Purpose Based largely on biomechanical modeling, several states (including NJ) recently enacted legislation requiring child passengers <2 years to remain in rear-facing child restraints and passengers <4 years in an approved rear- or forward-facing restraint. However, little is known regarding adherence with this legislation. Thus, we examined child restraint use and orientation (rear- vs. forward-facing) for child passengers involved in motor vehicle crashes in NJ.

Methods Utilizing data from the NJ Safety and Health Outcomes warehouse—which includes both driver- and passenger-level data from police-reported crashes—we selected all passengers age <9 who were in an identified seating location at the time of a 2017 crash (n=25,978). As a first step, we describe child passenger demographics and restraint use and orientation.

Results There were equal proportions of male and female passengers with an average age of 4.2+2.5 years. The majority (94%) were seated in the vehicle’s second or third row at the time of the crash. Over one-third (38%) of children <1 and almost half (48%) of children between ages 1 and 2 were not properly restrained in rear-facing restraints. Overall, nearly one in five (17%) children <4 were not properly restrained in either a rear- or forward-facing restraint. As age increased, use of restraints decreased, with the majority of children >6 using vehicle seat belts.

Conclusion Findings reflect a preliminary investigation of real-world child restraint use and orientation. Despite legal requirements for rear-facing restraint use for the youngest passengers, many children are improperly restrained and perhaps at greater injury risk.

Significance of Contributions This project is among the first to examine real-world child restraint use across an entire state, providing novel information regarding restraint orientation. Future research will leverage linked hospitalization data to examine child passenger injury outcomes and the contribution of driver-, child- and neighborhood-level characteristics to nonadherence.