Documentation:FIB book/Booster Seat Safety in Pediatrics

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Overview

Introduction

Overview of Problem

Motor vehicle collisions (MVC) are a leading cause of death among children, with most injuries and fatalities occurring in cases where child passengers are unrestrained or improperly restrained[1]. Research has shown that children between 2 and 5 years old who are secured with only seat belts face more than 3.5 times the risk of injury compared to those using child restraint systems (CRS)[2]. For children aged four to eight, booster seats provide a critical safety advantage, reducing the likelihood of injury by 45% compared to seat belts alone[3]. Despite their effectiveness, booster seat usage remains lower than ideal; in 2021, only 31% of children aged 4 to 7 in the United States were secured in booster seats, highlighting a significant gap in child passenger safety[4].

Proper restraint systems play a crucial role in protecting child passengers during a collision. A study by Urrechaga et al. examined the impact of child safety restraints on injury outcomes involving MVC pediatric patients and found that improperly restrained or unrestrained children were significantly more likely to sustain severe (defined as ISS > 25) injuries (10% vs. 4%) and were more frequently discharged to rehabilitation centers (5.2% vs. 1.5%) compared to properly restrained children[1]. The mortality rate among unrestrained or improperly restrained children was also higher at 4%, compared to 1% for those who were restrained properly[1].

One of the most commonly injured areas in MVCs is the head, with traumatic brain injuries from MVC being the leading cause of death among children aged 0-16 years old[5]. AIS 1 and AIS 2 traumatic brain injuries can lead to long-term cognitive and neuropsychological impairments, affecting a child’s ability to learn during the healing period[5]. Similarly, minor cervical spine injuries (AIS 1) are often sustained from frontal or rear impacts and can have lasting consequences[5]. The risk of a spinal injury resulting in permanent medical impairment is approximately 3% in children aged six and older and 1% in younger children[5].

Regulations and Guidelines

To prevent injury and mortality, provincial organizations and regulatory bodies have implemented laws and guidelines regarding CRS. Under the British Columbia Motor Vehicle Act Regulations Division 35, children under the age of nine must be securely fastened in a designated seating position using an appropriate restraint system[6].

ICBC’s child passenger safety guidelines further recommend that children between the ages of one and nine be seated in the rear and use a child seat or a booster seat, based on their age, height, and weight[7]. Children over one year old and weighing at least 9 kg (20 lbs) can use a forward-facing child seat until they reach 18 kg (40 lbs), after which they can transition to a booster seat[7]. Unlike child seats, which include a five-point harness to secure the child, booster seats raise the child to ensure the vehicle’s seat belt fits properly over the child. Children are required to use booster seats until they are nine years old or 145 cm (4’9”)[7]. Children aged three to six years old are in the transition phase to using a booster seat and are the primary demographic for booster seat use.

CMVSS 213.2

The Canada Motor Vehicle Safety Standard (CMVSS) regulates all vehicles in Canada and covers a wide range of safety aspects, including restraint systems. CMVSS 213.2 outlines the requirements for booster seats to ensure their effectiveness in protecting children.

According to CMVSS 213.2, booster seats must not include any parts that restrict the forward movement of the torso during a frontal impact. They are designed to be secured using a seat belt, allowing proper restraint without additional components that could interfere with torso movement in a crash[8].

Booster seats are required to be tested using specific anthropomorphic test devices (ATD), such as the Hybrid III 3-year-old child ATD, the Hybrid III 6-year-old child ATD, and the Hybrid III 6-year-old weighted child ATD[9]. The booster seats must remain in their original position during dynamic testing and meet specific safety thresholds, such as:

  • Limit the resultant acceleration of the upper thorax of the ATD to no more than 60g[8];
  • Limit the resultant acceleration of the center of gravity of the ATD’s head to no more than 80g during forward movement;
  • Prevent the head of the ATD from passing through a vertical transverse plane located 813 mm forward of the Z-point of the standard seat assembly[8]; and
  • Prevent knee pivot point from passing through the vertical transverse plane located 915 mm forward of the Z-point of the standard seat assembly[8].

