Booster Seat 

Planning 

Guide 

Centers for Disease 

Control and Prevention 

National Center for Injury 

Prevention and Control 

 

 

Booster Seat 

Planning Guide 

By
 

Bethany A. West, MPH
 

Leslie L. Dorigo, MA
 

Kelly A. Mattick, MPH
 

Merissa A. Yellman, MPH
 

CAPT Erin K. Sauber-Schatz, PhD, MPH
 

Division of Injury Prevention,
 

National Center for Injury Prevention and Control,
 

Centers for Disease Control and Prevention,
 

Atlanta, Georgia
 

ACKNOWLEDGEMENTS 

We acknowledge and appreciate the important contributions
 

of MiChel’le Hull, MPH; CDR Jason Hymer, REHS, MPH; 


Ann Dellinger, PhD, MPH; and 


our colleagues at Brunet-García for preparing 


and organizing the contents of this guide.
 

SUGGESTED CITATION: West BA, Dorigo LL, Mattick KA, Yellman MA, Sauber-Schatz 

EK. Booster Seat Planning Guide. Atlanta, GA: National Center for Injury Prevention 

and Control, Centers for Disease Control and Prevention; 2021. Available at 

https://www.cdc.gov/transportationsafety/child_passenger_safety/boosterguide.html 

 

 

 

 

BOOSTER SEAT 

PLANNING How to Use this Guide 

CDC developed the Booster Seat Planning Guide to assist 

States, Tribes, Localities, and Territories (STLTs) with 

assessing, planning, and implementing improved booster seat 

laws to reduce crash injuries and deaths among children. 

The guide begins with an overview of the public health problem of motor vehicle crashes involving children and how 

crash injuries and deaths can be prevented. Next, the guide takes a step-by-step approach to help develop a tailored 

plan to prevent crash injuries and deaths among children in your STLTs. Finally, after working through the steps, you 

will end with an action plan and communication strategy. The guide also includes a brief list of resources, training 

aids, and links to technical assistance. 

 

 

 

 

Contents:

 Overview	 8
 

1.	 Learn About Your STLT’s 

Booster Seat Law
 

15
 

2.	 Find Motor Vehicle Crash 

Data Available for Your STLT
 

19
 

3.	 Create and Strengthen

Partnerships to Improve

Booster Seat Safety 

25 

4.	 Formulate Your Action Plan 34
 

5.	 Develop a Communication 

Plan for Action


36
 

 Appendix	 39
 
 

 

 

 

 

 

Overview 

Motor vehicle crashes are 

a leading cause of death among 

children in the United States.1

More than 600 children age 12 and younger are killed each year 

as passengers in motor vehicle crashes2 and more than 91,000 

are injured.1

 Deaths and injuries can be prevented in motor 

vehicle crashes with proper restraint use. 

There are several stages of proper restraint use 

for children3 that change as they grow: 

• Stage 1: Rear-facing car seat

• Stage 2: Forward-facing car seat

• Stage 3: Belt-positioning booster seat

• Stage 4: The vehicle’s seat belt

As age increases, 

proper restraint 

use decreases. 

For example, about 8% 

of infants under age 

1 were not properly 

restrained with a 

rear-facing car seat 

compared with more 

than 30% of booster 

seat-aged children not 

properly restrained 

with a booster seat.4 

8
 
 

 

 

 

 

 

Stages of Proper Restraint Use for Children 

Using the correct car seat or booster seat can be a lifesaver. Birth 

1 2 3 4 5 6 7 8 9 10 11 12+ 

Age by Years* 

REAR-FACING 

CAR SEAT 

Birth until age 2–4 

Buckle children in a 

rear-facing car seat 

with a harness until they 

reach the maximum 

weight or height limit 

of their car seat. Keep 

children rear-facing as 

long as possible. Never 

place a rear-facing car 

seat in the front seat. 

Front passenger air bags 

can injure or kill young 

children in a crash. 

FORWARD-FACING 

CAR SEAT 

When children 

outgrow their rear-facing 

car seat, they should 

be buckled in a 

forward-facing car 

seat with a harness 

until they reach the 

maxium weight or height 

limit of their car seat. 

After outgrowing 

rear-facing car seat 

and until at least 

age 5 

BOOSTER SEAT 

After outgrowing 

forward-facing car 

seat and until seat 

belt fits properly 

When children outgrow 

their forward-facing 

car seat, they should 

be buckled in a booster 

seat until the seat belt 

fits properly without a 

booster seat. 

Proper seat belt fit 

usually occurs when 

children are age 9–12. 

SEAT BELT 

When seat belt fits 

properly without a 

booster seat 

Children no longer 

need to use a booster 

seat when the seat belt 

fits them properly. 

A seat belt fits properly 

when the lap belt is 

across the upper thighs 

(not the stomach) and 

the shoulder belt is 

across the center of the 

shoulder and chest (not 

on the neck/face or off 

the shoulder). 

Keep children age 12 and younger properly buckled in the back seat. 

*Recommended age ranges for each seat type vary to account for differences in child growth and weight/height limits of car seats and booster seats. 

Use the car seat or booster seat manual to check for important information about installation, the seat weight and height limits, and proper seat use. 

Child passenger safety recommendations: American Academy of Pediatrics (AAP) 2018. 

www.cdc.gov/transportationsafety/child_passenger_safety 

9
 
 

 

 

 

 

 

 

 

 

 

 

Booster seat use 

reduces the risk for 

serious injury by 45% 

when compared with 

seat belt use alone.5 

To help prevent 

injury and death, 

booster seats should 

be used until proper 

seat belt fit can be 

achieved. 

Booster seats help ensure 

proper seat belt fit 

Booster seats are an important stage of child passenger safety because 

they elevate and position a child so that the seat belt’s lap and shoulder 

belts fit properly. When a car crash happens, properly fitting seat belts 

distribute the crash forces onto the skeleton, like the shoulder and hip 

bones, instead of the soft tissues, such as the stomach or neck. This 

helps to prevent injuries including spine and brain injuries. Booster seat 

use reduces the risk for serious injury by 45% when compared with seat 

belt use alone.5 

Proper seat belt fit occurs when the lap belt is across the upper thighs, 

not the stomach, and when the shoulder belt is across the center of the 

shoulder and chest, not on the neck/face or off the shoulder. This typically 

does not occur until children are age 9–12. Booster seats should be used 

until proper seat belt fit can be achieved to help prevent injury and death. 

