Patterns of booster seat usage among 4- and 5-year-old daycare children and caregiver knowledge about booster seats in Summit County, Ohio

Purpose. To determine the usage rates of booster seats among 4- and 5-year-old children and caregiver knowledge about boosters in a chain of 9 preschools in Summit County, Ohio.

Methods. Direct parking lot observation of child restraint usage was performed. Five questions were asked and a survey given to each driver. Geographical Information systems mapping was used to plot zip code and restraint type on a census income map of the county.

Results. 83 children were observed. 52% were found to be in a booster seat or car seat, 46% were found to be in an adult seat belt, and 2% were unrestrained. Four-year-olds were more likely to be in a booster or car seat than 5-year-olds (67% vs. 32%, p = .0059). Only 20% of caregivers knew the appropriate criteria for booster seat use. 34% of caregivers reported that their child's doctor had discussed booster seats and 29% saw a national commercial for booster seats. There was a significant difference between median income levels and whether a seat belt or a booster was used ($37,758 vs. $47, 686).

Conclusions. Booster seat use was found to be higher than the national average of 9-19%; however, only half of all children were in a booster or car seat; 16% of boosters were used incorrectly. Many caregivers were confused about when to use a booster seat. Primary care physicians and national ad campaigns reached only about a third of these caregivers. There is significant need for more booster seat education.