Background Few studies have assessed the child restraint use in Shanghai. We aim to investigate the prevalence of child restraint use and the potential risk factors affecting child restraint practice in Shanghai.

Methods A cross-sectional observational study was conducted near the pediatric hospitals, kindergartens, entertainment places, and shopping malls between 2015 and 2019 in Shanghai. Trained field workers observed and recoded the child restraint use in all passing motorized vehicles with children passengers at each site. A logistic regression model was used to examine risk factors on non-restraint use among children, adjusting for potential confounders.

Results Eight rounds of data were collected with a total sample size of 12,061 children. The total child restraint use rate was 6.42%. Child restraint use rate rose with fluctuation during the last 5 years, from 5.12% in round 1 to 8.55% in round 8 (p value <0.001). Results from the logistic regression model showed that children occupants with these factors had a higher risk for inappropriate child restraint use: children aged 5–12 years compared with those aged younger than 4 years (OR: 2.14; 95% CI: 1.79–2.55; p<0.001), children traveling with other children occupants compared to those who were the only child in a car (OR: 2.20; 95% CI: 1.51–3.20; p<0.001), and children traveling in a taxi compared with those in a sedan/saloon (OR: 32.98; 95% CI: 16.37–66.43; p<0.001).

Conclusion Child restraint use rate was low in Shanghai. Our finding may inform intervention programs among children with those risk factors to promote child restraint use.