Unfortunately, transitioning too soon from a booster seat to a seat belt 

remains common.4,6 This is often referred to as “premature graduation,” and 

it puts children at greater risk for injuries.3,7 One type of injury associated 

with premature graduation is called “seat belt syndrome.” This is a pattern 

of abdomen and spine injuries that can occur during crashes when seat 

belts are used prematurely.8,9

10
 
Booster seats make seat belts fit better.
 

BAD Seat Belt Fit: 

✗ The shoulder belt is across the 

neck or face; or too far out on 

the shoulder. 

✗ The lap belt is across the stomach. 

GOOD Seat Belt Fit with Booster Seat: 

✓ The shoulder belt is across the 

middle of the chest and shoulder. 

✓ The lap belt is across the 

upper thighs. 

Always properly buckle children age 12 and younger in the back seat! 

11
 
 

 

 

 

 

 

 

 

Increasing booster seat use 

Research has shown the most effective strategy to increase booster seat 

use is through updating, implementing, and enforcing state child restraint 

laws10 with booster seat provisions.11–15 These are commonly known as 

“booster seat laws.” In addition to increasing booster seat use, booster seat 

laws also reduce motor vehicle-related injuries and deaths in children under 

age 9 who are covered by these laws.11, 12, 16 

Most state laws do not align with best practice recommendations despite 

demonstrated effectiveness.17 As of December 2021, only four states 

require children to use booster seats until at least age 9: Louisiana, 

Tennessee, Washington, and Wyoming.17 Increasing the number of STLTs 

with booster seat laws that cover children until at least age 9 will increase 

booster seat use and help protect more children from a leading cause of 

injury and death. 

In addition to 

increasing booster 

seat use, booster seat 

laws also reduce 

motor vehicle-related 

injuries and deaths 

in children under 

age 9 who are 

covered by 

these laws.11, 12, 16 

12
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Success Stories
 

• The rate of children using car seats and booster seats increased nearly 

three-fold in five states that increased the booster seat age requirement 

to 7 or 8 years. The rate of children who sustained fatal or incapacitating 

injuries decreased by 17% in these states.11 

• Children age 4–8 in states with booster seat laws were over four times as 

likely to be using age-appropriate restraints and were 20% less likely to 

die than children in states without booster seat laws.12 

• In Milwaukee County, Wisconsin, observed booster seat use among 

children age 4–7 increased by 19 percentage points after booster seat 

laws were implemented.13 

• A study among children involved in crashes found that restrained children 

were 66% more likely to be buckled in appropriate restraints if their state 

law followed best practice recommendations.14 

• The death rate among 7-year-olds was 25% lower for the children in states 

with booster seat laws compared with states without booster seat laws.16 

Previous studies have demonstrated the effectiveness of booster seat use 

at reducing the risk for serious injury5 and the effectiveness of booster seat 

laws at increasing use and decreasing injuries and deaths.11–16 

Based on this collective evidence, CDC developed the Booster Seat 

Planning Guide to assist STLTs with assessing, planning, and implementing 

improved booster seat laws to reduce crash injuries and deaths among 

children under age 9. 

Studies from other 

countries have also 

demonstrated the 

effectiveness of 

booster seat laws. 

For example, 

in Canada: 

Provinces with 

booster seat laws had 

significantly higher 

observed booster seat 

use among children 

age 4–8 years than 

provinces without 

booster seat laws.18 

British Columbia’s 

booster seat law was 

passed in 2008 and 

covered children under 

age 9. It was associated 

with an 11% reduction 

in the monthly motor 

vehicle crash injury 

rate among children 

age 4–8 years, 

compared with children 

age 9–14 years.19 

13
 
 

 

 

 

 

 

 

 

 

 

 

 

BOOSTER SEAT 

PLANNING How to Use this Guide 

The guide outlines five steps to develop an action plan to 

move booster seat safety forward, including: 

1. Learning about your STLT’s booster seat law 

2. Learning about which motor vehicle data are available 

3. Creating and strengthening partnerships 

4. Forming an action plan 

5. Developing a communication plan 

Each step in the guide contains an introduction with helpful resources 

in the beginning and a series of assessment questions at the end that 

STLTs can use to assess strengths, weaknesses, and opportunities 

in their policies and programs focused on booster seat use. These 

questions will help identify action steps for developing an overall plan 

to increase booster seat use in the STLT. Website links throughout 

the guide can be used to find more information from CDC 

websites or external sources. 

The guide is designed to be adaptable and flexible to accommodate the 

unique needs of STLTs. You may choose to complete steps in a different 

order and/or may need to revisit some steps more than once as the plan 

progresses. Some STLTs might want to focus more attention on some 

areas of the guide than others. 

14
 
 

 

 

 

1. Learn About Your STLT’s 

Booster Seat Law 

Introduction 

Having a booster seat law that covers child passengers until at least age 

9 is one of the most effective strategies for increasing booster seat use 

and reducing motor vehicle-related injuries and deaths among children.11–16 

Gathering information about your STLT’s booster seat law is the first step 

in preparing your plan. This information will help you assess your STLT’s 

baseline and your unique needs and opportunities. 

Sources of Information 

You can find up-to-date information and details about your 

STLT’s booster seat law at: 

1. Insurance Institute for Highway Safety’s Seat belt and child seat laws 

by state webpage 

2. Governors Highway Safety Association’s Child Passenger Safety 

webpage 

3. STLT’s Department of Transportation website 

4. 	 STLT’s Highway Safety Office 

5. 	 Safe Kids’ Child Safety Laws by State webpage 

6. 	 You can also search for scientific studies about child restraint laws 

on pubmed.gov. 

When researching, 

try using keywords 

such as: 

• child passenger 

safety 

• booster seat law 

• booster seat 

• motor vehicle crash 

+ children 

• motor vehicle injury 

+ children 

• child restraint 

15
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Assess 

Use this list to determine the parameters of your STLT’s booster seat law. 

1 Booster seat 

law features 

• Until what age are children 

required to be in a booster seat? 

