279 - Prompting and Improving Car Seat Safety for Infants and Children​

Publication Number: 2269.279

Rachel A. Neuson, University of North Carolina at Chapel Hill School of Medicine, Apex, NC, United States; K'Shylah Whitehurst, University of North Carolina at Chapel Hill School of Medicine, Durham, NC, United States; Emily Vander Schaaf, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States

Background: The guidance a pediatrician provides regarding car seat safety can prevent life-threatening injury to a child. The most common reason children are not in booster seats is the inaccurate belief that they are large enough to use a regular lap-shoulder belt. Even with parental awareness, low-income families are often at risk of decreased adherence to guidelines due to the high cost of car seats.

Objective: This project aims to: (1) increase physician knowledge to allow for improved counseling regarding car seat safety, (2) provide free car seats to patients otherwise without access, and (3) improve rates of appropriate car seat use by addressing car seat safety at each visit.

Design/Methods: This project facilitated the development of a car seat safety education program for pediatric residents at the University of North Carolina (UNC) in partnership with UNC Trauma Center and Buckle Up NC, who led car seat safety training for approximately 40 residents from October 2024 through March 2025.

A grant from Carolina for the Kids allowed for the purchase of booster seats for distribution to patients in clinic. Booster seat distribution was tracked. Chart review compared rates of safe car seat use in children aged 5-10 seen for well-child checks in the months before and after the intervention.

Results: 23 car seats were distributed to children aged 4-9, with the majority of car seats given to 6- and 7-year-olds. 100% of children who received a car seat either had Medicaid or were self-pay. Most seats were distributed during well child checks, but 35% were distributed during sick visits, other follow up visits, or visits for a sibling. Rates of safe car seat usage increased from 68% pre-intervention (n=66) to 76% post-intervention (n=69) (p=0.08).

Conclusion(s): Nearly a third of school-aged children lacked appropriate car restraints, indicating a need for improved education and availability of restraints. Increasing resident knowledge of car seat safety promotes counseling regarding child safety restraints at all medical visits, as evidenced by improved rates of safe car seat use after resident education session and distribution of more than a third of car seats at non-well child visits.

Many children are only seen once per year for well visits, so complete follow up data regarding effectiveness of car seat distribution is not yet available, though is an area for future study. However, the demonstrated increase in safe car seat use in the early post-intervention period suggests that education in combination with the provision of car seats to patients otherwise without access improves rates of safe car seat use.

Ages of children who received free car seats during distribution period
Car seats were distributed to children aged 4-9, with the majority of car seats (55%) given to 6- and 7-year-olds.

Type of Visit
65% of booster seats were distributed during well child checks, 9% during sick or other follow up visits, and 26% during a visit for a sibling.

Percent of children safely restrained while driving
Of children aged 5-10 who weigh less than 80 pounds or are shorter than 4'9", 68% were safely using a car seat pre-intervention, which improved to 76% post-intervention (p=0.08).