Types of Booster Seats

Booster seats are generally categorized into two groups: high-back and low-back (or backless)[10]. The key feature in all booster seats is their ability to reposition the child for appropriate seat belt use. This is achieved either by raising the child to the point where the vehicle’s built-in seat belt lays appropriately across the lap[8] or by having a separate built-in belt[11].

The image shows a low-back booster seat

Low-back (or backless) booster seats consist of a platform for the child to sit on and rely on the vehicle’s back seat for support and the vehicle’s seat belt for restraint. Many models have armrests for comfort and to prevent the child from sliding sideways off the seat. The seats are typically not secured to the vehicle, but instead use friction from the child’s weight and the lap belt to remain in place[12].

High-back booster seats, in addition to a platform, have a backrest, usually with some amount of side padding and head support that may extend to completely enclose the torso. The high back allows for repositioning of the shoulder belt strap to ensure it crosses the child’s torso rather than the neck. High-back booster seats can either be held in place by the child’s weight and friction or secured to the vehicle using a latch system[11][13].

This image shows a high-back booster seat
Misuse

A 2016 study in Alberta covering 67 random childcare centers determined that 31.8% of booster-eligible children were improperly restrained and 23% of children using booster seats were in one that was inappropriate for their size or age. 20% of eligible children were not using a booster seat at all. Of these, 70% had improper seat belt placement indicating that the proper usage of seat belts and the purpose of booster seats were unknown. Golonka et al. conclude that misuse is largely due to ignorance rather than deliberate misuse, with uninformed drivers being the largest predictors of premature graduation (moving to the next style of booster seat for a larger child before they qualify). Overall, 90% of users who used an appropriate booster seat used it correctly, supporting the ignorance theory, and relieving possible misuse fault from the seats themselves[14]. While other studies have suggested other statistics, such as Morris et al. claiming 20% of belt positioning boosters were misused in Pennsylvania and south New Jersey[15] and Snowden et al. claiming that 77.5% of eligible children in Canada are prematurely graduated[14][16], it must be taken into account that much has changed in societal attitude, legislature, and booster technology since 2000 and 2009 respectively, such that we cannot directly compare these results, and simply understand that the misuse is much more prevalent than ideal.

Effect of Submarining. The image on the left shows improper lap belt placement resulting in submarining. The image on the right shows proper lap belt placement on the pelvis.
Submarining

One particular concern with booster seats is the risk of children submarining, which occurs when a child’s pelvis slips under the lap belt, causing the belt to sit directly on the abdomen instead of the pelvis. In a crash, the belt can compress the abdomen and lead to a variety of intra-abdominal and spinal injuries, which are often referred to as seat belt syndrome. 1.3% of children involved in MVC have abdominal bruising and 0.2% show intra-abdominal injury[17].

Booster Seat Design and Impact on Safety

Booster Seat Stiffness

The lap belt of the seat belt should be positioned on bony pelvic surfaces for optimal safety. Frontal impact finite element simulations using the PIPER 6-year-old model identified booster seat stiffness and child posture as the two most influential factors in submarining risk[18]. Low-stiffness boosters, such as inflatable designs, frequently failed to provide adequate restraint, allowing the pelvis to slip under the lap belt. A mathematical simulation using a Q3 ATD also found that softer cushions exhibited a tendency for submarining[19]. These findings highlight the importance of both booster seat stiffness in reducing injury risks for children transitioning from harness-style restraints to booster seats.

Backrest Types

A study by Menon et al. conducted front impact sled tests using Hybrid III 3-year-old and 6-year-old ATDs to evaluate injury risks across different CRS at speeds of 24, 40, and 56 kph[20]. The study compared forward-facing convertible child restraints, backless and high-back belt-positioning booster seats, and lap-shoulder seat belts to determine which provided the best biomechanical protection. For the 3-year-old ATD, the lowest injury measurements were observed in the forward-facing convertible restraint for all 3 speeds as expected. For the 6-year old ATD, at 24 and 40 kph all the restraint types performed similarly. However, at 56 kph, the 6 year-old ATD in the high-back booster seat, showed extreme cervical flexion and chin-to-chest contact were observed. This raised concerns about potential severe neck injuries, although such injuries are rarely reported in real-world crash data[21]. The researchers attributed this effect partly to the rigid thoracic spine design of the Hybrid III ATD, which may exaggerate neck loading compared to actual human biomechanics. The tests highlighted the importance of appropriate age-specific restraints[20]. The study also emphasized the need for further research on high-back booster seat performance at higher speeds and improvements in dummy biofidelity, particularly regarding spine stiffness and neck motion.