• Is the law based on age 

alone or does it also include 

language about child’s height 

or other requirements? 

• At what age are children 

permitted to use a seat belt 

without a booster seat? 

• Are children required to be in 

the back seat? 

If so, until what age? 

• What are the penalties for 

violating these laws? 

• Does the law include a primary 

enforcement feature which 

permits law enforcement 

officers to stop vehicles 

solely for a booster seat 

or car seat violation? 

• Are there any other details 

or exceptions in your STLT’s 

booster seat law that are 

important to know (e.g., 

weight requirements for 

booster seat use)? 

2 Booster seat 

law history 

• When was the booster seat 

law first passed and/or when 

did it go into effect? 

• Has the booster seat law been 

updated or changed since it 

was first established? 

° If yes, what changes have 

been made? 

° If no, does the current 

booster seat law have 

gaps compared to current 

evidence of best practice? 

• Which stakeholders or 

partners were involved in 

past booster seat efforts? 

3 Booster seat law 

evaluation and 

research 

• Has the booster seat law been 

evaluated for safety benefits? 

° If so, what were the 

results? 

° Are there studies in 

neighboring or similar 

STLTs that would be useful 

for comparison? 

° Do those STLTs have data 

to document booster seat 

law effectiveness? 

• Are there any studies about 

awareness of or compliance 

with the booster seat law 

among parents and/or 

caregivers in your STLT? 

° If so, what have these 

studies found? 

° Are there studies in 

neighboring or similar 

STLTs that would be useful 

for comparison? 

• How have parents, 

caregivers, and other 

stakeholders reacted to 

the booster seat law? 

° Are there any scientific 

data, reports, or studies to 

document public reaction? 

16
 
 

 

 

 

 

 

 

 

 

 

 

 

 

4 Policy and 

enforcement 

considerations 

• Are there policy gaps and/or

other policy considerations

that should be kept in mind?

• Are current booster seat laws

enforced?

° How many citations were

issued in the past year? 

5 Planning for 

improvements 

• Could a potential booster

seat law be written to cover

children until at least age

9 and/or include other

requirements such as

primary enforcement, seating

position, etc.?11–16 

• Could improvements to the

booster seat law also require

children to be buckled in the

back seat until 13 years of

age?3,7,20 

• In addition to extending the

ages covered in the booster

seat law, could the law

include mandating use of

federally approved booster

seats and not exceeding

the manufacturer’s

weight/height limits?

• How would a new booster

seat law or changes to the

law be enforced?

° Could there be plans for

enhanced enforcement

campaigns?

° Would additional training

for law enforcement 

officers be needed? 

• Could there be provisions

and/or assistance for certain

populations?

° Families with lower

incomes?

° Children with special

transportation needs?

° Emergencies?

• Could there be provisions

for what to do in unique

situations?

Taxis, ride share ° vehicles, or rental cars? 

Carpooling? ° 

Emergencies? ° 

Older car models that 

do not have lap and 

shoulder seat belts in 

all seating positions in 

the back seat? 

° 

• Could there be provisions

to promote booster seat

distribution over penalties?

Could your STLT provide 

a booster seat and 

education/support 

rather than penalties? 

° 

Could your STLT waive/ 

reimburse the fine/ 

penalty for violations 

for families that 

subsequently purchase 

a booster seat and 

present evidence 

of that purchase? 

° 

• Could there be “Good

Samaritan” provisions to

the law to limit liability

for Child Passenger

Safety Technicians? Good

Samaritan laws have been

passed in some states

to protect groups and

individuals from liability

claims when they offer

inspections and instruction

on how to properly install

and use booster seats.

17
 
 

 

 

ACTION 

STEP Background 

Identify which of these questions you need to answer to gather background information about booster 

seat laws in your STLT. 

Write your ideas below and then continue to the next section. You will have an opportunity to 

synthesize the ideas from this step with the other action steps in the guide to create an overall 

strategy in the fourth section of the planning guide. 

18
 
 

 

 

 

 

2. Find Motor Vehicle Crash 

Data for Your STLT 

Introduction 

Having data on crash injuries and deaths among children will support 

improvements to your STLT’s booster seat law. Data about motor vehicle 

crash injuries and deaths that are specific to your STLT provide valuable 

context that can also be compared to neighboring STLTs or the nation. 

Data can help identify ways in which booster seat laws could be modified 

to be more effective at saving lives and preventing injuries in your STLT. 

Additionally, data about current restraint practices and/or perceptions 

and knowledge of booster seat safety can help STLTs better understand 

the local context and focus strategies that are likely to fit the needs of 

the community. These data may already be available, or it might be worth 

conducting local surveys to learn more. 

Data are important 

for identifying, 

monitoring, and 

evaluating strategies 

to help demonstrate 

what works. 

Motor vehicle crash 

data can reveal 

patterns related to: 

• the number of 

child passengers 

• age of child 

passengers 

• types of restraint 

used 

• seating positions 

19 
Sources of Information 

Federal data sources provide national and state-level motor 

vehicle crash data. 

• CDC’s Web-based Injury Statistics Query and Reporting System 

(WISQARS) 

An interactive, online database that provides national and state-level 

fatality and cost of injury data, as well as national-level nonfatal injury 

data from emergency departments. For example, users could find the 

number of motor vehicle occupant deaths among children age 5–8 or 

9 years in a state. 

• CDC’s Wide-ranging Online Data for Epidemiologic Research (WONDER) 

A menu-driven system that allows users to query public health data 

(e.g., mortality and population data). 

• National Highway Traffic Safety Administration’s National Center for 

Statistics and Analysis (NCSA) 

NCSA is responsible for providing a wide range of analytical and statistical 

support to the National Highway Traffic Safety Administration (NHTSA) 

and the highway safety community. 

NCSA has numerous data resources including: 

° Fatality Analysis Reporting System (FARS) is a census of all crashes 

on U.S. public roadways involving one or more deaths occurring within 

30 days of the crash. FARS also includes police-reported crash 

characteristics (e.g., seating position, whether occupant was using 

a booster seat or seat belt, day and time of crash). 

° General Estimates System (GES) data come from a nationally 

representative sample of police-reported crashes of all severities 

(minor to fatal). 

