16th August 2019, Volume 132 Number 1500

Navneet Singh, Julie Chambers, James K Hamill

Road traffic crashes (RTC) injure children at a concerning rate. The Child and Youth Mortality Review Committee reported that 28–32% of all deaths in children aged 1–14 years are caused…

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Child car seats and booster seats save lives. Many children >5 years of age are not appropriately restrained. In 2013, the New Zealand Government amended child restraint legislation. We have shown that this has improved child restraint use in children aged 5–7 years. Since the law does not mandate booster seats for children >7 years of age, most of these children are still suboptimally restrained.



Child restraint practices among New Zealand children have fallen short of best practice recommendations. In 2013, New Zealand child restraint legislation was amended. The aim of the present study was to determine the child restraint practices of a cohort of children admitted to hospital and how practices have changed since the amendment in child restraint legislation.


We conducted interviews with the parents of 300 paediatric inpatients aged 0–13 years. Data were recorded on their child’s usual child restraint use, the restraint used during their trip to hospital, and parental knowledge of child restraint law and best practice recommendations. We compared their responses with those of our survey published in 2013, which was performed before the amendment in child restraint legislation.


The median age of the 300 children was three years: 181 (60%) were aged 0–4 years, 65 (22%) 5–9 years and 54 (18%) 10–13 years. One hundred and thirty-six (45%) were girls. Of children <5 years of age, 97% always used a child restraint. Of children 5–9 years of age, 60% always used a child restraint, 12% sometimes and 28% never. A significantly greater proportion of 5–9 year-old children used a child restraint at least some of the time in the present study compared to the 2013 study (47/65 versus 27/53, OR 2.49 [95%CI 1.09–5.81]). Child restraint use declined in children >6 years of age. On their journey to hospital, five children used no restraint, four of whom were held in the arms of a caregiver. Parental knowledge of child restraint recommendations correlated inversely with their compliance with the recommendations (OR 0.33 [95%CI 0.11–0.91]).


Consideration should be given to extending child restraint legislation to children older than seven years of age. Further studies could explore the barriers parents face to the use of child restraints and the potential effect of extending child restraint laws to older children.

Author Information

Navneet Singh, Medical Student, University of Auckland, Auckland;
Julie Chambers, Trauma Coordinator, Children’s Trauma Service, Starship Children’s Health, Auckland; James Hamill, Paediatric Surgeon, Department of Paediatric Surgery, Starship Children’s Health, Auckland.


We would like to thank Professor Stuart Dalziel, Faculty of Medical and Health Sciences, the University of Auckland, for helping with the creation of the interview questionnaire.
This work was financially supported by the Auckland District Health Board A+ Charitable Trust (grant number 6784).


James Hamill, Department of Paediatric Surgery, Starship Children’s Health, PO Box 92024, Auckland 1142.

Correspondence Email


Competing Interests



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