Similar to this ATD study, an epidemiological study by Arbogast et al. looked at injuries sustained by children aged 4-8 in side impact crashes compared with car seat type. Tylko's 2015 study indicates that there is a significant difference in injury outcomes during a side impact between a booster seat with and without a back in a side impact. While a backless booster seat made little difference compared to solely using the seat belt, having a back on the booster seat mitigated most central body injuries and reduced the magnitude of head, neck, and lower extremity injuries in a side impact[22]. These two studies indicate that a high back booster seat may be beneficial in certain crash scenarios and detrimental in others.

Booster Seat Size

The size of booster seats have increased, often occupying more space and featuring reinforced shells to enhance self-protection. However, this size increase may also increase risks for adjacent passengers. A biomechanics study, by Tylko et al., using Q6/Q6s ATDs in booster seats looked at head acceleration during a crash when another passenger is in the vehicle. The study points out that modern booster seats are increasingly designed to accommodate larger children and enhance side impact protection[23]. As a result, they have become bulkier, with reinforced shells and weights reaching up to 16 kg (35 lbs). While these features improve self-protection, they may pose risks to adjacent child passengers. The study found that in the far side seat location of a side impact collision the peak head acceleration of the ATD in the booster seat was found to be heavily dependent on whether contact occurred (booster seat hits another surface or another passenger), allowing for HIC15 values as high as 884[23].

Head Side Supports

The booster seat positions the child for optimal seat belt fit and posture rather than functioning as a primary restraint system. However, an on-road driving study indicates that awake child passengers frequently adopt a forward-head position during trips, influenced by visibility needs, activities, and the additional space provided by a booster seat’s backrest[24]. This forward posture can also result from pre-impact braking, leading to increased forward-head movement in the event of a frontal collision. The head can be positioned further than the coverage of most booster seats’ head side supports, posing problems in side-impacts. Therefore, it is unclear whether head side supports on a high-back booster seat are beneficial in all crash scenarios.

Seat Angle

A study by Johansson et al. used mathematical simulations and sled tests with a Q3 child ATD to assess booster seat design guidelines, focusing on cushion angle, the inclination of the seating surface relative to a horizontal plane[19]. A 12-degree seat angle (nearly flat) resulted in higher dummy accelerations, chest deflection, and forward-head displacement, though differences were minor. A 25-degree angle reduced these effects but increased lap belt force on the abdomen. The study highlighted the need to balance seat angle for optimal safety while ensuring ease of proper child restraint.

Backrest Angle

A study by Graci et al. examined how the booster seat performs at different vehicle seat recline angles, the inclination of the backrest relative to the vehicle's seat-back during lateral-oblique crashes using the THOR-AV-5F ATD[25]. The study found that the more reclined the seat, the less lateral motion occurred, suggesting that a reclined seat might help improve safety for children in booster seats for these types of crashes.

A sled-simulated frontal impact tests using the Large Omnidirectional Child (LODC) ATD found that booster seats with reclined vehicle seat recline angles at both 25° and 45° helped keep the lap belt in the correct position on the pelvis, preventing submarining[26]. It also reduced abdominal pressures and forces on the pelvis compared to when no booster was used.

Booster Seats and Seat Belts

Regardless of crash type, children using booster seats benefit from vehicle safety features, particularly seat belt systems equipped with pretensioners and load limiters.