° Fatality and Injury Reporting System Tool (FIRST) is a tool that lets us

ers build queries about fatal (FARS data) and injury crashes (GES/Crash 

Report Sampling System data). 

­

° National Survey of the Use of Booster Seats (NSUBS) provides 

national-level estimates of restraint use for all child occupants age 

≤12 years in the United States, with the primary purpose of estimating 

booster seat use among children age 4–7 years. Find NSUBS 

publications here. 

20
 
 

 

 

 

Fatal and nonfatal motor vehicle crash data might be available 

for your STLT through some of the following sources: 

1. STLT Departments of 

Transportation 

2. State Highway 

Safety Offices 

3. State departments 

of public safety 

4. State and local health 

departments 

5. Emergency medical 

services data 

6. Hospital data (e.g., 

emergency department, 

outpatient, inpatient, 

trauma registries) 

7. STLT Child Death 

Review teams 

8. Colleges/universities 

9. Nonprofit or 

nongovernmental 

organizations 

10. Insurance organizations 

11. State Office of the Medical 

Investigator, Medical 

Examiner, or Coroner 

12. Tribal or Bureau of 

Indian Affairs (BIA) 

Law Enforcement 

13. Tribal Transportation 

Safety Plans 

Additionally, you 

may want to know 

the number of children 

living in your STLT 

who are most directly 

affected by booster seat 

laws. This is typically 

children age 5–8 

or 9 years. 

Population data may 

be available at the 

following national 

data sources: 

• 	United States
 

Census Bureau
 

• 	CDC’s WONDER 

• 	Other STLT entities 

such as state 

and local health 

departments 

21
 
 

 

 

 

 

Assess 

1 Data 

• What data have you used or 

can you use to examine motor 

vehicle crash deaths and 

injuries among children age 

5–8 or 9 years in your STLT? 

° What have you learned 

or what can you learn 

from these data (such as 

the number of crashes 

involving children age 5–8 

or 9 years in your STLT, the 

number and rate of motor 

vehicle crash injuries, 

hospitalizations, and deaths 

among children age 5–8 

or 9 years in your STLT)? 

° How have you or how can 

you use this information? 

For example, can you 

compare leading causes 

of injury or death among 

children age 5–8 or 9 years 

in your STLT, and can you 

educate decision makers 

on the public health issue 

using STLT data? 

° What do these data suggest 

as possible opportunities 

for improvements in booster 

seat safety in your STLT? 

2 Unanswered 

questions 

• What are the most important 

unanswered questions about 

booster seat safety in your 

STLT? 

• What data are needed to 

answer these questions? 

° Do you have data about 

motor vehicle crash 

deaths, motor vehicle 

crash injuries, child 

restraint practices in your 

STLT, and perceptions/ 

opinions of booster 

seat safety? 

• How can you access existing 

data and/or collect data that 

you need to answer these 

questions? 

3 Neighboring 

STLTs 

• Do neighboring STLTs have 

data that could be helpful to 

you? 

22
 
 

 

 

 

4 Data collected 

in your STLT 

• Have survey data about 

booster seat use already been 

collected in your STLT? 

° If yes, what did you learn 

from these data? 

° If no, what could you 

learn from these data 

if they were collected? 

° How have you or can you 

use this information? 

• Are you able to collect 

data about child restraint 

practices in your STLT if data 

are not already available? 

If so, how? 

° For example, how many 

children age 5–8 or 9 

are properly restrained? 

° How many children are 

improperly restrained? 

For example, children 6 

years of age using only 

a seat belt. 

° How many children travel 

completely unrestrained? 

• Are you able to collect public 

perception data on booster 

seat use and reasons why 

parents/caregivers are not 

using booster seats for their 

children, if it is not already 

available? If so, how? 

° Is this something that 

you would want to do 

periodically as the effort 

progresses to document 

changes in perception 

(among the general public 

and/or decision makers)? 

° What are perceived 

barriers and facilitators to 

booster seat use? 

° How can you address 

barriers and facilitators to 

booster seat use? 

• Are the reasons why parents/ 

caregivers are not using 

booster seats for their 

children well understood? 

° Lack of knowledge about 

injury consequences and/ 

or the law? 

° Gaps in who is covered 

by the law? For example 

are there certain 

categories of children or 

ages not required to use 

booster seats? 

Inconvenience? ° 

° Inability to afford a 

booster seat?
 

° Carpooling?
 

5 Assistance with 

data analysis 

• Are there researchers 

or other individuals 

at local colleges/ 

universities, academic 

medical centers, health 

departments, hospitals, 

and/or other organizations 

that you could partner 

with to assist with 

data analysis? 

23
 
 

 

 

 

ACTION 

STEP Data 

Identify which of these questions you need to answer so that you have the best available data for 

planning booster seat law improvements in your STLT. 

Write your ideas below and then continue to the next section. You will have an opportunity to synthesize 

the ideas from this step with the other action steps in the guide to create an overall strategy in the 

fourth section of the planning guide. 

24
 
 

 

 

 

 

 

 

3. Create and Strengthen 

Partnerships to Improve 

Booster Seat Safety 

Improving booster 

seat safety requires 

strong, collaborative 

partnerships with 

many diverse groups 

with a vested interest 

in child passenger 

safety, such as: 

• 	Other STLT 


agencies
 

• 	Nongovernmental 

organizations 

• 	Experts in 


traffic safety
 

• 	Communication, 

social, and 

print media 

• 	Outreach and 


education 


• 	Funding 

• 	Data collection 

and analysis 

Introduction 

Efforts to improve booster seat safety require strong, collaborative 

partnerships with many diverse groups with a vested interest in child 

passenger safety. Creating these partnerships is an important step in 

the planning process. Partnerships will benefit from uniting behind a 

consistent message that is data driven and coupled with personal stories. 

Successfully uniting these efforts and partnerships often requires a wellestablished and cohesive Core Working Group with strong leadership 

capabilities that can organize and direct the process. 

The Core Working Group is typically responsible for 

implementing actions on behalf of the partnership 

and can dedicate substantial time to managing the 

effort and moving it forward. 

25
 
 

 

 

 

 

 

 

 

 

 

 

—

 

 

 

Core Working Group 

Successful Core Working Groups are composed of 

the roles listed below. 

