- BOOSTER SEATS AND THE FORGOTTEN CHILD: CLOSING A SAFETY GAP

[Senate Hearing 107-1091]
[From the U.S. Government Publishing Office]

S. Hrg. 107-1091

BOOSTER SEATS AND THE FORGOTTEN CHILD: CLOSING A SAFETY GAP

=======================================================================

HEARING

before the

SUBCOMMITTEE ON CONSUMER AFFAIRS, FOREIGN COMMERCE AND TOURISM

OF THE

COMMITTEE ON COMMERCE,
SCIENCE, AND TRANSPORTATION
UNITED STATES SENATE

ONE HUNDRED SEVENTH CONGRESS

FIRST SESSION

__________

APRIL 24, 2001

__________

Printed for the use of the Committee on Commerce, Science, and
Transportation

88-785 PDF Washington : 2004

____________________________________________________________________________
For Sale by the Superintendent of Documents, U.S. Government Printing Office
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SENATE COMMITTEE ON COMMERCE, SCIENCE, AND TRANSPORTATION

ONE HUNDRED SEVENTH CONGRESS

FIRST SESSION

JOHN McCAIN, Arizona, Chairman
TED STEVENS, Alaska ERNEST F. HOLLINGS, South Carolina
CONRAD BURNS, Montana DANIEL K. INOUYE, Hawaii
TRENT LOTT, Mississippi JOHN D. ROCKEFELLER IV, West
KAY BAILEY HUTCHISON, Texas Virginia
OLYMPIA J. SNOWE, Maine JOHN F. KERRY, Massachusetts
SAM BROWNBACK, Kansas JOHN B. BREAUX, Louisiana
GORDON SMITH, Oregon BYRON L. DORGAN, North Dakota
PETER G. FITZGERALD, Illinois RON WYDEN, Oregon
JOHN ENSIGN, Nevada MAX CLELAND, Georgia
GEORGE ALLEN, Virginia BARBARA BOXER, California
JOHN EDWARDS, North Carolina
JEAN CARNAHAN, Missouri
Mark Buse, Republican Staff Director
Ann Choiniere Republican General Counsel
Kevin D. Kayes, Democratic Staff Director
Moses Boyd, Democratic Chief Counsel
------

SUBCOMMITTEE ON CONSUMER AFFAIRS, FOREIGN COMMERCE
AND TOURISM

PETER G. FITZGERALD, Illinois, Chairman
CONRAD BURNS, Montana BYRON L. DORGAN, North Dakota
SAM BROWNBACK, Kansas JOHN D. ROCKEFELLER IV, West
GORDON SMITH, Oregon Virginia
JOHN ENSIGN, Nevada RON WYDEN, Oregon
GEORGE ALLEN, Virginia BARBARA BOXER, California
JOHN EDWARDS, North Carolina
JEAN CARNAHAN, Missouri
C O N T E N T S

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Page
Hearing held on April 24, 2001................................... 1
Statement of Senator Dorgan...................................... 71
Statement of Senator Fitzgerald.................................. 1

Witnesses

Baloga, Tom, President, Britax Child Safety, Inc................. 81
Prepared Statement........................................... 83
Lund, Adrian K., Chief Operating Officer, Insurance Institute for
Highway Safety................................................. 18
Prepared statement........................................... 21
Paul, Ph.D., Heather, Executive Director, National Safe Kids
Campaign....................................................... 72
Prepared statement........................................... 75
Quinlan, Kyran, M.D., MPH, Department of Pediatrics, University
of Chicago..................................................... 45
Prepared statement........................................... 47
Shelton, L. Robert, Executive Director, National Highway Traffic
Safety Administration.......................................... 4
Prepared statement........................................... 6
Skeen, Autumn Alexander, Child Passenger Safety Advocate......... 14
Prepared statement........................................... 16
Stone, Judith Lee, President, Advocates for Highway and Auto
Safety......................................................... 52
Prepared statement........................................... 54
Vondale, James, Director, Automotive Safety Office, Ford Motor
Company........................................................ 78
Prepared statement........................................... 80
Weinstein, Elaine B., Acting Director, Office of Safety
Recommendations and Accomplishments, National Transportation
Safety Board................................................... 10
Prepared statement........................................... 11
Winston, Flaura Koplin, M.D., Ph.D., Assistant Professor of
Pediatrics, Children's Hospital of Philadelphia and University
of Pennsylvania School of Medicine............................. 39
Prepared Statement........................................... 42

Appendix

The National Association of Governors' Highway Safety
Representatives, prepared statement............................ 93

BOOSTER SEATS AND THE FORGOTTEN CHILD: CLOSING A SAFETY GAP

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TUESDAY, APRIL 24, 2001

U.S. Senate,
Subcommittee on Consumer Affairs, Foreign Commerce and
Tourism,
Committee on Commerce, Science, and Transportation,
Washington, DC.
The Subcommittee met, pursuant to notice, at 10:12 a.m. in
room SR-253, Russell Senate Office Building, Hon. Peter G.
Fitzgerald, Chairman of the Subcommittee, presiding.

OPENING STATEMENT OF HON. PETER G. FITZGERALD,
U.S. SENATOR FROM ILLINOIS

Senator Fitzgerald. I am going to call this hearing to
order. This is the hearing of the Senate Commerce Committee,
the Subcommittee on Consumer Affairs, and it is a hearing on
``Booster Seats and the Forgotten Child: Closing the Safety
Gap.'' First, I will deliver my opening statement. If any other
members join us, I will give them an opportunity to give an
opening statement, and then we will turn to our first panel of
experts. I will ask each of you, if you have a prepared
statement, to submit your prepared statement for the record, to
condense your remarks and, if possible, give them impromptu. If
you do read your remarks, if you would try and limit them to 5
minutes, we would appreciate it. We will try and keep this
moving so that everybody has an opportunity to be heard.
Late last year, Congress passed the Transportation Recall
Enhancement Accountability and Documentation, or TREAD, Act,
which, at my insistence, included a requirement that the
National Highway Traffic Safety Administration update its
standards on child safety seats, including booster seats. The
enactment of this requirement is an important step toward
protecting our older child passengers. But I believe that we
can and should do more.
The National Highway Traffic Safety Administration, or
NHTSA, will, I hope, expand and improve its performance
standard for booster seats. But developing better booster seats
is of limited value if people do not use them. It has been
reported that only about 5 to 6 percent of children who should
be in booster seats are using them. In the United States, there
are 19.5 million so-called ``forgotten children,'' that is
children between the ages of 4 and 8; and we need to do a
better job of protecting them.
Those kids are too large to ride in child safety seats, but
some experts believe that they are often too small to be
properly seated in a three-point safety belt. In 1998, 495
children aged 5 to 8 were killed and 86,000 were injured in car
crashes and collisions. Indeed, car crashes and collisions are
the leading cause of death and serious injury in children under
10 in the United States.
Ongoing research is providing increasingly compelling
evidence of the need to use booster seats. Three-point shoulder
and lap belts, even those in the back seat where it is
recommended that children sit, currently are not made or tested
for children. Children who are graduated at 40 pounds or so
directly from their child safety seat to adult seat belts can
suffer serious harm.
In some crashes, the seat belts do not restrain the child
or the child's upper body. In others they do, but the shoulder
belt that cuts across the small child's neck and the lap belt
that rides high over her abdomen cause severe internal injuries
to the liver, spleen, intestines, and the spinal cord.
Parents obviously want to do what is best for their
children. Safety restraint use for children under a year old is
97 percent, and it is 91 percent for children ages 1 to 4.
These high usage rates are due in large part to mandatory child
restraint laws in all 50 states. Usage rates for booster seats,
however, fall woefully short of this level. Although all 50
states have mandatory child safety seat laws, there is no
similar uniform requirement for booster seat use, and there are
very serious gaps in state laws regarding child restraints
generally. Some states require seat belts only for children
sitting in the front seat. Others only require children to wear
seat belts if they are younger than 5 or 6 years old. According
to NHTSA, for children between ages 5 and 15, restraint use is
only 68.7 percent; and NHTSA data for 1998 shows that over 47
percent of fatally injured children ages 4 to 7 ride completely
unrestrained.
Only 3 states--Washington, California, and Arkansas--have
adopted mandatory booster seat laws and none of them are in
effect yet. Recent attempts to pass meaningful legislation in
other states, including my home state of Illinois, have failed.
A lack of understanding of the benefit of booster seats may
account for why more states have not acted, but there are also
unanswered questions about what booster seat laws should
require that could be retarding state action. Should children
be in booster seats until they are 4, 6 or 8 years old, 60
pounds or 80 pounds? Or should states not use age and weight
measures and instead rely on the fit of the particular child in
the particular vehicle? There appears to be no clear consensus.
Additionally, the federal standard for booster seats
currently only covers seats for children up to 50 pounds. NHTSA
was directed in the TREAD Act to consider changing this
standard to 80 pounds. In the meantime, though, what does it
mean for a state law to require that children up to 60 pounds
be in a ``federally certified booster seat''?
At today's hearing we will address these and other
questions. Some of the witnesses will speak about efforts
underway to address the ``forgotten child'', the child who has
outgrown her child safety seat and is inappropriately placed in
an adult-sized safety belt without an adult positioning booster
seat or, worse still, left completely unrestrained.
The education that these groups are providing is critical
to closing the knowledge gap. A recent survey of 1,000 parents
and caregivers conducted by NHTSA and Daimler-Chrysler revealed
that 96 percent of parents and caregivers did not know the
correct age at which a child no longer requires a booster seat
or a child safety seat.
Education is critical and I hope to further raise public
awareness. Education alone, however, is not enough. As I said
before, one of the reasons child safety seat usage is so high
is because it is mandated in all 50 states. People not only
want to comply with the law for the law's sake and for fear of
being penalized; they also understand that laws codify often
our knowledge or promote a desirable social end, in this case
child safety.
In the past, Congress has provided incentives for states to
adopt responsible highway laws. We have done so to encourage
states to adopt repeat offender and open container laws. Last
year, we did this to encourage states to adopt .08 blood
alcohol level laws. Perhaps it is still too early for federal
legislation to require states to adopt mandatory booster seat
use laws, because of the deficiency in the current federal
standard, because comprehensive medical data showing the
benefits of booster seats is still being developed, and because
a lot of states have yet to adopt adequate safety belt laws.
Nevertheless, I think the safety of the forgotten child is
extremely important and we need to consider all of the tools at
our disposal to advance it. One such tool is the continuation
of federal child passenger protection education grants, the
authorization for which expires this year.
In closing, there is still much we do not know. We do know,
however, that more needs to be done to protect many of our
child passengers between the ages of 4 and 8. I look forward to
working with my children in the U.S. Senate to develop
solutions to this critical issue.
With that, we are going to turn to our witnesses. On the
first panel we have: Mr. Robert Shelton, the Executive Director
of NHTSA; Ms. Elaine Weinstein, Acting Director, Office of
Safety Recommendations and Accomplishments at the National
Transportation Safety Board; Ms. Autumn Alexander Skeen from
the state of Washington, a child passenger safety advocate; Dr.
Flaura Winston--doctor, good to see you again--assistant
professor of pediatrics at the Children's Hospital of
Philadelphia and the University of Pennsylvania School of
Medicine; Dr. Kyran Quinlan--Dr. Quinlan is from the Department
of Pediatrics at the University of Chicago in my home state of
Illinois; thank you for being with us; and Ms. Judith Lee
Stone, the President of the Advocates for Highway and Auto
Safety.
In addition, we have added to the first panel Dr. Adrian K.
Lund, the Chief Operating Officer of the Insurance Institute
for Highway Safety. I understand that Dr. Lund may have a
different take on the whole issue and we decided to put him on
the first panel so that we might get some give and take.
With that, I want to start with Mr. Shelton, if he could be
kind enough to give us his testimony. Thank you all for being
here.

STATEMENT OF L. ROBERT SHELTON, EXECUTIVE DIRECTOR, NATIONAL
HIGHWAY TRAFFIC SAFETY ADMINISTRATION

Mr. Shelton. Thank you, Mr. Chairman, for inviting me to
testify on child booster seats. I also want to thank you, Mr.
Chairman, for sponsoring legislation to improve child passenger
safety. We are working hard to implement that legislation, now
a part of the TREAD Act enacted last November.
Traffic crashes are the leading cause of death for
children. Six out of ten children who die in passenger car
crashes are either not restrained at all or improperly
restrained. The most effective way to protect children in a
crash is to ensure that they are properly restrained in the
rear seat in an appropriate restraint system on every trip. For
the older child, generally 4 to 8 years old, booster seats,
properly used, can help prevent injury by making adult-sized
belts fit better.
Booster seats help prevent injury to children between 40
and 80 pounds. Without a belt-positioning booster seat, the lap
belt can ride up over the stomach and the seat shoulder belt
can cut across the neck. In a crash, this could cause serious
or even fatal injuries. With a booster seat, the lap and
shoulder belt fit correctly, reducing the risk of belt-induced
injury during a crash. Correct fit also reduces the chance of
ejection during a crash.
Based on current data, children should be in booster seats
until they reach about 80 pounds and a height of 4 feet 9
inches. Unfortunately, as you pointed out, few children who
could benefit from booster seats now use them. Most studies
show booster seat use rates below 10 percent. Survey data show
that these children often use seat belts instead or ride
totally unrestrained.
In 1998, NHTSA included questions about booster seat use in
a telephone survey of parents or caregivers of children under
the age of 6. They were asked if they were aware of booster
seats. While 76 percent said they were aware of booster seats,
only 53 percent of those who were aware said they had ever used
them for their children. The survey confirmed that children who
should be in booster seats often use seat belts instead.
Premature use of seat belts by a child can cause
significant injury in a crash. Many parents and caregivers do
not understand the risks that adult seat belts can pose to
children who weigh between 40 and 80 pounds. They also do not
understand that booster seats are designed to remedy this
problem. Educational efforts are needed to inform parents and
caregivers on the benefits of booster seats and when to
transition the child to seat belts.
A significant barrier to the use of booster seats is gaps
in state child passenger safety and seat belt use laws. These
gaps promote low booster seat use rates and premature
graduation of children from safety seats to seat belts. In many
states children over 4 can legally ride unrestrained in the
rear seat, because these laws apply only to front seat
occupants. In most states, children older than 4 are covered by
seat belt laws, not child restraint laws, a matter that
contributes to premature use of seat belts.
NHTSA is taking a number of steps to improve existing
standards for the performance and testing of booster seats.
Federal Motor Vehicle Safety Standard 213, Child Restraints,
establishes performance and structural integrity requirements
for booster seats. These requirements provide for dynamic tests
of the seats in three-point lap and shoulder belts that can
restrain children weighing up to 50 pounds.
In accordance with the TREAD Act, we are considering
whether to amend the standard to cover restraints for children
weighing up to 80 pounds. Though NHTSA recommends the use of
booster seats for children up to 80 pounds and many
manufacturers now recommend booster seats up to 80 pounds and
higher, we currently test booster seats with a dummy that
simulates a 6-year-old child weighing 47 pounds. At this time
we do not have an acceptable test dummy larger than a 47-pound
6-year-old child dummy and smaller than a 105-pound, 5th
percentile female dummy.
NHTSA has been working with the Society of Automotive
Engineers to develop a 10-year-old child dummy. We expect to
have a prototype of this dummy to evaluate this June.
Incorporation of the dummy's specifications into our standards
will require further testing and rulemaking. As an interim
measure, however, we are assessing the approach of adding
weights to the existing 6-year-old dummy to evaluate the
performance of booster seats for larger children.
In addition, we are conducting a study, as required by the
TREAD Act, on the use and effectiveness of booster seats. This
study will be completed by November.
We also are examining ways to expand our educational
efforts to raise awareness and increase the use of booster
seats and give parents, caregivers and others the information
they need to determine the correct use of all child safety
seats.
In 1998, NHTSA sponsored a blue ribbon panel of experts to
recommend better ways to protect children ages 4 to 16 years
old. Also in 1998, TEA-21 provided a new incentive grant
program targeting specific occupant protection laws and
programs. It authorized $83 million over 5 years for a two-part
program. Under the first part, a 5-year program, states receive
grants if they demonstrate they have in place certain occupant
protection laws and programs, such as a child passenger
protection law that requires minors to be properly secured in
an appropriate child system.
As you mentioned, Mr. Chairman, under part two, a 2-year
program which expires at the end of fiscal year 2001, states
receive grants if they carry out child passenger protection and
education activities, including activities on the use of
booster seats.
In 1999, to address the issue of non-use of booster seats,
NHTSA awarded a total of $800,000 to six states and communities
for pilot and demonstration programs to increase booster seat
use for children between ages 4 and 8 and seat belt use among
older children.
In February 2000, in response to one of the blue ribbon
panel's recommendations, NHTSA launched ``Don't Skip a Step,''
a national booster seat campaign to educate parents and
caregivers not to skip a step as their children grow, beginning
with rear-facing infant seats and progressing to forward-facing
child seats, booster seats, and ultimately properly restrained
in adult belts, in the back seat for all children 12 years and
under.
Also, raising booster seat awareness has been the keystone
of our national child passenger safety week campaign for the
last several years.
We will continue to implement our booster seat initiatives
by updating our legislative fact sheets, which provide
technical assistance to states. In addition, we are developing
a booklet, ``Protecting America's Children: The Case for Strong
Child Passenger Safety Laws,'' which will be completed this
summer, to highlight the need to close gaps in state child
passenger safety laws discussed earlier.
NHTSA also has been a close partner in the development and
refinement of the ``Boost America'' program sponsored by Ford
Motor Company. This $30 million program, to be launched next
week, will give away a million booster seats during the
program's first 12 months and award $1 million in grants to
local organizations to support grassroots booster seat advocacy
and distribution efforts.
NHTSA's web site now contains a separate section on child
safety seats, which makes it easy for the public to locate and
obtain specific information on all child seats, including
booster seats. This new service is designed to help families
obtain the latest safety seat information and guide parents and
caregivers to the right restraint choices for their children.
The site provides one-stop shopping to those who want to learn
about the correct use and installation of all child safety
seats, and links the user to a list of locations throughout the
Nation where parents and caregivers can have safety seats and
booster seats inspected. Additional information on booster
seats is also provided toll-free through our Auto Safety
Hotline.
Finally, NHTSA is currently developing a 5-year booster
seat education strategic plan, as required by the TREAD Act. We
will complete the plan by November of this year.
Mr. Chairman, this concludes my statement. I will be
pleased to answer any questions.
[The prepared statement of Mr. Shelton follows:]