Shoulder Belt Gap

Booster seats optimize belt positioning by preventing slouching and elevating the child’s seated height. This ensures the shoulder belt rests over the center of the clavicle and the lap belt is positioned below the anterior superior iliac spine (ASIS) thereby engaging stronger bony structures to improve load distribution. However, variations in this fit and positioning between the shoulder belt and the torso can impact restraint effectiveness during dynamic events[27].

A study by Baker et al. used crash test dummies (Hybrid III 6 and 10-year-olds), to test how different types of booster seats affected child safety during a simulated frontal crash. They found that boosters with larger gaps between the shoulder belt and the child’s torso show worse dynamic outcomes in crash tests, including more frequent belt slip-offs and increased occupant motion[27]. This slip-off can lead to increased lateral displacement, greater torso flexion, higher neck loading, and a greater risk of head strikes during a crash. The researchers hypothesize that this is due to the belt not initially making contact with the lower torso, causing more movement before the belt fully engages. Boosters with larger belt gaps also resulted in greater chest deflection, indicating more movement in the upper body during the crash.

A major factor in this shoulder belt gap is the backrest type of the booster seat. In the Baker et al. study, comparisons across different booster types revealed that high-back boosters generally result in larger belt gaps than low-back or low-profile designs, likely due to the addition of the backrest, however the specific shoulder gap size varies between models[27]. Overall, the study highlights how the initial fit of the shoulder seat belt in booster seats can impact safety outcomes.

Pretensioners & Force Limiting Belts

A study by van Rooji et al. used a multi-body simulation of a Hybrid III 6-year-old ATD in a booster seat to study the effects of seat belt slack, force-limiting belts, and pretensioners on injury risk[28]. The study aimed to evaluate how modern restraint countermeasures influence chest deflection and overall safety.

Validation against force-limiting belt setups showed an overestimation of sternum deflection, despite matching shoulder belt forces[28]. The study also found that the ellipsoid ATD model was highly sensitive to shoulder belt positioning over the chest, impacting sternum deflection measurements. The researchers suggested improving the model by replacing the ellipsoid chest with a rigid finite element (FE) chest to enhance contact accuracy between the belt and the ATD.

The best safety performance was observed with a combination of a force-limiting shoulder belt and an active pretensioner, which provided improved restraint response and reduced injury risk.

Overall Fit

This study examined how the design of booster seats affects the fit of seat belts and how that, in turn, influences crash performance[29]. Researchers used sled tests with a Q6 ATD in three different postures to see how various seat belt fits impacted dynamic crash outcomes. They found that the standard seating posture generally showed higher kinetic metrics (like acceleration or force) than more extreme positions like leaning forward or leaning inboard. However, the reference posture did not capture the higher head excursions seen in the leaning forward positions, indicating more postures (like leaning outboard or pre-submarining) should be tested for a full understanding of crash dynamics.

The study also revealed that the way the seat belt fits in the booster seat affects the dummy’s movement during the crash. A booster with better shoulder belt positioning, a lower lap belt, and a larger gap showed better overall crash performance in terms of kinematics and injury risks compared to another booster with worse shoulder and lap belt positioning. This suggests that booster seat design, particularly the fit of the seat belt, plays an important role in improving child safety during crashes.

Booster Seats and Side Airbag Interactions

Side airbags have been implemented in vehicles to mitigate injuries in side-impact collisions. However, studies indicate that passenger-side airbags pose a significant risk to children seated in the front. One study found that front passenger airbags were associated with a 31% increase in fatality risk for restrained children and an 84% increase for unrestrained children[30]. These airbags also need to be carefully considered and investigated for their potential risks to child occupants, particularly those in booster seats.

In-Position Interactions

A study conducted by Tylko and Dalmotas in 2000 examined in-position side airbag deployment scenarios using forward-facing child restraints and booster seats with a Hybrid III 3-year-old ATD[31]. They defined “in-position” as the child dummy being seated according to the manufacturer’s guidelines. The study used the Evenflo Ultara I Premier forward-facing child restraint and the Century Beverra Contour full-back booster seat. Both static and dynamic tests were performed with the dummy seated in the front passenger side seat. The static testing indicated a potential for the deploying side airbag to intrude into the child occupant space, which could lead to structural damage to the child seat, potentially compromising its protective capacity.

