children: 

guidelines for counseling parents. Pediatrics 1996;97:761–2. 

7. Segui-Gomez M, Glass R, Graham JD. Where children sit in motor vehicles: a 

comparison of selected European and American cities. Injury Prevention 

1998;4:98–102. 

8. National Highway Traffic Safety Administration. Special crash investigations 

monthly counts for airbag-related fatalities and seriously injured persons. 

Washington, DC: National Highway Traffic Safety Administration, 2000. 

9. Braver ER, Whitfield R, Ferguson SA. Seating positions and children’s risk of 

dying in motor vehicle crashes. Injury Prevention 1998;4:181–7. 

10. Insurance Institute for Highway Safety. Child restraint, belt laws as of January 2000. Available at: http://www.highwaysafety.org/safetylfacts/

statellaws/restrain.htm. Accessed January 31, 2000. 

MMWR (Morbidity and Mortality Weekly Report) 

February 5, 1999/48(04); 83–84

Notice to Readers 

National Child Passenger Safety Week—February 14–20, 1999 

In 1997, 1791 U.S. children aged <15 years were killed and 282,000 were injured 

while riding in motor vehicles (1). National Child Passenger Safety Week, February 

14–20, 1999, will highlight safety recommendations for children aged >4 years and 

weighing >40 lbs who have outgrown their child safety seats. 

Children who are too large for child safety seats often are restrained improperly 

or not at all. A recent observational study in four states indicated that, of children 

weighing 40–60 lbs, 75 percent were improperly restrained, and 19 percent were unrestrained (2). Of passengers aged 5–9 years in fatal crashes in 1997, 46 percent 

were unrestrained (1). 

For proper restraint, children who have outgrown child safety seats require booster seats used with vehicle lap/shoulder belts. Lap/shoulder belts usually do not fit 

children properly until they are 58 inches tall, have a sitting height of 29 inches, 

and weigh 80 lbs (3). Therefore, children aged <10 years probably will not be big 

enough to use a lap/shoulder belt without a booster seat. When smaller children restrained with only a lap belt or a poorly fitting lap/shoulder belt become involved 

in a crash, the belt tends to ride up onto the abdomen, allowing the pelvis to slide 

under the belt. This places pressure directly on the abdominal organs and may lead 

to the child flexing over the belt above the hips, resulting in abdominal and/or spinal injuries (4). 

Children should remain in their convertible child safety seats as long as they fit 

well. Convertible seats are the appropriate restraints for children until their ears 

reach the top of the back of the safety seat and their shoulders are above the top 

strap slots, or until they reach the upper weight limit of the seat. To help prevent 

51

deaths and injuries among young passengers who have outgrown their child safety 

seats, CDC recommends the following:

• Belt-positioning booster seats should be used until lap/shoulder belts fit properly (5). Belt-positioning boosters raise children so that the safety belt fits correctly (Figure 1) and should always be used with a lap/shoulder belt. Booster 

seats with high backs are recommended for vehicles with seat backs that do not 

support a child’s head. Shield boosters, which have a plastic shield in front of 

the child, do not provide as much upper-body protection and are no longer certified for children weighing >40 lbs. The American Academy of Pediatrics recommends that shield boosters not be used for children weighing <40 lbs, even 

if they are labeled for use at a lower weight (6). Shield boosters should only be 

used with their shields removed so they can function as belt-positioning booster 

seats with lap-shoulder belts.

• Lap/shoulder belts should fit properly (Figure 1). A child cannot ride comfortably and remain properly restrained until tall enough for the knees to bend 

over the edge of the seat when the child’s back is resting firmly against the seat 

back.

• Whenever possible, child passengers should be placed in the back seat.

The National Transportation Safety Board recommends that states upgrade their 

child passenger protection laws to require age-appropriate child restraint systems 

and booster seats for children aged <8 years and has asked automobile manufacturers to redesign the back seats of cars to be more accommodating to children (7). Additional information on child passenger protection is available on the World-Wide 

Web from the American Academy of Pediatrics at http://www.aap.org, the Society of 

Automotive Engineers at http://www.sae.org, the National Highway Traffic Safety 

Administration at http://www.nhtsa.dot.gov, the National Transportation Safety 

Board at http://www.ntsb.gov, and CDC’s National Center for Injury Prevention and 

Control at http://www.cdc.gov/ncipc. 

References 

1. US Department of Transportation, National Highway Traffic Safety Administration. Children: traffic safety facts 1997. Washington, DC: US Department of 

Transportation, National Highway Traffic Safety Administration, 1998. 

2. Decina LE, Knoebel KY. Child safety seat misuse patterns in four states. Accid 

Anal Prev 1997;29:125–32. 

3. Klinch KD, Pritz HB, Beebe MS, et al. Study of older child restraint/booster 

seat fit and NASS injury analysis. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, November 1994; report no. DOT–HS–808–248. 

4. Lane JC. The seat belt syndrome in children. Warrendale, Pennsylvania: Society of Automotive Engineers, 1993:159–64. (SAE no. 933098). 

5. American Academy of Pediatrics, Committee on Injury and Poison Prevention. 

Selecting and using the most appropriate car safety seats for growing children: 

guidelines for counseling parents. Pediatrics 1996;97:761–2. 

6. American Academy of Pediatrics. 1998 family shopping guide to car seats. Elk 

Grove Village, Illinois: American Academy of Pediatrics, 1998. 

7. National Transportation Safety Board. The performance and use of child restraints, seatbelts, and air bags for children in passenger vehicles. Washington, 

DC: US Department of Transportation, 1996; document no. NTSB/SS–96/01. 

52

Senator FITZGERALD. Thank you, Dr. Quinlan. 

Ms. Stone, thank you for being here. You are the State of Advocates for Highway and Auto Safety, and I compliment you for your 

long-time involvement in this issue. 

STATEMENT OF JUDITH LEE STONE, PRESIDENT,

ADVOCATES FOR HIGHWAY AND AUTO SAFETY 

Ms. STONE. Thank you so much, Mr. Chairman. Advocates has 

a long history of working on state and federal initiatives to improve 

child passenger safety. We have been at the forefront of lobbying 

in the states to close deadly loopholes in child restraint laws, to 

urge adoption of laws to encourage everyone to buckle up, and 

pushing the U.S. DOT to address regulatory gaps and omissions 

that affect the safety of children. 

In 1991 the Senate Commerce Committee authored and enacted 

a NHTSA reauthorization bill that contained a motor vehicle safety 

agenda as part of the larger ISTEA legislation. Under the leadership at that time of Senators Hollings, Danforth, Bryan, and Gorton, this legislation was a watershed for improvements in passenger vehicle safety. 

One of the provisions in ISTEA was intended to upgrade the 

safety of booster seats. More recently, the TREAD Act includes 

many provisions that can enhance the safety of child occupants and 

we commend you, Senator Fitzgerald, and other co-sponsors for 

your legislation and the reforms that it requires. 

Why should we be concerned at this time? Today there are over 

20 million children in this age group of about 4 to 9, and each year 

approximately 500 children ages 5 to 9 die, the equivalent of two 

to three elementary school populations. Nearly 100,000 more are 

injured as occupants in passenger vehicles. 40 percent of the children killed are completely unrestrained. 


424quin.eps
53

While other children, those in the ranges of zero to 4 years and 

10 to 15 years, have experienced reductions in death and injury in 

motor vehicle crashes over the past 20 years, the rate for those in 

this category, ages 5 to 9, has remained constant during that same 

period. Obviously we are not doing enough to protect these children. 

Since the back seat is supposed to be safer for children, it is our 

obligation as a society to provide for the safety of those children 

when their parents and guardians follow this safety recommendation. 

There are no federal safety standards for booster seats recommended for children over 50 pounds, as you have heard and others have said, and recommendations for their use are dependent 

upon voluntary manufacturer testing, with no government oversight. While booster seats may have backs or arms that prevent the 

lap belt portion of the seat belt from changing position, neither of 

these features are required by federal law. 

There are no structural or performance requirements for booster 

seats. Booster seats that are recommended for children who weigh 

50 pounds or less fall within the scope of the existing child restraint standard. 

States are moving to enact laws requiring booster seat use. Within the last 2 years, 3 states have passed booster seat laws and 15 

to 20 states have introduced some form of booster seat legislation 

just this year. 

Laws requiring the use of booster seats are important because 

they better protect children who use them and they educate parents and guardians. Currently, only 6.1 percent of booster-aged 

children are restrained in booster seats and booster seat laws will 

undoubtedly increase the percentage of children using them. 

What federal regulatory actions are needed? In 1991 Advocates 

worked with this Committee to enact into law legislative language 

in the ISTEA bill, which I mentioned before, which conferred broad 

legislative authority on NHTSA to address the safety of child booster seats used in passenger cars. Congress intended the agency to 

take aggressive action to improve the regulation and protection afforded by booster seats. Unfortunately, NHTSA responded narrowly and only took action to delete the prohibition against beltpositioning booster seats so that they now can be used without an 

overhead tether. 

This was a squandered opportunity for comprehensive improvements in booster seat protection. Advocates strongly recommends 

that these federal regulatory actions be implemented immediately. 

NHTSA should expand the scope of the child restraint standard to 

children who weigh up to 80 pounds. NHTSA should establish minimum requirements for booster seat performance and structural integrity, including booster seat back requirements that afford head 

and neck protection, requirements for the height of the booster seat 

platform, and requirements to ensure that the belt-positioning features function as designed. 

NHTSA should develop a child test dummy that is representative 

of a 10 year old child that can be used in testing booster seats. 

NHTSA should upgrade the seat back strength standard to protect against injuries from front seats collapsing onto children in the 

54

rear seat. This standard has not been substantially revised since 

1971 and failure of a front seat back in a crash resulting in its falling back onto the space occupied by a child in the rear greatly endangers the child. 

Because the rear seat environment is not fully friendly for children ages 4 to 8 years old, other actions need to be taken. Auto 

manufacturers should make built-in booster seats standard equipment in some model lines and promote the availability of this option in other models. Some manufacturers say these are available, 

but few dealers know about them and say that they can provide 

them. 

As more states enact child booster seat laws, there will be a demand for built-in booster seats. It will make compliance and enforcement of these laws easier and more effective. 

NHTSA and auto manufacturers should seek other opportunities 

to enhance the safety of children in the rear seat environment, including providing head restraints that protect taller children, vehicle seat designs that better accommodate children, and making adjustable upper anchorages for safety belts available as standard 

equipment in all rear seating positions of all passenger vehicles. 

Thank you, Mr. Chairman. I am happy to answer questions. 

[The prepared statement of Ms. Stone follows:]

PREPARED STATEMENT OF JUDITH LEE STONE, PRESIDENT, ADVOCATES FOR HIGHWAY

AND AUTO SAFETY

Summary of Testimony

Advocates for Highway and Auto Safety 

Child restraints are required and regulated for children up to four years of age, 

and lap/shoulder belts are designed to protect adults. In between is the ‘‘forgotten 

child,’’roughly ages 5 to 9 years old, who has not been the focus of safety laws and 

regulations. There are over 19.5 million children in the 5 to 9 year old age group, 

and about 500 of these children die each year as occupants in motor vehicle crashes. 

The motor vehicle fatality rate for this age group has remained constant over the 

past two decades, despite the fact that the fatality rate has decreased for other age 

groups—children 0 to 4, and children 10 to 15 years old, in the same time period. 

In addition, safety recommendations from government agencies and private organizations alike advise parents to place their children in the rear to maximize their 

safety. The safety of these children can be improved by requiring the use of booster 

seats, so that adult lap/shoulder belts will better fit these children, by regulating 

the performance of booster seats to ensure safety, and by making changes to improve the rear seat environment to afford children a safer ride. 

Advocates’ testimony contains the following recommendations:

• Every state should adopt a mandatory booster seat use law.

• NHTSA should expand the scope of the child restraint standard to children who 

weigh up to 80 pounds.

• NHTSA should establish minimum requirements for booster seat performance 

and structural integrity including booster seat back requirements that afford 

head and neck protection, requirements for the height of the booster seat platform, and requirements to ensure that belt-positioning features function as designed.

• NHTSA should develop a child test dummy that is representative of a 10-yearold child that can be used in testing booster seats.

• NHTSA should upgrade the seat back strength standard to protect against injuries from front seats collapsing onto children in the rear seat.

• Auto manufacturers should make built-in booster seats standard equipment in 

some model lines and promote the availability of this option in other models.

55

• NHTSA and vehicle manufacturers should seek other opportunities to enhance 

the safety of children in the rear seat environment including providing head restraints that protect taller children, vehicle seat designs that accommodate children, and making adjustable upper anchorages for safety belts available as 

standard equipment in all rear seating positions of all passenger vehicles. 

I. Introduction 

Good morning, Mr. Chairman and Members of the Subcommittee on Consumer Affairs, Foreign Trade and Tourism. My name is Judith Lee Stone, and I am the 

President of Advocates for Highway and Auto Safety (Advocates), a coalition of consumer, health and safety groups and insurance organizations working together to 

reduce motor vehicle deaths and injuries. Since its inception in 1989, Advocates has 

been involved in all aspects of child safety and protection issues in motor vehicles. 

Advocates has conducted legislative and educational campaigns to promote child 

safety and child restraint use including the ‘‘Children At Risk’’ campaign in 1993 

and the ‘‘Kids, Cars and Crashes’’ campaign launched in 1996. In 1999, I participated as a member of the Blue Ribbon Panel—Protecting Our Older Child Passengers—which issued a set of recommendations on child occupant safety, a copy of 

which I will submit for the record. I currently serve as a member of the Advisory 

Board of ‘‘Partners for Child Passenger Safety,’’ a ground breaking research project 

at The Children’s Hospital of Philadelphia supported by State Farm Insurance Companies. 

Advocates has been in the forefront of efforts to enact state laws to improve child 

safety in motor vehicles including amendments to close the gaps in existing state 

child restraint laws, and more recently, booster seat laws. Despite many efforts, 

there remains a long list of states whose occupant protection laws do not cover all 

ages of children in every seating position. A chart of states with ‘‘gaps’’ in their child 

restraint laws is attached to my testimony. 

On Capitol Hill, Advocates has worked to include child safety protection provisions in federal legislation such as the Intermodal Surface Transportation Efficiency 

Act of 1991 (ISTEA). The Senate Commerce Committee is to be commended for its 

role in drafting and enacting the motor vehicle safety provisions contained in the 

ISTEA legislation. Under the leadership of Senators Hollings, Danforth, Bryan and 

Gorton, the 1991 ISTEA legislation was a watershed for improvements in passenger 

vehicle safety. Ten years ago Advocates worked with the Committee to include a 

provision in ISTEA intended to upgrade the safety of booster seats. 

Advocates has also provided assistance on safety provisions contained in the 

Transportation Equity Act for the 21st Century (TEA–21) and, most recently, the 

Transportation Recall Enhancement, Accountability and Documentation or TREAD 

Act. Section 14 of the TREAD Act includes many provisions that can enhance the 

safety of child occupants, including improvements in child restraint testing, more 

stringent injury criteria and performance requirements for booster seats, to name 

just three. These and other child safety ideas were originally contained in the Child 

Passenger Protection Act of 2000, which was introduced by Sen. Fitzgerald as S. 

2070 in the last Congress, a bill that was wholeheartedly supported by Advocates. 

Advocates is acutely aware of the need for improved child safety and we have documented that this concern is shared by the American public. In a 1999 poll, commissioned by Advocates, the eminent pollster Lou Harris found that 93 percent of the 

American public overwhelmingly supports the federal government’s mission to set 

highway and auto safety standards, including standards for child safety. A 1998 Lou 

Harris poll showed that an impressive 90 percent of the public supports aggressive 

enforcement of child safety seat laws. 

While there have been improvements in safety for child passengers, clearly more 

can and should be done. My testimony will address the problem of the ‘‘forgotten 

child,’’ discuss what has been done on the state and federal levels, and recommend 

actions to prevent the continuation of needless deaths and injuries of our nation’s 

children. 

