Objective:  Given the known high rate of errors with child safety seat installation we sought to determine if hands-on instruction in child safety seat installation decreases the number of errors in installation compared to car safety seats presentation only.

Methods:  74 first time pregnant teens were invited to participate in Child Safety Seat presentations (CSS).  The teens were randomly assigned to one of three groups.  Group 1--CSS presentation only, Group 2--CSS presentation plus hands on installation, Group 3-- CSS presentation, hands on installation, video reviewing CSS installation.  Baseline knowledge was assessed prior to the program and child safety seat checks were performed after the program.

Results:  Although almost 60% of the teens were aware of the Ohio CSS law, how long a child should ride rear facing and how tight the car seat should be in the vehicle this same percentage had never received any instruction on how to install a safety seat.  Group 3 had the fewest overall errors.

Error Type	Group 1	Group 2	Group 3
Placing seat in car	50%	45%	40%
Seat not reclined 450	60%	45%	34%
Safety belt not routed correctly	40%	30%	25%
Seat not in locked mode/locking clip used incorrectly	30%	25%	17%

Conclusions: Although installation errors remain a significant problem, this study demonstrates that new parents are in need of education.  Training with hands on installation and video review results in fewer errors and therefore should be the preferred approach to education.