A follow-up study in 2001 further examined side airbag deployment with booster seats and child restraints[32]. This study used the Evenflo Ultara I Premier, Century Room to Grow forward-facing child seats, Evenflo rear-facing infant carrier, and the Century Beverra full-back booster seat. The findings indicated that side airbags had sufficient space for deployment when booster seats were correctly positioned. No structural damage to the booster seats was observed, suggesting they retained their integrity. This emphasizes the importance of proper booster seat installation in mitigating risks associated with side airbag interactions.

Out-of-Position (OOP) Interactions

The same study by Tylko and Dalmotas also employed static OOP tests to evaluate potential injury due to side airbag deployment[31]. This study involved positioning a Hybrid III 3-year-old, 6-year-old, and TNO Q3 3-year-old child dummies in various positions relative to the airbag. They tested various side airbag designs, including seat-mounted thorax airbags, head/thorax airbags, door-mounted airbags with head tubes, and curtain airbags combined with seat-mounted airbags in different car models. The study used a foam block as a substitute for a booster seat to ensure consistent positioning, and seat belts were omitted to isolate airbag-dummy interaction. Results showed that the risk of injury varies depending on the type of side airbag and the vehicle model. For example, in the Audi A6, the thorax airbag led to upper and lower neck tension as well as chest deflections that surpassed established injury thresholds. The forces on the upper and lower neck exceeded 1130 N, while chest deflections went beyond 36 mm, indicating a high risk of severe or potentially fatal neck and chest injuries. In contrast, in the Chevrolet Venture, the thorax airbag produced significantly lower injury values, suggesting a lower risk of severe injury compared to the Audi A6. However, the current research does not establish a direct comparison of injury risk across different airbag types, as each test result was unique to its respective vehicle model.

Injury Biomechanics

The biomechanics of injury related to the interaction between side airbags and children in booster seats vary depending on factors such as vehicle model, airbag deployment characteristics, and seating position. A 2001 study by Tylko and Dalmotas found that head accelerations remained relatively low (< 20g) in static airbag deployments, except in severe crash scenarios where the dummy’s head bottomed out and broke through the airbag[32]. Chest deflections were also minimal, with peak lateral sternum deflections generally below 15mm across all tested vehicles. Neck tensile forces, however, varied depending on vehicle design and crash dynamics. The study referenced a recommended tensile force limit of 1130N for the Hybrid III 3-year-old dummy in OOP static tests, emphasizing that some vehicle designs might pose a greater risk depending on airbag aggressivity.

The presence of a booster seat can mitigate the risk of airbag-related injuries compared to scenarios without booster seat support, assuming correct usage. However, variations in airbag aggressivity across vehicle models influenced injury outcomes, highlighting the need for further research on how different airbag designs impact child occupants in booster seats.

Conclusion

Improperly restrained children face a higher risk of injury in a MVC, which can result in long-term impairments or death. Booster seats reduce the risk of serious injury by ensuring children ages three to nine years old are properly restrained using the vehicle seat belt. However, certain design features of the booster seat have effectiveness that vary depending on the type of collision. High-back and low-back designs, as well as head side supports, can either be beneficial or detrimental based on the crash conditions. Regardless of crash type, proper fit is essential for booster seats to be effective. This includes ensuring that the seat belt sits properly on the child, with proper shoulder belt and lap belt positioning.

Limitations of Existing Literature

Current biomechanics research on booster seats faces several key limitations. Due to ethical concerns, most studies rely on computer simulations and ATDs rather than human volunteers or cadavers. Child cadavers are particularly difficult to obtain for research due to the emotional distress it would cause families. This limits biofidelity, as most studies rely on post-crash data for simulation-based investigations. While ATDs provide valuable data through load cells and accelerometers, they cannot accurately replicate soft tissue behavior, muscle response, spinal flexibility, and real-world child movement patterns. Other biomechanics studies on pediatric populations have used porcine animal models but anatomical differences in the spine and pelvis limit their real-world applicability especially in booster seats[33].