Prepared Statement of L. Robert Shelton, Executive Director, National
Highway Traffic Safety Administration
Mr. Chairman and Members of the Subcommittee, thank you for this
opportunity to testify on child booster seats. I also want to take this
opportunity to thank you, Mr. Chairman, for raising awareness about the
leading killer of children in America, motor vehicle crashes, and for
your sponsorship of legislation to improve child passenger safety. We
are working hard to implement that legislation, now a part of the
Transportation Recall Enhancement, Accountability, and Documentation
(TREAD) Act, enacted last November.
Traffic crashes are the leading cause of death for children of
every age from 5 to 16 years old. Six out of 10 children who die in
passenger motor vehicle crashes are either not restrained at all or are
improperly restrained. The single most effective way to protect
children in the event of a crash is to ensure that they are properly
restrained in the rear seat in appropriate restraint systems on every
trip. For children from 4 to 8 years old, booster seats, properly used,
can help prevent injury by making adult-sized seat belts fit correctly.
When to Use a Booster Seat
Booster seats are intended to be used as a transition to lap and
shoulder belts by children who have outgrown forward-facing child
safety seats. Children outgrow the weight and height limits of most
forward-facing child safety seats at around 4 years of age, when they
weigh about 40 pounds and are about 40 inches tall. At that time, they
should be moved to a booster seat to help the lap and shoulder belt fit
correctly. Based on current data, NHTSA believes children should stay
in booster seats until they reach about 80 pounds, and a height of four
feet, nine inches.
Booster seats help prevent injury to children between 40 to 80
pounds. Without a belt-positioning booster seat, the lap belt can ride
up over the stomach and the shoulder belt can cut across the neck. In a
crash, this could cause serious or even fatal injuries. With a booster
seat, the lap and shoulder belts fit correctly, reducing the risk of
belt-induced injury during a crash. Correct fit also reduces the chance
of ejection during a crash.
Why Is Booster Seat Use So Low?
Unfortunately, few children who could benefit from booster seats
use them. Most studies show booster seat use rates below 10 percent.
Survey data show that these children often use seat belts instead, or
ride totally unrestrained.
In 1998, NHTSA included questions about booster seat use in a
telephone survey of a randomly selected national sample of about 4,000
persons age 16 and older. A selected subgroup of this sample, parents
or caregivers of children under the age of 6, were asked if they were
aware of booster seats. While 76 percent of these participants said
they were aware of booster seats, 21 percent said they had not heard of
them and 3 percent were unsure. Of those who were aware of booster
seats, 53 percent said they had used them at some time for their
children.
The survey confirmed that children who should be in booster seats
often use seat belts instead. While most participants thought children
in rear-facing seats were expected to move on to other safety seats, 14
percent expected their older child to use seat belts. Slightly more
than half (55 percent) said that when children outgrow a child safety
seat they would use a different seat or booster seat while 43 percent
answered either that the children would graduate to seat belts or that
they did not know what would happen.
Premature use of seat belts by a child can cause significant injury
in a crash. A recent research project conducted for NHTSA by
TraumaLink, The Children's Hospital of Philadelphia, concludes that
many parents and caregivers simply do not understand the risk that
adult seat belts can pose to children who weigh between 40 and 80
pounds. They also do not understand that booster seats are designed to
remedy this problem.
The project identified several barriers to use of booster seats,
including child behavior; child discomfort; availability and cost; and
gaps in state child passenger safety and seat belt use laws. Potential
strategies to overcome these barriers focused on educational efforts
needed to inform parents and caregivers on the benefits of booster
seats and when to transition the child to seat belts.
The matter of state law drew particular comment in the project
report. The report found that gaps in state child passenger safety laws
and seat belt use laws promote low booster seat use rates and premature
graduation of children from safety seats to seat belts. For example, in
many states, children over the age of 4 can legally ride unrestrained
in the rear seat because these laws apply only to front seat occupants.
Since 1985, all 50 states and the District of Columbia have adopted
child restraint laws. All of these laws are primary laws (which means
that a law enforcement officer may stop a vehicle solely for restraint
law violations) and require that young children be properly secured in
a child safety seat. Though child restraint laws have helped to
increase the use of child restraints, they often fail to conform to
current best practices. For example, some states permit children as
young as two years of age to be restrained in a seat belt if the child
is in the rear seat, while others have no restraint requirements for
any rear-seat occupants other than for children under a specified age.
In most states, children older than 4 are covered by seat belt laws
(most of which are secondary enforcement laws), not child restraint
laws-a matter that contributes to premature use of seat belts.
The project also found that parents and caregivers rely on state
child restraint laws for instruction and guidance. They believe that
these laws are an accurate guide for what is recommended to be safe for
their children; but, many state laws do not provide such a guide. To
date, only two states, California and Washington, require the use of
booster seats. These laws require booster seat use only for children to
age 6 or 60 pounds.
Late last year, NHTSA provided technical assistance to the
DaimlerChrysler Corporation for a survey on parental attitudes and
expectations about state child restraint laws. Among the survey's
conclusions--released early this month--was the finding that parents
are confused about when children may safely ride in an adult safety
belts and the exact purpose of booster seats. The survey's findings
have reinforced the continuing need to make the purpose, use and
details of booster seats a top agency priority.
What NHTSA Is Doing: Motor Vehicle Safety Initiatives
NHTSA is taking a number of steps to improve existing standards for
the performance and testing of booster seats. Federal Motor Vehicle
Safety Standard (FMVSS) 213, ``Child Restraints,'' establishes
performance and structural integrity requirements for booster seats.
These requirements provide for dynamic tests of the seats in 3-point
lap and shoulder belts that can restrain children weighing up to 50
pounds.
In accord with the TREAD Act, we are considering whether to amend
the Standard to cover child restraints for children weighing up to 80
pounds. Though NHTSA recommends the use of booster seats for children
up to 80 pounds, and many child restraint manufacturers now certify
booster seats up to 80 pounds and higher, we currently test booster
seats with a dummy that simulates a 6-year-old child. At this time, we
do not have an acceptable test dummy larger than our 47-pound 6-year-
old dummy and smaller than our 95- 105-pound 5th percentile female
dummy.
To acquire a test dummy suitable for evaluating booster seats
designed for larger children, NHTSA has been working with the Society
of Automotive Engineers (SAE) to develop a 10-year-old child dummy,
which would be approximately 4-feet 6-inches tall and weigh 71 pounds.
We expect to have a prototype of the 10-year-old dummy to evaluate by
June 2001, but incorporation of the dummy's specifications into our
standards will require further testing and rulemaking. As an interim
measure, we are assessing the approach of adding weights to the
existing 6-year-old dummy to evaluate the performance of booster seats
for larger children. However, the primary concern for older children is
head excursion which is influenced by the height of the dummy. Thus,
adding weight to a 6-year-old dummy is not a satisfactory long-term
solution.
NHTSA is currently conducting a study, as required by the TREAD
Act, on the use and effectiveness of booster seats. This study is
hampered, however, by the lack of use of booster seats by older
children, which makes it hard to find enough crash cases with booster
seats to give reasonable estimates of their effectiveness. This study
will be completed this November.
In addition to setting and maintaining federal motor vehicle safety
standards, NHTSA conducts compliance tests to assure that the standards
are met. We generally test every child restraint model available on the
market each year for compliance with FMVSS No. 213. From 1996 to the
present, NHTSA has conducted compliance tests on 63 models of booster
seats. In 1998, we sent a letter to all child safety seat manufacturers
urging them to manufacture child seats so that they ``perform well
beyond the minimum requirements of our standard.'' We can also conduct
investigations and seek a recall if there is evidence that these
restraints contain a safety-related defect.
What NHTSA Is Doing: Education and Information Initiatives
In addition to NHTSA's motor vehicle safety initiatives to improve
booster seats, we are continually examining ways to expand our
educational efforts to give parents, caregivers and others the
information they need to determine the correct use of all child safety
seats. These efforts include initiatives to raise awareness and
increase the use of booster seats.
The agency has four strategies that have been determined to be
especially effective in meeting child passenger safety goals: public
education; high visibility law enforcement; public-private
partnerships; and strong legislation.
In1998, NHTSA sponsored a ``Blue Ribbon Panel'' of experts to
recommend better ways to protect children passengers 4 to16 years old.
In March 1999, the panel presented recommendations for these children
in three areas:

Marketing and Public Education--Educate parents and
caregivers on the importance of booster seats for children who
have outgrown child safety seats; generate peer programs for
increasing seat belt use among older children.

Legislation and Enforcement--Close gaps in the child
passenger safety and seat belt laws that leave children ages 4
to 16 unprotected; encourage high visibility enforcement of
child passenger safety laws.

Product Design and Implications--Improve booster seat design
for safety and comfort; develop recommendations for the use of
aftermarket products.

Also in 1998, the Transportation Equity Act for the 21st Century
(TEA-21) added a new incentive grant program to our occupant protection
efforts. Beginning in FY 1999, TEA-21 authorized $83 million over 5
years for a two-part program to target specific occupant protection
laws and programs. Under part one, a 5-year program beginning in FY
1999, states receive grants if they demonstrate that they have in place
certain occupant protection laws and programs, such as a child
passenger protection law that requires minors to be properly secured in
an appropriate restraint system. Under part two, a 2-year program in FY
2000 and 2001, states receive grants if they carry out child passenger
protection and education activities, including activities on the use of
booster seats.
Since 1998, NHTSA and AAA have jointly published a brochure, Buying
a Safer Car for Child Passengers, designed to help consumers make an
informed decision when purchasing a family vehicle. The brochure, which
is updated annually to include safety features available on new model
year vehicles, highlights information on booster seats.
In 1999, to address the issue of non-use of booster seats, NHTSA
awarded a total of $800,000 to six states and communities (NY, RI, TX,
WA, AZ, ND) for pilot and demonstration programs to increase booster
seat use for children between age 4 and 8 years old and seat belt use
among older children. Using final reports on these programs, due at the
end of 2001, NHTSA will develop ``best practices'' strategies and
educational materials for the use of the states and our national
partner organizations.
In February 2000, in response to one of the Blue Ribbon Panel's
recommendations, NHTSA launched Don't Skip a Step, a national booster
seat campaign to educate parents and caregivers not to skip any step as
their children grow: beginning with rear-facing infant seats and
progressing to forward-facing child safety seats, booster seats, and
properly restrained in an adult belt in the back seat for all children
12 and under. As part of the campaign, NHTSA has distributed campaign
brochures to enlist the support of child safety advocates, health care
providers, law enforcement personnel and others to help spread the
booster seat safety message across the country. An expanded booster
seat education program is planned for later this year. In addition,
raising booster seat awareness has been the centerpiece of NHTSA's
``National Child Passenger Safety Week'' campaign for the last several
years.
We will continue to implement our booster seat initiatives by
updating NHTSA's legislative fact sheets, which provide technical
assistance to the states. In addition, we are developing a booklet,
Protecting America's Children: The Case for Strong Child Passenger
Safety Laws, which will be completed this summer, to highlight the need
to close gaps in state child passenger safety laws discussed earlier.
In January 2001, the National Committee on Uniform Traffic Laws and
Ordinances developed a model law on occupant protection that provides
coverage for all occupants in all seating positions.
NHTSA has been a close partner in the development and refinement of
the ``Boost America!'' program sponsored by Ford Motor Company. This
$30-million program, to be launched at the end of this month, will give
away a million booster seats during the program's first 12 months, and
award $1 million in grants to local organizations to support grassroots
booster seat advocacy and distribution efforts. In addition, the
program will distribute pre-school and elementary school educational
materials promoting booster seat use. NHTSA plans to continue to work
with child safety seat manufacturers and retailers to raise consumer
awareness of booster seats.
NHTSA's web site, www.nhtsa.dot.gov, now contains a separate
section on ``Child Safety Seats,'' that makes it easy for the public to
locate and obtain specific information on all child seats, including
booster seats. This new Internet-based service, launched last month by
Secretary Mineta, is designed to help families obtain the latest child
safety seat information and guide parents and caregivers to the right
restraint choices for their children. When a user clicks on the icon,
``Child Safety Seats,'' the user is linked to a comprehensive source of
information, tips and recommendations. Dozens of full-color photos of
the different types of child safety seats are provided, together with
step-by-step installation guidelines. This site provides one-stop
shopping to those who want to learn about the correct use and
installation of all child safety seats, and includes: (1) a current
listing of all new child safety seats available; (2) a list of model
year 2001 vehicles with child safety seat features; (3) a description
and list of various features available on the restraints that may make
them easier to use and install; and (4) a child safety seat dictionary
of terms. The site also has links to a comprehensive list of locations
throughout the country where parents and caregivers can have child
safety seats and booster seats inspected, and to the brochure, Buying a
Safer Car for Child Passengers, mentioned earlier.
Additional information on booster seats also is available toll-free
through NHTSA's Auto Safety Hotline, 1-888-DASH-2-DOT. Our Hotline
operators are available to answer questions from 8 a.m. to 10 p.m.,
Eastern time, Monday through Friday. Messages can be left on tape 24
hours a day.
NHTSA currently is developing a 5-year booster seat education
strategic plan, as required by the TREAD Act, to reduce deaths and
injuries caused by failure to use the appropriate booster seat in the
4- to 8-year-old age group by 25 percent. Booster seat use will be
monitored using NHTSA's databases. We will complete the plan by
November of this year.
In closing, I would like to note that NHTSA staff have been active
participants at the Association for the Advancement of Automotive
Medicine's (AAAM) Conference on ``Booster Seats for Children,'' taking
place this week in Washington, DC. This conference has brought together
international experts in pediatric restraint science from Canada,
Sweden, the United States, the United Kingdom and Germany to review the
current state of the art in child booster seat design, materials,
tolerances and child riding behavior. The proceedings of the conference
will be published to serve as a guide to future research in child
safety engineering, provide recommendations for the medical community,
and address the formulation of effective restraint laws for 4- to 8-
year old children.
Mr. Chairman, this concludes my statement. I will be pleased to
answer any questions.

Senator Fitzgerald. Mr. Shelton, thank you very much.
Ms. Weinstein.

STATEMENT OF ELAINE B. WEINSTEIN, ACTING DIRECTOR,
OFFICE OF SAFETY RECOMMENDATIONS AND
ACCOMPLISHMENTS, NATIONAL TRANSPORTATION SAFETY BOARD

Ms. Weinstein. Good morning, Mr. Chairman. It is a pleasure
to represent the National Transportation Safety Board this
morning on this very important issue.
According to the National Highway Traffic Safety
Administration, in the decade of the 1990s, 8,600 children
between the ages of 4 and 8 died in motor vehicle crashes.
Highway crashes are the leading cause of death for children in
this country, Mr. Chairman, and we applaud you for holding this
much-needed hearing.
The Centers for Disease Control and Prevention have stated
that children who have outgrown child safety seats should ride
in a booster seat that positions the shoulder belt across the
chest, with the lap belt low across the upper thighs. Without a
booster seat, a child can slouch and slide forward, causing the
vehicle lap belt to ride up into the child's abdomen, resulting
in serious or fatal injuries.
The Safety Board agrees with that position, and in 1996 we
recommended that the states require children up to 8 years old
to use child restraint systems and booster seats. As you
mentioned, in the 4 years since our recommendation was issued
only 3 states--Washington, California, and Arkansas--have
enacted some form of booster seat legislation.
Another problem identified in the Safety Board's 1996 study
was that there are children who exceed the 60-pound weight
limit established by most child restraint manufacturers for
booster seats, but these children are still too short to
properly use lap and shoulder belts. In addition, the NHTSA
standard only covers child restraints for children up to 50
pounds. Also 4 years ago, the Safety Board asked NHTSA to
establish performance standards for booster seats that can
restrain children up to 80 pounds, but today there are still no
such standards.
Safety advocates often tell parents that the safest place
for their children in the car is the center of the back seat,
because it is the farthest away from a side or frontal crash.
Parents have been listening. Today 46 percent of back seat
occupants in crashes seated in the center seat are under the
age of 13. But to use one of the booster seats on the market
today, you need a lap and a shoulder belt in the center rear
seat position. Except few minivans and SUVs, which are today's
family car, many vehicles now have lap and shoulder belts in
the center rear seat position.
The Safety Board believes that the back seat of the car
should be designed with children in mind, and we have issued
several recommendations to the automobile manufacturers to make
the back seats of the cars more child-friendly.
In December of last year, the Safety Board sponsored a
meeting with safety advocates and representatives of industry
and government to identify immediate, short-term and long-term
actions that can be taken to ensure that all children are
equally protected when they are traveling on our nation's
roadways. We were particularly concerned about low income and
minority children.
Some of the solutions identified by participants include
more products, including booster seats that are compatible with
lap-only belts, more education of parents of 4 to 8 year old
children about the need to use booster seats, incentives such
as store-manufacturer coupons to purchase low-cost booster
seats, more availability of booster seats in stores that reach
low income and minority families, and retailer education to
ensure that booster seats are available.
Mr. Chairman, too many parents buckle their children into
adult restraints in their automobiles and think that their
child is safe. We know that that is not the case. The Safety
Board believes that action must be taken by the states, the
automobile manufacturers and NHTSA to ensure that there is one
level of safety for all children.
That completes my statement, Mr. Chairman. I would be happy
to answer any questions.
[The prepared statement of Ms. Weinstein follows:]

Prepared Statement of Elaine B. Weinstein, Acting Director, Office of
Safety Recommendations and Accomplishments, National Transportation
Safety Board
Good morning Mr. Chairman and Members of the Subcommittee. It is a
pleasure to represent the National Transportation Safety Board before
you today regarding child passenger safety, particularly the use of
booster seats by children between the ages of 4 and 8 years old.
Americans understandably react with horror at random acts of
violence that take the lives of innocent children, and they demand that
action be taken when a child is killed in a school firearm incident. In
1998, 121 children under age 10 died as a result of unintentional
firearm-related actions, according to the National Safe Kids Campaign.
That same year, 922 children under age 10 died as passengers in motor
vehicle crashes, according to the National Highway Traffic Safety
Administration's (NHTSA) Fatality Analysis Reporting System (FARS).
Although highway crashes are the leading cause of death for children in
this country, we do not hear a nationwide outcry every time a young
girl or boy dies in a traffic crash. Mr. Chairman, the Safety Board
applauds you for holding this hearing to bring much needed attention to
this important issue.
According to NHTSA, in the decade of the 1990s, over 90,000
children died in motor vehicle crashes, and over 9 million were
injured. Eight thousand six hundred of the children who died were
between the ages of 4 and 8. That equals about 16 children between the
ages of 4 and 8 killed each week in motor vehicle crashes. More than 70
percent of the 778 children age 4-to-8 killed in automobile accidents
in 1999 were totally unrestrained (546 children), and 13 percent (105
children) were in lap/shoulder belt restraint systems designed for
adults.
The Safety Board has for some time been concerned about the dangers
to our children when riding in an automobile. In 1996, the Safety Board
adopted a study on the performance and use of child restraint systems,
seatbelts, and air bags for children in passenger vehicles.
In part, the Board's 1996 report concluded that:

Children (especially those properly restrained) in the back
seats of vehicles are less likely to sustain injury than those
seated in the front seats;

Children of all ages need to be properly restrained and
should be covered by the states' child restraint and seatbelt
use laws;

More than two-thirds of the children in the Safety Board's
study sample were not in the appropriate restraint for their
age, height, and weight;

Children tended to be in restraint systems too advanced for
their development, such as moving from child restraint systems
to seatbelts rather than using booster seats; and

Booster seats that restrain children who weigh more than 50
pounds are not subject to any performance standards; however,
booster seats are necessary for some children above that
weight.

