Article Text

Download PDFPDF
Factors predicting incorrect use of restraints by children travelling in cars: a cluster randomised observational study
  1. Lynne E Bilston1,2,
  2. Wei Du3,
  3. Julie Brown1,4
  1. 1Neuroscience Research Australia and University of New South Wales, Randwick, New South Wales, Australia
  2. 2Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
  3. 3George Institute for International Health, University of Sydney, Sydney, Australia
  4. 4School of Medical Sciences, University of New South Wales, Randwick, New South Wales, Australia
  1. Correspondence to Lynne E Bilston, Neuroscience Research Australia and University of New South Wales, Barker St, Randwick, NSW 2031, Australia; l.bilston{at}


Background The benefits of correctly using size-appropriate restraints for children travelling in cars are well established, and considerable research has focused on the determinants of appropriate restraint choice. There are few studies of the factors associated with incorrect use.

Objective To determine predictors of incorrect restraint use by child occupants and how these differ from inappropriate use.

Methods A stratified multistage cluster sample of child occupants aged 0–10 years in New South Wales, Australia was used. Observation of restraint type and inspection of correctness of use was performed on arrival at schools, childcare centres, and child health clinics. An interview was conducted with the driver. Logistic regression was performed to estimate the effects of parental, family, and other characteristics on the likelihood of moderate or serious incorrect restraint use for restraint classes (rear/forward facing, booster, and seatbelt).

Results Significant factors varied depending on age and restraint class. Older child restraint users (OR per year of age 0.27, 95% CI 0.07 to 0.98) and seatbelt users (OR per year of age 0.54, 95% CI 0.45 to 0.64) were less likely to be incorrectly using their restraints than younger users. Child restraint and booster users from non-English speaking families were more likely to be incorrectly using their restraints. Having more children in the car appeared to reduce incorrect use for booster (OR 0.18, 95% CI 0.06 to 0.57) and seatbelt users (OR 0.39, 95% CI 0.16 to 0.93).

Conclusions There is a need to reduce incorrect restraint use by both education and improved restraint design. Education aimed at reducing incorrect use may need to be targeted differently to appropriate use programmes, as the predictive factors differ.

  • Restraint incorrect use
  • child occupant
  • child restraint
  • child
  • MVTC
  • passenger

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This research was supported by an Australian Research Council Linkage grant, with partner funding from the New South Wales Roads and Traffic Authority and the New South Wales Motor Accidents Authority. LEB is supported by an NHMRC senior research fellowship. WD is funded by an NHMRC Australia–China Exchange Fellowship.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of New South Wales Human Research Ethics Committee, NSW Dept of Education, NSW Dept of Health.

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