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Booster seat laws and child fatalities: a case–control study
  1. P Farmer1,
  2. A Howard2,3,
  3. L Rothman2,3,
  4. A Macpherson1,4
  1. 1
    School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
  2. 2
    Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
  3. 3
    Division of Orthopaedic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
  4. 4
    Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  1. Correspondence to Pamela Farmer, c/o Dr Alison Macpherson, York University, Department of Kinesiology & Health Science, Bethune College, 4700 Keele Street, Toronto, Ontario, Canada, M3J 1P3; farmer.pam{at}


A case–control study examined, primarily, the association between booster seat laws and fatalities among children in frontal collisions and, secondarily, the association between booster seat laws and reported restraint use, and restraint use and child fatalities. Children who died in a crash in the US were cases, and children who survived a fatal crash were controls. Subjects were child passengers (4–8 years old) in the Fatality Analysis Reporting System Database, 1995–2005. In states with a booster seat law, children were less likely to die than in states without a law (OR 0.80; 95% CI 0.66 to 0.98). They were also more likely to be restrained (adjusted OR 1.59; 95% CI 1.21 to 2.09) and were more likely to be correctly restrained (adjusted OR 4.44; 95% CI 3.18 to 6.20). It is concluded that booster seat laws are associated with a decrease in child deaths and an increase in correct restraint use among children involved in a fatal crash in the USA.

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  • Funding Funding for this study was from AUTO 21. This funding source did not have any involvement in the analysis and interpretation of data. In addition, AUTO 21 did not have any involvement in the writing of the report and the decision to submit the paper for publication.

  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.