II. The Problem: Preventable Deaths and Injuries of Our Children 

A. The ‘‘Forgotten Child’’

Each year approximately 500 children ages 5 to 9 die and nearly 100,000 more 

are injured as occupants in passenger vehicles. More than 40 percent of the children 

killed are completely unrestrained. Over the past 20 years, between 1978 and 1998, 

the combined rate of motor vehicle occupant deaths and injuries per one hundred 

thousand children in the population has dropped significantly for children ages 0–

4, by 35 percent, and for children ages 10–14, by 15 percent. The rate among motor 

vehicle occupants ages 5–9, however, has remained constant. The fatality rate for 

children in these age groups, when analyzed separately from the injury data, tells 

56

a similar story. I have attached to my testimony charts from the NHTSA’s Fatal 

Analysis Reporting System (FARS) that display these facts. These statistics are 

based on a current population of over 19.5 million children in the 5 to 9 year old 

age bracket. 

While a great deal of attention has been paid to child restraint systems for infants 

and toddlers, much less emphasis has been placed on providing for the safety of children generally between 4 and 8 years of age, and older, known as the ‘‘forgotten 

child.’’ These children have outgrown their toddler-sized child restraints but are still 

too small to fit properly in seat belt systems, the three-point lap/shoulder belts made 

to fit adults. Since the back seat is supposed to be safer for children than the front 

seat, and because parents are being told to put their children in the back seat, it 

is our obligation as a society to provide for the safety of those children when their 

parents follow this safety recommendation. 

B. Booster Seats: Child Restraints for Older Children 

Child restraint systems were developed to protect young children in moving vehicles. Child restraints for infants and toddlers generally have a hard plastic shell including a back and sides and an internal belt and buckle to hold the child securely 

within the restraint in the event of a crash. While the federal child restraint safety 

standard governs the structural performance and levels of safety protection afforded 

children up to 50 pounds, the legal obligation to place children in restraints emanates from mandatory child restraint use laws passed by each of the 50 states, the 

District of Columbia, and Puerto Rico. These state laws establish the maximum age 

or weight limit for children who are required to be in a restraint system, and those 

limits have predominantly been set at 4 years or 40 pounds. 

Although booster seats are a type of child restraint, they are intended for use by 

older children who because of their size have outgrown child restraints made for 

toddlers. Toddler restraints are intended to provide support and protection in a 

crash and keep the child inside the restraint. Booster seats are only intended to provide a platform that lifts the child up off the vehicle seat in order to improve the 

fit of the child in the adult seat belt. An improper fit of an adult seat belt causes 

the lap belt to ride up over the stomach and the shoulder belt to cut across the neck. 

In a crash a seat belt that does not fit properly can cause critical or even fatal injuries. In addition, if the shoulder strap portion of the lap/shoulder belt is uncomfortable, children will place it behind their backs, defeating any safety benefits the belt 

system might provide. Studies show that most adult belt systems do not fit children 

under 4’9’’ and less than 80 pounds. 

While booster seats may have backs, or arms that prevent the lap belt portion 

of the seat belt from changing position, neither of these features are required by 

federal law. In fact, there are no structural or performance requirements, as such, 

for booster seats. Booster seats that are recommended for children who weigh 50 

pounds or less fall within the scope of the existing child restraint standard. However, most booster seats are recommended for children over 50 pounds and are not 

covered by the federal child restraint standard. As a result, booster seats are, for 

the most part, not regulated and recommendations for their use are dependent upon 

voluntary manufacturer testing with no government oversight. 

III. Steps That Have Been Taken to Improve Child Passenger Safety on the 

State and Federal Levels 

A. State Laws 

Within the last two years, three states have passed booster seat laws. In March 

2000, Washington enacted the first law requiring children between a minimum of 

4 years of age or over 40 pounds and a maximum of 6 years of age or under 60 

pounds to be in booster seats, and it goes into effect on July 2, 2002. This law was 

inspired by Autumn Skeen who is here today to testify. Her son was killed when 

he was ejected from a vehicle while his seat belt was on. Even though the seat belt 

remained buckled, it did not keep him in the seat. 

In September 2000, California passed a law requiring children less than 6 years 

of age or less than 60 pounds to be properly restrained in a child passenger restraint system, effectively requiring booster seats; it goes into effect on January 1, 

2002. In February 2001, Arkansas became the third state to adopt a booster seat 

law requiring children up to age 6 and 60 pounds to be restrained in a child passenger safety seat, again effectively requiring booster seats, and the law will take 

effect later this year. While these states have led the nation with new booster seat 

laws, many states are considering following suit. Between 15 and 20 states have introduced some form of booster seat legislation this year. Laws requiring the use of 

booster seats are important because they better protect children who use them and 

educate parents and guardians. 

57

In addition to education, child restraint laws have been proven to increase use 

rates. According to NHTSA, restraint use from birth to age one is 97 percent, and 

ages one to four is 91 percent. From age five to 15, however, restraint use plummets 

more than 29 points to 68.7 percent. Additionally, a NHTSA study showed that only 

6.1 percent of booster-aged children were restrained in booster seats. Booster laws 

would undoubtedly increase this percentage. 

Furthermore, research supports the enactment of state booster seat laws. The 

Children’s Hospital of Philadelphia and State Farm Insurance Companies have 

brought this issue to the forefront of the national agenda on child passenger safety 

by creating the largest single research project in the country and the first comprehensive study devoted exclusively to pediatric motor vehicle injury. Findings 

from this research initiative, ‘‘Partners for Child Passenger Safety,’’ show that 83 

percent of children in this country between the ages of 4 and 8 are improperly restrained in adult safety belts. Many of these children, who should be using child 

safety seats or booster seats, are instead prematurely graduated to adult safety 

belts. This inappropriate restraint results in a 3.5-fold increased risk of significant 

injury and a more than four-fold increased risk of significant head injury. 

Advocates supports the adoption of booster seat laws in every state. 

B. Federal Regulation of Child Safety 

Although in the last 20 years there has been unequivocal progress in motor vehicle child safety, with improved child safety seat protection and adoption of state 

laws requiring their use, there has not been a great deal of progress with booster 

seats. The more we know, the more we are compelled to act in order to ensure maximum protection for every child of every age, on every ride in a motor vehicle. 

NHTSA has been in the lead on improving child safety in a number of ways. For 

example, in a 1995 final rule, the agency required child restraint manufacturers to 

determine the recommended use of their restraints in ranges of height and weight 

based on testing with different sizes of child crash test dummies. 

More recently, in 1999 NHTSA issued a rule to require a new system of child restraint anchorages in order to reduce the chances of incorrect installation of child 

restraints. At present, child restraints are secured to the vehicle frame with the vehicle lap belt or lap/shoulder belt system provided for adult occupants. The new 

‘‘LATCH’’ system, which stands for ‘‘lower anchors and tether for children,’’ provides 

a separate set of restraint-to-vehicle connectors and an overhead tether strap. The 

requirement, which applies to toddler restraints, but not to booster seats, is being 

phased-in and when fully implemented after September 1, 2002, will require each 

new vehicle to have a set of connecting bars that will interlock with matching connectors on new child restraints. The LATCH system will allow child restraints to 

be installed without using an adult lap belt or an adult lap/shoulder belt. Vehicles 

are already being produced with ready-to-use upper tether anchorages that will secure the top of the child restraint to the vehicle chassis. 

Although NHTSA’s record on child safety is commendable in many respects, and 

Advocates has strongly supported the agency in this area, the agency has not taken 

action on other important child safety initiatives. An opportunity to improve safety 

for the forgotten child was provided by Congress in 1991. ISTEA included a provision authored by the Senate requiring that NHTSA address through regulation the 

‘‘safety of child booster seats used in passenger cars and other appropriate motor 

vehicles.’’ Although Congress conferred broad legislative authority on NHTSA and 

intended the agency to take aggressive action to improve the regulation and safety 

protection afforded by booster seats, NHTSA chose to respond narrowly. The only 

action the agency took was to delete the prohibition against belt-positioning booster 

seats, so that they now can be used without an overhead tether. This de minimus

response by the agency to the 1991 ISTEA requirement squandered an opportunity 

for comprehensive improvements in booster seat protection for children ages 4–8 

years. 

To date, NHTSA has still made only a recommendation that when children outgrow child restraint seats, at around 40 pounds, they should be restrained in booster seats until they are big enough to fit in an adult safety belt, at about 80 pounds 

and about 4’9’’ tall. While this recommendation is useful, it does little reduce the 

annual fatality toll of 5–9 year olds. In 1999, another 500 children in this age group 

died as occupants in motor vehicles. This is the equivalent population of two or 

three elementary schools. Regulatory action is needed to address the broader safety 

concerns of booster seat performance and use, including expanding the scope of the 

child restraint standard to cover booster seats for children who weigh up to 80 

pounds. 

58

IV. What Needs to Be Done: Advocates’ Recommendations 

A. The Rear Seat Environment 

It has long been known that the rear seat is a safer location in most crashes. In 

recent years this message has been included in the recommendations to parents 

from many organizations, including NHTSA. However, the rear seat of most passenger vehicles is not designed for the comfort or safety of young children. Manufacturers have largely been concerned with designing features to accommodate adults. 

Although enormous resources have been expended to develop and market entertainment equipment for children in motor vehicles, particularly in the rear seat, by contrast little has been done to provide comfortable seating for children that would enhance safety. Moreover, agency regulations have also focused primarily on safety 

performance for adults, and on requirements for add-on child restraints for children 

0–4 years old. As a result, the rear seat environment is not particularly friendly for 

children ages 4 to 8 years old. 

Adult seat belts do not fit or properly restrain younger children. The required 

three-point lap/shoulder belt systems were designed for adults and provide crash 

protection for adults ranging in size, generally, from shorter females up to tall 

males. Adjustable upper anchorages were introduced to improve the comfort and fit 

of lap/shoulder belts for adults. But even with the addition of adjustable upper anchorages, which allow for some movement in the positioning of the shoulder portion 

of the belt, adult seat belts do not fit the average sized 4 to 8 year old child. Moreover, NHTSA only requires adjustable upper anchorages in the front seat, so only 

a small percentage of vehicles even have adjustable upper anchors in the rear outboard seating positions. 

Even when a child is large enough to fit in a lap/shoulder belt, most manufacturers provide lap/shoulder belts only in the rear outboard seating positions, where 

children (and adults) are at greater risk in a side impact crash. While some manufacturers make lap/shoulder belts available as options in the center seating position, 

few provide this design as standard equipment. Generally, only lap belts are available for children in the center rear seating position. 

Head restraints are also not currently required in rear seating positions. While 

rear seat head restraints have become more popular in recent years, they are still 

not available in most passenger vehicles and are not standard equipment. The 

heads of taller children may rise above the top of the vehicle seat back, especially 

if they are using a backless booster seat. Thus, taller children using backless booster 

seats may have no head and neck support in the event of a rear end collision. At 

present, few booster seats are designed with backs. Although the lack of head restraints in rear seating positions is most certainly a problem for adults, it also poses 

a severe problem for taller children since they are likely to have weaker neck muscles than adults. 

Rear seats are primarily designed to suit the comfort and convenience of adults 

in terms of both seat angle and depth. Since manufacturers have moved to angled 

or sloped seats to improve comfort for adults, children end up sitting even lower and 

have less visibility out of windows than when bench seats were the norm. In addition, the depth of rear seats, from front to back, is too long for the shorter legs of 

children, and particularly the shorter femurs (thigh bones) of younger children, who 

cannot bend their legs at the knee if they are seated with their backs against the 

vehicle seat back. As a result of these two design features, children of booster seat 

age are often uncomfortable when they sit back in the vehicle seat because they may 

not be able to bend their legs at the knee. This discomfort motivates children to 

move forward on the seat both to get a better view out of the front windows because 

of the slope of the seat, and to sit more comfortably with their legs bent and feet 

on the floor. This positioning compromises the protection afforded by the seat belt 

and booster seat. 

Finally, the collapse of front seats in a crash also poses a danger to children in 

the rear seat. When a front seat back fails in a crash, it falls back into the space 

occupied by a child in the rear. Not only can a child be struck by the collapsing seat 

and head restraint, but the front seat occupant can be thrown rearward, over the 

collapsed front seat colliding with an occupant in the rear seat with a great deal 

of force. Such secondary collisions within the vehicle have anecdotally been reported 

as the injury mechanism in a number of deaths and serious injuries to children. In 

order to protect all rear seat occupants, but especially children, NHTSA must improve the seat back strength requirements in the current vehicle safety standards. 

The current federal safety standard for seat back strength has not been substantially revised to improve seat back performance since the standard was first adopted 

in 1971. In fact, NHTSA research and tests for the proposed amendments to the fuel 

59

integrity standard showed that almost all front seats failed in 50 miles-per-hour 

rear impact collisions. 

This confluence of design issues makes it all the more important that manufacturers and NHTSA focus on the plight of the forgotten child. Since parents are being 

instructed to place children in this age group in the rear seat for their own safety, 

it is imperative that the rear seat be a safe environment in which comfort reinforces 

safe behaviors. 

B. Stuck in Neutral Recommendations 

Advocates addressed several aspects of the child restraint issue in our 1999 safety 

report entitled Stuck In Neutral—Recommendations For Shifting The Highway And 

Auto Safety Agenda Into High Gear, which is available on Advocates’ web site at 

www.saferoads.org. With respect to child restraints, the report concluded that 

NHTSA should take action on the following four recommendations:

1) expand the scope of the child restraint standard to children who weigh 80 

pounds; 

2) establish minimum requirements for child booster seats and belt-adjusting 

devices; 

3) develop a child test dummy that is representative of a 10-year-old child; and, 

4) require that child restraints be dynamically [crash] tested.

The first three of these recommendations are specifically relevant to booster seats. 

The provisions of section 14 of the TREAD Act require NHTSA to consider these 

issues as part of a larger rulemaking on child restraint safety. 

C. Child Restraints up to 80 Pounds 

NHTSA should expand the scope of the child restraint standard to children who 

weigh up to 80 pounds. Advocates wholeheartedly supports the language in section 

14 of the TREAD Act that requires consideration of protection for children who 

weigh more than 50 pounds. Advocates has on many occasions stated that children 

ages 4 to 8 years old, and older, are disenfranchised under both state restraint laws 

and federal occupant protection requirements. We firmly believe that the current 50 

pound weight limit should be raised to 80 pounds and that minimum performance 

requirements for booster seats should be regulated by NHTSA. Additionally, 

NHTSA should enhance its education and publicity campaign to disseminate information about the need for, and to promote the use of, child booster seats. 

D. Booster Seat Design/performance Requirements 

NHTSA should establish minimum requirements for child booster seats and beltadjusting devices. Advocates also supports the initiative in Section 14 of the TREAD 

Act to have NHTSA determine the need to establish minimum requirements for 

booster seat performance and structural integrity that are dynamically tested. We 

realize that booster seats function differently from infant/toddler restraints, and are 

intended to enable children to use adult seat belts to provide safety protection in 

a crash. Booster seats may also not be considered as complex, from an engineering 

standpoint, as infant/toddler restraints. Nevertheless, NHTSA should ensure that 

booster seats perform this function properly and afford children adequate levels of 

safety. 

Currently, booster seats are subject to performance requirements and compliance 

testing for all child restraints, but only up to the 50 pound limit of the child restraint standard. Booster seats recommended for children over 50 pounds are not 

subject to the requirements of that standard. This means that parents have no 

means to independently evaluate the safety of a booster seat for older children and 

they must rely on manufacturer recommendations. NHTSA should determine what 

performance requirements and safety features, as a minimum, should be common 

to all booster seats. For example, since booster seats are intended to lift children 

and improve their fit in an adult seat belt, a requirement might be appropriate to 

set a minimum height for the booster seat platform above the vehicle seat. Use recommendations could be based on this requirement. Also, booster seats without backs 

may result in neck or head injuries, especially for taller, older children whose heads 

and necks clear the top of the rear vehicle seat back. Currently, even booster seats 

with backs are not required to provide crash protection for the child’s head and 

neck. Booster seats with improved backs may be necessary to protect taller children 

from head and neck injuries. Likewise, belt-adjusting arms should be examined to 

determine whether they are necessary to enhance booster seat safety. The agency 

should also test booster seat features to ensure that they do not interfere with safe 

performance of the seat belt system in a crash. 

