Article Text

Download PDFPDF
Systematic review of child passenger safety laws and their associations with child restraint system use, injuries and deaths
  1. Emma B Sartin1,
  2. Leah R Lombardi1,
  3. Jessica H Mirman2
  1. 1 Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  2. 2 Department of Clinical and Health Psychology, Centre for Applied Developmental Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Emma B Sartin, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia PA 19104, USA; sartine{at}


Background and objective Many countries and all US states have legislation that mandates how children of certain ages and/or sizes should be restrained in vehicles. The objective of the current systematic review was to describe the associations between legislation and three outcomes: child restraint system use, correct child restraint system use and child passenger injuries/deaths.

Methods Included studies were published between 2004 and 2020 and evaluated associations between child passenger safety laws and the outcomes described above. Three literature searches using three search terms (child passenger safety, car seat use, booster seat use) were completed in PubMed and PsycINFO, with the last search occurring in January 2021. Studies are presented based on the outcome(s) they evaluated. The original protocol for this review is registered with PROSPERO (ID: CRD42019149682).

Results Eighteen studies from five different countries evaluating a variety of different types of legislation were included. Overall, positive associations between legislation and the three outcomes were reported. However, there were important nuances across studies, including negative associations between booster seat legislation and correct child restraint use. Further, there were also negative associations between various types of legislation and outcomes for populations with less formal education and lower incomes, and for racial and ethnic minorities.

Conclusion Overall, child passenger safety legislation appears to be positively associated with child restraint system use, correct child restraint use and child passenger injuries/deaths. However, there is a need to more comprehensively characterise how different types of legislation influence child passenger safety outcomes to promote equitable effects across populations.

  • legislation
  • motor vehicle occupant
  • systematic review
  • child

Data availability statement

Data are available upon request.

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.

Data availability statement

Data are available upon request.

View Full Text


  • Twitter @GoodmanSartin

  • Contributors EBS, LRL and JHM contributed to the conception or design of the work. EBS and LRL contributed to the acquisition, analysis and interpretation of data. EBS, LRL and JHM drafted the manuscript and helped revise it critically for important intellectual content. EBS, LRL and JHM provided final approval of the manuscript submitted and agree to be accountable for all aspects of the work and in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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