1. Leader

• Can devote a significant amount of time to the day-to-day
 

management of the partnership
 

• Is organized and communicates effectively

• Has expertise or knowledge about child passenger safety

• Can help the group come to consensus and make decisions

• Can effectively delegate tasks

• Is energetic, enthusiastic, motivational, and positive-minded

• Listens and considers all issues from the wide range of stakeholders

and community groups

2. Certified Child Passenger Safety Technician or Instructor

• Has training, technical expertise, and field experience in child

passenger safety—particularly in education and installation of child

restraints. Ideally has several years of experience

3. Booster Seat Expert

• Has training, technical expertise, and field experience in child

passenger safety. Could be an additional certified Child Passenger

Safety Technician or Instructor

• Has scientific/research expertise in child passenger safety and in

collecting, analyzing, and interpreting related data

4. Booster Seat Champion

• Often has a personal story or can find and partner with someone who 

does 

° Can seek out families who are willing to put a face to the issue and

perhaps tell their story with either a good or bad crash outcome. 

This reinforces and personalizes the data. The combination of data 

with a relatable, illustrative story can be very powerful. 

• Can push ideas forward

• Is persuasive

• Is especially motivated to improve booster seat safety

• Often can mobilize resources or other forms of support

Likewise, the Core 

Working Group can 

have many members 

covering the same role. 

What is important 

for success is that 

each of these roles is 

represented in the 

Core Working Group. 

26
 

These roles are not 

meant to be mutually 

exclusive—many 

core members may 

be able to represent 

several of the roles 

and take on multiple 

responsibilities.
 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. Partners and community collaborators from diverse 

backgrounds who are passionate about booster seat 

safety and represent the characteristics of the 

population in your STLT 

• Very helpful to have “nontraditional” partners outside of the typical 

traffic safety/public health field such as businesses that serve 

parents/caregivers or children, parent teacher associations, fire 

departments, academic institutions, etc. 

6. Additional members who: 

• Believe they can make a difference 

• Have patience, persistence, and a high level of motivation 

7. Media connections and social media expertise 

• Ideally connected to several media outlets such as newspaper, radio, 

TV, internet, or social media 

• Has ability to craft the message and package material for the media,21 

or is connected to someone who has expertise 

• Has social media expertise to disseminate messages to a wide array of 

audiences, such as parents, caregivers, schools, and legislators, or is 

connected to someone who has expertise 

8. Collaborations with coalitions 

• Connections with other traffic safety coalitions 

• Connections with other coalitions, such as local children’s hospital 

coalitions that are outside of traffic safety but interested in child 

wellbeing 

9. Tribal community members 

• Will your partnership include Tribal communities or consortium? 


If so, include a Tribal community member as part of the
 

core working group
 

27
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

CORE WORKING 

GROUP Create a Booster Seat 

Safety Partnership 

Matrix 

The Core Working Group will create a 

booster seat safety partnership matrix. 

Partnerships are crucial to executing a well-established, cohesive, large 

scale effort to improve booster seat safety in your STLT. Partnerships must 

be formed, fostered, and effectively utilized to be truly beneficial. You and 

your working group will be able to strategically strengthen your STLT's 

booster seat policy in an effective and efficient manner by collaborating 

with the right people and organizations. Expanding your network will 

garner additional support and resources. 

The Booster Seat Safety Partnership Matrix below can help document 

a new booster seat safety partnership and/or assess the strengths, 

weaknesses, and needs of an existing group. 

• 	In the left column, you will find examples of potential partners who 

STLTs have utilized in the past when they enhanced their booster seat 

laws. Partnerships do not require all these members. This list is intended 

only as a starting point for you to consider which partnerships would be 

beneficial to your working group. There also may be partnership members 

that are not listed that would be important in your STLT. 

• 	The second row lists general categories of skills or expertise your 

working group may need. 

• 	The third row lists examples of specific capabilities that your working 

group may need. 

• 	First, place a check in the cells of the matrix to inventory your current 

partnership’s members and capabilities. Then, consider which capabilities 

you are missing and which additional members you want to recruit to 

create the strongest possible partnerships. 

Please note that this 

list is not exhaustive. 

The matrix includes 

ideas and examples 

of partners, skills/ 

expertise, and 

capabilities that have 

been important for 

successful traffic 

safety partnerships 

in the past. 

28
 
PARTNER’S ROLE/RESPONSIBILITIES/SKILLS

DATA COMMUNITY EFFORTS COMMUNICATION EFFORTS COALITION COLLABORATION LEGISLATIVE EXPERTISE OTHER

Collecting data

Analyzing and interpreting data

Learning about the community’s perception of booster seat safety and providing further education on the topic

Working with key stakeholders

Writing and/or creating print materials, website content, and/or social media

Working with the media and/or the public

Organizing and leading the coalition

Managing partnership meetings

Knowledge about the legislative process

Educating decision makers

Contributing resources (time, money, in-kind, etc.)

Other:

SRTNEARNTIAL POTEP

NTRNMEVEGO

State and/or Regional Departments ofTransportationState Highway Safety OfficesState Departments of Public SafetyHealth DepartmentsRegional NHTSA Office RepresentativesSTLT Decision Makers/LeadersOther:

AL CHILD RNE

ATIONS

Y (OR GE

ANIZG

T

) OR

AFE

YT

AFFIC S

AFES

TR

Safe Kids Worldwide and/or your Local Safe Kids CoalitionsNational Child Passenger Safety BoardGovernors Highway Safety AssociationRegional AAA OfficeOther:

NTMECENFORW EAL

State Police/State Highway PatrolLocal Police DepartmentsSheriff’s DepartmentsOther:

BOOSTER SEAT SAFETY PARTNERSHIPMATRIX:Core Working Group
PARTNER’S ROLE/RESPONSIBILITIES/SKILLS

DATA COMMUNITY EFFORTS COMMUNICATION EFFORTS COALITION COLLABORATION LEGISLATIVE EXPERTISE OTHER

Collecting data

Analyzing and interpreting data

Learning about the community’s perception of booster seat safety and providing further education on the topic

Working with key stakeholders

Writing and/or creating print materials, website content, and/or social media

Working with the media and/or the public

Organizing and leading the coalition

Managing partnership meetings

Knowledge about the legislative process

Educating decision makers

Contributing resources (time, money, in-kind, etc.)