Two years ago, to focus attention on our 1996 safety
recommendations, the Safety Board implemented a comprehensive campaign
regarding children passenger safety. We met on several occasions with
automobile and child safety seat manufacturers, participated at child
safety seat fitting stations and check points, testified at legislative
hearings, spoke at and attended numerous conferences and symposia, and
held several meetings. As a direct result of the Board's work, we have
seen many improvements regarding child passenger safety, especially
related to increasing proper use of child safety seats. For instance:

NHTSA developed a guidebook for states to use in
establishing and operating fitting stations;

Many states have set up fitting stations at health centers
or in police, sheriff, or fire stations;

DaimlerChrysler established Fit for A Kid, a nationwide
program of permanent fitting stations, at selected dealerships.
Fit for a Kid is now in all 50 states, and much of the U.S.
population is less than an hour's drive from a Fit for a Kid
location;

General Motors established mobile fitting stations in every
state in partnership with the National Safe Kids Campaign; and

Ford Motor Company established the ``Boost America'' program
to provide support for existing community fitting stations, to
conduct child safety seat inspections, and to implement a
campaign to give away booster seats to needy families.

Mr. Chairman, it is unfortunate that booster seats are still not
recognized or understood by the public as the next step in child
passenger protection after a child outgrows a child restraint system.
Seatbelt Fit for 4-to-8-year-old Children
Once children outgrow child restraint systems, they often use the
vehicle seatbelts. In the crashes investigated for the Safety Board's
1996 study, 73 children should have been in booster seats according to
their age, height, and weight, but only 11 children were restrained in
booster seats. Fifteen children in our study cases were improperly
restrained by the vehicle seat belt. Fourteen of those children should
have been in booster seats, and the other one should have been in a
child safety seat.
Vehicle seat belts, like air bags, were designed to protect adults.
Poor shoulder belt fit was reported in 8 seatbelt misuse cases by
children in our sample as the reason for wearing the shoulder belt
under the arm or behind the back. Moderate to severe injuries were
sustained by 9 of the children; all but 1 were involved in high
severity crashes. Five children in the study who sustained no or minor
injuries were involved in low to moderate severity crashes. Improper
use of the lap/shoulder belt decreased as the child's height increased
above 50 inches, resulting in a better fit of the shoulder portion of
the belt.
According to the Centers for Disease Control and Prevention,
children who have outgrown their child safety seats should ride in a
booster seat that positions the shoulder belt across the chest, and
with the lap belt low across the upper thighs. Without a booster seat,
a child can slouch and slide forward, causing the vehicle lap belt to
ride up on to the child's abdomen, resulting in serious or fatal
injures.
The Safety Board believes that children of all ages need to be
properly restrained and should be covered by the states' child
restraint and seatbelt use laws. Accordingly, on October 31, 1996, the
Safety Board recommended to the Governors and Legislative Leaders of
the 50 states and U.S. Territories, that children up to 8 years old be
required by the state's mandatory child restraint use law to use child
restraint systems and booster seats. In the over five years since the
safety recommendation was issued, only three states--Washington,
California, and Arkansas--have enacted some form of booster seat law.
Another problem identified in the Safety Board's 1996 study was
that there were 22 children who exceeded the 60-pound weight limit
established by most child restraint manufacturers for booster seats,
but were too short (all of these children were less than 59 inches
tall) for lap/shoulder belts according to the age, height, and weight
classification system used by the Board. NHTSA's own research confirms
that ``the minimum size child in this study who could use three-point
belts alone had a sitting height of 74 cm [29.6 inches], standing
height of 148 cm [59.2 inches], and weight of 37 kg [82 pounds].'' On
September 20, 1996, the Safety Board asked NHTSA to establish
performance standards for booster seats that can restrain children up
to 80 pounds. NHTSA responded to the Board's recommendation with a
letter to the child restraint manufacturers asking them if they had
plans to produce booster seats for older children and if there was a
need for federal standards. NHTSA subsequently convened a Blue Ribbon
Panel on older children in 1998 which recommended a number of actions
similar to what the Safety Board asked for in it's 1996
recommendations.
Mr. Chairman, when discussing child passenger safety there are two
additional areas that need to be discussed--child-friendly back seats
and children in low income families.
Child-Friendly Back Seats
The Safety Board believes that the back seat of vehicles should be
designed with children in mind. We have issued safety recommendations
to the automobile manufacturers to design child-friendly back seats by
having center lap/shoulder belts in the rear seats of new vehicles,
lap/shoulder belts in the rear outboard seating positions that fit
older children, and built-in child safety seats.
The Safety Board first asked manufacturers to consider installing
center lap/shoulder belts in all newly manufactured passenger vehicles
following a 1986 safety study on the performance of lap belts in
frontal crashes. Although more vehicles have lap and shoulder belts in
the center rear seat position today than in 1986, few minivans or sport
utility vehicles--today's family car--have lap/shoulder belts available
for children in all back seat positions.
Safety advocates often tell parents that the safest place for their
children is the center position in the back seat because it's the
farthest away from a side or frontal crash. Parents have been
listening. NHTSA's FARS data show that 46 percent of all back seat
occupants seated in the center position are under the age of 13, and 75
percent of them are under the age of 21. Vehicle occupants seated in
the center rear seat position should be afforded the same level of
protection as other occupants of the back seat.
The Board has also recommended that lap/shoulder belts in the rear
outboard seating positions should fit older children comfortably and
securely. Manufacturers have argued that the adjustable upper shoulder
belt anchorages, now standard in the front seat, aren't feasible in the
back seat because the back seat's design renders the anchorage
ineffective. If that is true, the Safety Board has suggested that
manufacturers put their design teams to work looking for alternative
solutions.
Lastly, the Board recommended that vehicles should have built-in
child safety seats. Few manufacturers offer a built-in safety seat. It
is almost solely an optional equipment item, and often is not marketed
well. Auto manufacturers have suggested that built-in child seats are a
tough sell. Many people who have children young enough to use them are
not in the market for a new car, and car dealers do not want to stock
vehicles with integrated seats.
Children in Low Income Families
A concern recently expressed by the Safety Board involves the use
of booster seats in older vehicles. Booster seats currently on the
market are, with one exception, designed for use with lap and shoulder
belts. However, lap/shoulder belts have only been required in the
outboard seating position of vehicle back seats since 1990. That means
that about 34 percent of all cars (some 43 million vehicles) still in
use today have lap belts in all back seat positions. Shoulder belts
still are not required in the center back seat position, and many
current model vehicles, including sport utility vehicles, only have lap
belts in the center rear seat position. When Board representatives
participated in child safety seat fitting stations and check points, we
were told that it is difficult to find booster seats for use in
vehicles with lap-only belts.
According to the 1995 National Personal Transportation Survey,
conducted for the Federal Highway Administration, the average age of
vehicles owned by low-income households is 11 years. Therefore, it is
reasonable to assume that low-income families with children between the
ages of 4 and 8 years old are likely to own a vehicle with lap-only
belts in the back seat. The Safety Board is concerned that adequate,
affordable protection is not readily available for these children when
they are transported in cars.
In December 2000, the NTSB sponsored a meeting with safety
advocates and representatives of industry and government to identify
immediate, short-term, and long-term actions that can be taken to
ensure that all children are equally protected when they are traveling
on our nation's roadways. Some of the solutions identified by the
participants include:

More products, including lap-only belt compatible
restraints;

More education of parents of 4-to-8-year old children about
the need to use booster seats;

Incentives, such as store/manufacturer coupons, to purchase
low cost booster seats and more availability of booster seats
in stores that reach low-income and minority families; and

Retailer education to ensure that booster seats are
available.

As a result of the Safety Board's meeting, representatives of the
Departments of Transportation, Health and Human Services, and the
Safety Board's Chairman signed a Letter of Intent to work together to
increase the availability of child safety seats and booster seats for
low-income families.
Mr. Chairman, too many parents buckle their children into adult
restraints in their automobiles and think their child is safe. We know
that is not the case. The Safety Board believes that action must be
taken by the states, the automobile manufactures, and NHTSA to ensure
that there is one level of safety for all children.
That completes my statement, and I will be happy to respond to any
questions you may have.

Senator Fitzgerald. Ms. Weinstein, thank you very much.
Ms. Autumn Alexander Skeen from Walla Walla, Washington.
Thank you very much for being here.

STATEMENT OF AUTUMN ALEXANDER SKEEN,
CHILD PASSENGER SAFETY ADVOCATE

Ms. Skeen. Mr. Chairman and Senators: I am Autumn Alexander
Skeen of Washington state. Thank you for allowing me to
testify. It is seemly that this opportunity would come less
than 2 weeks after my son's birthday. Spring and Easter are the
most painful times now, their message of new life and green
glory underscoring what Anton has lost. He would have been 9
years old this year, just like your son.
But Anton was 4 years old and a good-sized lad when he, his
sister and I came home from Japan for summer vacation in June
1996, leaving my husband at his post in Tokyo as the Pacific
editor of Stars and Stripes. We were to have a whole summer at
our family cabin in central Oregon.
My parents live in Seattle and for the summer I borrowed
their SUV, a 1988 Dodge Raider. In the whirl of travel, my mind
quickly touched upon the basics of transport. The front seats
were where the only lap and shoulder belts were in this
vehicle, and of course it had no air bags. Washington state law
said you could buckle children Anton's size and weight, nearly
50 pounds and too big for a child car seat, into seat belts. I
concluded he should be up front with the best seat belts.
I am a journalist. I had researched the law in 1993,
writing on the lack of child passenger safety laws on Indian
reservations. So I felt knowledgeable about the law. I was a
mom who played by the rules: bike helmets, limited TV time,
brush teeth and bed time by 8:30.
Anton's grandmother remembers buckling him into the seat
that morning when we left Seattle. ``I get to ride up in front
with mommy,'' he crowed to her. He was a sunny child, loving,
smart, healthy--everything a parent could want.
He and I headed toward central Washington, planning to
visit friends there before driving on to Oregon. My daughter
Geneva was to follow us the next day with my sister, her aunt.
Two and a half hours into our drive, we were traveling
approximately 65 miles an hour on I-82, crossing a high desert
steppe, a desolate place used by the Army as a firing range.
Anton's head leaned against the window as he fell asleep in the
warm sun.
When the noon news faded, I reached for the car radio,
which was positioned exceptionally low, just over the car's
hump. At the same time, we passed a semi truck in the right-
hand lane, and basically that is all I remember. At the same
time I leaned over, we apparently hit a gust of wind, drifting
onto the shoulder, which had no rumble strips. I must have
startled when I realized where we were and overcorrected. The
wheels bit into the volcanic ash and sand, tripping the vehicle
into a triple roll.
They found me unconscious in the car, critically injured,
but nonetheless alive. The seat belt held me in, saving my
life. But next to me they found no one. When the Washington
State Patrol examined the car, they found Anton's seat belt
still clicked shut, but Anton was in the median, dead from
massive head injuries. The seat belt had failed to hold him in
and he was thrown out, only to have the car roll over him, and
just that fast this beautiful boy was gone, never to be seen
nor held by me again.
Anton did get to the cabin in Oregon in the end, but as
ashes, ashes we spread in the cold Metolius River. I have a
river since then, too, for the pain of missing him and the pain
of knowing what he has missed is an insurmountable sorrow for
his father and me.
I realize, however, one mother's broken heart alone is not
enough to change a nation's behavior. But Anton's death was no
anomaly. Some 500 children in Anton's age group bloody the road
sides of America and die. Thousands more are hurt for life.
Since this last Thanksgiving, within a 50-mile radius of my
house, in separate incidents a 5\1/2\ year old boy in an adult
seat belt was partially thrown out in a rolling pickup truck
and died, a 6 year old girl in an adult seat belt was thrown
out in a crash and died. Last week, in a three-car collision
another 6 year old was injured by the adult seat belt itself.
These are just the recent ones I know about in rural southeast
Washington state.
These are not statistics who suffer or die. These are
worlds that die: Tonka trucks and teddy bears packed away, Dr.
Seuss and Curious George stories boxed up, hollow birthdays
celebrated only with prayers and burning candles. The start of
the school year only signals more sadness for us parents,
mentally graduating lost children along: first grade, second
grade, and now third grade.
Because many of these deaths are preventable, guilt and
blame drive divorce, chemical dependency, family dysfunction,
and, yes, suicide, to fill the empty silhouette of a child.
I was fortunate in one way. My marriage and psyche have
survived this catastrophe. Nonetheless, almost equal to my
sorrow is my rage, at myself and at the other elements of this
horror--foremost, the lack of regulation in regard to safety
practices and safety equipment for passengers smaller than 170-
pound males. Where have our governments been? Even though car
crashes are the number one killer of children, apparently there
has not been enough dead youngster data to set off a
commensurate alarm.
Yet people in safety and automotive circles have known
about this problem of poor fit for the post-car seat aged child
since the late 1980's. Safety equipment in a car is no
guarantee, but it does imply a chance. Perhaps Anton would not
have survived the crash forces, but we will never know, because
his seat belt did not, could not, deliver.
Too late, in retrospect I see how ludicrous it was to think
its ill fit would suffice. But I extrapolated then that if the
law said it was OK, someone somewhere had tested the
engineering. Adult seat belts are better than nothing.
Nonetheless, they present an illusion of safety, a lie in
effect to these children who trust us with their very lives,
the same way I naively trusted the law.
I am not the only one. Parents are awash in health and
safety messages. Their priority filters tell them that if a
warning is not law the potential is not life-threatening.
Nothing could be further from the truth when it comes to car
crashes.
In our commuter society, children travel more than a
thousand car trips a year, and yet they are subjected to the
capricious nature of state child passenger safety laws, all of
which, even Washington and California's new improved ones, fall
short of best practice. But parents do not realize this.
These treasured children are Americans first. They carry
American passports, not state passports. They deserve a uniform
standard of regulatory protection coast to coast, whether that
involves auto design or booster seats or both. As citizens, it
is their birth right to come of age. We all failed Anton. Good
conscience and good government demand we not fail another
vulnerable young spirit.
This ends my testimony. I will answer any questions. Thank
you.
[The prepared statement of Ms. Skeen follows:]

