Background Road traffic injuries are the second leading cause of injury death among children in China. Around 1/3 of child road traffic injuries and deaths occurred in child passengers; however, child restraint use is low and there is no national safety seat legislation. Objectives of this study: describe ownership and use of child restraints as well as parental knowledge and attitudes in the developed cities of Shanghai and Shenzhen; analyse the barriers to child restraint ownership and use.

Methods By using stratified cluster random sampling, a total of 7,189 parents of children aged <1–6 years, who also owned a private car, participated in a self-report survey. Descriptive and multivariate analyses were used to describe collected information and determine which variables were associated with always use of child restraints.

Results Of participating parents, 39.2% owned, 33.2% ever used, 17.1% always used, and 11.4% properly used a child restraint for their child. Only 16.3% of parents answered all six key child passenger safety questions correctly. Multivariate analysis determined that the following factors influenced always using a child restraint: child’s age, parental education, family income, price of car, gender of the child’s driver, frequency child travels by car, average and longest distance child travels in a week, drivers’ seat belt use, and parents’ knowledge on child passenger safety. The leading reasons for not owning a child restraint were lack of space, low frequency of child traveling by car, difficulty installing the child restraint, and cost. The leading reasons for not using a child restraint when one was owned were: child refusal, short traveling distance, difficulty installing or using the restraint, and no space.

Conclusions This study demonstrated low child restraint use in two major Chinese cities and barriers that will need to be addressed before child restraint ownership and use will increase.