Other:

POTENTIAL PARTNERS

ARETH CALHE

Individual/local Chapters of the American Academy of Pediatrics or the American Academy of Family PhysiciansState Hospital Associations and/or Local/Regional Hospital AssociationsOther:

 YNCGE

ONSEP

RME

SRE

E

Emergency Medical ServicesFire Departments/Other Fire Safety Entities/OrganizationsOther:

CHARESRE

Colleges/UniversitiesInjury Control Research CentersOther:

SAR

ATION/ DUCS/ EOL

ACURRICUL

CHO

TRXE

S

School Board MembersElementary SchoolsParent Teacher AssociationsOther:

SESSINESBU

Businesses that Serve Parents and/or ChildrenNewspaper, Radio, TV, Internet, and/or Other Media Outlets/Media OrganizationsOther:

OTHER Other:

BOOSTER SEAT SAFETY PARTNERSHIPMATRIX:Core Working Group
 

 

 

 

 

 

 

Assess
 

1 Does a partnership

(or multiple

partnerships) 

already exist in 

your STLT that can 

focus on booster 

seat safety and/or 

booster seat laws? 

• If yes: 

° Which partners are 

currently represented? 

° What additional partners 

would be interested, should 

be involved, and need to be 

recruited? 

• If no, how can you form this 

group? 

° Which partners would 

need to be represented? 

° What partners would 

be interested, should 

be involved, and need 

to be recruited? 

° What will be the roles of 

each partner or member? 

° What core group will be 

primarily responsible for 

doing the work? 

° Who will lead the effort? 

° Who will recruit other 

needed members/partners? 

2 What does the 

partnership need 

to succeed? 

How will the 

partnership

function? 

3 Does your 

partnership have

the expertise,

resources, and 

other capabilities

it may need? 

° What knowledge, 

expertise, capabilities, 

and skills does each 

partner bring? 

° What gaps exist? 

Are there additional 

expertise, capabilities, 

and skills needed? 

If so, how can these 

be acquired? 

4
 Would the 

partnership benefit 

from additional 

training? 

Training could be 

conducted by members 

themselves if they have 

particular experience or 

expertise, or potentially 

outside trainers could 

be brought in. 

If you are going to

be working with 

other cultural 

groups, then 

use cultural 

competence to 

ensure effective 

communication. 

5 

° Will your partnership 

include Tribal communities 

or consortium? If so, see 

section below on Tribal 

cultural competence. 

31
 
Tribal Cultural Competence 

When working with American Indian and Alaska Native people (Tribal communities), it is important to have active intentions. It is your responsibility to 

practice active learning and positive communication. When local, state, or 

federal programs plan to work with a Tribal community, Tribal cultural competence is essential to ensure active learning and communication. 

• Learn more about the Tribe(s) you will be working with

° Review the Tribal community’s website:

− Explore resources/programs available in the community.

− Review the Tribe’s Directory for contact information (if available). 

− Research the Tribe’s history, government structure/leadership, 

jurisdiction, cultural activities, traffic safety codes, and review 

their Tribal operations. 

• Understand diversity exists among Tribal communities

° There are 574+ federally recognized Tribes in the United States, and

several other Tribes that do not have federal recognition.

− Language, operations, services, ceremonies, and government 

structures differ greatly from community to community. 

− Programs designed and implemented at the local or state level may 

not work as planned in Tribal communities. Best practices and 

programs can be tailored locally for Tribal communities through 

active communication and planning. 

If you plan to work with Tribal communities, the National Indian Health Board 

offers a free online Working with Tribes Training for local, state, and federal 

officials interested in partnering with Tribes. The Substance Abuse and 

Mental Health Services Administration has developed the American Indian 

and Alaska Native Culture Card that offers basic guidance to enhance 

Tribal cultural competence. 

32

This information 

provides you a brief 

introduction to the 

Tribal community 

and prepares you for 

initial outreach to the 

community. 

It is important to first 

research and understand 

the community you are 

working with in order 

to establish an active 

partnership.
 

 

ACTION 

STEP Partnership 

Identify which of these questions you need to answer to improve your current partnership or form a new
 

partnership to support booster seat laws in your STLT.
 

Write your ideas below and then continue to the next section. You will have an opportunity to synthesize
 

the ideas from this step with the other action steps in the guide to create an overall strategy in the
 

fourth section of the planning guide.
 

33
 
4. Formulate Your

Action Plan

Introduction 

It is now time to bring together information from the previous three steps 

to formulate your action plan! Your plan should include any additional tasks 

necessary to develop a comprehensive strategy for your STLT, in addition to 

incorporating components from the prior steps in the guide. 

Be sure to keep track of your efforts as you move forward with your 

plan. You can use this to develop a list of lessons learned, best 

practices, and challenges faced, which can be beneficial for 

future efforts in your organization and other STLTs. 

Assess 

1 What changes are

needed to improve

booster seat safety

in your STLT? 

2 What steps are

needed to implement 

changes to improve

booster seat safety 

in your STLT? 

° Who will you engage

and when can this be 

completed?

 

3 How will you monitor 

progress to ensure

that your partnership

is on track with 

the plan? 

° How will you make

mid-course adjustments 

if they are needed? 

34 
 

 

Identify the steps your partnership will undertake. Consider using this template to list each step, 

who is responsible, and a projected completion date. 

Action Plan ACTION 

STEP 

What is the main goal or objective to improve booster seat safety in your STLT: 

What are the main steps your partnership needs to 

undertake to make progress towards this goal? 

Who will 

do this? 

When can 

this be 

completed? 

Resources 

needed? 

1) 

2) 

3) 

4) 

5) 

6) 

7) 

8) 

9) 

10) 

35
 
5. Develop a

Communication

Plan for Action

Introduction 

A communication and education plan should be developed for how the 

partnership will educate key audiences about the benefits of improving 

your booster seat law. 

Your communications plan may include steps for developing print 

and/or online materials, working with media outlets, creating and 

posting on social media, and identifying parents/caregivers, health 

care providers, and other community members who can provide 

personal stories of their experience with booster seats and the 

importance of child passenger safety. 