Prepared Statement of Autumn Alexander Skeen, Child Passenger Safety
Advocate
Mr. Chairman and Senators of the Committee, I am Autumn Alexander
Skeen of Washington state.
Thank you for allowing me to testify. It is seemly that this
opportunity would come less than two weeks after our son's birthday.
Spring and Easter are the most painful times now, their messages of new
life and green glory underscoring what Anton has lost. He would have
been nine years old this year, just like your son, Senator Fitzgerald.
But Anton was four years old and a good-size lad, when he, his
sister and I came home for summer vacation in June 1996, leaving my
husband at his post in Tokyo as the Pacific editor of Stars and
Stripes. We were to have a whole summer at our family cabin in Central
Oregon.
My parents live in Seattle and for the summer I borrowed their SUV,
a 1988 Dodge Raider. In the whirl of travel, my mind quickly touched
upon the bases of transport: The front seats were where the only lap-
shoulder belts were in this vehicle. And of course, it had no air bags.
Washington state law said you could buckle children Anton's size and
weight--nearly 50 pounds and too big for a child carseat--into
seatbelts. I concluded he should be up front with the best seatbelts.
I'm a journalist; I had researched the law in 1993, writing on the lack
of child passenger safety laws on Indian reservations, so I felt
knowledgeable about the law. I was a mom who played by the rules--bike
helmets, limited TV time, brushed teeth and bedtime by 8:30.
Anton's grandmother remembers buckling him into the seat that
morning we left Seattle: ``I get to ride up in front with Mommy!'' he
crowed to her. He was a sunny child, loving, smart, healthy--everything
a parent could want.
He and I headed toward Central Washington, planning to visit
friends there before driving on to Oregon. My daughter Geneva was to
follow us the next day with my sister, her aunt. Two and a half hours
into our drive, we were traveling approximately 65 miles an hour on
I82, crossing a high desert steppe, a desolate place used by the army
as a firing range. Anton's head leaned against the window as he fell
asleep in the warm sun.
When the noon news faded I reached for the car radio, which was
positioned exceptionally low, just over the car's hump. At the same
time, we passed a semi-truck in the right-hand lane. And basically
that's all I remember. At the same time I leaned over, we apparently
hit a gust of wind, drifting onto the shoulder, which had no rumble
strips. I must've startled when I realized where we were and
overcorrected. The wheels bit into the volcanic ash and sand, tripping
the vehicle into a triple roll.
They found me, unconscious in the car, critically injured, but
nonetheless alive. The seatbelt held me in, saving my life.
But next to me, they found no one. When the Washington State Patrol
examined the car, they found Anton's seatbelt still clicked shut, but
Anton was in the median, dead from massive head injuries. The seatbelt
had failed to hold him in, and he was thrown out, only to have the car
roll over him.
And just that fast, this beautiful boy was gone, never to be seen
nor held by me again.
Anton did get to the cabin in Oregon in the end but as ashes,
Senators, ashes we spread in the cold Metolius River. I have wept a
river since then, too, for the pain of missing him and the pain of
knowing what he has missed is an insurmountable sorrow for his father
and me.
I realize, however, one mother's broken heart alone is not enough
to change a nation's behavior, but Anton's death was no anomaly. Some
500 children in Anton's age group bloody the roadsides of America and
die; thousands more are hurt for life. Since this past Thanksgiving,
within a 50-mile radius of my house in separate incidents, a 5\1/2\
year old boy in an adult seatbelt was partially thrown out in a rolling
pick up and died; a 6-year-old-girl in an adult seatbelt was thrown out
in a crash and died, last week in a three-car collision another 6-year-
old was injured by the adult seatbelt itself. And those are just the
ones I know about in rural southeast Washington.
These aren't statistics who suffer or die, these are worlds that
die: toy trucks and teddy bears packed away; bedtime stories boxed up;
hollow birthdays celebrated only with prayers and burning candles. The
start of the school year only signals more sadness for parents--
mentally graduating lost children along: first grade, second grade, and
now third grade. Because most of these deaths are preventable, guilt
and blame drive divorce, chemical dependency, family dysfunction and
yes, suicide to fill the empty silhouette of the child.
I was fortunate in one way--my marriage and psyche have survived
this catastrophe. Nonetheless, almost equal to my sorrow is my rage--at
myself and at the other elements of this horror, foremost the lack of
regulation in regard to safety practices and safety equipment for
passengers smaller than 170-pound males.
Where have our governments been? Even though car crashes are the #1
killer of children, apparently there hasn't been enough dead-youngster
data to set off a commensurate alarm. Yet, people in safety and
automotive circles have known about this problem of poor fit for the
post-carseat age child since the late 1980's. Safety equipment in a car
is no guarantee, but it does imply a chance. Perhaps Anton would not
have survived the crash forces, but we'll never know because his
seatbelt did not, could not deliver. Too late, in retrospect I see how
ludicrous it was to think its ill fit would suffice. But I extrapolated
then that if the law said it was OK, someone somewhere had tested the
engineering. Adult seatbelts are better than nothing, nonetheless they
present an illusion of safety, a lie in effect, to these children who
trust us with their very lives, the same way I naively trusted the law.
I'm not the only one. Parents are awash in health and safety
messages. Their priority-filters tell them that if a warning is not
law, the potential is not life threatening. Nothing could be further
from the truth when it comes to car crashes.
In our commuter society, children travel more than 1,000 car trips
a year and yet they are subjected to the capricious nature of state
child passenger safety laws, all of which, even Washington and
California's new improved ones, fall short of best practice. But
parents don't realize this.
These treasured children are Americans first; they carry American
passports, not state passports. They deserve a uniform standard of
regulatory protection coast to coast, whether that involves auto
design, or booster seats or both. As citizens, it's their birthright to
come of age. We all failed Anton; good conscience and good government
demand we not fail another vulnerable young spirit.

Senator Fitzgerald. Ms. Skeen, I want to thank you for that
very powerful and compelling testimony and thank you and
applaud you for your courage in coming forward with that, and
for all the good work and advocacy you have been doing in this
area. We will work so that there are not other parents what
have to undergo the suffering that you have endured, and we
will keep Anton in our memories. Thank you very much for your
courage in coming forward with that powerful testimony.
Mr. Lund, the Chief Operating Officer of the Insurance
Institute for Highway Safety, thank you for being here.

STATEMENT OF ADRIAN K. LUND, CHIEF
OPERATING OFFICER, INSURANCE INSTITUTE FOR
HIGHWAY SAFETY

Dr. Lund. Thank you, Mr. Chairman. The Insurance Institute
for Highway Safety is a nonprofit research and communications
organization that identifies ways to reduce motor vehicle
crashes and crash losses.
Senator Fitzgerald. Mr. Lund, could you just pull that
microphone a little bit closer to you. I would appreciate it.
Thank you.
Dr. Lund. I am the Institute's Chief Operating Officer and
I am here to discuss the issue of child occupant protection, in
particular the advisability of requiring booster seats. With me
today are Michele Fields, General Counsel for the Institute,
and Shelly Martin, our Government Affairs Representative, who
will help me at various stages.
To begin, I want to emphasize that the Institute believes
that the main issue with regard to child occupant protection is
the fact that so many children ride unrestrained. Although
child restraint use is up markedly since the 1970's and 1980's,
only one in three children killed in motor vehicle crashes in
1999 were restrained.
When it comes to protecting infants and children in motor
vehicles, the key issue is whether a restraint system is used.
It is not the type of restraint or whether it is installed
precisely as the manufacturer intended. Although these can be
important, it is not the main issue. Research indicates that
even when restraints are misused, they do often provide good
protection. We should not lead parents to assume that the belt
provides no protection.
When the Institute evaluated child restraint laws around
the nation last year, we did not consider what kind of
restraint a law requires for children or how extensively it
defined proper use of the restraint. Instead, the principal
concern was whether the laws included provisions that we know
from data maximize the use of some kind of restraint. Our
emphasis throughout was to ensure that all children in all
vehicle seats are restrained all the time.
In this situation, where do boosters come in? Restraint use
is a particular concern among those children who are graduating
from child restraints and for whom boosters are being
recommended. Research shows that restraint use declines
precipitously among children ages 3 to 6 compared with their
zero to 2 year old. It declines from around 95 percent to
around 40 to 50 percent in rear seats. We do not know why this
decline occurs, but it means these children are at increased
risk of injury in crashes.
Are boosters the answer? The fact is boosters can help. A
child should use a lap belt that fits over the upper legs or
pelvis and not the stomach. The shoulder belt should cross the
center of the chest. It should not come across the neck and
face. For some children, this optimal level of restraint may
not be achievable without a booster seat. However, the
Institute believes that requiring boosters is a misplaced
priority at this time.
First, requiring boosters complicates the first priority in
protecting child occupants, which is to get kids buckled up in
the first place. It means that we must convince parents not
only to buckle their children, but also to have booster seats
available for all the children they might carry. A parent who
buckled their child into a vehicle's lap-shoulder belt alone
would become a law-breaker even if no booster were required to
achieve a good fit.
Now, a second concern at the Institute is that booster
seats are not all the same. They do not fit all cars or all
kids the same. To get a handle on this, the Institute has
examined how different booster seats fit two different children
in three different vehicles. Our finding is that booster seats
sometimes improve belt fit and sometimes have no effect or can
make things worse.
I have asked Shelly to help us look at some exhibits here.
I would like to start with this picture of 6 year old Laura in
the rear seat of a Honda Accord. As you can see, the adult lap-
shoulder belt fits Laura in this vehicle reasonably well
without a booster. Now, she still might benefit from a booster
in perhaps another vehicle with different belt geometry. But in
this vehicle, when we looked at different booster seats we saw
that they were as likely to worsen belt fit for her as to
improve it.
The second exhibit----
Senator Fitzgerald. Dr. Lund, could I stop you for a second
and ask you how much that young girl who you said was 6 years
old weighed?
Dr. Lund. She weighs 62 pounds.
Senator Fitzgerald. 62 pounds.
Dr. Lund. So she's just over the 60-pound limit, but well
under the 80-pound limit.
Senator Fitzgerald. How tall would she have been?
Dr. Lund. She is 52 inches.
Senator Fitzgerald. 52 inches, and she does look like she
fits into that.
Dr. Lund. Yes.
Now, the second exhibit shows a different story. This is 5
year old Camron in the rear seat of a Hyundai Excel. Without
benefit of a booster, we see two problems with the belt fit.
First, the belt does lie across Camron's neck and face. But
most importantly, we see that the belt crosses his stomach
rather than lying down on his thighs or across his pelvis.
Now, if we go to the next exhibit, we see Camron in a
Britax Star-Riser booster seat. This is not an ad for Britax,
but there are other boosters that do this as well. But we see
that with this Britax seat a good improvement in the belt fit.
We see that the belt has been re-routed across the chest and,
most importantly, the arms on this seat are keeping the lap
belt low on the thighs and pelvis. That is what you want to do
to avoid abdominal injuries.
Now, if we go to the next exhibit, here is the problem that
we see. This is the Jupiter Comfort Rider GTX booster. It does
not help so much. The belt fit is somewhat better as it passes
over the shoulder, but it achieves this by lengthening the
amount of shoulder belt that is out. That means that in a
frontal crash this seat is going to rotate further in that
crash, allowing the head to go further forward. We know that in
real world crashes a problem for kids is head injuries, even
restrained kids.
More importantly in my view in this case, though, is the
fact that if you look at that lap belt fit on the child, you
see that the lap belt is still in the stomach, threatening
abdominal injuries in a severe frontal crash.
Thus, our research is indicating that booster seats do not
necessarily improve belt fit. Whether they do depends on the
specific child, the specific booster seat, and the specific car
model in which the two are positioned.
That leads me to the final point that I would like to make.
Booster seats are not well defined. In general, a booster seat
raises a child up for a better fit. But does this mean a firm
cushion qualifies as a booster seat? What about a phone book?
We note that the National Highway Traffic Safety Administration
sets forth extensive testing requirements for infant and child
seats, and all states require the use of federally approved
seats. These seats have been tested and approved.
But these requirements do not apply to booster seats for
children who weigh more than 50 pounds. It makes no sense in
our view to require the use of special restraint devices that
have not been tested or approved for the children that they are
required for.
Given these observations, the Institute has the following
recommendations for improving child occupant protection at this
time. The very first order of business is to get older children
into restraints. Lap-shoulder belts may have limitations, but
they still greatly improve the likelihood that children will
survive in crashes. State legislatures are already moving to
remove the loopholes in restraint legislation that are partly
responsible for the decline in restraint use by elder children.
The next step is we have got to get the police enforcing those
laws as well.
At the same time, though, we must recognize that these
belts do not fit all children well. Research should proceed to
document the benefits that booster seats can and cannot
provide. We need to understand not only the potential
limitations of lap-shoulder belts, but also the aspects of
booster seats that help or do not help.
We do not yet--I go back to my point that not all boosters
are the same, and our problem is we do not know which
differences are the most important. We need research. At a
minimum, before we require booster seats we need a federal
definition of booster seats that is based on science and test
requirements that are standard and realistic.
That concludes my testimony, Mr. Chairman.
[The prepared statement of Dr. Lund follows:]

Prepared Statement of Adrian K. Lund, Chief Operating Officer,
Insurance Institute for Highway Safety
The Insurance Institute for Highway Safety is a nonprofit research
and communications organization that identifies ways to reduce motor
vehicle crashes and crash losses. I am the Institute's chief operating
officer, and I am here to discuss the issue of child occupant
protection--in particular, the advisability of requiring booster seats.
Main Issue is Whether Restraints are Used
The proportion of children who ride restrained has increased
markedly since the early 1980s,^1,\2\ but too many children
still ride unrestrained. The results are deadly. In 1999, more than
1,300 child passengers (12 and younger) died in crashes. Only 36
percent of them were restrained. Another 14 percent were either
improperly restrained (in all likelihood, gross misuse of the child
seat or safety belt) or restraint use was unknown. Fifty percent of the
children who died were unrestrained. Thus, nearly two of every three
child deaths probably involved a failure to use an available restraint
system. Among the older children in this group, restraint use was lower
than among the infants and youngest children (0-3 years old).
---------------------------------------------------------------------------
\1\ Williams, Allan F. 1976. Observed child restraint use in
automobiles. American Journal of Diseases of Children 130:1311-17.
\2\ National Highway Traffic Safety Administration. May 1999.
National occupant protection use survey, 1998, controlled intersection
study (draft). Research Notes. Washington, D.C. U.S. Department of
Transportation.

CHILDREN KILLED IN PASSENGER VEHICLES, 1999
----------------------------------------------------------------------------------------------------------------
Unrestrained Unknown/Improper Restraint Restrained
Age Count -----------------------------------------------------------------------------------
NO. Percent NO. Percent NO. Percent
----------------------------------------------------------------------------------------------------------------
0-3 years 451 172 38% 80 18% 199 44%
4-6 years 281 148 53% 37 13% 96 34%
7-8 years 215 119 55% 33 15% 63 29%
9-12 years 362 212 59% 33 9% 117 32%
----------------------------------------------------------------------------------------------------------------
TOTAL 1,309 651 50% 183 14% 475 36%
----------------------------------------------------------------------------------------------------------------
Source: Fatality Analysis Reporting System

So, when it comes to protecting infants and children in motor
vehicles, the key issue is whether a restraint system is used--not what
type of restraint or whether it is installed precisely as the
manufacturer intended (research indicates that, even when restraints
are misused, they often provide good protection).\3\ What matters is
that so many children still are riding unprotected by any kind of
restraint.
---------------------------------------------------------------------------
\3\ Melvin, John W.; Weber, Kathleen; and Lux, Paula. Performance
of child restraints in serious crashes. Proceedings of the 24th Annual
Conference of the American Association for Automotive Medicine, 117-31.
Morton Grove, IL: American Association for Automotive Medicine.
---------------------------------------------------------------------------
Ratings of State Laws Based on Likelihood of Increasing Restraint Use
The Insurance Institute for Highway Safety always has placed the
highest importance on enacting and enforcing laws that require
restraint use by all children sitting in all vehicle seats. Last year
the Institute rated selected traffic safety laws in every state, based
on research indicating the extent to which the laws enhance highway
safety (attachment).\4\ To evaluate laws protecting child passengers,
the Institute considered the comprehensiveness of both child restraint
and adult belt use laws, which cover older children. The laws that earn
the highest ratings provide primary coverage for all children 12 and
younger in all vehicle seats. (Primary coverage means police may stop
and ticket motorists for restraint violations alone. All child
restraint laws are primary, but most adult belt laws are secondary,
which means motorists have to be stopped for some other violation
first.) Laws with low ratings allow some children to ride unrestrained.
---------------------------------------------------------------------------
\4\ Insurance Institute for Highway Safety. 2000. How state laws
measure up. Status Report 35:10.
---------------------------------------------------------------------------
Children too old to be covered under the child restraint laws in 11
states (Alabama, Arizona, Idaho, Illinois, Indiana, Iowa, Minnesota,
Mississippi, New Jersey, Ohio, and Pennsylvania) are protected by adult
belt laws that apply only to people riding in the front seat. Thus, it
is perfectly legal in these states for children to ride unrestrained in
rear seats. This makes no sense. The back seat is where we tell parents
it is safest for their children to ride, so restraint laws should cover
the kids who sit there. Closing such loopholes in the laws should be
our highest priority.
In rating the laws, the Institute did not consider what kind of
restraint a law requires for children of various ages. Adults could
buckle children into rear-facing infant restraints, forward-facing
child restraints, or adult lap/shoulder belt systems, as appropriate.
This reflects the Institute's major concern, which is to ensure that
all children in all vehicle seats are restrained all the time.
Restraint Use Declines After Age Two
The problem of children riding unrestrained is not uniform from
infant through preteen years. Restraint use declines after age two,
according to recent Institute surveys conducted in three states. In
particular, restraint use drops off precipitously among children ages
3-6 compared with 0-2 year-olds.\5\ We do not know why this is
happening, but it means these children are at unnecessary injury risk
in crashes.
---------------------------------------------------------------------------
\5\ Ferguson, Susan A.; Wells, JoAnn K.; and Williams, Allan F.
2000. Child seating position and restraint use in three states. Injury
Prevention 6:24-28.

PERCENT OF CHILDREN RESTRAINED
------------------------------------------------------------------------
FRONT SEAT (in REAR SEAT (in
percent) percent)
------------------------------------------------------------------------
MICHIGAN
younger than 1 82 96
1-2 years 69 98
3-6 years 56 44
7-12 years 69 39
NORTH CAROLINA
younger than 1 89 94
1-2 years 83 96
3-6 years 66 57
7-12 years 79 39
TEXAS
younger than 1 77 89
1-2 years 64 92
3-6 years 55 42
7-12 years 73 37
------------------------------------------------------------------------
Source: Ferguson, Susan A.; Wells, JoAnn K.; and Williams, Allan F.
2000. Child seating position and restraint use in three states. Injury
Prevention 6:24-28.