Another major challenge in current research is replicating children's postures in booster seats. Children adopt various positions and can end up out-of-position by leaning forward, slouching while sleeping, or shifting due to lap belt discomfort. The Hybrid III ATD’s limited lateral neck flexibility prevents it from mimicking common sleeping positions, such as when children often rest their heads on the side[32]. This makes it difficult to assess injury risks in these positions, particularly regarding side airbag interactions.

Current booster seat designs with head side supports may not adequately protect children who frequently lean forward during travel[24]. There is also limited research on how these supports interact with curtain airbags, especially considering the possibility of booster seat movement or airbag obstruction.

Overall, research on interactions between side airbags and booster seats remains limited. While studies have thoroughly documented that fully powered airbags pose high injury risks to children—especially more aggressive designs[30]—the available research suggests that properly restrained children in booster seats benefit from side airbags. However, there is insufficient research on airbag depowering in these scenarios, which could potentially reduce injury risks to out-of-position children.

Recommendations for Future Work

Given the importance of booster seats in reducing and preventing injury, their design should be optimized considering factors such as seat stiffness, size, seat angle, back support, and seat recline to provide optimal safety and support to children while preventing submarining. Future booster seat designs could include integrating sensors to detect submarining risk and incorrect seat belt positioning[31]. Additionally, investing in resources to educate parents on age-appropriate restraints and proper restraint usage is essential for reducing booster seat misuse.

From a research perspective, further studies are needed to evaluate booster seat performance at higher speeds while considering a wider range of child postures. Vehicles on highways can go up to 120 kph; however, the studies conducted have only evaluated booster seat performance at 24 to 56 kph. Improvements in ATD biofidelity, especially regarding spine stiffness and neck motion, are also crucial in improving the accuracy of test results. Additionally, limited research has been done on the interactions between booster seats and adjacent passengers during side impact collisions, as well as booster seat compatibility with side airbags. Further research in these areas is essential to improving booster seat safety and reducing the risk of injuries to children involved in MVC.