Message framing, a communication strategy for building support for 

evidence-based solutions, may be particularly useful in communication 

planning. The goal when it comes to outreach and education is ensuring 

that your message is heard by the people you need to hear it and that it 

compels them to follow through on your cue to action. It is a good idea 

to have your communication specialist involved in your workgroup from 

the very beginning. 

In your communication 

plan, be sure to 

identify the: 

• “What”

• “Why”

• “Who”

• “How”

36 
 

 

 

 

 

 

 

 

 

 

 

 

 

Assess
 

1 Which specific

audiences do you 

want to reach, 

and how will you 

reach them? 

Examples of 

audiences could 

include stakeholders/ 

organizations responsible 

for decision-making, 

parents/caregivers, law 

enforcement, media, 

educators, etc. 

• What do audiences 

currently think about the 

status of child passenger 

safety in your STLT? 

• What STLT and traditional 

media channels can you use 

to reach your audience? 

Examples include newspapers, 

radio, television, newsletters 

or e-newsletters, school 

newspapers, websites, blogs, 

social media outlets, listservs, 

etc. You want to place your 

messages in channels or 

places that people are 

already using for child health 

information. 

• Could you use common 

places people go to distribute 

print or electronic material? 

For example, day cares, 

pediatrician offices, urgent 

cares, children’s hospitals? 

• Are you considering the full 

spectrum of diversity of people 

who live in your STLT? 

° Do you have channels to 

reach groups identified as 

having higher rates of crash 

injuries and deaths? (e.g., 

low literacy materials, infor

mation in other languages) 

­

2
 How will you 


educate those in 

your STLT about 

the strength of 

the evidence for 

extending ages

covered by 

booster seat laws 

to save lives? 

• What educational materials 

will you need? (e.g., print 

materials, videos, radio 

spots, social media posts, 

blog posts). 

° Are there existing materials 

that can be leveraged? 

Do new materials need to 

be created? 

• Would visual demonstrations 

be beneficial? 

• What about personal 

anecdotes/stories by 

families/friends of crash 

victims and/or survivors? 

3 How can message

framing be used 

to enhance 

understanding 

and support for 

improving child 

passenger safety? 

• How can the data you 

previously collected be 

used to frame the message? 

• How have others used 

framing in messaging to 

improve understanding and 

support for traffic injury 

prevention initiatives? 

• How can you learn more about 

this approach and/or acquire 

expert assistance in this area 

of communication science? 

4
 How can you frame


discussion about 

booster seat laws 

as a proven strategy

to improve child 

passenger safety? 

What do you know

about the main 

barriers that have 

prevented progress

in the past? 

5
 Have there been 

any recent highprofile events you

can use to bring 

more attention to 

the continued need 

to protect child 

passengers? 

For example, a recent 

crash, updated booster 

seat legislation in 

neighboring STLTs and 

resulting impact, new 

data, etc. 

37
 
 

 

ACTION 

STEP Communication 

Identify what can you do to educate decision makers, opinion leaders, and the general public about how 

improving booster seat laws can increase booster seat use and reduce injuries and deaths in your STLT. 

Write your ideas below. 

38
 
 

 

 

 

 

 

 

 

 

 

 

 

Appendix: Resourdix: Resources 

Links to Training Aids 

• 	 American Academy of Pediatrics Child Passenger Safety Policy Statement: 

https://pediatrics.aappublications.org/content/142/5/e20182460 

• 	 American Academy of Pediatrics Child Passenger Safety Technical Report: 

https://pediatrics.aappublications.org/content/142/5/e20182461 

• 	 Safe Kids Worldwide: Child Passenger Safety AdvoKit 

www.safekids.org/sites/default/files/documents/cps_advokit_2021_update_final.pdf 

• 	 The Children’s Hospital of Philadelphia: Car Seat Safety for Kids Website 

contains links to videos and instructional materials: www.chop.edu/carseat/ 

• 	 The Children’s Hospital of Philadelphia has created a series of 37 educational illustrations, with 

descriptions in both English and Spanish, to help demonstrate proper restraint use for a variety 

of ages, sizes, vehicle types, and restraint types: 

https://injury.research.chop.edu/child-passenger-safety-tools 

• 	 The Washington State Booster Seat Coalition has a resource available online entitled “Choosing 

a Campaign Message” that provides simple steps and clear messaging for developing your plan: 

http://depts.washington.edu/booster/pdf/manual/extra/message.pdf 

• 	 Aspen Institute’s Continuous Progress Advocacy Tools provide a step-by-step roadmap for planning 

advocacy efforts and conducting evaluations before, during, and after a campaign: 

www.aspeninstitute.org/programs/aspen-planning-and-evaluation-program/tools/ 

• 	 Guide for the 2020 National Child Passenger Safety Technician Certification Training: 

www.cpsboard.org/technician-resources/ 

• 	 Tribal Injury Prevention Resource Center Fact Sheets: www.thetiprc.com/fact-sheets 

• 	 Albuquerque Area Southwest Tribal Epidemiology Center Fact Sheets: 

www.aastec.net/reports-pubs/ 

• 	 National Conference of State Legislatures: Traffic Safety Review –Seat Belts and Child Passenger Safety 

39
 
 

 

 

 

Appendix: Resources (cont'd.) 

Links to Technical Assistance 

The following national organizations have expertise in updating STLT booster seat laws and can either 

connect you to their local chapters or address your questions directly. 

• Safe Kids Worldwide: www.safekids.org/our-work/public-policy/ 

• Advocates for Highway and Auto Safety: www.saferoads.org/ 

• American Academy of Pediatrics: www.services.aap.org/en/advocacy/ 

• Council of State Governments: www.csg.org 

• National Conference of State Legislatures: www.ncsl.org 

• National Child Passenger Safety Board: www.cpsboard.org 

• American Automobile Association (AAA): www.AAA.com/SafeSeats 

• National Governors Association: www.nga.org 

• Tribal Injury Prevention Resource Center: www.thetiprc.com 

In addition, the Centers for Disease Control and Prevention, National Center for Injury Prevention and 

Control, provides additional resources in the area of Child Passenger Safety. 

