Background In China, road traffic injuries are the leading cause of death in children under age 14. Although children are increasingly travelling in cars, there is no national polices or laws for child safety seats in cars.

Methods A cross-sectional survey and semi-structured interview were conducted in the maternity departments of two hospitals in China. Parents of newborns were recruited after delivery and surveyed on their knowledge, attitudes and behaviours regarding child safety seats use. Pregnant women were also interviewed to learn about their views and decisions regarding child safety seats use. Both quantitative and qualitative methods were used to analyse the data collected.

Results Of a total of 242 parents of newborns recruited in the quantitative survey, 202 (83.5%) parents had heard of child safety seats, and 149 (61.6%) parents reported they would use child safety seats for their babies. Parents’ knowledge, car ownership, occupation, and income were significantly associated with their decision regarding use of child safety seats. Three themes were identified from the qualitative interview of 30 pregnant women: (1) the pregnant women perceived child passenger safety as important; (2) the car ownership, and price and quality of child safety seats were major influencing factors of their decisions on use of child safety seats, and (3) lack of awareness and lack of laws requiring use were perceived to contribute to low use of child safety seats in China.

Conclusion Lack of knowledge and awareness on child passenger safety were found to be two most important factors associated with low use of child safety seats. Effective interventions are urgently needed to improve parents’ knowledge before laws are enacted and implemented.