In addition, NHTSA should adopt separate injury criteria for children and adults. 

More stringent injury criteria scaled for the bodies of children have already been 

60

adopted by NHTSA for the occupant protection standard which governs safety belts 

and air bag performance. The agency should also adopt these more stringent injury 

criteria for the child restraint standard. These scaled injury criteria should also be 

applied to any extension of the child restraint standard to children who weigh over 

50 pounds. 

E. 10-year Old Crash Test Dummy 

NHTSA should develop a child test dummy that is representative of a 10-yearold child that can be used in testing booster seats. This was among the recommendations of the Blue Ribbon Panel on Protecting Our Older Child Passengers, 

and Advocates fully endorses this proposal. While there is already an effort to develop such a test dummy, efforts should be made to ensure that it is ready for use 

in the near future. Adoption of a 10-year-old child test dummy will permit testing 

at the upper weight range of booster seat recommendations. Auto manufacturers 

will also be able to use the 10-year-old dummy to improve the designs of rear seats 

to better accommodate the safety of all sizes of children. 

F. Built-in Booster Seats 

Similar to the design of integrated child restraints, booster seats can be built into 

vehicle seats. Built-in booster seats would afford greater stability and protection 

since the seat is built into the vehicle seat and attached to the vehicle chassis. Builtin booster seats would be specifically designed to function with the three point lap/

shoulder belts installed at the same seating position. As more states enact child 

booster seat laws there will be a demand for built-in booster seats. It will make compliance and enforcement of these laws easier and more effective. Parents, relatives, 

friends and visitors will be able to accommodate children as passengers in a safer, 

more convenient way. 

Thank you, Mr. Chairman, for the opportunity to address these important issues. 

Advocates is prepared to work with the Committee in its evaluation of the implementation of the TREAD Act and other safety recommendations, and I will answer 

any questions you and the Committee may have. 

Disclosure of Federal Grants and Contracts 

I, Judith Lee Stone, President of Advocates for Highway and Auto Safety, hereby 

certify that Advocates for Highway and Auto Safety has not received any federal 

funds in fiscal years 2000 and 2001. 

Respectfully submitted, 

JUDITH LEE STONE, 

President. 

Advocates for Highway and Auto Safety

Table 6

Occupant Fatality and Injury Rates per Population by Age Group, 1975–1999

Age Group (Years)

(Fatality Rate per 100,000 Population) 

Year –5 5–9 10–15

1975 4.50 2.71 5.71

1976 4.50 2.56 6.14

1977 4.68 2.83 6.44

1978 4.61 2.66 6.60

1979 4.35 2.84 6.13

1980 4.24 2.67 6.00

1981 3.75 2.43 5.24

1982 3.67 2.22 4.85

1983 3.55 2.33 4.60

1984 3.13 2.33 5.21

1985 3.18 2.36 5.52

1986 3.42 2.30 6.07

1987 3.78 2.60 6.00

1988 3.82 2.64 5.74

1989 3.93 2.92 5.48

1990 3.30 2.50 5.25

61

Table 6—Continued

Occupant Fatality and Injury Rates per Population by Age Group, 1975–1999

Age Group (Years)

(Fatality Rate per 100,000 Population) 

Year –5 5–9 10–15

1991 3.13 2.39 4.86

1992 2.99 2.41 4.75

1993 3.14 2.35 4.67

1994 3.46 2.35 5.07

1995 3.17 2.46 5.15

1996 3.40 2.34 5.07

1997 3.16 2.42 4.96

1998 3.03 2.60 4.60

1999 2.93 2.54 4.48

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KEY TO STATE HIGHWAY SAFETY LAW CHART 

Graduated Driver Licensing (GDL) Systems—Optimal graduated driver licensing 

systems consist of a learner’s stage, an intermediate stage and an unrestricted driving stage. Within each of these stages, there are provisions that are optimal to providing safe circumstances under which to develop driving skills. Four of these provisions are #1–4 below. Each state’s law is intricate and this chart should serve only 

as a guide. To fully understand a state’s law, one should review it.

A. Learner’s Stage 

1. Six Month Holding Period: A novice driver must be supervised by an adult 

licensed driver at all times. If the learner remains conviction free for six 

months, he or she progresses to the intermediate stage. In an optimal provision, there is not a reduction in this amount of time if the driver takes a driver’s education course. 

2. 30–50 Hours of Supervised Driving: A novice driver must receive 30–50 

hours of behind-the-wheel training with an adult licensed driver. In an optimal provision, there is not a reduction in this amount of time if the driver 

takes a driver’s education course. 


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B. Intermediate Stage: While optimally this stage should continue until age 18, 

states have been given credit in this chart for having the following two restrictions 

for any period of time, i.e., 6 months.

3. Nighttime Restriction: Because a majority of the crashes involving teens 

occur before midnight, the optimal period for supervised nighttime driving is 

from 9 or 10 p.m. to 5 a.m. Unsupervised driving during this period is prohibited. 

4. Passenger Restriction: Limits the number of teenage passengers that ride 

with a teen driver driving without adult supervision. The optimal limit is no 

more than one teenage passenger. Sometimes family members are excepted. 

5. Child Restraint Law—No Gaps: A state is considered not to have gaps in 

its child restraint laws if all occupants up to age 16 are covered by either 

a child restraint law or a safety belt law. 

6. Statewide Red Light Camera Law: Laws vary widely among the states. 

While some states require legislation to allow localities to operate red light 

running photo enforcement programs, other states do not require enabling 

legislation and laws are passed at a local level. States with an ‘‘X’’ in this 

column have statewide laws. For more information on state laws and legislation, see Advocates’ intersection safety chart. 

7. Repeat Offender Law: Complies with the Transportation Equity Act for the 

21st Century (TEA–21): States with an ‘‘X’’ in this column have voluntarily 

submitted their repeat offender law to the National Highway Traffic Safety 

Administration (NHTSA) for review and have been found to be in compliance 

with the provision in the federal highway bill, TEA–21. (Note: States may 

have one or more of the repeat offender law requirements under TEA–21, but 

only those states that fully comply with the federal law are listed as in compliance.) 

8. Open Container Law: Complies with the Transportation Equity Act for the 

21st Century (TEA–21): States with an ‘‘X’’ in this column have voluntarily 

submitted their open container law to the National Highway Traffic Safety 

Administration (NHTSA) for review and have been found to be in compliance 

with the provision in the federal highway bill, TEA–21. (Note: States may 

have one or more of the open container law requirements under TEA–21, but 

only those states that fully comply with the federal law are listed as in compliance.) 

9. Unattended Children Law: A person responsible for a child who is 8 years 

of age or younger shall not leave that child in a motor vehicle without being 

supervised in the motor vehicle by a person who is at least 14 years of age. 

10. U.S. Population: U.S. population data taken from the 2000 state population 

estimates according to the Population Estimates Program, Population division, 

U.S. Census Bureau. Available on-line at http://www.census.gov/statab/www/

part6.html. 

(Sources: Advocates for Highway and Auto Safety, Air Bag and Seat Belt Safety 

Campaign, American Automobile Association, Federal Highway Administration, Insurance Institute for Highway Safety, Mothers Against Drunk Driving, National 

Committee on Uniform Traffic Laws and Ordinances, National Highway Traffic 

Safety Administration, National Transportation Safety Board, National SAFE KIDS 

Campaign, state agencies and U.S. Census Bureau)

Senator FITZGERALD. Ms. Stone, thank you very much. All of you, 

thank you for your testimony. 

I would like to go to some questions and I would prefer to kind 

of keep this free-wheeling and have any of you jump in if you want 

to respond to something that somebody else on the panel is saying. 

My first thought listening to all this is, what about a requirement that automobile manufacturers make the seat belts adjustable so that they could come down to fit a young child, perhaps 

doing that as an alternative to a requirement—have a requirement 

that your child be in a booster seat or that he or she be fastened 

in an adjustable safety belt that can be properly fitted for a youngster? Nobody has mentioned that. Dr. Winston? 

Dr. WINSTON. The problem with that is that the issue is more 

thigh length than how tall the child is. The injuries that we worry 

about are not as much the injuries to the neck. That is not where 

66

the problem is. The problem is that the thigh is too short, and the 

child will slide forward on the seat, causing the lap portion of the 

belt to ride up. This will then make the shoulder portion even more 

uncomfortable and also will have the child further far forward, and 

in the event of a crash the child will be able to slip out of the belt 

or move forward and hit the head. 

There are quite a few vehicles that already have adjustable 

shoulder restraints. 

Senator FITZGERALD. What vehicles are they? 

Dr. WINSTON. I would defer to the manufacturers. 

Mr. SHELTON. We have a list, Mr. Chairman. I do not recall any 

off the top of my head, but we have a brochure we put out called 

‘‘Buying a Safer Car for Child Passengers,’’ and in that brochure 

we identify vehicles that have adjustable rear safety belts in them. 

I believe it is around 20 percent of the new vehicle fleet have them. 

Senator FITZGERALD. Is that right? Okay. 

Mr. SHELTON. Approximately, off the top of my head. But I would 

like to reiterate what Dr. Winston said. One of the concerns that 

we would have is one of the main reasons children need booster 

seats is because of lap belt fit and an adjustable shoulder belt does 

not address the issue of lap belt fit. 

Senator FITZGERALD. Well, can the lap belt be adjustable? Clearly you could make a lap belt that fit a child, right? 

Mr. SHELTON. It is not a matter of length. It is a matter of angle 

and location—unfortunately, there is a compromise between protection for adults and protection for children. 

Dr. LUND. Mr. Chairman, if I could followup on that. 

Senator FITZGERALD. Yes. 

Dr. LUND. You pose an interesting idea and I think one that has 

a lot of merit. Certainly in Europe there is a move in their new car 

assessment program to put more of the onus for how car safety 

seats for children and booster seats as well perform in those cars, 

putting more of the onus on the manufacturer of that vehicle, asking them to name the child seat that could be used in a test. 

I personally think that as we go forward part of what is going 

to have to happen to make sure that booster seats perform as we 

on this panel all want them to perform is there is going to have 

to be greater coordination between the child seat manufacturers or 

booster seat manufacturers and the vehicle manufacturers to make 

sure that the boosters or the child seats are compatible with the 

seats themselves. So that is one thing. The onus is going on them. 

I would like to also come back and say that one of the developments that we thought was very positive here, and it is a shame 

to see that the public is not picking up on it that greatly, is the 

provision by manufacturers of built-in child restraints. 

You talked about making the belts adjustable, and it is very difficult, as Mr. Shelton said, to adjust the lap belt. But you can put 

in a built-in child seat that folds down or folds up or modifies the 

seat geometry so that it works. 

Senator FITZGERALD. How many manufacturers are doing that 

right now? 

Dr. LUND. They are available from a number of manufacturers. 

We were able to get pictures only of a Volvo. It was the only one 

being delivered. But we have the Dodge Caravan; Daimler-Chrysler 

67

provided this in minivans for some time. You can ask DaimlerChrysler, but I think that they will tell you that the uptake on that 

option by consumers was not very good. 

Ms. STONE. Mr. Chairman, if I could just respond to that same 

question. We made some calls around to some dealers just before 

this hearing to see and practically none of the dealers we talked 

to even knew what they were. So no matter whether they are available as an option, the dealerships really do not know about them. 

So I think that they are largely unavailable unless they come as 

standard equipment. 

Senator FITZGERALD. I have never heard of them being offered 

and I am someone who has an 8 year old boy and have been thinking about this issue for years and always on the lookout for cars 

that have it as an available option. I have never heard of it being 

offered. 

Ms. WEINSTEIN. Mr. Chairman, I would like to add to the discussion. The Safety Board, as I mentioned, made three recommendations to the auto manufacturers to design the back seats of cars for 

children. One of the recommendations was for built-in car seats; 

one of the recommendations was for adjustable upper anchorages. 

What we are getting in response on the adjustable upper anchorages is that the design of the car does not really permit them to 

put the adjustable anchorage in the back seat the same as it does 

in the front seat. What some of the manufacturers have done is 

lowered the retractor anchorage to the back of the back seat, which 

does make it fit a little bit better for shorter adults and taller children. 

On the built-in child restraint systems, the manufacturers are 

telling us that there is no market out there for them. Our question 

back to them is, what have you done to sell them, and they have 

not done very much. I think that that is certainly an area that 

could solve a lot of problems, including for low income families, because when they would buy the car the built-in child restraint 

would already be there. 

Dr. QUINLAN. If I could add one other bit, I want to make it very 

clear, adjustable upper anchorages alone are not a solution. It has 

to be combined with some integrated support from below. The lap 

belt is the safety issue for children, for children in this age range, 

is the lap belt, the lap belt riding over the hips, crossing across the 

tender stomach. 

In the violence of the crash, the lap belt wraps around the abdomen like a rope around a pillow. There is nothing to stop it until 

it reaches bone when it hits the back bone, and finally the child 

is stopped by the fracture of the spine. 

So a lower cushion to boost the child up is absolutely necessary. 

Adjustable upper anchorages do not do that. 

Senator FITZGERALD. I have an Oldsmobile Aurora that does not 

have in the center of the rear seat a three-point lap belt and my 

wife does not even want to let me drive my son in my car. She 

makes me take him in her car, which has a three-point lap belt in 

the center rear seat. 

What should parents do who have a car with a rear seat that 

does not have a three-point shoulder belt in the center rear? Would 

they be better off putting them to one of the outboard sides, where 

68

are at greater risk of side impact collision? Would anybody care to 

speak to that issue? 

Mr. SHELTON. Again, Mr. Chairman—well, not again, but as I 

mentioned before we have a brochure for parents who are looking 

for a new car. The ‘‘Buying a Safer Car’’ brochure for a child passenger does identify vehicles that have a center lap shoulder belt 

standard or optional. In many cases also, manufacturers will offer 

a retrofit shoulder belt for the rear seat, although it is typically for 

an outboard position, not a center seating position. 

So if you have a car I think you have to use what you have, 

which would be to put the child in the outside seating position 

using the three-point belt, and the child would be much better off 

than putting the child in the center seating position, on balance. 

Senator FITZGERALD. Autumn. 

Ms. SKEEN. I live in a part of the state that is quite agricultural. 

We have more than a 30 percent Hispanic population. One of the 

things that I have noticed in the national brochures is that they 

are not in Spanish. Certainly, my concern and one of the reasons 

that I have pushed for the law is that I wanted this to not be just 

safety for the urban and the well educated and the well to do. My 

concern is that you have to be fairly educated to even know that 

there is a brochure out there that says that there are certain kinds 

of vehicles. 

Also, from talking to local dealerships, if you want safety equipment like that you have to special order. Oftentimes I think people 

just sort of go out and buy a car off the lot almost, not quite on 

impulse but almost. So as far as availability, it is not quite out 

there. 

Dr. QUINLAN. If I can also add, I would like to use this as an opportunity to make sure people are aware of the over 14,000 child 

passenger safety technicians that are out there in the country right 

now, who are ready to help with specific child passenger questions 

like the one you just asked. 

Senator FITZGERALD. Where are they? 

Dr. QUINLAN. You can go to NHTSA’s web site and you can locate 

your closest technician by entering your zip code. 

Senator FITZGERALD. Are these people typically at car dealerships? 

Dr. QUINLAN. Sometimes at car dealerships, sometimes at hospitals, sometimes at traffic safety offices, law enforcement agencies. 

Senator FITZGERALD. Are these people certified? 

Dr. QUINLAN. They are trained by NHTSA in a 4-day course and 

certified by AAA, and they are a very reliable source of specific 

technical information that I really think is underutilized. 

But there are products specific for your case. There is a seat out 

there that can go to 60 pounds with just a lap belt, so a child who 

is under 60 pounds can get into a Futura 20/60 and can use that, 

just lap belt in the center, in exactly the situation you said. So 

there is a variety of special products the technicians are the experts on knowing. 