40
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix: References 

1. 	 Centers for Disease Control and Prevention (CDC). Web-based Injury Statistics Query and Reporting 

System [online]. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control 

and Prevention; 2020. Available at http://www.cdc.gov/injury/wisqars 

2. 	 National Highway Traffic Safety Administration (NHTSA). Traffic Safety Facts, 2019 Data: Children. 

Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration; 

2021. Available at https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/813122 

3. 	 Durbin DR, Hoffman BD, Council on Injury, Violence, and Poison Prevention. Technical Report – Child 

Passenger Safety. Pediatrics. 2018;142(5):e20182461. doi:10.1542/peds.2018-2461 

4. 	 Enriquez, J. National Highway Traffic Safety Administration (NHTSA). The 2019 National Survey of the 

Use of Booster Seats (Report No. DOT HS 813 033). U.S. Department of Transportation, National Highway 

Traffic Safety Administration; May 2021. Available at https://crashstats.nhtsa.dot.gov/Api/Public/ 

ViewPublication/813033 

5. 	 Arbogast KB, Jermakian JS, Kallan MJ, Durbin DR. Effectiveness of Belt Positioning Booster Seats: An 

Updated Assessment. Pediatrics. 2009;124(5):1281–1286. doi:10.1542/peds.2009–0908 

6. 	 Privette F, Nwosu A, Pope CN, Yang J, Pressley JC, Zhu M. Factors Associated With Child Restraint Use in 

Motor Vehicle Crashes. Clin Pediatr (Phila). 2018;57(12):1423–1431. doi:10.1177/0009922818786002 

7.	 Durbin DR, Hoffman BD, Council on Injury, Violence, and Poison Prevention. Policy Statement – Child 

Passenger Safety. Pediatrics. 2018;142(5):e20182460. doi:10.1542/peds.2018-2460 

8. 	 Durbin DR, Arbogast KB, Moll EK. Seat belt syndrome in children: A case report and review of the 

literature. Pediatr Emerg Care. 2001;17(6):474–477. doi:10.1097/00006565-200112000-00021 

9. 	 Szadkowski MA, Bolte RG. Seatbelt Syndrome in Children. Pediatr Emerg Care. 2017;33(2):120–125. 

doi:10.1097/PEC.0000000000001027 

10. 	Zaza S, Sleet DA, Thompson RS, Sosin DM, Bolen JC; Task Force on Community Preventive Services. 

Reviews of evidence regarding interventions to increase use of child safety seats. Am J Prev Med. 

2001;21(4 Suppl):31–47. doi:10.1016/s0749-3797(01)00377-4 

11. 	 Eichelberger AH, Chouinard AO, Jermakian JS. Effects of Booster Seat Laws on Injury Risk Among 

Children in Crashes. Traffic Inj Prev. 2012;13(6):631–639. doi:10.1080/15389588.2012.660663 

12. 	Farmer P, Howard A, Rothman L, Macpherson A. Booster seat laws and child fatalities: a case–control 

study. Inj Prev. 2009;15(5):348–350. doi:10.1136/ip.2008.021204 

13. 	Brixey SN, Corden TE, Guse CE, Layde PM. Booster seat legislation: does it work for all children? Inj Prev. 

2011;17(4):233–237. doi:10.1136/ip.2010.029835 

41
 
 

 

 

 

 

 

 

 

 

 

Appendix: References (cont'd.) 

14. 	Benedetti M, Klinich KD, Manary MA, Flannagan CA. Predictors of restraint use among child occupants. 

Traffic Inj Prev. 2017;18(8):866–869. doi:10.1080/15389588.2017.1318209 

15. 	Venkatraman V, Richard CM, Magee K, Johnson K. National Highway Traffic Safety Administration 

(NHTSA). Countermeasures That Work: A Highway Safety Countermeasure Guide for State Highway 

Safety Offices, 10th Edition, 2020 (Report No. DOT HS 813 097). U.S. Department of Transportation, 

National Highway Traffic Safety Administration; July 2021. Available at https://www.nhtsa.gov/sites/ 

nhtsa.gov/files/2021-09/15100_Countermeasures10th_080621_v5_tag.pdf 

16. 	Mannix R, Fleegler E, Meehan WP III, Schutzman SA, Hennelly K, Nigrovic L, Lee LK. Booster Seat Laws 

and Fatalities in Children 4 to 7 Years of Age. Pediatrics. 2012;130(6):996–1002. 

doi:10.1542/peds.2012-1058 

17. 	 Insurance Institute for Highway Safety/Highway Loss Data Institute. Seat Belt and Child Seat Laws by 

State. Arlington, VA: Insurance Institute for Highway Safety/Highway Loss Data Institute; 2021. 

Available at https://www.iihs.org/topics/seat-belts/seat-belt-law-table 

18. 	Snowdon A, Rothman L, Slater M, Kolga C, Hussein A, Boase P, Howard A. A comparison of booster 

seat use in Canadian provinces with and without legislation. Inj Prev. 2009;15(4):230–233. 

doi:10.1136/ip.2008.020537 

19. 	Brubacher JR, Desapriya E, Erdelyi S, Chan H. The impact of child safety restraint legislation on child 

injuries in police-reported motor vehicle collisions in British Columbia: An interrupted time series analysis. 

Paediatr Child Health. 2016;21(4):e27–e31. doi:10.1093/pch/21.4.e27 

20. Bauer M, Hines L, Pawlowski E, Luo J, Scott A, Garnett M, Uriell M, Pressley JC. Using Crash Outcome Data 

Evaluation System (CODES) to examine injury in front vs. rear-seated infants and children involved in a 

motor vehicle crash in New York State. Inj Epidemiol. 2021;8(1):32. doi:10.1186/s40621-021-00328-8 

21. 	Will KE, Decina LE, Maple EL, Perkins AM. Examining the relative effectiveness of different message 

framing strategies for child passenger safety: Recommendations for increased comprehension and 

compliance. Accid Anal Prev. 2015;79:170–181. doi:10.1016/j.aap.2015.03.008 

42
 

For more information please contact 

Centers for Disease Control and Prevention 

1600 Clifton Road NE, Atlanta, GA 30329 

800-CDC-INFO (232-4636) | 888-232-6348 

Contact CDC-INFO: wwwn.cdc.gov/dcs/contactus/form 

Web: www.cdc.gov/transportationsafety/ 

Publication date: December 2021 

Centers for Disease 

Control and Prevention 

National Center for Injury 

Prevention and Control