Are Booster Seats the Answer?
There is merit in the idea of booster seats for some children who
have outgrown their child restraints. Experts agree that a child should
use a lap belt that fits over the upper legs or pelvis (not the
stomach) and a shoulder belt that crosses the center of the chest (not
the face or neck). The knees should bend at the edge of the vehicle
seat so the child is not encouraged to slouch down for comfort,
displacing the lap belt up over the stomach or perhaps even allowing
the child to slide out from under the belt system.
For some children, this level of restraint may not be achievable
without a booster seat, so some people would like to require boosters.
The idea is that adult belts will fit better, more 3-6 year olds will
ride restrained, and these children will be better protected than in
adult belts alone. Three states already have passed booster seat
requirements covering children to age 6 or 60 pounds: Arkansas,
California, and Washington. States also are considering legislation
that would extend booster seat requirements to children who weigh less
than 80 pounds or are shorter than 57 inches, as recommended on the
National Highway Traffic Safety Administration's website.\6\
---------------------------------------------------------------------------
\6\ National Highway Traffic Safety Administration. 2001.
www.nhtsa.dot.gov/people/injury/childps/Boosterseat/talking.html.
Washington, D.C. U.S. Department of Transportation.
---------------------------------------------------------------------------
The Institute believes emphasizing boosters is a misplaced
priority. One problem is that it complicates the task of complying with
the law. Parents have to buy boosters and have them available for any
children they might take along in their cars. A parent who buckles a
child into a vehicle's lap/ shoulder belt alone would become a
lawbreaker, even if no booster were needed to achieve a good belt fit.
Adding booster seat requirements for 4-6 year olds without also
extending the coverage of child restraint laws to 7-12 year-olds still
would leave substantial numbers of children unprotected.
Booster seat requirements still might be a good idea if the
boosters were to greatly improve the fit of adult safety belts. But it
is not clear that they do. Institute researchers have tried to get a
handle on this by buckling two children (a 6-year-old girl 52 inches
tall weighing 62 pounds; a 5-year-old boy 45 inches tall weighing 42
pounds) into 6 different booster seats positioned in 3 different
passenger vehicles (a small car with contoured seats, a midsize car
with bench seats, and a passenger van with captain's chairs). For
comparison, the researchers conducted the same placements with a Hybrid
III dummy representing a 6-year-old boy (50th percentile height at 45
inches tall; 75th percentile weight at 52 pounds). Sixty-three
different placements were assessed, including ones in which no booster
seats were used (adult belt systems only).
One finding is that some booster seats are very good--that is, they
route the adult lap/shoulder belt correctly--while others provide only
marginal improvement in belt fit. Getting a good one does not
necessarily mean buying the most expensive one. The Britax Star-Riser
is a good choice at $100. Evenflo's Right Fit is another good booster
seat costing only $20.

Adult safety belts alone (above left) do not fit some children,
like 5-year-old Camron who weighs 42 pounds. The shoulder belt cuts
across his face and neck, while the lap belt is much too high across
his stomach instead of lower on his upper legs or pelvis. Plus his
knees do not bend at the edge of the vehicle seat, so he is likely to
scoot forward. The right booster seat can help. The key is to get the
right one. The Jupiter Komfort Rider GTX (above middle) does not help
much. The shoulder belt is routed better than with an adult belt alone,
but the lap belt still is positioned too high. A better fit is in the
Britax Star-Riser (above right), which routes both the lap and shoulder
portions for a correct fit. But not every child 4-8 years old needs a
booster seat. Laura (below), who is nearly 7 and weighs 62 pounds, fits
reasonably well in an adult belt system without a booster.

The main finding of this research is that booster seats enhance
belt fit in some configurations. In others, a booster makes no
difference or results in a poorer fit. All of this variability makes it
difficult, if not impossible, to generalize about which groups of
children would benefit from a booster seat requirement. It depends on
the specific child, the specific booster seat, and the specific car
model in which the two are positioned.
An even more basic problem with requiring booster seats is that we
in the United States do not have a clear definition of what boosters
for older children are. In general, a booster seat raises a child up
for a better fit in an adult belt system. Does this mean a firm cushion
would qualify as a booster seat? What about a phone book? Kids, even
when they are the same age, vary widely in height and weight. Booster
seats vary in size and shape. Vehicle seats vary from bench-type to
contoured. Safety belt systems also vary from car model to model. So
which boosters work best in which vehicles? Which children need booster
seats in what vehicle models? For how long? The answers vary from child
to child and vehicle to vehicle. There is too much variability to apply
a single booster seat requirement to all kids of specified ages (or
heights or weights) in all cars.
Another issue involves testing. The National Highway Traffic Safety
Administration sets forth extensive testing requirements for infant and
child restraints. All states require the use of federally approved
seats. But these requirements do not apply to booster seats for
children who weigh more than 50 pounds. It makes no sense to promote,
let alone require, the use of devices for older children that have not
been tested or approved.
Recommendations
The first order of business is to get older children in restraints
regardless of what type of restraint is used. Lap/shoulder belts may
have limitations, but they still greatly improve the likelihood that
children will survive in crashes. State legislators already are
extending child restraint laws to cover older children, which
accomplishes two objectives. It closes loopholes that once allowed some
children to ride unrestrained, and it extends primary enforcement of
restraint laws to more children. (All child restraint laws are primary,
but most adult belt laws are secondary.)
At the same time, government and other researchers are proceeding
with studies to document the benefits that booster seats can and cannot
provide. These studies should continue. We need to understand not only
the limitations of lap/shoulder belts for children but also the aspects
of booster seats that help remedy such limitations. Not all booster
seats are the same, and we do not yet know which differences are the
important ones. At a minimum, we need a federal definition of booster
seats based on science and test requirements that are standard and
realistic.
______

State Traffic Laws Rated Good to Poor, Revealing Nation's Best and
Worst
Ratings Based on Likelihood Laws Will Enhance Traffic Safety by
Influencing Driver Behavior
Traffic safety laws are on the books in every state to reduce
deaths and injuries in crashes by changing driver behavior. The idea is
to deter dangerous behavior like driving while impaired by alcohol and
encourage beneficial habits like buckling up safety belts.
How do these laws compare from state to state? Overall the
strongest laws in the United States are in California, the District of
Columbia, and Maryland. The weakest traffic safety laws are those in
Montana, South Carolina, and South Dakota.
Research has repeatedly shown the benefits of good traffic safety
laws that are enforced. This has been established as the only way to
achieve high belt use rates, for example. The starting point is to put
a good law on the books, which is why the Institute has conducted a
comprehensive assessment of key traffic safety laws in all 50 states
and the District of Columbia.
``We didn't evaluate every law by any stretch,'' says Institute
senior vice president Allan Williams. ``We looked at provisions of
selected laws that research shows have improved driver behavior.
Clearly some states do a better job than others of getting good traffic
safety laws on the books.''
Even if a law includes strong provisions, enacting it isn't
sufficient to influence the behavior of many drivers. The necessary
next step to maximize a law's effectiveness is to publicize and enforce
it. ``People don't usually comply with traffic laws because they think
doing so will prevent crashes or save lives. People comply if they
believe there's a real chance of getting a ticket or points on their
license if they don't. This is why we didn't give high marks to laws
that are on the books but are hard to enforce,'' Williams explains.
Institute researchers assessed alcohol-impaired driving laws, young
driver licensing laws, safety belt use laws, child restraint use laws,
motorcycle helmet use laws, and laws allowing camera enforcement of red
light violations. A rating of good, acceptable, marginal, or poor is
assigned to each law, or set of related laws, in each state (see pp.
32-33). These ratings reflect how well the provisions of a given law
can be expected to improve safety, based on research identifying what
works and doesn't work to achieve such improvements.

DUI/DWI laws: ``There used to be a lot of high-profile activity to
reduce alcohol-impaired driving. But lately people seem to
believe we've solved this problem, so the push to strengthen
laws and enhance enforcement has waned,'' Williams says. The
Institute has evaluated four separate DUI/DWI laws in all
states and the District of Columbia.
1. Under administrative license revocation laws, the license of
every driver arrested for DUI/DWI is automatically revoked for a
specified time. The success of such laws in reducing fatal crashes has
been documented since the late 1980s (see Status Report, March 14,
1988). The best administrative license revocation laws require driver's
license removal for at least 30 days with few or no exceptions for
hardship.
``Administrative license revocation is the cornerstone of an
effective DUI or DWI program,'' Williams says. Yet Kentucky, Michigan,
Montana, New Jersey, Pennsylvania, Rhode Island, South Carolina, South
Dakota, and Tennessee still don't have such laws on the books. Another
17 states don't require revocations lasting at least 30 days.
2. Under the laws in 21 jurisdictions, it's illegal to drive with a
blood alcohol concentration, or BAC, at or above 0.08 percent
(elsewhere it's usually 0.10 percent). Research indicates that 0.08
laws have reduced fatal crashes in which alcohol is a factor.
3. Across the United States, it's illegal for people younger than
21 to drive with any measurable BAC. All jurisdictions have such laws,
dubbed zero tolerance, because in 1998 the federal government began
withholding highway funds from states without the provisions. But the
laws are far easier to enforce in some states than others. Institute
researchers found that laws in Massachusetts, Nevada, New Jersey, New
Mexico, North Dakota, Rhode Island, and Tennessee are virtually
unenforceable because police must suspect a young driver has a high BAC
before administering a breath test to check for violations of the zero
tolerance law, under which any measurable BAC constitutes a violation
(see Status Report, March 11, 2000; on the web at
www.highwaysafety.org).
4. High-profile sobriety checkpoints are effective ways to deter
alcohol-impaired driving. They increase drivers' perceptions that
apprehension is likely to follow the offense. Yet checkpoints aren't
permitted in Idaho, Iowa, Michigan, Minnesota, Montana, Oregon, Rhode
Island, Texas, Washington, Wisconsin, or Wyoming.
Graduated licensing laws: The newest drivers are the most hazardous
because they're not only inexperienced but also immature. Teenage
drivers have the highest crash risk of any group, and 16 year-olds pose
a much greater risk than older teens. This is why graduated licensing
is being embraced by state legislators. Its purpose is to protect
beginners by phasing in full driving privileges so teenagers graduate
to unrestricted licenses over at least a year (see Status Report, March
11, 2000; on the web at www. highwaysafety.org).

Beginning with Florida in 1996, ``graduated licensing has caught on
rapidly,'' Williams points out. ``An impetus has been media attention
on young driver crashes, especially fatal crashes. This attention has
kept the issue in the forefront and helped make state legislators
receptive to graduated licensing.''
Now only nine states (Alabama, Arizona, Hawaii, Kansas, Montana,
Nevada, Oklahoma, Texas, and Wyoming) fail to include any of the key
provisions of graduated licensing. In the other 42 jurisdictions,
there's wide variation in the strength of the provisions.
Williams explains that ``the most important aspect of graduated
licensing is to restrict driving once a beginner gets a license.
GOOD LAWS
ALCOHOL
Alabama
California
Florida
Hawaii
Kansas
New Hampshire
Utah
Vermont
YOUNG DRIVERS
California
District of Columbia
Massachusetts
New Jersey
Oregon
Tennessee
Washington
SAFETY BELT USE
California
District of Columbia
Oregon
CHILD RESTRAINT USE
Alaska
California
Colorado
Connecticut
Delaware
District of Columbia
Georgia
Hawaii
Kansas
Louisiana
Maryland
Michigan
Missouri
New Hampshire
New York
North Carolina
North Dakota
Oklahoma
Oregon
Rhode Island
Tennessee
Texas
Utah
Vermont
Virginia
Washington

HOW LAWS ARE RATED
Alcohol Laws
GOOD: an administrative license revocation law that mandates at least a
30-day revocation for a violation with few or no exceptions for
hardship; a law under which it's illegal to drive with a blood alcohol
concentration (BAC) at or above 0.08 percent; a readily enforceable law
under which it's illegal for anyone younger than 21 to drive with any
measurable BAC (enforcement is impeded in some states because police
must suspect that a young driver has a high BAC before administering an
alcohol test to check for any measurable BAC); and sobriety checkpoints
must be permitted
ACCEPTABLE: an administrative license revocation law (not necessarily
including a 30-day revocation) or a law under which it's illegal to
drive with a BAC at or above 0.08 percent plus at least one of the
other provisions listed above (see GOOD)
MARGINAL: a readily enforceable law under which it's illegal for anyone
younger than 21 to drive with any measurable BAC plus no limitations on
conducting sobriety checkpoints
POOR: one or none of the four provisions listed above (see GOOD)
Young Driver Licensing Laws
GOOD: minimum 6-month learner's phase; once licensed, beginners are
subject to restrictions beginning at 10 p.m. or earlier and extending
to 5 a.m. and/or a restriction that allows no more than one passenger
when driving unsupervised; and beginners must wait until age 17 for
their unrestricted licenses
ACCEPTABLE: law includes the late evening/night driving restriction
and/or passenger restriction listed above, and beginners must wait
until age 17 for their unrestricted licenses; or law includes a minimum
learner's phase (any length) plus some restrictions on driving hours
and/or passengers, and beginners must wait until age 16\1/2\ for their
unrestricted licenses
MARGINAL: law includes a minimum learner's phase (any length) plus,
once a beginner is licensed, some restrictions on driving hours and/or
passengers; or law includes only a learner's phase lasting a minimum of
6 months; or law includes only restrictions on driving hours and/or
passengers once a beginner is licensed
POOR: minimum learner's phase shorter than 6 months and no restrictions
on driving by beginners
Safety Belt Use Laws
GOOD: law allows primary enforcement (police may stop and ticket
motorists for belt law violations alone); fines and/or license points
are imposed for violations; and law applies to occupants in rear as
well as front seats
ACCEPTABLE: law allows primary enforcement but doesn't require belt use
in rear seats
MARGINAL: law allows secondary enforcement (police must stop motorists
for other violation before enforcing belt law)
POOR: either no belt use law or law doesn't impose any fine or license
points
Child Restraint Use Laws
GOOD: all children younger than 13 in all vehicle seats are required to
ride in infant restraints, child seats, or safety belts; enforcement is
primary (see above for definition of primary enforcement)
MARGINAL: all children younger than 13 in all seats are required to
ride in infant restraints, child seats, or safety belts; enforcement
under adult belt laws may be secondary (see above for definition of
secondary enforcement)
POOR: some children younger than 13 aren't required to be restrained
Motorcycle Helmet Use Laws
GOOD: all motorcycle riders must wear helmets
POOR: either no helmet use law or law covers only some riders
Red Light Camera Enforcement Laws
GOOD: law grants specific statewide authority for camera enforcement
ACCEPTABLE: operational camera enforcement without specific state
authority
MARGINAL: law restricts authority for camera enforcement to specific
communities only
POOR: no law grants authority for camera enforcement and no operational
camera enforcement
GOOD LAWS
MOTORCYCLE HELMET USE LAWS
Alabama
California
District of Columbia
Georgia
Maryland
Massachusetts
Michigan
Mississippi
Missouri
Nebraska
Nevada
New Jersey
New York
North Carolina
Oregon
Pennsylvania
Tennessee
Vermont
Virginia
Washington
West Virginia
RED LIGHT CAMERA ENFORCEMENT
California
Colorado
Delaware
District of Columbia
Hawaii
Maryland
States accomplish this by prohibiting unsupervised driving in high-
risk situations like at night or with passengers. The tougher these
restrictions are and the longer they last past a beginner's 16th
birthday, the higher we rated a state's licensing law covering young
drivers. Also important is an initial learning phase lasting six months
or longer when only driving under supervision is allowed.''

Safety belt use laws: In 1984, New York enacted the nation's first
law requiring motorists to buckle up. Within 2 years, 22 jurisdictions
had such laws, and now all but New Hampshire does. But the provisions
vary widely.
For example, most states still don't allow police to stop motorists
solely for belt violations (primary enforcement). Enforcement is
secondary, which means motorists have to be stopped for some other
violation first. This impedes enforcement and explains, in part, why
belt use is significantly lower in the United States than in Canada and
elsewhere. The laws in only 17 U.S. states and the District of Columbia
allow primary enforcement, and even in these states the laws don't
always cover people riding in rear seats.
``One thing we know from repeated research conducted since the
early 1980s is that belt law effectiveness depends on publicity and
enforcement,'' Williams says (see Status Report, Jan. 15, 2000; on the
web at www. highwaysafety.org). ``It's harder to enforce a secondary
law. This is why, when we rated state belt use laws, we considered
whether the provisions for enforcement are primary or secondary. We
also considered whether all occupants are covered.''
Child restraint laws: To evaluate these, the Institute assessed not
only the comprehensiveness of state laws covering very young children
but also the adequacy of adult belt laws, which cover older children.
What matters most is whether these laws together provide primary
coverage for all children younger than 13 in all seats or allow some
children to ride unrestrained.
For example, children too old to be covered under the child
restraint laws in 14 states are protected by adult belt laws that apply
only to people riding in the front seat. Thus, it's perfectly legal for
children to ride unrestrained in rear seats.
``This makes no sense,'' Williams says. ``The back seat is where we
tell parents it's safest for their children to ride, so restraint laws
should cover the kids who sit there.''
Motorcycle helmet use laws: By the 1970s, helmet laws had been
enacted in virtually all states. All riders were covered, and injuries
among cyclists were reduced. (Wearing a helmet reduces the risk of
death in a motorcycle crash by about onethird). But by 1980 most states
had abandoned their motorcycle helmet laws or substantially weakened
them by applying them only to riders younger than a specified age,
usually 18.
Now all riders are covered in only 21 jurisdictions. Helmet laws
aren't on the books in Colorado, Illinois, or Iowa, and they're watered
down in another 27 states.
``You might as well not have a law that doesn't apply to all
riders,'' Williams says, ``because so few motorcyclists are the younger
riders covered under the weak laws. Helmet use rates in states with
limited laws are about the same as in states without any laws at all''
(see Status Report, April 4, 1998; on the web at www.highwaysafety.
org). For this reason, the Institute assigned poor ratings to the laws
in all states where helmet laws don't apply to all riders.
Red light camera enforcement: Running red lights is a good example
of ``everyday'' aggressive driving. It's less spectacular but a lot
more common than the occasional headline-grabbing instances of
aggressive driving known as road rage.
Until a few years ago, red light violators had to be apprehended
and ticketed one by one. The odds of this were so small that offenders
found little reason to change their ways. But now they do, at least
where red light cameras have been installed to snap photos of vehicles
whose drivers deliberately run red lights. Then the violators are
ticketed by mail.
Such programs reduce red light running by about 40 percent (see
Status Report, July 11, 1998; on the web at www.highwaysafety. org),
but there's a problem. Relatively few red light camera programs are
operational, in many cases because state laws haven't been enacted to
authorize them. In only six jurisdictions (California, Colorado,
Delaware, the District of Columbia, Hawaii, and Maryland) is camera
enforcement specifically authorized for use statewide.
``Cameras shouldn't merely be permitted in the United States. They
should be in wide use, as in other countries,'' Williams says. ``Red
light running kills hundreds of people every year, more than half of
them struck by the signal violators. To make a dent in this toll, we've
got to encourage the use of the camera technology we know will deter
the would-be violators.''
For more information: Specific provisions of selected traffic
safety laws in all 50 states and the District of Columbia are detailed
at www.highwaysafety.org. Click on ``safety facts'' and then choose
``state laws.''