References

  1. ↑ Jump up to: 1.0 1.1 1.2 Urrechaga, Eva M.; Cioci, Alessia C.; Allen, Megan K.; Saberi, Rebecca A.; Gilna, Gareth P.; Turpin, Alexa G.; Perez, Eduardo A.; Ford, Henri R.; Sola, Juan E. (May 2022). [10.1016/j.jss.2021.12.015 "Improper Restraint Use in Pediatric Patients Involved in Motor Vehicle Collisions"] Check |url= value (help). Journal of Surgical Research. 273: 57–63 – via Elsevier Science Direct.
  2. ↑ Winston, F.K. (June 2000). "The danger of premature graduation to seat belts for young children". Pediatrics. doi:10.1542/peds.105.6.1179.
  3. ↑ Arbogast, Kristy B.; Jermakian, Jessica S.; Kallan, Michael J.; Durbin, Dennis R. (Nov 2009). "Effectiveness of Belt Positioning Booster Seats: An Updated Assessment". Pediatrics. 124 (5): 1281–1286. doi:10.1542/peds.2009-0908. ISSN 0031-4005.
  4. ↑ Boyle, Lacey L. "The 2021 National Survey of the Use of Booster Seats".
  5. ↑ Jump up to: 5.0 5.1 5.2 5.3 Bohman, Katarina; Stigson, Helena; Krafft, Maria (Jan 2014). "Long-Term Medical Consequences for Child Occupants 0 to 12 Years Injured in Car Crashes". Traffic Injury Prevention. 15 (4): 370–378. doi:10.1080/15389588.2013.826799. ISSN 1538-957X 1538-9588, 1538-957X Check |issn= value (help).
  6. ↑ "Motor Vehicle Act Regulations".
  7. ↑ Jump up to: 7.0 7.1 7.2 "Child car seats".
  8. ↑ Jump up to: 8.0 8.1 8.2 8.3 8.4 "Consolidated federal laws of Canada, Motor Vehicle Restraint Systems and Booster Seats Safety Regulations". Jan 2025.
  9. ↑ "Child Restraint Systems" (PDF). Transport Canada - Motor Vehicle Safety. May 2012.
  10. ↑ "Booster Seat Testing". Transport Canada.
  11. ↑ Jump up to: 11.0 11.1 "How to Install a Combination Car Seat Forward-Facing". 30 March, 2025. Check date values in: |date= (help)
  12. ↑ "How to Install a Backless Booster Seat". 30 March, 2025. Check date values in: |date= (help)
  13. ↑ "How to Install a High-Back Booster Seat". 30 March, 2025. Check date values in: |date= (help)
  14. ↑ Jump up to: 14.0 14.1 Golonka, Richard P.; Dobbs, Bonnie M.; Rowe, Brian H.; Voaklander, Don (Mar 2016). "Prevalence and predictors of booster seat use in Alberta, Canada". Canadian Journal of Public Health. 107 (2): e155–e160. ISSN 1920-7476 – via Springer Link.
  15. ↑ Morris, Shannon D.; Arbogast, K. B.; Durbin, D. R.; Winston, F. K. (1 December, 2000). "Misuse of booster seats". Injury Prevention. 6: 281–284. doi:10.1136/ip.6.4.281 – via PubMed. Check date values in: |date= (help)
  16. ↑ Snowden, A; Rothman, L; Slater, M; Kolga, C; Hussein, A; Boase, P; Howard, A (3 August, 2009). "A comparison of booster seat use in Canadian provinces with and without legislation". Injury Prevention. 15: 230–233. doi:10.1136/ip.2008.020537 – via PubMed. Check date values in: |date= (help)
  17. ↑ Lutz, Nicolas; Nance, Michael L.; Kallan, Michael J.; Arbogast, Kristy B.; Durbin, Dennis R.; Winston, Flaura K. (June 2004). "Incidence and clinical significance of abdominal wall bruising in restrained children involved in motor vehicle crashes". Journal of Pediatric Surgery. 39 (6): 972–975. doi:10.1016/j.jpedsurg.2004.02.029. ISSN 1531-5037. PMID 15185237 – via PubMed.
  18. ↑ Forman, Jason; Miller, Matthew; Perez-Rapela, Daniel; Gepner, Bronislaw; Edwards, Marcy A.; Jermakian, Jessica S. (Jan 2023). "Investigation of factors influencing submarining mitigation with child booster seats". Traffic Injury Prevention. 24 (1): 75–81. doi:10.1080/15389588.2022.2153594. ISSN 1538-9588 – via Taylor & Francis Online.
  19. ↑ Jump up to: 19.0 19.1 Johansson, Marianne; Pipkorn, Bengt; Lövsund, Per (Sep 2009). "Child Safety in Vehicles: Validation of a Mathematical Model and Development of Restraint System Design Guidelines for 3-Year-Olds through Mathematical Simulations". Traffic Injury Prevention. 10 (5): 467–478. doi:10.1080/15389580903149243. ISSN 1538-9588 – via Taylor & Francis Online.
