Each year in the United States, more than 130,000 children younger than age 13 are treated in EDs after motor vehicle collisions (MVCs). MVCs are a leading cause of death in U.S. children, in part because child passengers continue to be inappropriately restrained. Studies have shown that 20% of children aged 1 to 3 years and nearly 50% of those aged 4 to 7 years do not use the recommended restraint for their age. MVC-related ED visits for children offer a chance for ED personnel to convey tips for proper use of child passenger restraints to prevent future injuries.

Missing Key Opportunities

Recently, my colleagues and I published a study in Pediatric Emergency Care that examined emergency physician awareness of and referrals to child passenger safety resources. Our results suggest that many EDs aren’t taking advantage of opportunities to educate families on child passenger safety. The survey, which included responses from more than 600 emergency physicians drawn from a national sample, found significant variability by practice setting in the availability of child passenger safety resources.

More than one-third of responding ED physicians reported uncertainty about whether their departments provided child passenger safety resources to parents. Less than half of respondents said that a parent of a 2-year-old being discharged following an MVC would be provided with discharge instructions that include advice about car seats.

Our analysis also revealed that only half of pediatric trauma center physicians would always recommend replacing a 3-year-old’s car seat following a roll-over MVC, and even fewer adult and non-trauma center physicians would do so. Children seen in general EDs without pediatric specialization were least likely to receive car seat information, but these EDs treat more than 85% of children who obtain emergency care.


Recommendations for Replacing Child Safety Seats After MVCs (Summary)

Child safety seats should always be replaced following a car crash unless these conditions are met:

1. The airbags did not deploy.
2. There was no vehicle intrusion nearest the safety seat
3. The vehicle could be driven away from the collision.
4. No passengers were injured.

Source: Adapted from the National Highway Transportation Safety Administration

A Wake Up Call

Based on our findings, families appear to be frequently discharged from EDs after an MVC without being referred to local resources that can provide additional child safety seat information. This is concerning because child safety seats are complicated, and serious misuses are common.

More needs to be done to eliminate preventable MVC–related injuries through correct and consistent use of child passenger restraints. Pediatric injury prevention outreach to general EDs is needed to increase the number of children who can benefit from existing community child passenger resources. It’s hoped that our research will spur more EDs to begin providing resources to patients and connecting parents to existing community resources.


Macy ML, Clark SJ, Cunningham RM, Freed GL. Availability of child passenger safety resources to emergency physicians practicing in emergency departments within pediatric, adult, and nontrauma centers: a national survey. Pediatr Emerg Care. 2013;29:324-330. Available at: http://journals.lww.com/pec-online/Abstract/2013/03000/Availability_of_Child_Passenger_Safety_Resources.10.aspx. Macy ML, Freed GL. Child passenger safety practices in the U.S.: disparities in light of updated recommendations. Am J Prev Med. 2012;43:272-281. Macy ML, Freed GL, Reed MP. Child passenger restraints in relation to other second-row passengers: an analysis of the 2007-2009 National Survey of the Use of Booster Seats. Traffic Inj Prev. 2013;14:209-214. Macy ML, Clark SJ, Sasson C, Meurer WJ, Freed GL. Emergency physician perspectives on child passenger safety: a national survey of attitudes and practices. Acad Pediatr. 2012;12:131-137.