Senator FITZGERALD. Dr. Lund, correct me if I am wrong, but you 

have been a little bit of a contrarian with respect to the booster 

seats. In your testimony you said ‘‘Emphasizing booster seats is a 

misplaced priority’’ and that what we really need to do is focus on 

69

encouraging the use of seat belts because you point out that better 

to be restrained than completely unrestrained, and we have too 

many kids in this country who are completely unrestrained. 

But we have got to be concerned, do you not think, about the 

kids like Anton, so that there are kids who are restrained, but who 

are too small for that three-point seat belt, and in a serious collision could go flying out the seat? What do we do about that? 

Dr. LUND. Mr. Chairman, I do agree with you. We are all here 

because we are all concerned about child passenger safety. There 

is no question about that. I think we do need to do something 

about the situations such as Anton. This is a case where the belt 

has failed him. 

The problem that the Institute is dealing with is not that the 

adult lap-shoulder belts are perfect or the final answer, but what 

I do not want to do is to move to a law that requires parents to 

put children in booster seats and a parent goes out and buys a 

booster seat because the manufacturer says, this is a booster seat, 

so now I am in compliance with the law, and then we have the 

child in a booster seat that fits the way that the Komfort did on 

Camron and then have that parent later say: I did not realize that 

the lap belt coming across the stomach was a problem; why did not 

somebody tell me? Why was that seat available for my child? 

The same situation—I do not want to see that happen. The law 

does become a way of telling people information about what is 

good. They will buy the booster rather than the concept of proper 

belt fit. 

We have heard a lot about educating the parents the put children in boosters, but I think where we are right now is we do know 

how belts should fit. What we do not know is that all boosters do 

that and they do need to be educated on belt fit and parents need 

to be educated to shop for the booster, not just go buy a booster 

to comply with the law. 

Senator FITZGERALD. Well, do you think we should have as a first 

step federal minimum standards on requirements for booster seats, 

and then once we have those down, once we have the science behind that, then think about encouraging the states to adopt mandatory booster seat usage laws? 

Dr. LUND. Absolutely, Mr. Chairman. This is—as I said, it is a 

misplaced priority, which means a timing issue. We are all on the 

same side here. 

Senator FITZGERALD. So we have to get the standards here. 

Dr. LUND. We have to know what we want parents to use first. 

Senator FITZGERALD. Do you all agree that we ought to have federal standards that go up to, say, 80 pounds as opposed to the 50 

pounds? Does anybody disagree with that? 

[No response.] 

Senator FITZGERALD. No. 

Dr. Winston, you are anxious to speak. 

Dr. WINSTON. Yes. I think one of the challenges with the photographs that you saw from the Insurance Institute is those are children placed in booster seats. They are not children in crashes. I 

think we need to think about it. I wholeheartedly agree that we 

should have standards for the booster seats. It is very confusing to 

the parents that there still are shield boosters out on the market. 

70

There are many different varieties of boosters and parents get confused. 

But the real world experience with children in crashes, demonstrates that existing belt-positioning booster seats are exceedingly effective. It is rare to find serious injuries to children in beltpositioning booster seats in our study. The same experience is in 

Sweden. When a child is in a belt-positioning booster seat, they 

have many fewer minor injuries than children in seat belts. 

Senator FITZGERALD. Your studies are based on data provided by 

State Farm? 

Dr. WINSTON. What happens in our study is that each day we 

hear about crashes that are reported to State Farm Insurance 

Companies in 15 states and the District of Columbia. With the appropriate privacy safeguards, State Farm sends information to the 

Children’s Hospital of Philadelphia, from claims in which consent 

to release data was obtained. 

We then do onsite crash investigations and in-depth telephone 

interviews with parents and have amassed the world’s largest data 

base related to children in crashes. 

Senator FITZGERALD. How many crashes are in that data base 

total? 

Dr. WINSTON. So far, we have 137,000 children in approximately 

90,000 crashes. 

Senator FITZGERALD. There is no other bigger data base, I would 

imagine, that is out there. 

Dr. WINSTON. No. 

Senator FITZGERALD. You have a fantastic set of data. 

Dr. WINSTON. We are very lucky. The generosity of State Farm 

has been great. 

The issue that I am pointing out is that real world data are more 

important than photographs. In the first photograph of the child 

who was more properly restrained, she would have moved that 

shoulder belt behind her back. It was right over her neck. If you 

look at that photograph, she would have been uncomfortable, if the 

belt had remained over her neck. 

But in the event of a crash, when a child is in a belt-positioning 

booster seat, the belt would fit well. The child would remain in the 

shoulder belt and our data are bearing out that the children do 

quite well. 

Let us keep in mind how much a booster seat costs. This is an 

important issue vs. the cost of a child’s injuries. A belt-positioning 

booster seat, a backless belt-positioning booster seat at my retailer, 

is under $20. That is what we are talking about here. 

One of the challenges with the integrated seats, as much as I 

think they are wonderful, is they are quite expensive. These 

backless boosters work well and are very effective. 

Ms. WEINSTEIN. Mr. Chairman, I would like to point out that 

speed is another issue that needs to be considered in this discussion. In the Safety Board’s 1996 study we found that for children 

who were in high-speed crashes it mattered whether they were in 

the appropriate restraint for their age, height and weight. The children who were improperly restrained in high-speed crashes, which 

we define as a change in velocity of more than 20 miles an hour, 

71

those who were improperly restrained were much more likely to be 

killed and seriously injured. 

Dr. LUND. Mr. Chairman, if I might, I would like to followup on 

one thing that Dr. Winston said. It is by way of making sure that 

we do not think that the better belt positioning offered by boosters 

is a panacea for restraint use. We recently—the assumption is 

made that if the belt fits better the child will not move the shoulder belt or will leave it on. We recently had—our photographer who 

was involved in taking these pictures has children in this age 

group and he took a week-long trip and he took some of our better 

fitting booster seats. 

He found that, with the exception of one of them, the children 

did move the belts. They wiggled in the booster seats just as they 

did on a car seat. They did in fact remove that and come out from 

behind the shoulder belt. 

So we must keep in mind that this is not a panacea. The main 

thing it cannot do, as Kyran Quinlan said, is that if you get a good 

booster that moves the child up and positions that lap belt better, 

that is the main benefit that we can get. 

Senator FITZGERALD. I would like to give, if I could, Senator Dorgan the opportunity to speak for a moment. He is the ranking 

member of this Committee. Then, because of time constraints, we 

are going to have to go on to the second panel. Senator Dorgan, 

thank you. 

STATEMENT OF HON. BYRON L. DORGAN,

U.S. SENATOR FROM NORTH DAKOTA 

Senator DORGAN. Mr. Chairman, thank you very much. 

I wanted to say to the panelists that we appreciate very much 

your being here. As is often the case in the Senate, this week is 

very busy with hearings. I have 16 hearings of committees and subcommittees this week, and I was not able to be here earlier because 

I am on the Appropriations Committee and we are meeting with 

Secretary Norton right at the moment. So I am going to go back 

there. 

But I did want to come and say this. I had the opportunity to 

review much of your testimony in your prepared statements. I 

think your contribution in that testimony is very significant. 

Senator Fitzgerald has had an abiding interest in this subject 

and, despite the fact that my colleagues and I have been absent 

this morning, Senator Fitzgerald and I will work on these issues 

with great diligence, especially with Senator Fitzgerald’s leadership. This hearing I hope will help us make some progress in a 

very significant area. 

I have a 14 year old son and a 12 year old daughter and we have 

been through this period. My wife insisted the cars not move an 

inch until everyone was belted up and cinched down correctly in 

the right car seats and booster seats and so on. I understand the 

concerns. I understand the dangers that are involved with children 

in automobiles in circumstances where they are not properly restrained. 

I think this hearing is a real contribution. I want to thank our 

chairman and thank you for your indulgence. I just want you to understand why I was not here and why many of my colleagues are 

72

not here, but I think you are making a very significant contribution 

this morning. 

I thank you for being here and presenting the testimony. 

Senator FITZGERALD. Senator Dorgan, thank you very much. 

We will take just one more comment from Ms. Stone here and 

then we will go on to the second panel. 

Ms. STONE. Thank you very much, Senator. I just wanted to talk 

a little bit about history repeating itself in part. Dr. Quinlan mentioned in his testimony about the child restraint laws being passed 

starting over 25 years ago. The first one was in 1978. I was at the 

Department of Transportation at that time, as were some others in 

this room. 

It really was an amazing situation, because that was a movement that was started by pediatricians as well. So we are glad to 

see the pediatricians out here again. 

What I wanted to say about it is that the states did not wait for 

perfect science. The standard was in place, but it was not the best 

standard it could be. They went ahead and passed the laws. No, 

they were not perfect, but they did pass them. 

I really believe that we are at the exact same spot on this issue 

with booster seats. I would not want to wait until everything, all 

the t’s are crossed in i’s are dotted, in order to move forward with 

state laws, because I think that we can do a lot of help, do a lot 

of service to the American people, by passing those laws and using 

them as education tools. 

I do not know how they will be enforced. I think they will be difficult to enforce. Any traffic safety law is. But I really believe that 

it is time for us to use them as educational tools, as they were used 

starting in 1978. That is how we got where we are today. 

Senator FITZGERALD. Ms. Stone, thank you very much for those 

remarks. All of you, you were excellent witnesses. I want to thank 

you for coming here and participating. 

We will now go to our second panel. We will take just a 1 or a 

2-minute break and we will come back. 

[Recess.] 

Senator FITZGERALD. I would like to resume the hearing now. On 

the second panel we have three witnesses: Ms. Heather Paul, Executive Director of the National SAFE Kids Campaign. Ms. Paul, 

thank you for being here. Mr. James Vondale, Director of Automotive Safety Office of Ford Motor Company. Mr. Vondale, thank 

you. Mr. Baloga, the President of Britax Child Safety, Inc., and I 

think we saw a picture of one of your child safety seats earlier. 

Thank you, Mr. Baloga, for being here. 

Ms. Paul, if you would like to begin. 

STATEMENT OF HEATHER PAUL, PH.D.,

EXECUTIVE DIRECTOR, NATIONAL SAFE KIDS CAMPAIGN 

Ms. PAUL. Senator, thank you so much. You have done wonderful 

work in this area and I think I am a witness to history here today 

to see so much attention paid to specifics of booster seats. I have 

seen tremendous transformation of this whole traffic safety community since I started only 7 years ago. So thank you again. 

I am here on behalf of 303 SAFE Kids Coalitions, made up of 

firefighters, traffic safety police, public health department officials. 

73

Actually, we are making up some of the core child passenger safety 

technicians who you alluded to earlier. I have Joe Colella and 

Karen DiCapua here, who are some of the best technicians in the 

country. Because of them and so many others, we have seen this 

problem of booster seat use from the micro perspective as well as 

a macro one. 

In regards to the micro one, we have been hands on, have 

checked over 160,000 car seats since we began in 1996 with the 

first car seat checkups, with a national campaign in place thanks 

to the support of General Motors. Ironically, we began just the 

same year that Autumn Skeen’s son was taken so tragically, and 

a lot has happened in the last 5 years. 

We have also been with 3200 General Motors dealerships, training them, having them stage these car seat checkups. In addition, 

we have been in the parking lots and the shopping malls, in the 

daycare centers, with the UAW, La Raza, and NAACP in distributing over $5 million worth of free car seats. 

So we have seen it all. We have seen the upscale fathers in their 

Mercedes sport utility vehicles and we looked at absolutely the 

poorest of the poor in remote rural areas, in the inner city, where 

the back seat of their cars is a testament to the state of their poverty. They are pre-1989, they are in a state of deterioration, they 

have lap belt only if they are lucky, if they have just the amount 

of children who could even be restrained in that back seat. 

When it comes to booster seats, actually it is the same problem 

whether you are rich or poor: tremendous underutilization, as all 

these other articulate experts have cited today, and a fundamental 

cluelessness on the part of parents on why they think they need 

them. 

We know this through our conducting thousands of car seat 

checkups, which take about 40 minutes each. If you think of that, 

it is an extraordinary act of public service. Parents say all kinds 

of things about boosters through our focus groups and through the 

car seat checkups. Why would they use this low-back booster, for 

instance, this thing that looks like something that you just sit tall 

on in a restaurant? What is so important about this seat? What, 

seat belt syndrome? What is that? Why this seat? Why not an adult 

belt system? Surely the absence of that little seat cannot give my 

child spinal cord injuries, or cause major internal organ damage 

that is impossible. Finally: Why would I use that? There is no law 

in my state, is there? As other very responsible parents—we abide 

by the law—So why on earth would you ask me to use this? 

These are very legitimate questions. So there is an awful lot we 

need to do on the public education side. That attitude and perception on the part of parents segues right into the other aspect of our 

work, and you have cited that—thank you so much—through our 

recent study. This is the first-ever, in-depth analysis of current 

child occupant protection laws across the country. 

It is not a pretty picture, Senator. As you well know, even Illinois 

is not doing very well, and I will get to that in a second. 

So we were harsh graders. SAFE KIDS gave half the states Fs. 

That is quite extraordinary. Another third earn D’s, and there were 

other shocking facts. How could children be exempt in some states 

because they are nursing when their mother is up front? How could 

74

children be exempt from using restraints in the back seat or the 

front seat if they are driving with an out of state driver with out 

of state plates? How can they be exempt from the law if they are 

simply sitting in the back seat? 

In fact, only two states, California and Washington—and they 

were cited here today, and now Arkansas—have a law that goes 

only as high, finally, as 5, not to the age of 8, what we are talking 

about today. These new laws in California and Washington do not 

even take effect until 2002. In fact, Arkansas, most recently 

passed, does go into effect this summer. 

Another 11 states dictate a child restraint only up to the age of 

4. So that means the rest of the states fundamentally say it is just 

okay to be in an adult belt system. 

No state law covers children in a child restraint up until the age 

of 8. I am sorry to say, Senator, in the state of Illinois that children 

between the ages of 6 and 8 can actually ride totally unrestrained 

in the back seat if they are with a driver over the age of 18. Obviously, that is counterintuitive and quite absurd. 

In our rating of child occupant protection laws we thought we 

took some risks with very stringent grading. No good teacher would 

stand behind half your students getting F’s. But we are really dealing with the harsh realities of motor vehicle crashes and killing 

thousands of children and injuring them every year. So we know 

that it matters, so much so that we have presented a grid to you 

today—Judy Stone has alluded to it as well—where 23 states since 

our report was issued in February, with Safe Kids’ assistance, have 

moved forward, either introducing a bill, improving that bill that 

was already introduced, or actually enacting a much better law, 

which is the case with Arkansas. 

So once in a while a stick works as well as a carrot, there is no 

question about it. 

In terms of the research, we certainly, as an advocacy group, rely 

on the facts of groups like Flaura Winston as well as NHTSA, and 

we indeed want a universal standard, more research, heavier crash 

test dummies when it comes to children up to the age of 8. 

I will also say that the National SAFE Kids Campaign is affiliated with Children’s National Medical Center and there is a 

NHTSA-supported siren study there, the only study in the country 

that is doing a review, forensic studies of kids in crashes who were 

improperly restrained, and Dr. Eichelberger and his team look at 

those cases as they come into Children’s Hospital. 

There is no question, even though this data base, as is the problem here, is very small—20, 30 cases—that he sees very serious injuries from seat belt syndrome that would not be there, according 

to his team, if these same children were in booster seats. 

Outside of the issue of demand, which we are talking about right 

now namely—the need to better educate parents so that they ask 

for these seats, there is also the other side of the ratio, which is 

the supply. What does it look like in the marketplace? How can we 

mandate, how can we ask parents to choose a different restraint 

system if they are not easily accessible. 

It is a changing situation. According to the car seat manufacturers that I spoke with, only 5 years ago it was a very grim picture. 

There was hardly anything out there. In fact there were less than 

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a half million, booster seats, sold a year. That now is up to a million seats a year. 

Now, that does not put a dent in the roughly 20 million children 

between the ages of 4 and 8, that is true. 

Senator FITZGERALD. How many car seats are sold each year, do 

you know? 

Ms. PAUL. Twice that amount. 

