Child Passenger Safety State of Knowledge: A Literature Review

Passarge, Pamela; Barlow, Allyson; Benson, Aaron; O’Connor, Virginia R; Kissner, Erin; King, Katrina; Walker, Lorrie; Watson, Christine E; Jackson, Steve; Raymond, Paula · 2026 · ROSA P / United States. Department of Transportation. National Highway Traffic Safety Administration

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Summary

This systematic literature review synthesizes behavioral safety research on child passenger safety (CPS) in the United States, focusing on children up to age 12. Published by the National Highway Traffic Safety Administration (NHTSA) in 2026, the report analyzes empirical studies published between 2000 and 2022. The review was motivated by the need to identify gaps in available information and address stakeholder needs regarding the reduction of child fatalities and injuries in motor vehicle crashes. It covers the current state of CPS, the history of regulations, types of child restraint systems (CRS), factors influencing non-use and misuse, and interventions such as education, legislation, and community programs. The methodology involved a comprehensive search and screening of behavioral science literature, excluding opinion pieces, advocacy materials, and non-behavioral topics like engineering or biomechanics. Data sources included national observational surveys (e.g., NOPUS, NSUBS, NCRUSS), self-reported caregiver behaviors, and crash data from systems like the Fatality Analysis Reporting System (FARS). The review categorizes findings into non-use, misuse, education and outreach, state laws and enforcement, and strategies for communities with lower CRS use. Key findings indicate that while restraint use for children under 8 was high (93.4% in 2021), non-use increased with age and was more prevalent among drivers with lower incomes, Black drivers, and those in rural areas. Misuse, defined as incorrect restraint use, was common, particularly premature transitions from booster seats to seat belts and improper installation of rear-facing seats. Misuse was associated with lower income, lower education, rural residence, and lack of caregiver knowledge or confidence. Regarding interventions, the review found that state laws significantly increased restraint use and reduced fatalities, with effectiveness enhanced when combined with enforcement and education. Educational programs were most effective when they included hands-on training, tailored content, and multi-modal approaches. Community-led programs that fostered local ownership and provided low-cost access to CRSs were identified as promising solutions for communities with historically lower usage rates. The significance of this review lies in its comprehensive synthesis of behavioral factors affecting CPS, providing evidence-based guidance for policymakers and practitioners. It highlights that while legislative mandates are crucial, they often lag behind best practices and must be supported by education and enforcement to be effective. The report underscores the importance of addressing socioeconomic disparities in restraint use and misuse, suggesting that multifaceted interventions targeting knowledge, access, and community engagement are necessary to further reduce child injuries and fatalities. The findings support the continuation of robust state laws, improved enforcement strategies, and targeted educational outreach to ensure proper CRS use across all demographic groups.

Key finding

Multifaceted interventions combining education, enforcement, and low-cost access to child restraint systems, particularly when led by communities, are the most effective strategies for reducing child passenger safety non-use and misuse.

Methodology

review

Provenance

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Summary generated by qwen3.6-27b-prismaquant on 2026-06-10; verification: verified.

Topics

Ranked by relevance to this paper. Hover a topic for its definition.

• child passenger safety
• seat belt use

Information type

What kind of knowledge this paper contributes, grouped by family — independent of topic (what it is about) and method (how it was studied).

• Empirical Findings: observational prevalence