Senator Fitzgerald. Dr. Lund, thank you very much.
Dr. Flaura Winston, the assistant professor of pediatrics
at the Children's Hospital of Philadelphia. Thank you, Dr.
Winston, for being here.

STATEMENT OF FLAURA KOPLIN WINSTON, M.D., Ph.D.,
ASSISTANT PROFESSOR OF PEDIATRICS,
CHILDREN'S HOSPITAL OF PHILADELPHIA AND UNIVERSITY OF
PENNSYLVANIA SCHOOL OF MEDICINE

Dr. Winston. Good morning, Mr. Chairman, Members of the
Committee. Thank you for the opportunity to speak. My name is
Dr. Flaura Koplin Winston. I am a biomechanical engineer as
well as a board-certified pediatrician and the mother of two
young boys, Zachary and Andrew. I head a pediatric injury
research center at the Children's Hospital of Philadelphia and
the University of Pennsylvania.
Together with State Farm Insurance Companies, we have
created the world's largest surveillance system for children in
motor vehicle crashes, Partners for Child Passenger Safety. We
now have hard data on which to base policy--not simply fitting
children in booster seats, not opinions, but hard data on
137,000 children in real crashes. Based on these numbers, more
than 1.5 million U.S. children are passengers in motor vehicle
crashes annually.
Today more than 750 children will be injured. Nearly 100 of
these children will be seriously injured or killed.
Unfortunately, the most common serious injuries are to the
brain. I understand that in most cases, restraints will save a
child's life. That has been demonstrated many times. But many
children will still be seriously injured if they are
inappropriately restrained. Many of these serious injuries will
be to the brain.
As a physician, I know the brain is the organ least able to
recover. These injuries to the brain tend to be the most
devastating to families and it is essential to prevent these
injuries.
In a nutshell, my research shows that most parents have
gotten the message to place their youngest children in car
seats in the rear of the vehicle. My research bears out that
these properly restrained children are the least likely to
sustain devastating injuries. But at the same time, it is
glaringly obvious that most parents have not gotten the message
that children under age 9 are too small for adult seat belts
and require car seats or belt-positioning booster seats.
This lack of awareness has led to devastating injuries that
could be prevented. My research points to the need for ensuring
a more consistent message to parents about appropriate
restraint, backed up by consistent laws and their enforcement.
Preventable injuries occur every day.
Let me demonstrate the safety advantages of a belt-
positioning booster seat. This is a simulation that was based
on multiple crashes that we investigated. The above simulation
shows a 6 year old child properly restrained in a belt-
positioning booster seat. This child barely moves during the 35
mile per hour crash.
In the below simulation, the same child is improperly
restrained in a seat belt. This child dummy demonstrates what
many children will do with an uncomfortable seat belt that
falls over their neck. The child would move the seat belt
behind her back. As you can see, she is thrown forward
dramatically without the torso protection.
Our data indicate that inappropriately restrained children
can strike their head, making them four times more likely to
suffer brain injuries than children in booster seats. Further,
children in adult seat belts, as you all very well know, suffer
intestinal, liver, spleen, and spinal cord injuries, all due to
the excessive bending during a crash from being in a seat belt
rather than a belt-positioning booster seat.
Now, please look at this graph of recommended restraint
use. I am defining recommended restraint in that children under
4 need to be in car seats and children 4 to 8 year olds need to
be in booster seats. What you can see is an alarming dip in
recommended restraint between the ages of 3 and 8. More than 80
percent of children through age 2 are appropriately restrained
in car seats, according to our study. This is good news.
Beginning at age 3, appropriate restraint use drops to 52
percent. Nearly half of 3 year old children are not in car
seats. By age 4, the most prevalent form of restraint is,
inappropriately, the adult seat belt and virtually no 7 or 8
year old children are in belt-positioning booster seats.
Instead of using car seats or belt-positioning booster
seats, many children between ages 3 and 8 are inappropriately
restrained in adult seat belts. It is important to note that
many children older than 8 are too small for adult seat belts
and may benefit from belt-positioning booster seats.
Existing laws have been very effective in getting those
youngest children into car seats. But the laws as they
currently stand are a patchwork that differ widely and fail to
incorporate current best practice guidelines. This serves as a
source of confusion for parents.
We have conducted extensive focus groups to actually ask
about this and the parents in our study suggested that strong
laws that are enforced are important for sending clear,
consistent messages regarding child passenger safety. Parents,
much like Ms. Skeen, look to the law.
The responsibility for the safe transportation of children
must be shared, though, by educators, regulators, legislators,
manufacturers, and the parents. All of us must share
responsibility for America's children. Clearly, we must ensure
that all children are restrained. I agree with that. That will
save lives.
But this is not enough. We want the best protection for our
children, and we now know that children over 40 pounds are
seriously injured when they are improperly restrained. We want
the best. We need to determine evidence-based uniform
guidelines for appropriate restraint for all children. We need
to consistently incorporate these guidelines into state laws
and enforce them. We need to ensure that high quality, low
cost, user friendly, comfortable restraints are available for
all children in all vehicles.
I am happy to say that State Farm Insurance Companies and
the Children's Hospital of Philadelphia are doing their part.
We have collaborated in many efforts to get the appropriate
restraint message to parents, doctors, advocates, legislators,
enforcement agencies, and manufacturers, and now have produced
the nation's first in-school curriculum to educate young
children about booster seats.
Efforts such as these have resulted in an increased booster
seat awareness. Our data are showing a trend of increased
booster seat use. But overall, appropriate restraint use
remains very, very low.
Partners for Child Passenger Safety is here to help you in
your important work and we commend all the hard work that you
have been doing. If there is any way that we can provide
additional data, we will be glad to do that.
Mr. Chairman, I am ready to respond to any questions you
might have.
[The prepared statement of Dr. Winston follows:]

Prepared Statement of Flaura Koplin Winston, M.D., Ph.D.,
Assistant Professor of Pediatrics, Children's Hospital of
Philadelphia and University of Pennsylvania School of Medicine
Good morning, Mr. Chairman, Members of the Committee. Thank you for
the opportunity to speak.
My name is Dr. Flaura Koplin Winston. I am a practicing
pediatrician at The Children's Hospital of Philadelphia, a faculty
member at the University of Pennsylvania School of Medicine, a
biomechanical engineer, a clinical researcher, and a mother of two
boys, Zachary and Andrew, who inspire my research to make every ride
safe for children. The Children's Hospital of Philadelphia is a Level
One Pediatric Trauma Center, designated to care for the most seriously
injured children, but much of our work is devoted to preventing injury.
We realize that the best way to care for our children is to keep them
safe, avoiding the physical and emotional pain and suffering that
accompany every childhood injury.
I am the Principal Investigator of Partners for Child Passenger
Safety, the world's largest surveillance system for children in
automobile crashes. Begun in 1997, Partners for Child Passenger Safety,
a collaboration between State Farm Insurance Companies, the University
of Pennsylvania, and The Children's Hospital of Philadelphia, is the
first comprehensive research study of how and why children are injured
or killed in motor vehicle crashes.
Each day the Partners research team receives information, with
privacy safeguards, from State Farm on nearly 200 children involved in
crashes in 15 states (AZ, CA, DE, IL, IN, M.D., MI, NC, NJ, NY, NV, OH,
PA, VA, and WV) and the District of Columbia. The research team
conducts in-depth telephone interviews and on-site crash investigations
in order to estimate the number of children in crashes; identify
specific safety problems for children in motor vehicles; suggest
solutions to those problems; and evaluate real-world effectiveness of
vehicle and restraint system features.
In this testimony, I will describe the national problem of children
in motor vehicle crashes in terms of the number of crashes involving
children and the number of children who are injured in these crashes. I
will also describe the high proportion of children who are
inappropriately restrained for their age and size and the mechanism of
injuries due to inappropriate restraint. The key message is that the
vast majority of parents across the country are not adequately
protecting their 4-to-8-year-old children in crashes. These parents can
do a better job by appropriately restraining these children in belt-
positioning booster seats in the rear seat of their vehicles on every
ride.
With just two years of data collection, Partners for Child
Passenger Safety has collected information on more than 90,000 crashes
involving roughly 137,000 children under age 16. Based on these
numbers, we estimate that each year in the United States, more than 1.5
million children are passengers in motor vehicle crashes. More than 750
children will be injured today, nearly 100 of these children will be
seriously injured. Unfortunately, the most common serious injuries are
to the brain, which can lead to devastating long-term disabilities.
Motor vehicle crashes are very violent events that occur in
milliseconds, in the blink of an eye. Our data indicate that nearly
half of crashes involving children occur within seven minutes from
home. All it takes is a split second for an errand, a car pool, or a
family outing to turn into tragedy.
Last summer we learned of a tragic case in which a 7-year-old,
we'll call him Jared, was the only fatality. On a warm June evening in
Arizona, Jared's father swerved and crossed the center line of the
highway and struck a pickup truck head-on. There were no airbags in the
vehicle, yet Jared's father survived this serious crash without brain,
spinal cord, or organ injury. Jared, unfortunately, was inappropriately
restrained in a lap-shoulder belt in the front seat of his father's
mid-size sedan. During the crash, his sub-optimal restraint allowed him
to move forward and strike the windshield. Jared suffered a lethal
injury to his cervical spine--a fracture with complete dislocation. If
Jared had been restrained in a belt-positioning booster seat in the
back seat of his father's car, he likely would have survived. His
younger siblings in the rear seat survived the crash. A simple action--
using the appropriate restraint and placing the child in the rear
seat--could have likely prevented a family's lifetime of mourning.
Just a few months ago, I learned of another preventable tragedy. At
7:00 in the morning, a 5-year old girl from Ohio, let's call her
Latasha, was the only passenger injured in a moderate severity crash.
Her 22-year old mother was driving their full-size sedan when another
vehicle made a left turn into the path of their vehicle, impacting the
right side. Latasha's mother, who was wearing her lap and shoulder
belt, was uninjured. Latasha's 18-month-old sister, who was
appropriately restrained in her child safety seat in the rear seat, was
uninjured. Latasha, who was sitting in the right rear seat next to her
sister, was inappropriately restrained in a lap-shoulder belt. Latasha
suffered bilateral severe kidney damage. Our investigation indicated
that the inappropriate restraint caused the serious injuries known as
``seat belt syndrome.'' If Latasha had been restrained in a belt-
positioning booster seat, she would likely have been uninjured.
Preventable injuries such as these occur every day.
Our data indicate that most parents ensure that their children are
restrained. The simple act of restraining a child makes it three times
less likely that that child will be injured in a crash. Many parents
further protect their children by placing them in the back seat,
thereby making it an additional two times less likely that their
children will be injured in most vehicles. Further, most parents ensure
that their youngest children are restrained in child safety seats.
Accordingly, these children have the lowest chance of getting injured
of any age group.
However, I am particularly concerned with children between age 3
and 8 years. That is where our data show an alarming decrease in
recommended restraint use [refer to recommended restraint use chart--
Attachment A]. Note the u-shape in this graph of recommended restraint
use by age. More than 80 percent of children through age 2 years are
appropriately restrained. Beginning at age 3, appropriate restraint
drops to 52 percent. By age 4, the most prevalent form of restraint is
the adult seat belt. Only 24 percent of children age 4 are in booster
seats. By age 7, virtually no children are in booster seats. Instead of
using car seats or belt-positioning booster seats, many children ages
3-to-8 years old are inappropriately restrained in adult seat belts.
For optimal protection during crashes, children should ride in child
safety seats with full harness until the seat is completely outgrown
based on manufacturer height and weight limits. This is usually around
4 years old and 40 pounds, at which point children should be placed in
belt-positioning booster seats. They should remain in the belt-
positioning booster seat until they are big enough for the adult seat
belt to fit correctly. Correct adult seat belt fit is not achieved
until a child is at least 4 feet 9 inches tall and 80 pounds, often
around the age of nine.
Last June, Partner's for Child Passenger Safety published an
article in the journal Pediatrics about the risk of premature
graduation of children to adult seat belts. We found that 2-to-5-year-
old children who were placed in adult seat belts were 3.5 times more
likely to suffer significant injury and four times more likely to
suffer head injury when compared to children in the same age group who
used car or booster seats. There is a 50 to 75 percent reduction in
serious injuries to child passengers who are placed in belt-positioning
booster seats rather than seat belts alone.
Why are booster seats so much more effective than adult seat belts
in protecting 4 to 8-year-olds in car crashes? Standard equipment
vehicle seat belts are designed for adults. During a crash, adult seat
belts spread the forces of the crash over the strong, hard bones--the
hips, shoulders, and chest--and keep the occupant in place so that the
head, face and chest are less likely to strike the inside of the
vehicle. An adult seat belt fits correctly when the lap portion of the
belt rides low over the hips and the shoulder portion of the belt
crosses the sternum and shoulder. Correct seat belt fit is not usually
achieved until a child is 9 years old, the age at which the child's
thigh is long enough for the child to sit against the back of the seat,
the hips are sufficiently developed to anchor the belt, and the child's
sitting height is sufficient for the shoulder belt to fit properly over
the shoulder and sternum.
When a child is ``prematurely graduated'' to an adult seat belt,
the lap portion of the belt rides up over the soft abdomen and the
shoulder portion crosses the neck or face, causing many children to
move the shoulder belt behind their back or under their arm. Incorrect
fit of the vehicle belt places the child at risk for ``submarining'' or
sliding out of the lap belt during a crash. Rapid, ``jack-knife''
bending around a poorly positioned vehicle adult seat belt increases
the risk of intra-abdominal and spinal cord injuries, also known as
``seat belt syndrome'' and brain injury due to impact of the head with
the child's knees or the vehicle interior.
Our data indicate that the majority of the injuries to children
prematurely graduated to seat belts are to the head, likely due to
excessive head excursion. In addition, Partners data show that children
in adult seat belts suffered the only reported cases of abdominal
injuries, including intestinal, liver, and spleen injuries.
Let me demonstrate the safety advantage of a belt-positioning
booster seat by this crash simulation. [Booster seat crash simulation
computer model] The above simulation shows a 6-year-old child properly
restrained in a belt-positioning booster seat. This child barely moves
during the 35 m.p.h. crash. This same child is represented in the below
simulation of the same crash. She is improperly restrained in an adult
seat belt. Like many children, she has slipped the shoulder portion of
the belt behind her back. As you can see, she is thrown forward
dramatically. The inappropriate fit of the adult seat belt and lack of
upper body restraint puts the child at risk for severe head, spine,
abdominal and brain injury.
What is at stake is the safety of our children. Under contract to
the National Highway Traffic Safety Administration, we conducted focus
groups and in-depth discussions with parents about the barriers to
using belt-positioning booster seats. There are many reasons parents
give for prematurely placing their child in vehicle seat belts. Some
parents are unaware of the likelihood of crashes and the injuries that
can result. Others are not awareof current best practice regarding
child passenger safety. Still others do not realize that children are
actually more comfortable in belt-positioning booster seats rather than
in adult seat belts alone. Clearly, education is needed.
Parents with older vehicles face additional challenges in finding a
child restraint compatible with vehicles that only have lap belts in
the rear seat. Clearly, there is a role for new technologies.
However, many parents of 4-to-8-year-old children are aware of the
risks of crashes, are aware of the injuries, know that belt-positioning
booster seats can reduce the risk of injuries, and have vehicles that
can accommodate belt-positioning booster seats in the rear. Yet, they
fail to use these devices. According to parents in our focus groups,
the only strategy to ensure that these parents are optimally protecting
their children is through strong laws that are enforced.
Our current laws are not in alignment with best practice
recommendations from the National Highway Traffic Safety Administration
and the American Academy of Pediatrics and this serves as a source of
confusion for parents. Much of the opposition to closing the gaps in
child passenger restraint laws concerns the inconvenience and cost to
adults to comply with these laws. My question to you, Senators, is
this: What value do we, as a nation, place in the life of a child? A
backless belt-positioning booster seat costs less than $20 at my local
retailer.
I am happy to say that State Farm Insurance Companies and The
Children's Hospital of Philadelphia are doing their part. We have
collaborated in many efforts to get the appropriate restraint message
to parents and have now collaborated to produce the nation's first in-
school curriculum, called Safe Cruisin' with the Good Neigh Bear, to
educate young children about booster seats. We regularly share our
study data with doctors, advocates, regulatory agencies, and
manufacturers. In 2001 we will be producing state-specific fact sheets
on each state involved in the Partners study to aid advocates in their
educational efforts. But there is much more to be done.
Efforts such as these have resulted in an increased awareness of
booster seats. For the first time, Partners data is showing a trend of
increased booster seat use. Maybe the climate is right for closing the
gap in occupant restraint laws to require booster seats for older
children.
If parents continue to restrain their young children in vehicle
seat belts or, worse, not restrain them at all, we will continue to
have tragic, preventable, costly injuries to our children, our most
precious resource. As a pediatrician, pediatric injury researcher, and
mother of two young children, I am here to provide a voice for
children, all children. They need our protection. They need appropriate
restraint on every ride.
Mr. Chairman, I am ready to respond to any questions the Committee
might have.
______

Senator Fitzgerald. Thank you, Dr. Winston.
Dr. Quinlan from the Department of Pediatrics at the
University of Chicago. Thank you for being here.

