Background Use of top tethers with forward-facing child restraints is a simple way for parents to keep their children safer when travelling in passenger vehicles, but tether use remains low.

Objectives To obtain an updated estimate of top tether use.

Methods Data on forward-facing child restraints were collected through an observational survey in the Washington DC metropolitan area during July–August 2010. The study sample included all forward-facing restraints that were installed in parked passenger vehicles and visible such that tether use could be observed. For each restraint, certified child passenger safety technicians collected information on the vehicle, seat row, restraint position, and tether.

Results A total of 1321 cars, minivans, pickups, and sport utility vehicles, with a total of 1543 forward-facing child restraints, were observed. Tethers were used with 43.0% of all forward-facing child restraints. Tether use was similar (42.7–45.4%) among cars, minivans, and sport utility vehicles but lower (17.2%) for pickups. Tether use was higher (47.5%) for 2001 and newer vehicles, but dropped to 43.0% when only taut installations were considered.

Conclusions Despite LATCH education campaigns and the increased availability of tether anchors, observed tether use was less than 50%. Tether use was even lower in older vehicles, yet many children continue to travel in these vehicles. If tether anchors are unavailable, parents should be encouraged to retrofit vehicle seating positions. Because many child restraints are still installed with vehicle seat belts, efforts to educate parents on the importance of tether use regardless of installation method may be warranted.