Senator FITZGERALD. Twice that amount. 

Ms. PAUL. Yes, two million car seats a year according to one 

manufacturer who I discussed this with this week. Perhaps folks 

from Britax can qualify that, but that is the information I have. 

Also, there is a positive trend in that, more retail space is being 

allocated for booster seats, maybe up to one to one, as many booster seats are on some shelves as car seats. 

There is another interesting phenomenon, which maybe you will 

speak to this as well, 70 percent of booster seats are sold by four 

retailers: Walmart, Kmart, Toys-R-Us and Target. That is not the 

best situation. That means that they potentially have a stranglehold on the nature of the booster seats available. Really, it might 

depend on brand managers or other aspects of retail life that would 

command exactly how parents see, perceive them, what education 

they get onsite as to what booster seats to choose. 

Also, its important to note that relatively the industry is small. 

It is a $350 million industry that handles all car seats in America. 

The advertising budgets are also small. If we want public education 

done, we certainly can not rely on the manufacturers when they do 

not even have the money for a television ad. When is the last time 

you saw a television ad on car seats in general? We can get 

Pokemon ads from Toys-R-Us, but we are not going to get one on 

car seats. So therefore the burden is even greater on advocates like 

us, as well as the government, to provide that public education. 

So finally, I would say too, as Flaura has, that our 300 coalitions 

stand ready to help in any way we can. Thanks to the incredible 

generosity of General Motors, they have committed to us for another 5 years, and that we will be checking tens of thousands more 

car seats, getting more data. If there is any way that we can contribute our traffic safety folks in terms of surveillance, more public 

education, demonstrations on what works, how can we get to parents with the incredible seriousness of an issue that Autumn has 

revealed so painfully. 

So on that note, thank you very much. 

[The prepared statement of Ms. Paul follows:]

PREPARED STATEMENT OF HEATHER PAUL PH.D., EXECUTIVE DIRECTOR, NATIONAL

SAFE KIDS CAMPAIGN

My name is Heather Paul and I am the Executive Director of the National SAFE 

KIDS Campaign. It is my pleasure to testify before the Subcommittee today. Mr. 

Chairman, thank you for inviting me to address this important topic of child restraints for older children and other critical child occupant protection initiatives. I 

also want to take this opportunity to express our appreciation for your sponsorship 

of last year’s Child Passenger Protection Act and for making child passenger safety 

a priority for your Subcommittee. The Child Passenger Protection Act, passed by the 

106th Congress, helped us to refocus on how we can all protect children when they 

are traveling on our nation’s roads. 

76

I. History of the National SAFE KIDS Campaign 

As you and many Members of the Subcommittee know, the National SAFE KIDS 

Campaign is the first and only national organization solely dedicated to addressing 

an often unrecognized problem: More children under age 14 are being killed by what 

people call ‘‘accidents’’ (motor vehicle crashes, fires, and other injuries) than by any 

other cause.

For well over a decade, the National SAFE KIDS Campaign (hereinafter ‘‘SAFE 

KIDS’’) has been focusing on this problem through the work of its national headquarters and its over 300 state and local SAFE KIDS coalitions—including thirteen 

SAFE KIDS coalitions in Illinois alone. From its inception, SAFE KIDS has relied 

on developing injury prevention strategies that work in the real world—conducting 

public outreach and awareness campaigns, organizing and implementing hands-on 

grassroots activity, and working to make injury prevention a public policy priority. 

The on-going work of SAFE KIDS coalitions reaching out to local communities 

with injury prevention messages has helped lead to the decline of the unintentional 

injury death rate during the past decade—a 35 percent decline for children ages 14 

and under. However, with one out of every four children—or more than 14 million 

children ages 14 and under—sustaining injuries that are serious enough to require 

medical attention each year, SAFE KIDS remains committed to reducing unintentional injury by implementing prevention strategies, and increasing public awareness of the problem and its solutions. 

II. National SAFE KIDS Campaign’s Child Occupant Protection Initiatives 

Since 1996, SAFE KIDS has partnered with General Motors to develop and implement the SAFE KIDS BUCKLE UP program to address the needless tragedies associated with motor vehicle crashes—the leading cause of unintentional-related death 

among children ages 14 and under. The SAFE KIDS/General Motors program is an 

historic long-term, initiative that has committed over $20 million to the problem. 

The partnership’s commitment and longevity are certainly warranted. Consider 

these statistics:

• In 1998, 1,765 child occupants ages 14 and under died in motor vehicle crashes. 

Children ages 4 and under accounted for 33 percent of these childhood motor 

vehicle occupant deaths.

• In 1999, an estimated 272,000 children ages 14 and under were injured as occupants in motor vehicle-related crashes.

• As of November 1, 2000, 98 children were killed by passenger side air bags. 

Nearly 89 percent of all children killed by passenger side air bags were either 

unrestrained or improperly restrained at the time of the crash.

A. Alarming Child Safety Seat Misuse Rate: 4 out of 5 Child Safety Seats Improperly 

Installed 

An integral component of our the SAFE KIDS/GM partnership are Car Seat 

Check Up events conducted nationwide by the more than 300 SAFE KIDS coalitions, together with General Motors dealerships and its employees. These events are 

open to the public and provide families with free, hands on instruction on how to 

use child safety seats, booster seats, and safety belts correctly. The events not only 

occur at fixed sites like General Motors dealerships, but are also held at places 

where families go on a more regular basis, such as shopping malls and childcare 

centers. SAFE KIDS is better able to reach these additional families when we expanded our General Motors’ partnership and created the first ever nationwide Mobile Car Seat Check Up program. General Motors donated 51 Mobile Car Seat 

Check Up vans to coalitions in each state and the District of Columbia. These vans 

are packed with child passenger safety literature, tents, cones, child safety seats, 

booster seats, and everything necessary to hold a Car Seat Check Up event at a 

community venue. 

As we have found at these events and reported in our 1999 study, Child Passengers at Risk in America: A National Study of Car Seat Misuse, misuse of child 

safety seats is widespread. It is estimated that although 96 percent of parents believe they install their child safety seat correctly, approximately 85 percent of children placed in child safety seats are actually improperly restrained. Over the past 

four years, the National SAFE KIDS Campaign has checked more than 160,000 

child safety seats through over 4,000 nationwide Check Up events and given away 

more than 100,000 child safety seats to families in need. Our national numbers are 

consistent with what we find in Check Up events in Illinois. In Illinois, close to 200 

Check Up events resulted in over 6,000 child safety seats being checked—with a 90 

percent misuse rate. We know that those parents and caregivers who attend our 

77

check up events leave not only with their child safety seat installed correctly, but 

also leave with a better understanding about how to travel with their children safely. 

B. Shocking Child Safety Seat Nonuse Rate: 40 Percent of Children Continue to Ride 

Completely Unrestrained 

Our dealership-based and mobile check-up events have helped address the alarming misuse rate of child safety seats. Significantly, however, a full 30 percent of children still ride completely unrestrained. Our SAFE KIDS/General Motors’ child occupant protection program addresses this problem also. In May of 1998, the United 

Auto Workers and General Motors joined the America’s Promise initiative by committing $5 million over three years to purchase child safety seats for families in lowincome communities. The program aims to reduce the 1,800 deaths and 270,000 injuries among children in motor vehicle crashes every year. Far too often kids hurt 

in car crashes are not restrained at all. Special emphasis is placed on serving African-American and Latino children, who are being killed and injured in disproportionate numbers on our nation’s highways. The seats are being distributed through 

a partnership with the National Council of La Raza (NCLR), the National Association for the Advancement of Colored People (NAACP), General Motors and SAFE 

KIDS. 

As of March of 2001, a total of 30 NCLR affiliates and five NAACP branches in 

24 different sites have established themselves as ongoing distribution centers, after 

receiving training and technical assistance in child passenger safety from SAFE 

KIDS coalitions and child passenger safety experts. Twenty-one additional NAACP 

branches joined with SAFE KIDS coalitions to hold one-day child safety seat checkup and distribution events in September of 2000. Representatives from these affiliates and branches have distributed over 76,000 child safety seats, including over 

27,000 booster seats, and educated low-income families on proper use. 

SAFE KIDS adamantly believes a properly used and correctly installed child safety seat is the best way to protect our nation’s children from the dangers of car 

crashes. We believe, through our program and with the help of other dedicated child 

safety advocates and partner organizations, children will be better protected on our 

nation’s highways. 

III. Most State Child Occupant Protection Laws Have Dangerous Gaps and 

Weaknesses 

We know the best practices as to how to protect children when they travel and 

we know that in order to persuade parents to buckle up their children, we need to 

educate them about the benefits of proper restraint and the consequences of not restraining their children at all. Most experts agree that strong occupant protection 

laws, coupled with consistent enforcement, are a proven way to get children and 

adults to buckle up. Yet shockingly, a majority of states have gaps in their coverage—leaving certain motor vehicle occupants, especially children, unprotected. 

Loopholes in child passenger safety laws are confusing to parents who look to the 

law for guidance on how to best protect their children. They also serve as disincentives to law enforcement by negating the law’s intent and failing to give police officers a clear directive to keep kids safe when traveling. These laws can leave children lawfully restrained, but woefully at risk. 

A. Child Passengers At Risk in America: A National Rating of Child Occupant Protection Laws 

The first child occupant protection law was passed in Tennessee in 1978. Since 

then, all states have passed laws mandating that children be restrained in motor 

vehicles. Disappointingly, the numbers of unrestrained children injured and killed 

on America’s roadways have remained alarmingly high for the last two decades, 

bringing renewed attention to all aspects of child passenger safety. 

The reasons for nonuse and misuse are complex. However, most experts agree 

that one key factor has been weak state laws, many of which have gaps in coverage 

related to age, seating position, lack of specific child safety seat use, and other exemptions and insufficient penalties. Loopholes in child passenger safety laws are 

confusing to parents who look to the law for guidance on how to best protect their 

children. Weak laws also prevent police officers from adequately helping to protect 

children who travel on roads in their states. 

Many safety advocates are working toward improving their child occupant protection laws. To further these efforts, the National SAFE KIDS Campaign recently 

completed the most comprehensive analysis of our nation’s child occupant protection 

laws. We reviewed each existing child occupant protection law and then measured 

them against a model law that we believe provides a benchmark for every state legVerDate 0ct 09 2002 12:13 Nov 30, 2004 Jkt 088785 PO 00000 Frm 00081 Fmt 6633 Sfmt 6621 S:\WPSHR\GPO\DOCS\88785.TXT JACK PsN: JACKF
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islature. Assessments were based on the language of each law, not on its implementation, enforcement, or other state child passenger safety programs. 

Existing weaknesses and gaps are frightening. Nearly half of all states earned F’s 

and more than a third earned D’s.

• Nineteen states allow children to ride completely unrestrained. For instance, 

New Jersey’s state law permits any child ages 5 and older to ride completely 

unrestrained in the back seat. Pennsylvania’s law is even worse—a father can 

transport his four year old without safety restraints in the rear seat. In a crash, 

these unrestrained children are thrown violently within the interior of the car 

or even ejected from the vehicle all together.

• Thirty-four states allow kids to ride completely unrestrained in certain circumstances by exempting drivers and/or other responsible parties from compliance with their child restraint laws. For example, in Idaho and Tennessee a 

child can lawfully ride unrestrained if he/she is being nursed or his/her ‘‘personal needs’’ are being attended to. SAFE KIDS believes that a child should 

never be unrestrained in a moving vehicle merely because the child, at a moment in time, needs some extra attention.

• According to a majority of state laws, if there are not enough safety belts for 

all passengers, children can ride completely unrestrained. Other states allow 

children traveling in cars with out-of-state plates, or being driven by a resident 

of another state, to ride completely unrestrained. SAFE KIDS believes a child 

born in Louisiana, traveling in Louisiana, but driven by his out-of-state grandmother still deserves the full protection of an effective law.

Although all these scenarios are legal, they leave our children in potentially dangerous, life-threatening situations. Inconsistent state laws do children a grave injustice. No child in America should be dependant on the state in which they live for 

their safety on the road. SAFE KIDS believes that child passenger safety laws 

should apply equally across all of the states and the District of Columbia. 

B. Closing the Gaps Across the Map by 2006

This rating of state child restraint laws clearly demonstrates that child safety 

needs to be a higher priority for our state legislators, governors, and citizens. In response, SAFE KIDS and its more than 300 coalitions have launched a five-year initiative to ‘‘close the gaps’’ in these laws, helping to ensure that all children are properly protected while traveling in motor vehicles. SAFE KIDS has provided individualized, tailored recommendations to each state legislature on how it can better protect its most vulnerable population and supplied model provisions to guide them in 

their efforts. Nationwide, SAFE KIDS coalitions have been working to upgrade their 

state child occupant protection laws, educating families on how to properly restrain 

their children, and assisting states in their law enforcement efforts. Already, at 

least 20 states have introduced bills to upgrade their law and three states (Arkansas, Georgia, and New Mexico), in response to their poor grades, have improved 

their existing laws—raising their failing or near failing grades to Bs. 

IV. Conclusion 

SAFE KIDS believes that a strong law, coupled with effective programming, is the 

cornerstone of any state’s commitment to child passenger safety. SAFE KIDS is 

dedicated to continuing its effort to both helping parents safely transport their children and assisting state legislatures with improving their child restraint laws. Today’s hearing, along with the awareness it will produce, will help SAFE KIDS and 

other child safety advocates better protect our nation’s children.

Senator FITZGERALD. Ms. Paul, thank you very much. 

Mr. Vondale. 

STATEMENT OF JAMES VONDALE, DIRECTOR,

AUTOMOTIVE SAFETY OFFICE, FORD MOTOR COMPANY 

Mr. VONDALE. Thank you. Good morning, Mr. Chairman. I am 

James Vondale, Director of the Automotive Safety Office for Ford 

Motor Company, and I appreciate the opportunity to be here today 

to discuss child safety and also booster seats. Ford has worked for 

many years to increase the proper restraint use by vehicle occupants of all ages and, while our overall efforts will continue, we 

79

have increased our focus recently on the need to further improve 

the effectiveness of restraint systems for children aged 4 to 8. 

Ford believes that booster seats should be used by children who 

have outgrown child safety belts but are too small to wear the safety belts in the vehicle now. In a crash, poor belt fit can reduce the 

protection that the safety belts should provide against the risk of 

serious or fatal injuries. Booster seats help address that concern by 

raising the child in the seat, filling the size gap so that the safety 

belts fit properly. 

Booster seats are simple to use and they can be moved easily, 

they can be moved easily from vehicle to vehicle. Unfortunately, as 

we know, available data shows that only a small percentage of children aged 4 to 8 use booster seats. 

Ford strongly supports the efforts of this Committee and the 

other initiatives that can increase booster seat use. In fact, Ford 

believes booster seats and child safety are so important that we 

launched the Boost America! program in April of last year. Because 

of the importance and broad scope of this undertaking, we 

partnered with a number of prominent safety-minded organizations 

and individuals. Like all of our prior efforts to increase proper use 

of safety restraints, we believe education is critical to increasing 

booster seat use. 

A key component of our education strategy is the distribution of 

innovative, professionally developed educational materials to 

daycare centers, preschools, and elementary schools across the 

country. The Boost America! program has already forwarded educational materials to more than 150,000 daycare centers, 

preschools, and elementary schools, and through direct financial 

grants to states and local programs Boost America has already 

sponsored more than 60 car seat inspection events in 13 states and 

the District of Columbia and Puerto Rico, and we have certified 

over 300 new child passenger safety technicians during 20 certification courses in 7 states. 

Additionally, the Boost America! program will distribute one million free booster seats nationwide. Half a million of those seats will 

be distributed to lower income families through United Way of 

America agencies around the country. The remaining half a million 

seats will be distributed by a voucher system through Ford Motor 

Company dealers and our partners. The vouchers will permit the 

remaining seats to be obtained at Toys-R-Us stores. 

With your permission, I would like to submit additional information about the Boost America! program to the Committee for the 

record. 