  20. ↑ Jump up to: 20.0 20.1 Menon, Rajiv; Ghati, Yoganand; Ridella, Stephen; Roberts, David; Winston, Flaura (Mar 2004). "Evaluation of Restraint Type and Performance Tested with 3- and 6-Year-Old Hybrid III Dummies at a Range of Speeds". SAE International. doi:10.4271/2004-01-0319.
  21. ↑ Huelke, D. F.; Mackay, G. M.; Morris, A.; Bradford, M. (Dec 1993). "A review of cervical fractures and fracture-dislocations without head impacts sustained by restrained occupants". Accident; Analysis and Prevention. 25 (6): 731–743. doi:10.1016/0001-4575(93)90037-w. ISSN 0001-4575. PMID 8297440 – via PubMed.
  22. ↑ Arbogast, Kristy B.; Jermakian, Jessica S.; Kallan, Michael J.; Durbin, Dennis R. (Nov 2009). "Effectiveness of Belt Positioning Booster Seats: An Updated Assessment". Pediatrics. 124 (5): 1281–1286. doi:10.1542/peds.2009-0908. ISSN 0031-4005.
  23. ↑ Jump up to: 23.0 23.1 Tylko, Suzanne; Bohman, Katarina; Bussières, Alain (Nov 2015). "Responses of the Q6/Q6s ATD Positioned in Booster Seats in the Far-Side Seat Location of Side Impact Passenger Car and Sled Tests". SAE Technical Paper. doi:10.4271/2015-22-0012.
  24. ↑ Jump up to: 24.0 24.1 Jakobsson, Lotta; Bohman, Katarina; Stockman, Isabelle (May 2023). "Real-World Protection of Booster-Seated Children – Needs and Challenges In Future Transportation". 27th International Technical Conference on the Enhanced Safety of Vehicles (ESV): Enhanced and Equitable Vehicle Safety for All: Toward the Next 50 Years.
  25. ↑ Graci, Valentina; Humm, John; Hauschild, Hans (Nov 2024). "The effect of reclined seat-back angles on the LODC with and without a belt-positioning booster during far-side lateral-oblique impacts". Traffic Injury Prevention: S208–S216. ISSN 1538-9588 – via Taylor & Francis Online.
  26. ↑ Graci, Valentina; Hauschild, Hans; Maheshwari, Jalaj; Humm, John (Oct 2022). "The effect of a moderately reclined seat-back angle on the kinematics of the Large-Omnidirectional Child Anthropomorphic Test Device with and without a belt-positioning booster in frontal crashes". Traffic Injury Prevention. 23: S117–S122. doi:10.1080/15389588.2022.2097668. ISSN 1538-9588 – via Taylor & Francis Online.
  27. ↑ Jump up to: 27.0 27.1 27.2 Baker, Gretchen H.; Mansfield, Julie A.; Bolte IV, John H. (Oct 2024). "Influence of initial belt torso contact on the kinematics and kinetics of booster-seated ATDs in frontal-oblique impacts". Traffic Injury Prevention. 25: S183–S192. doi:10.1080/15389588.2024.2378380. ISSN 1538-9588 – via Taylor & Francis Online.
  28. ↑ Jump up to: 28.0 28.1 Rooij, Lex van; et al. (Mar 2003). "The Effects of Vehicle Seat Belt Parameters on the Injury Risk for Children in Booster Seats". SAE International. doi:10.4271/2003-01-0500. Explicit use of et al. in: |last= (help)
  29. ↑ Maheshwari, Jalaj; Griffith, Madeline; Baker, Gretchen; Patton, Declan; Mansfield, Julie (Sep 2023). "Effect of naturalistic seating postures and seatbelt routing on booster-seated Q6 ATD kinematics and kinetics in frontal impacts". Accident Analysis & Prevention. 189: 107140. doi:10.1016/j.aap.2023.107140. ISSN 0001-4575 – via Elsevier Science Direct.
  30. ↑ Glass, Roberta J.; Segui-Gomez, Maria; Graham, John D. (May 2002). "Child Passenger Safety: Decisions about Seating Location, Airbag Exposure, and Restraint Use". Risk Analysis. 20 (4): 521–528 – via Wiley Online Library.
  31. ↑ Jump up to: 31.0 31.1 Tylko, Suzanne; Dalmotas, Dainius J. (Oct 2000). "Assessment of Injury Risk to Children From Side Airbags". SAE Technical Paper. doi:10.4271/2000-01-SC02.
  32. ↑ Jump up to: 32.0 32.1 32.2 Tylko, Suzanne; Dalmotas, Dainius (Jun 2001). "SIDE AIRBAGS: EVALUATING THE BENEFITS AND RISKS FOR RESTRAINED CHILDREN". SAE Technical Paper.
  33. ↑ Prasad, Priya; Daniel, Roger P. (1984/10/01). "A Biomechanical Analysis of Head, Neck, and Torso Injuries to Child Surrogates Due to Sudden Torso Acceleration". SAE Transactions. 93: 784–799. doi:10.4271/841656. ISSN 0096-736X – via saemobilus.sae.org. Check date values in: |date= (help)


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