STATEMENT OF KYRAN QUINLAN, M.D., MPH,
DEPARTMENT OF PEDIATRICS, UNIVERSITY OF CHICAGO

Dr. Quinlan. Thank you. Good morning, Mr. Chairman. My name
is Kyran Quinlan. I am a board-certified pediatrician on the
faculty at the University of Chicago. I am an injury
epidemiologist, trained at the National Center for Injury
Prevention and Control at the Centers for Disease Control and
Prevention, and I have a master's in public health in
epidemiology. I am a child passenger safety researcher, a
clinician, and a fellow in the American Academy of Pediatrics.
I also have personal experience caring for children who have
suffered preventable crash injuries. I regularly counsel
parents in my practice on the need for belt-positioning
boosters and I was a part of the recent unsuccessful attempt
for a booster law in the chairman's home state of Illinois.
Thank you for this opportunity to discuss this important
issue. I am here today with two recommendations: First, that
Congress promote booster laws in each state; and second, that
Congress support the National Highway Traffic Safety
Administration to lead an intensive and sustained public
education campaign to promote belt-positioning boosters.
Motor vehicle trauma is the leading threat to the health of
our children. While most age groups have experienced recent
significant declines in crash deaths, the unchanging annual
count of 500 dead and nearly 90,000 injured has clearly
established the 4 to 8 year age range as the forgotten children
in traffic safety.
These children are real. There was the 5 year old boy who
was brought to our hospital recently after a crash. He was
small for a 5 year old and, despite being buckled in a lap-
shoulder belt, he was ejected from his family's car.
Unconscious and bloody, he lay motionless in the street with a
broken skull, pelvis, thigh, and shin bones. He lived and his
bones will mend, but he will have a long road back with
rehabilitation for his severe brain injury.
Then there was the 8 year old boy we recently treated. He
had put the shoulder belt behind his back to keep it from
rubbing and cutting across his neck. In the instant he was
thrown violently forward in the crash, the poorly fitting lap
belt crushed his soft internal organs and then fractured his
spine, leaving him paralyzed. Multiple abdominal surgeries were
successful at repairing the injuries to his intestines and
other internal organs. Much less successful, however, have been
the attempts to bring him out of the growing depression from
realizing that, while only 8 years old, he will never walk
again.
Too big for a car seat, not big enough for seat belts made
for adults, these children need belt-positioning booster seats.
But few families are using them. Data from Partners for Child
Passenger Safety, from Dr. Winston, tell us that in our state
specifically, Mr. Chairman, that at most 20 percent of the 4 to
5 year olds are using boosters, just a handful of 6 year olds
do, and virtually no 7 or 8 year olds are currently using
booster seats.
This fits with what I see in my practice on the South Side
of Chicago. I recently saw a family with a 4 year old who had
outgrown her car seat, her forward-facing car seat, and was
using just a seat belt. I discussed the need for a belt-
positioning booster and advised the family to get her one. The
next time I saw them, they had not gotten a booster seat. The
mom said: I remember what you told me, I remember you told me
that my daughter's back could break in a crash and that she
could be paralyzed, but I just have not gotten around to it
yet.
Being able to say that riding without a booster is against
the law would help me to persuade parents to use one.
So I recommend first that Congress promote booster laws in
each state. The laws should require children to be in belt-
positioning boosters from the time they outgrow a forward-
facing car seat and until they are large enough to sit safely
using the vehicle lap-shoulder belt. So far just three states--
Washington, California, and Arkansas--have passed booster laws.
Many other states, including our own home state, Mr. Chairman,
have introduced booster bills, but have not been successful in
passing them.
Booster laws will protect children. Fewer children will be
injured and fewer will be killed when it becomes illegal to
ride without one.
Second, Congress should support NHTSA to lead an intensive
and sustained public education campaign to promote belt-
positioning booster seats. Related to this is the section
2003[b] of TEA-21, that is the child passenger protection
education grants which fund innovative demonstration projects.
Funding for section 2003[b] should be extended.
While a huge undertaking, safety promotion on this scale
has been done successfully before. 25 years ago, just a handful
of infants and toddlers used car seats. Today usage in these
two groups, as you mentioned, is over 90 percent. We can
promote belt-positioning boosters and we will see an increase
in their use. How quickly that happens will depend in part on
the degree of different investment in promoting them now and
promoting reasonable laws regarding their use.
This is an exciting and historic time in child passenger
safety, similar in many respects to 1977, when Tennessee passed
the first car seat law. By 1985, just 8 years later, all states
had one and putting an infant in a car seat started to become
just what you do. Seeing the day that belt-positioning booster
seats are in common use will require laws supported by
sustained public education.
Thank you for the opportunity to testify here today. I
would be happy to answer any questions that you have.
[The prepared statement of Dr. Quinlan follows:]

Prepared Statement of Kyran Quinlan, M.D., MPH, Department of
Pediatrics, University of Chicago
Good morning Mr. Chairman and Members of the Subcommittee. My name
is Kyran Quinlan. I am a pediatrician on faculty at the University of
Chicago. I am a clinician, a child passenger safety researcher and a
member of the American Academy of Pediatrics. Thank you for this
opportunity to discuss this important issue.
We are talking today about how to better protect our children from
the greatest threat to their health. In the United States, nothing
kills more children than motor vehicle crashes. Each year, about 500 of
our children aged 4-8 years die and another 90,000 are injured while
riding in a motor vehicle. With most occupant safety attention focused
on younger child passengers, this older group of what has been termed
``forgotten children'' has not experienced any real decrease in their
occupant fatality rates over the last 20 years.
These children are real. I could tell you about the 5-year-old boy
who was brought to the University of Chicago recently after being in a
crash. He was small for a 5-year-old. Despite being buckled up in a
lap/shoulder belt, he was ejected from his family's car. Unconscious
and bloody, he lay motionless in the street with a broken skull,
pelvis, thigh and shin bones. He lived, and his bones will mend, but he
will have a long road back with rehabilitation for his severe head
injury. Or I could tell you about the 8-year-old boy who was recently
cared for at our hospital after being in a crash. He put the shoulder
belt behind his back to keep it from rubbing and cutting across his
neck. In the instant he was thrown violently forward in the crash, the
only thing that stopped him was the poorly-fitting lap belt. After
crushing his soft internal organs, the lap belt then found and
fractured his back bone leaving him paralyzed. Multiple abdominal
surgeries were successful at repairing the injuries to his intestines
and other internal organs. Much less successful however, have been the
attempts to bring him out of the growing depression from realizing that
while only 8, he will never walk again.
These children are too big for a car seat, but are not big enough
to fit safely in the seat belts of the car. They need booster seats to
raise them up so that the lap belt fits low and snug across their upper
thighs and the shoulder belt crosses their collarbone and not their
neck. Not using a booster seat puts these children at unnecessary risk.
As you have just heard from Dr. Winston, there is good evidence that
boosters protect children, but few families are using them. In Illinois
specifically, Dr. Winston's system tells us that at most about 20
percent of the 4-5-year-olds use boosters, just a handful of 6-year-
olds do, and virtually no 7- or 8-year-olds do.
This fits with what I see on the south side of Chicago. I recently
saw a family with a 4-year-old who had outgrown her car seat and was
using just a seat belt. I discussed the importance and need for a
booster and advised them to get one for her. At the next visit, they
told me they had not gotten a booster. I frankly told them I was
interested to know if there was something I could have said that would
have been more persuasive the first time. The mom said, ``no, I
remember what you said. You told me that without a booster, my
daughter's back could break and she could become paralyzed in a crash,
but I just hadn't gotten around to it.'' I could use help to convince
parents to use boosters. Being able to say that riding without a
booster is against the law would certainly help.
So there's a real problem here. We're dealing with the leading
killer of children, and we know that boosters protect children, but
changing the way people buckle their children up is difficult.
What do I think Congress can do? 2 main things:

1. Congress should promote booster laws in each state. These
laws should require children to be in boosters from the time
they outgrow a forward-facing car seat until they are large
enough to sit safely using the vehicle lap/shoulder belt. So
far, just three states, Washington, California, and Arkansas
have booster laws. Many other states have introduced booster
bills but have not been successful. I was part of the recent
unsuccessful effort to pass booster legislation in Illinois.
Congress should consider providing incentives to the states to
pass booster laws. Tying the receipt of state highway funds to
passing a booster law is one mechanism. Booster laws will
protect children. Less children will be injured and less
children will be killed when it becomes illegal to ride without
a booster.

2. Congress should support the National Highway Traffic Safety
Administration to lead an intensive and prolonged public
education campaign to promote booster seats. The recent booster
promotion efforts by NHTSA and the National SAFE KIDS campaign
have been significant, but much more needs to be done. We are
talking here about changing a social norm, changing the way
virtually everyone buckles up this group of children. While it
is a huge undertaking, safety promotion on this scale has been
done successfully before. Twenty five years ago, just a handful
of infants and toddlers used car seats. Today, usage in these
two groups is over 90 percent. We can promote boosters, and we
will see increased use of boosters. How quickly that happens
will, in part, depend on the degree of federal investment in
promoting boosters now.

Thank you, Mr. Chairman, for the opportunity to testify here today.
I look forward to the day when parents would not think of taking a trip
without their child in a booster. Getting booster use to be that common
can be achieved through booster laws and intensive and sustained public
education. I would be happy to answer any questions you and the members
of the Subcommittee may have.
______

MMWR (Morbidity and Mortality Weekly Report)
February 25, 2000/49(07);135-7
Motor-Vehicle Occupant Fatalities and Restraint Use Among Children Aged
4-8 Years--United States, 1994-1998
In the United States, more children aged 4-8 years die as occupants
in motor-vehicle--related crashes than from any other form of
unintentional injury (1). To reduce the number of deaths and injuries
caused by motor-vehicle-related trauma, child passengers in this age
group should be restrained properly in a vehicle's back seat (2). To
characterize fatalities, restraint use, and seating position among
occupants aged 4-8 years involved in fatal crashes, CDC analyzed 1994-
1998 data from the Fatality Analysis Reporting System (FARS), which is
maintained by the National Highway Traffic Safety Administration
(NHTSA). This report summarizes the results of that analysis, which
indicate that during 1994-1998, little change occurred in the death
rate, restraint use, and seating position among children aged 4-8 years
killed in crashes.
Motor-vehicle occupants who died in crashes during 1994-1998 were
included in the analysis of FARS data. FARS is a census of traffic
crashes in which at least one occupant or nonmotorist (e.g.,
pedestrian) died within 30 days of a crash on a public road within the
50 states, District of Columbia, and Puerto Rico. FARS includes
information about restraint use and seating position derived from
police crash reports. Restraint use (e.g., seat belts, child-safety
seats [CSSs], and belt-positioning booster seats) was reported as used
or not used. Seating position was designated as front, back, other, or
unknown. Injury death rates per 100,000 population were calculated
using annual estimates from the Bureau of the Census.
During 1994-1998, 14,411 child occupants aged 4-8 years were
involved in crashes where one or more fatalities occurred; of these,
2549 (17.7 percent) died. Approximately 500 child occupants died each
year during the study period; the average annual age-specific death
rate was 2.6 per 100,000 population (Table 1). In 1994, restraint use
among fatally injured children was 35.2 percent (177 of 503); in 1998,
restraint use was 38.1 percent (201 of 527). The proportion of fatally
injured children seated in the back seat of a vehicle involved in a
crash was 50.1 percent (252 of 503) in 1994 and 53.7 percent (283 of
527) in 1998.
Reported by: Div of Unintentional Injury Prevention, National
Center for Injury Prevention and Control, CDC.

TABLE 1. Number of deaths, death rate,* restraint use, and seating position among fatally injured motor-vehicle
occupants aged 4-8years--United States, 1994-1998
----------------------------------------------------------------------------------------------------------------
No. Restrained No. seated in Seated in back
Year No. deaths Death rate restrained (in percent) back (in percent)
----------------------------------------------------------------------------------------------------------------
1994 503 2.65 177 35.2 252 50.1
1995 498 2.58 168 33.7 208 41.8
1996 499 2.55 188 37.7 250 50.1
1997 522 2.64 198 37.9 257 49.2
1998 527 2.66 201 38.1 283 53.7
----------------------------------------------------------------------------------------------------------------
Total 2549 2.61 932 36.6 1250 49.0
----------------------------------------------------------------------------------------------------------------
*Per 100,000 age-specific population.
Source: Fatality Analysis Reporting System, National Highway Traffic Safety Administration.

Editorial Note: During 1994-1998, child occupant death rates did
not decrease, restraint use among fatally injured child occupants
changed little, and the proportion of fatally injured children seated
in the back seat of a motor vehicle involved in a crash remained fairly
constant. Children aged 4-8 years represent a special population for
motor-vehicle occupant protection. Having outgrown CSSs designed for
younger passengers, children aged 4-8 years frequently sit unrestrained
or are placed prematurely in adult seat belt systems. Public health and
traffic safety organizations recommend that children in this age group
be restrained properly in booster seats (3). This study found that
nearly two thirds of fatally injured children were unrestrained at the
time of the crash. Only 4%-6% of children aged 4-8 years used booster
seats when riding in motor vehicles (4,5).
Belt-positioning booster seats raise a child so that the shoulder
belt fits securely between the neck and arm and the lap belt lies low
and flat across the upper thighs. Children do not fit in adult lap/
shoulder belts without a booster seat until they are 58 inches tall and
weigh 80 lbs (3,6). Children should ride in a booster seat from the
time they graduate from their forward-facing CSS until approximately
age 8 years or until they are tall enough for the knees to bend over
the edge of the seat when the child's back is resting firmly against
the seat back.
Despite recommendations for children to ride in the back seat
whenever possible to reduce risk for injury in a crash, approximately
one fourth of child passengers ride in the front seat (7). Riding in
the back virtually eliminates injury risk from deployed front-seat
passenger air bags and places the child in the safest part of the
vehicle in the event of a crash. As of January 1, 2000, 35 children
aged 4-8 years have died while seated in front of air bags. Of these
children, 31 (89 percent) were either unrestrained or improperly
restrained (8). Riding in the back seat is associated with at least a
30 percent reduction in the risk for fatal injury (9). Approximately
half of those children in this study who were fatally injured were
sitting in the back seat.
The 50 states, District of Columbia, and Puerto Rico have child-
passenger safety laws; however, substantial gaps in coverage exist for
child passengers aged 4-8 years. For example, in 19 states, children
this age can ride unrestrained in the back seat of a motor vehicle. In
most states, children as young as age 4 years may use an adult seat
belt. No state requires the use of booster seats for children who have
outgrown their CSSs (10). Three states have laws requiring that
children be seated in the back seat of passenger vehicles. The ages of
the children covered by these laws vary by state.
The findings in this study are subject to at least three
limitations. First, police crash reports overestimate restraint use;
therefore, restraint use may be lower for children in this age group.
Second, vehicle miles traveled have increased during 1994-1998;
consequently, improvements in fatality rates may be masked by increased
exposure to travel. Finally, increases in restraint use and resulting
changes in occupant fatalities may require many years of investigation
before they become apparent.
Reducing fatalities among motor vehicle occupants aged 4-8 years
will require finding effective strategies to promote booster seat use
and placement of children in the back seat. Public health and traffic
safety efforts should be accelerated to increase appropriate occupant
protection among children aged 4-8 years as a primary means to reduce
fatal motor-vehicle--related injuries. Efforts are under way by CDC and
others to determine the best ways to encourage booster seat use and to
increase the prevalence of properly restrained children riding in the
back seat.
References
1. National Center for Health Statistics. Annual mortality tapes.
Hyattsville, Maryland: US Department of Health and Human Services, CDC,
1994-1998.
2. National Transportation Safety Board. Safety recommendation.
Washington, DC: National Transportation Safety Board, 1997.
3. CDC. National Child Passenger Safety Week--February 14-20,
1999. MMWR 1999;48:83-4.
4. Winston FK, Durbin DR, Bhatia E, Werner J, Sorenson W. Patterns
of inappropriate restraint for children in crashes. Joint session
organized by the European Vehicle Passive Safety Network, AAAM, and
IRCOBI. London, England: Professional Engineering Publishing Limited,
1999.
5. Decina LE, Knoebel KY. Child safety seat misuse patterns in
four states. Accid Anal Prev 1997;29:125-32.
6. American Academy of Pediatrics Committee on Injury and Poison
Prevention. Selecting and using the most appropriate car safety seats
for growing children: guidelines for counseling parents. Pediatrics
1996;97:761-2.
7. Segui-Gomez M, Glass R, Graham JD. Where children sit in motor
vehicles: a comparison of selected European and American cities. Injury
Prevention 1998;4:98-102.
8. National Highway Traffic Safety Administration. Special crash
investigations monthly counts for airbag-related fatalities and
seriously injured persons. Washington, DC: National Highway Traffic
Safety Administration, 2000.
9. Braver ER, Whitfield R, Ferguson SA. Seating positions and
children's risk of dying in motor vehicle crashes. Injury Prevention
1998;4:181-7.
10. Insurance Institute for Highway Safety. Child restraint, belt
laws as of January 2000. Available at: http://www.highwaysafety.org/
safety_facts/state_laws/restrain.htm. Accessed January 31, 2000.
______