In conclusion, Ford Motor Company is a leading champion of 

child safety and booster seats. In fact, Ford was the first vehicle 

manufacturer to market a child restraint system in the U.S., beginning way back in 1957. In fact, Ford Motor Company was the first, 

second, and third manufacturer to market child restraint systems 

in the United States. Ford’s Tot-Guard child restraint was introduced back in 1967 and it was sold by Ford and its dealers for 

many years until more modern child restraint systems became 

readily available in the marketplace. 

Ford’s sponsorship of the Boost America! program demonstrates 

our firm commitment to dramatically increase the use of booster 

80

seats, and we look forward to working together with you and with 

others in the safety community on this very important safety issue. 

Thank you. 

[The prepared statement of Mr. Vondale follows:]

PREPARED STATEMENT OF JAMES VONDALE, DIRECTOR, AUTOMOTIVE SAFETY OFFICE, 

FORD MOTOR COMPANY

Good morning, Mr. Chairman, Members of the Committee. I am James Vondale, 

Director of Ford Motor Company’s Automotive Safety Office. I appreciate the opportunity to be here today to discuss child safety and booster seats. 

Over the past-few-decades, significant advances have been made in vehicle safety 

technology, and traffic fatality rates have declined steadily. Unfortunately, motor vehicle crashes remain the leading cause of death of children ages 5 to 14 in the U.S. 

Additionally, while injuries and fatalities involving infants and toddlers are down 

because of new developments in restraint technology, the wide availability of child 

safety seats, and aggressive education efforts, injuries and fatalities among children 

ages four to eight have declined only slightly. We are pleased with the progress that 

has been made to improve child passenger safety. But, Ford Motor Company is not 

satisfied and we continue to put motor vehicle safety, and particularly child safety, 

high on our agenda for continuing efforts for improvement. 

Ford has worked for many years to increase proper restraint use by vehicle occupants of all ages. While our overall efforts will continue, we have increased our focus 

recently on the need to further improve the effectiveness of restraint systems for 

children. Ford believes that booster seats should be used by children who have outgrown child safety seats but are too small to wear vehicle safety belts properly. According to the National Highway Traffic Safety Administration, a child under 80 

pounds is almost always too small physically to benefit as much from an adult safety belt alone as the child could benefit if better positioned by a booster seat. In a 

crash, poor belt fit can reduce the protection that the safety belts otherwise would 

provide against the risk of serious or fatal injuries. Booster seats help address that 

concern by raising the child in the seat, filling the size gap so the safety belts fit 

properly. Booster seats are also simple to use and can be moved easily among different vehicles. Unfortunately, available data indicates that only a small percentage 

of children between the ages of 4 and 8 are using booster seats. 

Ford strongly supports the efforts of this Committee and other initiatives that can 

increase booster seat use. In fact, Ford believes booster seats and child safety are 

so important that we launched the Boost America! program in April of last year. 

Because of the importance and broad scope of this undertaking, we have partnered 

with a number of prominent safety minded organizations. Like all of our prior efforts to increase proper use of safety restraints, we believe education is critical to 

increasing booster seat use. A key component of our education strategy is the distribution of innovative, professionally developed educational materials to day care 

centers, pre- schools and elementary schools across the country. The Boost America! 

program has forwarded educational materials to more than 150,000 centers and 

schools. Boost America! has already sponsored more than 60 car seat inspection 

events in 13 states, the District of Columbia and Puerto Rico and certified 317 new 

child passenger safety technicians during 20 certification courses in 7 states. 

Additionally, the Boost America! program will distribute 1 million free booster 

seats nationwide. Half a million of the seats will be distributed to lower income families through United Way of America agencies around the country. The remaining 

half a million seats will be distributed by a voucher system through Ford Motor 

Company dealers and our partners. The vouchers will permit the remaining seats 

to be obtained at Toys-R-Us stores. I would like to submit additional information 

about the Boost America! program to the Committee for the record. 

In conclusion, Ford Motor Company is a leading champion of child safety and 

booster seats. In fact, Ford was the first vehicle manufacturer to market a child restraint system in the U.S., beginning in 1957. Ford’s Tot Guard child restraint was 

introduced in 1967 and sold by Ford and its dealers for many years until more modern child restraint systems became readily available in the marketplace. Ford’s 

sponsorship of the Boost America! program demonstrates our firm commitment to 

dramatically increase the use of booster seats and we look forward to working together with you and others in the safety community on this important safety issue.

81

Senator FITZGERALD. Mr. Vondale, thank you very much for that, 

and congratulations to Ford Motor Company for the good work you 

are doing in this area. 

When will you be distributing the one million booster seats? Over 

what period of time is that? 

Mr. VONDALE. That will be distributed shortly, the distribution 

period will begin. I believe that will cover about a 2-year period. 

Senator FITZGERALD. It is very important work and I compliment 

you and Ford Motor Company for your efforts in this area. Thank 

you. 

Mr. Baloga, thank you for being here. 

STATEMENT OF TOM BALOGA, PRESIDENT,

BRITAX CHILD SAFETY, INC. 

Mr. BALOGA. You are welcome, Mr. Chairman. I am Tom Baloga, 

President of Britax Child Safety, Incorporated. My company is located in Charlotte, North Carolina. We are the U.S. subsidiary of 

Britax International, Warwick, England. Based on global sales, 

Britax is the world leader in child restraint sales. We have manufacturing and R and D in England, Germany, Australia, and sales 

offices in France, Sweden, Finland, and the Far East, and we have 

been manufacturing in the U.S. since 1996. So we have a very global perspective on child restraints. 

I would like to make three main points in my testimony. No. 1, 

adult belts are too big for children 4 to 8 years old and most parents do not know this, and a national child restraint law would correct this. No. 2, we child restraint manufacturers must do a better 

job attracting 4 to 8 year olds to use restraints. No. 3, Congress has 

the power to remove an impediment to education by passing a 

Good Samaritan law for child restraint educators. 

All over the world, children in child seats are being protected. 

Despite everything, child seats are doing an excellent job protecting 

children. But we can and must always do better. Seat belts in vehicles are primarily designed to be used by themselves to protect 

adults, not children, and the reason is that vehicle seat belts are 

positioned optimally for adults and therefore they are too big for 

children. 

If vehicles were produced with a wide range of adjustment for 

adults and bigger children, as you had asked the question earlier, 

there would be a potentially huge problem of misuse by adults who 

would never adjust the seat belt to the adult position. What that 

means is that if you can accommodate children and move the seat 

belt low enough for the child, you would have a large number of 

adults who would never adjust it to the higher position and you 

could severely compromise protection. 

Most parents wrongly believe that at 40 pounds or 3 to 4 years 

of age their children can safely use an adult seat belt and they do 

not understand that a child’s hip bones do not develop sufficiently 

until about the age of 7 to 10, and then the child can be big enough 

to avoid a lap belt resting against the soft abdomen, as previous 

people have testified. 

Seat belts must hold a human in a crash via the human’s bone 

structure. Only strong bone can support the crash loads. Frontal 

crash forces can easily make the child’s body momentarily weigh 

82

2,000 pounds. This would be a 50-pound child experience a 45-g 

frontal crash, as in, for example, a 30 mile crash into a bridge 

abutment. 

If a restrained child presses against a seat belt with a momentarily 2,000-pound force into the abdomen, the child will suffer lap 

belt syndrome, which has been mentioned by previous testifiers. 

This means severe internal injuries, including spinal column separation and paralysis. This happens if the child is too small for the 

adult belt and the lap belt rides up on the abdomen. 

The problem is not one of available products to protect children, 

since there are many restraints on the U.S. market for children 

older than 3 years old. The problem is that most parents honestly 

do not know adult seat belts are too big for their children and this 

false impression is partly due to state laws that end requirements 

for child restraint too young. 

Most infants and toddlers are being restrained, but parents find 

out that state laws for child restraints end at about 3 years of age 

and they wrongly believe that above this age their children can 

safely use the adult belt. 

I believe that the same formula for success in getting infants and 

toddlers into child seats will work for getting big kids into restraints. Laws need to be updated as soon as possible and, since 

state laws seem to be very slow getting started, it may be appropriate to consider enacting a national child restraint use law. 

For about 10 years Germany, Sweden and Austria have required 

the use of an appropriate restraint device for children up to 12 

years old or less than 1.5 meters in height, which is about 4 foot 

11. This has resulted in a tremendous number of children being 

protected and using booster seats. There is now activity under way 

to make this a Europe-wide directive. 

A U.S. federal law or strong encouragement for states to adopt 

a uniform child restraint law up to 80 pounds would be very desirable. Recently, the Florida State Senate approved legislation to require children 8 or younger to ride in a child restraint and we hope 

this sparks interest and action by other states. I hope that bringing 

attention to this issue can at least educate parents that adult belts 

are too big for children. 

We manufacturers must do more. As child restraint manufacturers, we have an obligation to do even better to make big kids’ seats 

attractive to kids. There are boosters on the market now in fabrics 

of denim, camouflage, and themes for older kids, like NASCAR racing and so forth. But we manufacturers need to mobilize our efforts 

to prove that it is cool to be restrained. Peer pressure at that age 

is very, very important to keep children riding safely. 

I believe our industry via our Juvenile Product Manufacturers 

Association is ready and willing to do its part to attract older kids, 

and I will carry that forward with our JPMA. 

Removing a road block to education. There are many wonderful 

organizations like SAFE Kids and volunteers providing education 

on proper child restraint use. The majority of adults want all children to be protected and when they realize the need they will respond. In the U.S. there is currently a significant disincentive for 

more people to become involved in education on child restraints. 

Fear of litigation stops many organizations, volunteers, and sales 

83

people from helping educate adults on proper child restraint use. 

A Good Samaritan law for child passenger protection educators 

would remove this disincentive and free up tremendous resources 

to provide personal education to those who can use it. I have sent 

a request to you to respectfully consider sponsoring such legislation 

for a Good Samaritan law. 

While instructions, labels, flyers, videos, manuals and demonstrations are important, person to person information with 

hands-on guidance is often most effective. It is frustrating to us as 

a manufacturer when retailers tell us they are afraid to provide detailed fitting instructions to consumers because they fear product 

liability lawsuits. On the advice of legal counsel, most retailers forbid their staff from attaching a child seat into a consumer’s vehicle 

and volunteer advocates who conduct safety seat checks do a terrific job, but many admit they operate in fear of litigation. 

In closing, I would like to reiterate that products are already on 

the market to better protect children and parents often wrongly believe that adult seat belts are okay after 3 years of age, and updating laws and improving education can lead to significant improvements to restraints for big kids. 

Thank you and I am ready to answer any questions you might 

have. 

[The prepared statement of Mr. Baloga follows:]

PREPARED STATEMENT OF TOM BALOGA, PRESIDENT, BRITAX CHILD SAFETY, INC. 

Mr. Chairman and Members of the Subcommittee, I am Tom Baloga, President 

of Britax Child Safety, Inc. My company is located in Charlotte, NC and we are the 

U.S. subsidiary of Britax International, Warwick, England. Based on global sales, 

Britax is the world’s leading manufacturer of child restraints. Britax has manufacturing and R&D in England, Germany, and Australia and sales offices in France, 

Sweden, Finland, and the Far East. We have been manufacturing in the U.S. since 

1996. 

All over the world, children in childseats are being protected. Despite everything, 

childseats are doing an excellent job protecting children, but we can and must always do better. 

Seat belts in vehicles are primarily designed to be used, by themselves, to protect 

adults not children. The reason is that the vehicle seatbelts are positioned optimally 

for adults and they are therefore ‘‘too big’’ for children. If vehicles were produced 

with a wide range of adjustment for adults and bigger children there would be a 

potentially huge problem of misuse by adults who would never adjust the seatbelts 

to the ‘‘adult position.’’ Most parents wrongly believe that after 40 lbs. or 3–4 years 

of age their children can safely use an adult seatbelt. They don’t understand that 

until a child’s iliac crests (hip bones) are developed at about the age of 7 to 10 and 

the child is big enough to avoid the lap belt resting against the soft abdomen, an 

adult seatbelt provides inadequate protection to a young child. 

Seatbelts MUST hold a human in a crash via the human’s bone structure. Only 

strong bone can support the crash loads. Frontal crash forces can easily make the 

child’s body momentarily ‘‘weigh’’ 2,000 pounds This would be a 50 pound child experiencing a 45 g. frontal crash as in a 30 mph crash into a bridge abutment. If 

a restrained child presses against a seatbelt with a momentary 2000 pound force 

and the force is going into the abdomen, the child will suffer ‘‘lap belt syndrome’’ 

which means severe internal injuries including spinal column separation and paralysis. This happens if the child is too small for the adult belt and the lap belt rides 

up on the abdomen. 

The problem is NOT one of available products to protect children since there are 

many restraints on the U.S. market for children older than 3 years old. The problem 

is that most parents honestly don’t know adult seatbelts are too big for their children and this false impression is partly due to state laws that end requirements for 

child restraint too young. 

84

Current State Laws Are Out of Date 

Most infants and toddlers are being restrained but many parents find out that 

state laws for child restraints end at about 3 years of age and they believe that 

above this age children can safely use adult belts. I believe that the same formula 

for success in getting infants and toddlers into childseats will work for getting ‘‘big 

kids’’ into restraints. Laws need to be updated as soon as possible. Since state laws 

seem to be very slow in getting started it may be appropriate to enact a National 

Child Restraint Use Law. For about the 10 years Germany, Sweden and Austria require the use ‘‘an appropriate restraint device’’ for children up to 12 years old or 

less than 1.5 meter in height (i.e. 59 inches or 4 ft. 11 in.). There is now activity 

underway to make this a Europe-wide directive. A U.S. Federal Law or strong encouragement to states to adopt uniform child restraint laws up to 80 lbs. or 4 ft. 

9 in. would be very desirable. Recently the Florida State Senate approved legislation 

to require children 8 or younger to ride in child restraints and we hope this sparks 

interest and action by other states. I hope that bringing attention to the issue can 

at least educate parents that adult belts are too big. 

Manufacturers Must Do More 

We child restraint manufacturers have an obligation to do even more to make our 

‘‘big kids seats’’ attractive to the kids. There are boosters on the market with fabrics 

in denim, camouflage, and themes for older kids like NASCAR racing etc. but we 

manufacturers need to mobilize our efforts to prove that it’s cool to be restrained. 

I believe our industry via the Juvenile Products Manufacturer’s Association (JPMA) 

is ready and willing to do it’s part to attract older kids. 

Removing a Roadblock to Education 

There are many wonderful organizations and volunteers providing education on 

child restraint use. The majority of adults want all children to be protected and 

when they realize the need they will respond. In the U.S. there is currently a significant disincentive for more people to become involved in education on child restraints. Fear of litigation stops many organizations, volunteers, and sales people 

from helping educate adults on proper child restraint use. A ‘‘Good Samaritan Law 

for Child Passenger Protection Educators’’ would remove this disincentive and free 

up tremendous resources to provide personal education to those who can use it. 

While instructions, labels, flyers, videos, manuals, and demonstration fixtures are 

important, person-to-person information with hands-on guidance is often most effective. 

It is frustrating to us when retailers tell us that they are afraid to provide detailed fitting instructions to consumers because they fear product liability lawsuits. 

On the advice of legal counsel most retailers forbid their staff from attaching a 

childseat into a consumer’s vehicle. Volunteer advocates who conduct safety seat 

checks do a terrific job but many admit that they operate in fear of litigation. 

In closing I would like to reiterate that :

• Products are already on the market to better protect children

• Parents often wrongly believe that adult seatbelts are ok after 3 years of age

• Updating laws and improving education can lead to significant improvements 

to restraints for big kids.

Thank you and I’m ready to answer any questions you might have.

Senator FITZGERALD. Thank you very much. 

Mr. Baloga, are those child safety seats or booster seats manufactured by your company? 

Mr. BALOGA. No. 

Senator FITZGERALD. No. I do not know if anybody—who put 

those up there? Did anybody want to do a demonstration? 

Ms. PAUL. I turn to Joe Colella. Would you like to see? 

Senator FITZGERALD. Well, I was wondering if those were for 

demonstration purposes. 

