Association Between Weight and Risk of Crash-
Related Injuries for Children in Child Restraints
WHAT’S KNOWN ON THIS SUBJECT: Previous work has shown
that overweight children might have limited options for child
restraints, which could increase their motor vehicle
crash–related injury risk. With the increasing number of
available child restraint systems, assessment of real-world crash
injury risks is necessary.
WHAT THIS STUDY ADDS: This study found that absolute weight
was not associated with increased risk of motor vehicle crash–
related injury for children 1 to 8 years of age who were using
child restraint systems. Parents should restrain their children
according to current recommendations.
of injury in motor vehicle crashes (MVCs) for children 1 through 8
years of age who were using child restraints.
METHODS: This was a cross-sectional study of children 1 to 8 years of
age in MVCs, in which cases from the National Automotive Sampling
System Crashworthiness Data System were used. Abbreviated Injury
Scale scores of ?2 indicated clinically significant injuries.
Data System study sample included 650 children 1 to 5 years of age in
forward-facing child restraints who weighed 20 to 65 lb and 344 chil-
dren 3 to 8 years of age in belt-positioning booster seats who weighed
30 to 100 lb. With adjustment for seating position, type of vehicle, di-
association between absolute weight and clinically significant injuries
in either age group (odds ratio: 1.17 [95% confidence interval: 0.96–
1.42] for children 1–5 years of age in forward-facing child restraints
age in belt-positioning booster seats).
CONCLUSIONS: The risk of clinically significant injuries was not asso-
ciated with weight across a broad weight range in this sample of
children in MVCs who were using child restraint systems. Parents
Highway Traffic Safety Administration. Pediatrics 2011;128:1148–1152
AUTHORS: MarkR. Zonfrillo, MD, MSCE,a,bMichaelR.
Elliott, PhD,c,dCarolA. Flannagan, PhD,eand DennisR.
Durbin, MD, MSCEa,b
aCenter for Injury Research and Prevention, Department of
Pediatrics, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania;bCenter for Clinical Epidemiology and
Biostatistics, School of Medicine, University of Pennsylvania,
Philadelphia, Pennsylvania; andcDepartment of Biostatistics,
School of Public Health,dInstitute for Social Research, and
eTransportation Research Institute, University of Michigan, Ann
child passenger safety, prevention, injury, obesity
AIS—Abbreviated Injury Scale
BPB—belt-positioning booster seat
CIREN—Crash Injury Research and Engineering Network
NASS-CDS—National Automotive Sampling System
Crashworthiness Data System
MVC—motor vehicle crash
FFCR—forward-facing child restraint
Accepted for publication Aug 26, 2011
Address correspondence to Mark R. Zonfrillo, MD, MSCE, Division
of Emergency Medicine, Children’s Hospital of Philadelphia, 34th
Street and Civic Center Boulevard, Philadelphia, PA 19104. E-mail:
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2011 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have
no financial relationships relevant to this article to disclose.
ZONFRILLO et al
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; originally published online November 28, 2011; 2011;128;1148
Mark R. Zonfrillo, Michael R. Elliott, Carol A. Flannagan and Dennis R. Durbin
Association Between Weight and Risk of Crash-Related Injuries for Children in
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