Ms. PAUL. This low back booster seat illustrates how parents 

might dismiss its importance. It really doesn’t look so sturdy, 

therefore parents might not think it important and certainly cannot be the difference between life and death or serious injury 

85

caused by an adult belt system. Then there’s a high back boosert 

that more imitates a front-facing convertible seat, so that parents 

see this as a more obvious transition, a graduation from small child 

into larger child seat. So there are some interesting issues of perception. 

Mr. BALOGA. I can point out the aspects of the booster that are 

very, very critical to proper attachment of the seat belt on the 

child. These are horns that hold the seat belt down low so that it 

does not creep up on the child’s abdomen. When adults sit in a vehicle, the belt is raised up sufficiently so that the belt lays across 

the thighs. That is the optimal position. 

On a child who sits too low, it is very easy for the belt to ride 

up and that is where the loads of the seat belt are going the push 

into the soft abdomen. Of course, the abdomen has no bone protection. You do not have the hip bones developed until they are about 

8 years old. So these horns artificially act as the hip bones and 

they will hold the lap belt down low. 

Senator FITZGERALD. So that alone is a booster seat. Most booster seats that I have seen and the ones that my own son used, they 

had a full back to it as well. 

Mr. BALOGA. Like this, yes. 

Senator FITZGERALD. But that is a booster seat, not just a child 

safety seat? 

Mr. BALOGA. Correct. It converts into a booster seat. You know, 

the harness can be removed. The lap belt, if you notice the cutout 

here, this holds it down low to simulate these horns. That will hold 

the lap belt down low. Then I have possibilities here to slide the 

shoulder belt in different locations. There are three possible locations to hold the shoulder belt in the proper position. 

Senator FITZGERALD. Great. Well, thank you very much. That 

was a helpful illustration. 

I wanted to get back to the issue. A few of you have mentioned 

the standards in the European Community and suggested that they 

are much tougher than we are here. In fact, some of the European 

countries have a requirement that all children under age 11—did 

I hear that correctly——

Mr. BALOGA. 12. 

Senator FITZGERALD. 12? 

Mr. BALOGA. Yes. 

Senator FITZGERALD.—must ride in some child restraint. Could 

you tell us a little bit more about the specifics of those laws in Europe? Apparently the European Union is considering a Europe-wide 

standard? 

Mr. BALOGA. Yes. The age is 12 years old or 1.5 meters, which 

is about 4 foot 11. If you are shorter, if you are shorter than this 

or you are younger than this, you must ride in an appropriate restraint. That means either an infant seat, a toddler seat, or a 

booster seat. 

Senator FITZGERALD. Does the law get more specific than that? 

Does it break down the age at which you must be riding in a booster seat, as opposed to a child safety seat? 

Mr. BALOGA. No, no. That is taken care of by the European requirements for the appropriateness of the actual child restraint, to 

have group zero, group one, group two, and so forth. So depending 

86

on the weight of the child, you will select a restraint appropriate 

for the child. So the law states that below 12 years old you must 

be riding in an appropriate restraint, and then ‘‘appropriate’’ is determined by the actual restraint itself, if you follow the labeling instructions. 

Senator FITZGERALD. Do you think we should have a law like 

that in the United States? 

Mr. BALOGA. Yes. I would say 80 pounds would be the weight 

limit that I would recommend, 8 years, 80 pounds. 

Senator FITZGERALD. Do you think the Europeans are wrong in 

going up to 12 years of age? 

Mr. BALOGA. I think it is too high. I think it is unnecessary. I 

think it is a situation where you would be hard pressed to find an 

11 year old who would sit in a booster seat. I think we should be 

more realistic. 

Senator FITZGERALD. They just do not want to sit in those seats. 

They are anxious to graduate out of that. 

Mr. BALOGA. Which is what I mentioned about we manufacturers 

have to do a better job of attracting these older kids. 

Senator FITZGERALD. But the Europeans must have felt they had 

some science behind their requirement there, kids up to 12 years 

old. What is the science behind it? They must be finding injuries. 

Mr. BALOGA. It originated in that in some of those European 

countries a child 12 years and younger could not ride in a front 

seat and that was the origin of it. For many, many years a child 

could not ride in a front seat until they were 12. With the advent 

of two-seaters and convertibles and so forth, they needed to make 

amendments to that. But that is really the origin, that riding in 

the front was not permitted. 

Senator FITZGERALD. Now, with respect to an appropriate booster 

seat in Europe, what qualifies as an appropriate booster seat and 

would some of the booster seats on the market in this country not 

qualify as appropriate booster seats in Europe? 

Mr. BALOGA. As far as meeting the European requirements, I do 

not have a good answer because we do not take the U.S. booster 

seats and test them to the European requirements. I know that our 

Britax seats meet the European requirements. 

Senator FITZGERALD. You do sell them in Europe? 

Mr. BALOGA. Yes. 

Senator FITZGERALD. You designed them to meet the European 

specifications? 

Mr. BALOGA. And the U.S., yes. 

Senator FITZGERALD. And the U.S. But we only have—what are 

our specifications? 

Mr. BALOGA. Well, when you start with a booster seat below 50 

pounds you are automatically required to meet Standard 213, because Standard 213, the U.S. requirement, goes up to 50 pounds. 

So for example, our booster seat that goes from 40 pounds to 100 

pounds—and we have three models that do that—they must meet 

the requirements of Standard 213 anyway. 

So we would test them, for example, with a 6 year old child that 

weighed—the dummy weighs 47 pounds, and it would have to meet 

U.S. requirements. Above that, we would use a European P–10 

dummy that is equivalent to a test for 80 pounds. Then for 100 

87

pounds we would use a fifth percentile female U.S. dummy that is 

weighing 104 pounds. 

So there are devices for testing and they are capable of being 

used for compliance and also for assurances to us as a company 

that we are protecting children. We are running these tests regardless of whether there is a U.S. requirement or not. 

Senator FITZGERALD. How many booster seats a year does Britax 

sell? 

Mr. BALOGA. In the world or in the U.S.? 

Senator FITZGERALD. In the world and in the U.S. Would you 

know? 

Mr. BALOGA. In the world, probably one million. In the U.S., we 

are very new in this market, so we are very small; on the order 

of 100,000. 

Senator FITZGERALD. Is that right? So most of your sales are 

overseas. But you are headquartered here, right? 

Mr. BALOGA. We are headquartered in Warwick, England. 

Senator FITZGERALD. Okay. 

Mr. BALOGA. We are only in the U.S. since 1996. 

Senator FITZGERALD. You are a British company? 

Mr. BALOGA. Yes. 

Senator FITZGERALD. Okay. 

Mr. Vondale, does Ford Motor Company collaborate at all with 

the manufacturers of the child safety seats and booster seats? Does 

the auto industry generally? 

Mr. VONDALE. Yes, we collaborate with the child seat manufacturers. In fact, as a part of our Boost America program we collaborated very closely with several of the manufacturers—Century. We 

developed with them the booster seats that we are going to be distributing across the United States. 

Senator FITZGERALD. Oh, you developed a specific booster seat for 

this program? 

Mr. VONDALE. One of the seats, the high-backed booster, was developed especially for this distribution and it is available only 

through the distribution. The other seat is similar to a seat that 

is on the market, but again it was developed and tested and evaluated very carefully with the two child restraint manufacturers. 

Senator FITZGERALD. So you had your own engineers involved in 

that process of designing that seat? 

Mr. VONDALE. They were involved from the beginning in terms 

of the evaluation of that seat, in fact both seats. 

Senator FITZGERALD. Ms. Paul, you look anxious to speak. 

Ms. PAUL. I was just going to say as a sidebar, talking about the 

state of child restraints in Europe, we are doing some work in 

Brazil now and we have lots of testimony from other developing nations, and it is a very, sorry situation. 5 percent of kids in Brazil 

are in car seats and car seats cost over $200 because of high import 

tariffs. So the problems are just so replete worldwide as traffic and 

urbanization become the number one way kids are really going to 

die in the streets. 

Senator FITZGERALD. They are putting tariffs on safety equipment like that. 

Ms. PAUL. Yes. 

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Senator FITZGERALD. That does not seem like a good public policy. 

Ms. PAUL. No, it does not seem like a good public policy. 

Senator FITZGERALD. For Ms. Paul: Do we know that passing or 

improving a gap-closing law actually changes behavior? Would just 

passage of a law improve the usage of child safety seats? 

Ms. PAUL. That is a universal question in the halls of Congress, 

is it not, oftentimes? There is some evidence and we rely strongly 

on—for instance, we know that when you have a primary enforcement law you can expect that seat belt usage rates on the average 

go up by 17 percent. Now, that is adult use. But then there is research that correlates adult seat belt use with parents and caregivers using child restraints. 

We also know when we look at bike helmet laws that SAFE Kids 

has helped pass bike helmet laws in 16 states and we have seen 

a 60 percent drop in head trauma from bicycles because of the use 

of the helmets. So you can sort of tease out some of these correlations. 

The CDC has also done a study that tracks, I believe, a correlation between primary seat belt laws passed and a rise in use by 

African Americans of seat belts. So we put together these isolated 

studies to make a case that laws really matter. Of course, we know 

attitudinally they absolutely matter, because parents say: If there 

is no law I am not sure I feel bound to do this. 

I will say, too, parenthetically, looking at the 23 states that are 

moving ahead in closing those gaps, most include language that 

only covers children up to the age of 6. So the concerns that the 

Insurance Institute have are valid in that we should move ahead 

with research at the same time as we move ahead with passing 

booster seat laws. If we are going to demand 8 years of age and 

80 pounds, we need good research behind these laws. Probably the 

research on booster seat effectiveness is most needed on older children of higher weights. These are the children who are much more 

emotionally independent, they demand freedom, autonomy, they 

want to be in that adult belt system. We know that. 

So these are important reasons why we need the research behind 

mandates for booster seats of seven and eight year olds. 

Senator FITZGERALD. Mr. Vondale, Ford now owns Volvo, is that 

correct? 

Mr. VONDALE. Yes, that is true. 

Senator FITZGERALD. I understand that Volvo’s web site regarding its Safety Concept Car states that: ‘‘Today’s generation of rear 

seats is designed for adults and modified to suit children. In the 

Volvo SCC, Volvo cars approach the matter from the opposite direction and presents a rear seat that is designed first and foremost 

for children, while functioning perfectly well for adults, too. Both 

the seats in the rear of the SCC have electrically adjustable seat 

cushions that can be varied vertically. This is done so that the rear 

seat can be altered to suit all those children who have outgrown 

rearward-facing child seats. The seat cushion height is adjusted 

steplessly to exactly match the child’s height and with due attention to belt geometry, comfort, and forward visibility.’’

Is Ford considering incorporating this feature into its regular 

Ford cars as opposed to its Volvo subsidiary? 

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Mr. VONDALE. Senator, one of the advantages of having Volvo as 

one of Ford’s brands now is our ability to use the strength of 

Volvo’s safety reputation and safety expertise to develop new concepts and new ways to address these issues. So we are working 

with Volvo to, as a concept car, to evaluate those types of systems. 

Certainly one of our plans with Ford Motor Company is if these 

systems are in fact proven out and they are feasible, then they can 

be considered for cascading through the other Ford brands. Right 

now we are working with Volvo on those types of concepts and we 

think that it does have some promise. 

Senator FITZGERALD. Are those adjustable seats available on the 

market now with Volvo, or is that just a concept? 

Mr. VONDALE. That is a concept car. In fact, I was handed a note: 

The concept car will be here on May 7th, and we probably will be 

able to share that information with you. But it is a concept car. 

Senator FITZGERALD. Will it be here for an exhibit on May 7th? 

Okay. But that is not offered in any production model, then, yet, 

these adjustable seats? 

Mr. VONDALE. No. That is a very new and——

Senator FITZGERALD. Revolutionary. 

Mr. VONDALE.—revolutionary concept that is being explored as a 

part of the Volvo concept car. 

Senator FITZGERALD. I guess my question, just to followup on 

that a little bit, would be, if we were to go forward and mandate 

booster seats or greater booster seat usage, that would clearly be 

one way of addressing this whole issue. But do you think the technology will be out there that we can actually mandate that the cars 

themselves have seats that are adjustable to fit children? 

Now, in the past panel the panelists did not seem to think the 

mandating any requirements in the cars was the way to go because 

they thought it was too difficult. Clearly, the car seat or booster 

seat industry would probably prefer us the require booster seats. 

After all, there is some self-interest in this. If we mandate booster 

seats, that is going to mandate buying your product. 

But I do not know if that is the right thing to do for our kids 

in this country. 

Mr. BALOGA. Senator, when my son Matthew was born we looked 

for a built-in child restraint and could have bought one from Chrysler at the time. The question that we asked was, will it accommodate an infant? The answer was no, because infant restraints have 

to be rear-facing and they are very complicated to build into a seat 

and bulky, so that is out of the question. 

Then the second issue was, if we buy a vehicle with a built-in 

child restraint we also have to buy a portable restraint because 

when grandma and grandpa and our relatives take the child we 

would then be expected to give them our car, which is rather inconvenient. So the practical issue is built-in restraints have been 

available and the public has decided it is not convenient. 

You also have to sit on the restraint when it is folded in, which 

makes it very hard and uncomfortable. While I would grant you 

that technologically it is not impossible to design a system, at this 

point it is just not practicable to do so. From the issue of the relatives transporting children, you would have to buy a portable restraint anyway. 

90

Senator FITZGERALD. But any kind of federal mandate it seems 

to me could be written in such a way so that a parent or a caregiver is complying with the law if they have got their child in the 

required safety restraint, whether it is built into the car or it is 

portable and it is basically a booster seat. 

Mr. BALOGA. Yes. 

Senator FITZGERALD. Would Ford have anything to add here? 

Mr. VONDALE. Senator, I think just looking at the booster seats 

that are presented in front of us it is pretty clear that particularly 

the backless booster seat is a clear example of a very simple seat 

that we have found is very effective in addressing the issues here, 

and that is also very affordable to the customer and one that can 

be moved from vehicle to vehicle. All of those kinds of things are 

very important to customers. 

Senator FITZGERALD. Is the backless booster seat as effective as 

one with a back? 

Mr. VONDALE. When we have looked at both backless and high 

back, we find that the backless booster seat works very well in vehicles that have a sufficient high back behind the child. We want 

to make sure that the child’s head and neck are protected. In those 

vehicles, particularly much older vehicles, where the back seat is 

much lower, you would want to consider a high-backed booster 

seat. So I think that is the real issue of choosing between a 

backless booster and the high-backed booster, is the neck protection that is available to the child in the vehicle that it is being used 

in. 

Senator FITZGERALD. The ones that you are going to be distributing as part of your campaign, they have a high back? 

Mr. VONDALE. We are distributing both. We have a backless 

booster that will be available for vehicles that have a sufficiently 

high back seat to help protect the child’s neck and head, and then 

we will have high-backed boosters for those vehicles that need the 

high back, extra height protection. 

Senator FITZGERALD. Are you doing any advertising campaign to 

demonstrate the availability of your, or publicize the availability of 

the seats you will be giving away? 

Mr. VONDALE. As I said, there is a strong educational program 

that is going forth. We are using United Way and their network 

to help get to those people who are of lower income. We think that 

is a very effective way, rather than advertising, to get directly to 

the people who need these seats. 

As a part of the Ford Motor Company and our partners’ giveaway—for example, AAA and others will be involved with us—yes, 

there will be communications to let customers know about the 

availability of this program. 

Ms. PAUL. I think you have also hit on the complexity that has 

not been really worked out yet as to what the protocol is to determine exactly which low-back, high-back seat is best, considering all 

the variables of car seat dimensions and a child’s weight and size, 

and the fact that when you talk about—and many people get this 

wrong—a give-away program, you just cannot give a low income 

mom a seat and expect her to know what to do with it. So then 

we are back to the trained technicians who need to be certified by 

at least 4 days of training and hundreds more hours of hands-on 

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experience, being able to guide them best, to then help them put 

that seat in right. 

So it is a really complicated business. 

Mr. VONDALE. That is a good point. One of the other reasons we 

are using the United Way is the agencies there will be able to work 

with the people who are getting these seats, to give them information, so that they make the right choice and the seat fits properly. 

Senator FITZGERALD. Well, with that I want to thank all of you. 

Both panels have been wonderful. I really appreciate your interest 

and willingness to come here to Washington to testify. I am hoping 

that some good will come out of this. I think we have learned a lot 

here. 

For the most part, I think all the witnesses have given pretty 

clear direction on what we ought to be doing. We will take all of 

your full written statements and put them in the record, and we 

will look forward to continuing to work with you on this very important issue. 

Thank you all very much for being here. Thanks. With that, I am 

going to adjourn this meeting. 

[Whereupon, at 12:23 p.m., the Subcommittee was adjourned.] 

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APPENDIX

PREPARED STATEMENT OF THE NATIONAL ASSOCIATION OF GOVERNORS’ HIGHWAY

SAFETY REPRESENTATIVES

Introduction 

The The National Association of Governors’ Highway Safety Representatives 

(NAGHSR) is pleased to submit testimony to the Consumer Subcommittee on the 

issue of child passenger safety. NAGHSR is a nonprofit association representing 

state highway safety agencies. Its members are appointed by their governors to administer federal behavioral highway safety grant programs, develop the annual 

state Highway Safety Plan, and implement highway safety programs in the state. 

NAGHSR focuses on the behavioral aspects of highway safety such as impaired driving, failure to use occupant restraints and child passenger restraints, excessive 

speeding and aggressive driving, distracted and fatigued driving, and unsafe bicycling, walking and motorcycling. 

Overview of the Problem 

Research by the National Highway Safety Administration (NHTSA) has consistently shown that occupant restraints are the most cost-effective way to prevent 

deaths and injuries in motor vehicle crashes. Hence, the failure to properly restrain 

drivers and occupants of a vehicle, including children, is a priority issue for 

NAGHSR members. 

Unrestrained children in motor vehicle crashes are an especially troublesome, 

often tragic, yet preventable problem. However, it is important to keep the problem 

in perspective. Inadequate occupant protection is still overwhelmingly an adult 

problem. According to 1999 data from the Fatal Analysis Reporting System (FARS), 

children aged nine and under represented only 3 percent of occupants killed in a 

motor vehicle crash and 5.4 percent of occupants injured in such crashes. Children 

nine and under killed in a vehicle who were unrestrained represent only 2.9 percent 

of the total unrestrained occupants. 

Additionally, ensuring that children are placed in restraints is a far bigger problem than ensuring that the restraints are used properly. According to 1999 FARS 

data, 55 percent of fatally injured children ages four to nine are completely unrestrained. Restraint use for children from birth to age one is 97 percent, and ages 

one to four, 91 percent. From age five to 15, restraint use plummets to 68.7 percent. 

Hence, a major focus of state occupant protection efforts for children is to make sure 

that children are restrained and that they are kept in appropriate restraints for as 

long as possible before being moved to safety belts. 

Generally, state child passenger protection programs have three or four components: legislation, public information and education programs, enforcement and 

child safety seat clinics and fitting stations. Although legislation is a very important 

component, it is only one element of a comprehensive approach to child passenger 

safety. Without education and enforcement, legislation alone will have a limited impact upon behavior. 

Legislation 

Two states had enacted booster seat laws prior to the 2001 legislative session. In 

2000, Washington was the first to enact a booster seat law which requires children 

up to 6 years old or 60 pounds to be restrained in booster seats. The law will take 

effect July 1, 2002. California subsequently enacted a law that would require children up to 6 years old or 60 pounds to be in booster seats. California’s law will take 

effect Jan. 1, 2002. 

During this year’s sessions, the states have been very active on the legislative 

front. Many states have pending legislation that would close the gaps in child restraint laws or specifically require older children to be restrained in booster seats. 

There are two distinct problems with the drafting of state booster seat legislation. 

First, all state child restraint laws require that children be placed in child restraint 

systems that are consistent with federal safety standards (FMVSS 213). (See atVerDate 0ct 09 2002 12:13 Nov 30, 2004 Jkt 088785 PO 00000 Frm 00097 Fmt 6601 Sfmt 6621 S:\WPSHR\GPO\DOCS\88785.TXT JACK PsN: JACKF
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* The information referred to was not available at the time this hearing went to press. 

tached Arkansas law which is typical of how state laws are written.)* However, the 

current federal child restraint standard only covers safety seats for children 49 

pounds or less. Hence, by referencing the federal standard, state booster seat laws 

encourage parents to put children into boosters that are untested and potentially 

unsafe. 

Further, by referencing the federal standard such laws are put into a legal ‘‘grey’’ 

area. A good defense lawyer could easily mount a challenge to such a law in court 

because there is no federal standard for child restraints for children 50 pounds or 

above. In order to rectify this situation, the National Highway Traffic Safety Administration (NHTSA) must raise the standard for child restraints and do so as quickly 

as possible. 

Secondly, there is currently no consensus on the appropriate age or weight for 

booster seats and hence, it is difficult to know how to write a state law. Some states 

have used a 6 year old or 60 pounds limit. Others have higher limits. The difficulty 

with a limit based on age or weight is that there are always exceptions. A standard 

child passenger safety seat may better serve children who have reached the age 

limit but not the weight limit. Larger children who have reached the weight limit 

but not the age limit may better suited to a booster seat. A number of researchers 

and child safety advocates believe that the best test for children is a ‘‘fit’’ test. If 

the child can sit in a booster seat with his/her legs bent over the edge, with the 

lap belt low on the hips, and with the shoulder belt properly positioned across the 

chest, then that seat is right for the child. It is difficult, however, to write a fit test 

into state legislation. NHTSA should reconvene its Blue Ribbon Panel on Child Restraint Usage and encourage it to take the lead on the development of researchbased guidelines for use of booster seats. 

There are also concerns about mandating booster seats in states that have large 

low income populations. These populations typically own older vehicles with lap-only 

belts in rear seats. Booster seats are not compatible with and cannot be used with 

such vehicles. Retrofit kits for older cars are expensive and scarce. Child restraint 

manufacturers should be encouraged to develop booster seats that can be properly 

used with lap-only seat belts. 

Despite these difficulties, many states have forged ahead with booster seat legislation because they are concerned about the safety of young children and want to take 

every precaution to protect them. NAGHSR conducted an informal poll of its member State Highway Safety Offices (SHSO’s) the week of April 16 and 33 states have 

responded to date. Of the 33 respondents, 14 states have introduced booster seat 

laws this session. Of those, one was enacted (Arkansas) and one was killed (Maryland). The remainder are still pending. Individual state responses are as follows: 

Arkansas—legislation enacted in February that would require children 6 years of 

age or at least 60 pounds to be in an age-appropriate child passenger safety seat. 

The law will go into effect this summer. 

Colorado—booster seat bill may be introduced next session. 

Connecticut—legislation is pending that strengthens existing CPS law. 

Delaware—booster seat bill is pending. 

District of Columbia—current child restraint law is being re-written and strengthened. A booster seat bill is expected to be introduced shortly. 

Georgia—legislation introduced to strengthen child safety seat law and mandate 

booster seat use. Booster seat portion not accepted by legislature. 

Hawaii—booster seat bill pending. The legislature enacted a booster seat bill that 

would require children to be in booster seats if they are under 80 pounds or 8 years 

old. The bill is awaiting the Governor’s signature. It would go into effect Jan. 1, 

2002. 

Iowa—bill pending which would raise the age of child restraint coverage to 5 and 

would require children age 13 or younger to be restrained in any seating position 

in a vehicle. 

Illinois—booster seat bill is pending. 

Kansas—booster seat bill introduced. Senate passed bill but no action has been 

taken by House. Passage unlikely. 

Louisiana—booster seat bill is pending. 

Maryland—booster seat bill passed Maryland Senate 41–4 but killed on House 

floor. 

Massachusetts—booster seat bill is pending. 

Missouri—Senate bill passed but House action is uncertain. Passage unlikely. 

Minnesota—Booster seat bill introduced but stalled in committee. 

New Hampshire—may file a booster seat bill later this spring. 

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North Carolina—will hold a study commission on the issue this year; expect to 

file a booster seat bill in 2002. 

New Jersey—booster seat bill is pending. Bill also requires children 8–18 to wear 

safety belts in any seating position in vehicle. 

New Mexico—current CPS law strengthened, effective 7/1/2001. 

Oregon—booster seat bill is pending. 

Rhode Island—booster seat bill pending; chances of passage are very good. 

Texas—booster seat bill is pending. 

Vermont—booster seat bill is pending. 

Clinics and Fitting Stations 

Every state has trained Child Passenger Safety (CPS) technicians who are certified in NHTSA’s four day standardized training curriculum. The course includes 

three days of classroom instruction and one day of hands-on training and student 

evaluation. There are strict standards a student must pass before he/she can become 

a certified technician. Technicians learn about and are evaluated on booster seats 

as part of their standardized NHTSA training. 

State Highway Safety Offices are the primary financial supporters of technician 

training. They pay for technician training from a variety of federal sources: Section 

402 State and Community Highway Safety grants (23 U.S.C. 402); Section 157 incentive grants to increase seat belt usage (23 U.S.C. 157); Section 405 occupant protection incentive grants (23 U.S.C. 405); and Section 2003(b) child passenger protection incentive grants (Section 2003(b) of TEA–21). According to NHTSA, there are 

more than 15,000 trained CPS technicians, and more are being trained every day. 

Every state also conducts CPS clinics on a regular basis. The clinics are special 

events held during a fixed period of time on an identified date. At a clinic, trained 

technicians check the proper installation of child restraints, hand out information 

about child restraints, and educate parents and caregivers on the proper type, use 

and fit of child restraints. Correction of booster seat installations and booster seat 

education are a big part of state CPS clinics. The clinics are typically held in conjunction with safety fairs, at grocery stores or pre-schools, at local retailers, hospitals, or day care centers, etc. 

States may also conduct a select number of special events each year focused on 

booster seats. Utah, for example, conducted 150 clinics in both rural and urban 

areas last year. At least one special event focused on booster seats. Parents with 

children aged 4–8 were encouraged to attend, and special booster seat education was 

provided. Low cost or no-cost booster seats were also given to attending parents. 

Nearly every state also has permanant fitting stations. These are places with a 

trained technician open to the public on a regularly schedule basis. A parent or 

caregiver can make an appointment and bring his/her vehicle and child restraint for 

an inspection by a trained technician. As with the CPS clinics, booster seat education is an integral part of the fitting. The fitting stations are typically car dealerships, fire stations, local police departments, county health departments, etc. Some 

states operate mobile fitting stations (usually a retrofitted bus) which can provide 

child safety seat and booster seat inspections in less densely populated areas of a 

state. 

Most states also give child restraints (including booster seats) to low income families. Last year, Utah distributed approximately 3,500 booster seats to needy families. Delaware’s Office of Highway Safety is presently coordinating a number of 

booster seat distributions for low income families with such partners as the federal 

Women, Infants, and Children (WIC) program, Head Start, PTA’s, elementary 

schools, and pediatricians. 

Even small states actively promote booster seats at their CPS clinics and fitting 

stations. Montana, for example, conducts clinics all year long in the seven largest 

counties and several of the smaller counties. The state also operates twelve fitting 

stations. At almost all of these forums, booster seats are included in the process to 

educate parents about child safety seat usage and installation. 

The Section 2003(b) program is a major source of funding for both fitting stations, 

CPS clinics, and child restraints (including booster seats). This program was authorized under TEA–21 at $7.5 million for 2000 and 2001 only. The 2003(b) program, 

which is an earmark out of the obligation limitation for federal-aid highways, should 

be funded at $7.5 million each year for the remaining two years of TEA–21. 

Public Information and Education 

In addition to fitting stations and clinics, every state also has an educational program aimed at informing parents about the proper use of child restraints, including 

booster seats. States typically provide education through public service announcements, websites, banners, posters, brochures, special contests and media events, 

96

press releases, videos, or through classes for parents. States may also conduct CPS 

workshops and summits to keep trained technicians apprised of the latest developments in child passenger safety, including booster seat safety. The technicians, in 

turn, use the updated information when they communicate with parents at fairs, 

clinics, fitting stations, and the like. 

Some State Highway Safety Offices have special educational programs for targeted populations. Connecticut, for example, has a safety program specially geared 

toward the Latino population to teach them about the importance of child restraints, 

including booster seats. In Georgia, an aggressive outreach program was implemented to raise awareness and increase child restraint use (including booster seat 

use) in designated low-income, minority and rural Georgia communities. Georgia is 

also partnering with minority organizations, minority sororities and fraternities, 

historically black colleges and faith communities to host minority health fairs and 

help educate the minority community about the need for child restraints, including 

booster seats. The Oklahoma highway safety office is funding a full-time traffic safety educator through the Latino Community Development Agency. The educator will 

hold twenty workshops in English and Spanish to educate parents about child restraint use, including booster seats, and will distribute printed materials as well. 

Maryland’s educational program is typical of those found in most states. The 

Maryland Kids in Safety Seats (KISS) program is the primary educational resource 

for child passenger safety. Information is provided to parents about child restraints 

and booster seats through a partnership with social clubs, day care centers, 

preschools, elementary schools, the health care community, and other community organizations. Another component is the ‘‘Prescription for Your Child’s Safety,’’ a partnership between the Maryland Chapter of the American Academy of Pediatrics, the 

Maryland Highway Safety Office, and Maryland Safe Kids. The program, which has 

reached more than 3,000 family practitioners and pediatricians in the state, provides a check-off form for doctors to use with families. The form provides guidance 

to doctors on appropriate child restraints, including booster seats. The Baltimore 

City Community Traffic Safety Program, in partnership with the Baltimore Safe 

Kids Coalition, has offered a Give Kids A Boost program for the last several years 

for city residents. When children are brought to specified locations to visit the 

TIKEmobile, they can receive an immunization booster shot as well as a free booster 

seat. Parents are also given assistance with installation of all child restraints. 

NAGHSR and its members have also been an active participant in the Ford Motor 

Company Boost America! Campaign. This $30 million campaign is intended to raise 

public awareness about the importance of booster seats and has three parts: an educational component, a booster seat distribution component, and a grant component. 

The State Highway Safety Offices will be a key partner in the booster seat distribution component. A half a million booster seats will be given to low income families. 

The booster seats will be disseminated at press events that will be held in a different state each week for the next year. The SHSO’s will help organize these 

events, and state-funded child passenger safety technicians will be on hand to disseminate the seats and offer installation advice. 

Once a state enacts a booster seat law, the state typically undertakes an educational campaign to notify parents of the new law. Washington, for example, used 

its Child Passenger Safety Teams—located in 30 of 39 counties—to get the word out. 

The SHSO has also developed booster seat public service announcements for both 

radio and television. The office is also developing an interactive educational video 

for kids of booster seat age. Additionally, the SHSO is working with broadcast companies and radio stations who are sponsoring booster seat events. 

Enforcement 

Since there are no booster seat laws currently in effect, the states have not yet 

undertaken special booster seat enforcement efforts. Rather, states typically enforce 

child restraint laws as part of their regular enforcement waves and biannual enforcement campaigns. In Michigan, for example, booster seat use is a prime message 

in all occupant protection enforcement campaigns. As more and more states enact 

booster seat laws, it can be expected that states will undertake special enforcement 

efforts to increase usage rates. 

Summary of Recommendations 

In summary, all states are conducting a number of activities to promote booster 

seats. In order to maximize state efforts, however, the following should be undertaken:

• NHTSA should upgrade FMVSS 213 to cover restraints that can accommodate 

children up to 80 pounds.

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• NHTSA should reconvene the Blue Ribbon Panel on Child Restraint Usage and 

develop uniform guidelines on the use of booster seats.

• Manufacturers should be encouraged to develop booster seats that are compatible with lap-only belts for use in the rear seats of older vehicles.

• Congress should extend the funding for the Section 2003(b) program which is 

slated to expire at the end of FY 2001.

Thank you for the opportunity to submit the views and recommendations of the 

National Association of Governors’ Highway Safety Representatives (NAGHSR).

Æ