MMWR (Morbidity and Mortality Weekly Report)
February 5, 1999/48(04); 83-84
Notice to Readers
National Child Passenger Safety Week--February 14-20, 1999
In 1997, 1791 U.S. children aged <15 years were killed and 282,000
were injured while riding in motor vehicles (1). National Child
Passenger Safety Week, February 14-20, 1999, will highlight safety
recommendations for children aged >4 years and weighing >40 lbs who
have outgrown their child safety seats.
Children who are too large for child safety seats often are
restrained improperly or not at all. A recent observational study in
four states indicated that, of children weighing 40-60 lbs, 75 percent
were improperly restrained, and 19 percent were unrestrained (2). Of
passengers aged 5-9 years in fatal crashes in 1997, 46 percent were
unrestrained (1).
For proper restraint, children who have outgrown child safety seats
require booster seats used with vehicle lap/shoulder belts. Lap/
shoulder belts usually do not fit children properly until they are 58
inches tall, have a sitting height of 29 inches, and weigh 80 lbs (3).
Therefore, children aged <10 years probably will not be big enough to
use a lap/shoulder belt without a booster seat. When smaller children
restrained with only a lap belt or a poorly fitting lap/shoulder belt
become involved in a crash, the belt tends to ride up onto the abdomen,
allowing the pelvis to slide under the belt. This places pressure
directly on the abdominal organs and may lead to the child flexing over
the belt above the hips, resulting in abdominal and/or spinal injuries
(4).
Children should remain in their convertible child safety seats as
long as they fit well. Convertible seats are the appropriate restraints
for children until their ears reach the top of the back of the safety
seat and their shoulders are above the top strap slots, or until they
reach the upper weight limit of the seat. To help prevent deaths and
injuries among young passengers who have outgrown their child safety
seats, CDC recommends the following:

Belt-positioning booster seats should be used until lap/
shoulder belts fit properly (5). Belt-positioning boosters
raise children so that the safety belt fits correctly (Figure
1) and should always be used with a lap/shoulder belt. Booster
seats with high backs are recommended for vehicles with seat
backs that do not support a child's head. Shield boosters,
which have a plastic shield in front of the child, do not
provide as much upper-body protection and are no longer
certified for children weighing >40 lbs. The American Academy
of Pediatrics recommends that shield boosters not be used for
children weighing <40 lbs, even if they are labeled for use at
a lower weight (6). Shield boosters should only be used with
their shields removed so they can function as belt-positioning
booster seats with lap-shoulder belts.

Lap/shoulder belts should fit properly (Figure 1). A child
cannot ride comfortably and remain properly restrained until
tall enough for the knees to bend over the edge of the seat
when the child's back is resting firmly against the seat back.

Whenever possible, child passengers should be placed in the
back seat.

The National Transportation Safety Board recommends that states
upgrade their child passenger protection laws to require age-
appropriate child restraint systems and booster seats for children aged
<8 years and has asked automobile manufacturers to redesign the back
seats of cars to be more accommodating to children (7). Additional
information on child passenger protection is available on the World-
Wide Web from the American Academy of Pediatrics at http://www.aap.org,
the Society of Automotive Engineers at http://www.sae.org, the National
Highway Traffic Safety Administration at http://www.nhtsa.dot.gov, the
National Transportation Safety Board at http://www.ntsb.gov, and CDC's
National Center for Injury Prevention and Control at http://
www.cdc.gov/ncipc.
References
1. US Department of Transportation, National Highway Traffic
Safety Administration. Children: traffic safety facts 1997. Washington,
DC: US Department of Transportation, National Highway Traffic Safety
Administration, 1998.
2. Decina LE, Knoebel KY. Child safety seat misuse patterns in
four states. Accid Anal Prev 1997;29:125-32.
3. Klinch KD, Pritz HB, Beebe MS, et al. Study of older child
restraint/booster seat fit and NASS injury analysis. Washington, DC: US
Department of Transportation, National Highway Traffic Safety
Administration, November 1994; report no. DOT-HS-808-248.
4. Lane JC. The seat belt syndrome in children. Warrendale,
Pennsylvania: Society of Automotive Engineers, 1993:159-64. (SAE no.
933098).
5. American Academy of Pediatrics, Committee on Injury and Poison
Prevention. Selecting and using the most appropriate car safety seats
for growing children: guidelines for counseling parents. Pediatrics
1996;97:761-2.
6. American Academy of Pediatrics. 1998 family shopping guide to
car seats. Elk Grove Village, Illinois: American Academy of Pediatrics,
1998.
7. National Transportation Safety Board. The performance and use
of child restraints, seatbelts, and air bags for children in passenger
vehicles. Washington, DC: US Department of Transportation, 1996;
document no. NTSB/SS-96/01.
______

Senator Fitzgerald. Thank you, Dr. Quinlan.
Ms. Stone, thank you for being here. You are the State of
Advocates for Highway and Auto Safety, and I compliment you for
your long-time involvement in this issue.

STATEMENT OF JUDITH LEE STONE, PRESIDENT,
ADVOCATES FOR HIGHWAY AND AUTO SAFETY

Ms. Stone. Thank you so much, Mr. Chairman. Advocates has a
long history of working on state and federal initiatives to
improve child passenger safety. We have been at the forefront
of lobbying in the states to close deadly loopholes in child
restraint laws, to urge adoption of laws to encourage everyone
to buckle up, and pushing the U.S. DOT to address regulatory
gaps and omissions that affect the safety of children.
In 1991 the Senate Commerce Committee authored and enacted
a NHTSA reauthorization bill that contained a motor vehicle
safety agenda as part of the larger ISTEA legislation. Under
the leadership at that time of Senators Hollings, Danforth,
Bryan, and Gorton, this legislation was a watershed for
improvements in passenger vehicle safety.
One of the provisions in ISTEA was intended to upgrade the
safety of booster seats. More recently, the TREAD Act includes
many provisions that can enhance the safety of child occupants
and we commend you, Senator Fitzgerald, and other co-sponsors
for your legislation and the reforms that it requires.
Why should we be concerned at this time? Today there are
over 20 million children in this age group of about 4 to 9, and
each year approximately 500 children ages 5 to 9 die, the
equivalent of two to three elementary school populations.
Nearly 100,000 more are injured as occupants in passenger
vehicles. 40 percent of the children killed are completely
unrestrained.
While other children, those in the ranges of zero to 4
years and 10 to 15 years, have experienced reductions in death
and injury in motor vehicle crashes over the past 20 years, the
rate for those in this category, ages 5 to 9, has remained
constant during that same period. Obviously we are not doing
enough to protect these children.
Since the back seat is supposed to be safer for children,
it is our obligation as a society to provide for the safety of
those children when their parents and guardians follow this
safety recommendation.
There are no federal safety standards for booster seats
recommended for children over 50 pounds, as you have heard and
others have said, and recommendations for their use are
dependent upon voluntary manufacturer testing, with no
government oversight. While booster seats may have backs or
arms that prevent the lap belt portion of the seat belt from
changing position, neither of these features are required by
federal law.
There are no structural or performance requirements for
booster seats. Booster seats that are recommended for children
who weigh 50 pounds or less fall within the scope of the
existing child restraint standard.
States are moving to enact laws requiring booster seat use.
Within the last 2 years, 3 states have passed booster seat laws
and 15 to 20 states have introduced some form of booster seat
legislation just this year.
Laws requiring the use of booster seats are important
because they better protect children who use them and they
educate parents and guardians. Currently, only 6.1 percent of
booster-aged children are restrained in booster seats and
booster seat laws will undoubtedly increase the percentage of
children using them.
What federal regulatory actions are needed? In 1991
Advocates worked with this Committee to enact into law
legislative language in the ISTEA bill, which I mentioned
before, which conferred broad legislative authority on NHTSA to
address the safety of child booster seats used in passenger
cars. Congress intended the agency to take aggressive action to
improve the regulation and protection afforded by booster
seats. Unfortunately, NHTSA responded narrowly and only took
action to delete the prohibition against belt-positioning
booster seats so that they now can be used without an overhead
tether.
This was a squandered opportunity for comprehensive
improvements in booster seat protection. Advocates strongly
recommends that these federal regulatory actions be implemented
immediately. NHTSA should expand the scope of the child
restraint standard to children who weigh up to 80 pounds. NHTSA
should establish minimum requirements for booster seat
performance and structural integrity, including booster seat
back requirements that afford head and neck protection,
requirements for the height of the booster seat platform, and
requirements to ensure that the belt-positioning features
function as designed.
NHTSA should develop a child test dummy that is
representative of a 10 year old child that can be used in
testing booster seats.
NHTSA should upgrade the seat back strength standard to
protect against injuries from front seats collapsing onto
children in the rear seat. This standard has not been
substantially revised since 1971 and failure of a front seat
back in a crash resulting in its falling back onto the space
occupied by a child in the rear greatly endangers the child.
Because the rear seat environment is not fully friendly for
children ages 4 to 8 years old, other actions need to be taken.
Auto manufacturers should make built-in booster seats standard
equipment in some model lines and promote the availability of
this option in other models. Some manufacturers say these are
available, but few dealers know about them and say that they
can provide them.
As more states enact child booster seat laws, there will be
a demand for built-in booster seats. It will make compliance
and enforcement of these laws easier and more effective.
NHTSA and auto manufacturers should seek other
opportunities to enhance the safety of children in the rear
seat environment, including providing head restraints that
protect taller children, vehicle seat designs that better
accommodate children, and making adjustable upper anchorages
for safety belts available as standard equipment in all rear
seating positions of all passenger vehicles.
Thank you, Mr. Chairman. I am happy to answer questions.
[The prepared statement of Ms. Stone follows:]

Prepared Statement of Judith Lee Stone, President, Advocates for
Highway and Auto Safety
Summary of Testimony
Advocates for Highway and Auto Safety
Child restraints are required and regulated for children up to four
years of age, and lap/shoulder belts are designed to protect adults. In
between is the ``forgotten child,''roughly ages 5 to 9 years old, who
has not been the focus of safety laws and regulations. There are over
19.5 million children in the 5 to 9 year old age group, and about 500
of these children die each year as occupants in motor vehicle crashes.
The motor vehicle fatality rate for this age group has remained
constant over the past two decades, despite the fact that the fatality
rate has decreased for other age groups--children 0 to 4, and children
10 to 15 years old, in the same time period.
In addition, safety recommendations from government agencies and
private organizations alike advise parents to place their children in
the rear to maximize their safety. The safety of these children can be
improved by requiring the use of booster seats, so that adult lap/
shoulder belts will better fit these children, by regulating the
performance of booster seats to ensure safety, and by making changes to
improve the rear seat environment to afford children a safer ride.
Advocates' testimony contains the following recommendations:

Every state should adopt a mandatory booster seat use law.

NHTSA should expand the scope of the child restraint
standard to children who weigh up to 80 pounds.

NHTSA should establish minimum requirements for booster seat
performance and structural integrity including booster seat
back requirements that afford head and neck protection,
requirements for the height of the booster seat platform, and
requirements to ensure that belt-positioning features function
as designed.

NHTSA should develop a child test dummy that is
representative of a 10-year-old child that can be used in
testing booster seats.

NHTSA should upgrade the seat back strength standard to
protect against injuries from front seats collapsing onto
children in the rear seat.

Auto manufacturers should make built-in booster seats
standard equipment in some model lines and promote the
availability of this option in other models.

NHTSA and vehicle manufacturers should seek other
opportunities to enhance the safety of children in the rear
seat environment including providing head restraints that
protect taller children, vehicle seat designs that accommodate
children, and making adjustable upper anchorages for safety
belts available as standard equipment in all rear seating
positions of all passenger vehicles.
I. Introduction
Good morning, Mr. Chairman and Members of the Subcommittee on
Consumer Affairs, Foreign Trade and Tourism. My name is Judith Lee
Stone, and I am the President of Advocates for Highway and Auto Safety
(Advocates), a coalition of consumer, health and safety groups and
insurance organizations working together to reduce motor vehicle deaths
and injuries. Since its inception in 1989, Advocates has been involved
in all aspects of child safety and protection issues in motor vehicles.
Advocates has conducted legislative and educational campaigns to
promote child safety and child restraint use including the ``Children
At Risk'' campaign in 1993 and the ``Kids, Cars and Crashes'' campaign
launched in 1996. In 1999, I participated as a member of the Blue
Ribbon Panel--Protecting Our Older Child Passengers--which issued a set
of recommendations on child occupant safety, a copy of which I will
submit for the record. I currently serve as a member of the Advisory
Board of ``Partners for Child Passenger Safety,'' a ground breaking
research project at The Children's Hospital of Philadelphia supported
by State Farm Insurance Companies.
Advocates has been in the forefront of efforts to enact state laws
to improve child safety in motor vehicles including amendments to close
the gaps in existing state child restraint laws, and more recently,
booster seat laws. Despite many efforts, there remains a long list of
states whose occupant protection laws do not cover all ages of children
in every seating position. A chart of states with ``gaps'' in their
child restraint laws is attached to my testimony.
On Capitol Hill, Advocates has worked to include child safety
protection provisions in federal legislation such as the Intermodal
Surface Transportation Efficiency Act of 1991 (ISTEA). The Senate
Commerce Committee is to be commended for its role in drafting and
enacting the motor vehicle safety provisions contained in the ISTEA
legislation. Under the leadership of Senators Hollings, Danforth, Bryan
and Gorton, the 1991 ISTEA legislation was a watershed for improvements
in passenger vehicle safety. Ten years ago Advocates worked with the
Committee to include a provision in ISTEA intended to upgrade the
safety of booster seats.
Advocates has also provided assistance on safety provisions
contained in the Transportation Equity Act for the 21st Century (TEA-
21) and, most recently, the Transportation Recall Enhancement,
Accountability and Documentation or TREAD Act. Section 14 of the TREAD
Act includes many provisions that can enhance the safety of child
occupants, including improvements in child restraint testing, more
stringent injury criteria and performance requirements for booster
seats, to name just three. These and other child safety ideas were
originally contained in the Child Passenger Protection Act of 2000,
which was introduced by Sen. Fitzgerald as S. 2070 in the last
Congress, a bill that was wholeheartedly supported by Advocates.
Advocates is acutely aware of the need for improved child safety
and we have documented that this concern is shared by the American
public. In a 1999 poll, commissioned by Advocates, the eminent pollster
Lou Harris found that 93 percent of the American public overwhelmingly
supports the federal government's mission to set highway and auto
safety standards, including standards for child safety. A 1998 Lou
Harris poll showed that an impressive 90 percent of the public supports
aggressive enforcement of child safety seat laws.
While there have been improvements in safety for child passengers,
clearly more can and should be done. My testimony will address the
problem of the ``forgotten child,'' discuss what has been done on the
state and federal levels, and recommend actions to prevent the
continuation of needless deaths and injuries of our nation's children.
II. The Problem: Preventable Deaths and Injuries of Our Children
A. The ``Forgotten Child''
Each year approximately 500 children ages 5 to 9 die and nearly
100,000 more are injured as occupants in passenger vehicles. More than
40 percent of the children killed are completely unrestrained. Over the
past 20 years, between 1978 and 1998, the combined rate of motor
vehicle occupant deaths and injuries per one hundred thousand children
in the population has dropped significantly for children ages 0-4, by
35 percent, and for children ages 10-14, by 15 percent. The rate among
motor vehicle occupants ages 5-9, however, has remained constant. The
fatality rate for children in these age groups, when analyzed
separately from the injury data, tells a similar story. I have attached
to my testimony charts from the NHTSA's Fatal Analysis Reporting System
(FARS) that display these facts. These statistics are based on a
current population of over 19.5 million children in the 5 to 9 year old
age bracket.
While a great deal of attention has been paid to child restraint
systems for infants and toddlers, much less emphasis has been placed on
providing for the safety of children generally between 4 and 8 years of
age, and older, known as the ``forgotten child.'' These children have
outgrown their toddler-sized child restraints but are still too small
to fit properly in seat belt systems, the three-point lap/shoulder
belts made to fit adults. Since the back seat is supposed to be safer
for children than the front seat, and because parents are being told to
put their children in the back seat, it is our obligation as a society
to provide for the safety of those children when their parents follow
this safety recommendation.
B. Booster Seats: Child Restraints for Older Children
Child restraint systems were developed to protect young children in
moving vehicles. Child restraints for infants and toddlers generally
have a hard plastic shell including a back and sides and an internal
belt and buckle to hold the child securely within the restraint in the
event of a crash. While the federal child restraint safety standard
governs the structural performance and levels of safety protection
afforded children up to 50 pounds, the legal obligation to place
children in restraints emanates from mandatory child restraint use laws
passed by each of the 50 states, the District of Columbia, and Puerto
Rico. These state laws establish the maximum age or weight limit for
children who are required to be in a restraint system, and those limits
have predominantly been set at 4 years or 40 pounds.
Although booster seats are a type of child restraint, they are
intended for use by older children who because of their size have
outgrown child restraints made for toddlers. Toddler restraints are
intended to provide support and protection in a crash and keep the
child inside the restraint. Booster seats are only intended to provide
a platform that lifts the child up off the vehicle seat in order to
improve the fit of the child in the adult seat belt. An improper fit of
an adult seat belt causes the lap belt to ride up over the stomach and
the shoulder belt to cut across the neck. In a crash a seat belt that
does not fit properly can cause critical or even fatal injuries. In
addition, if the shoulder strap portion of the lap/shoulder belt is
uncomfortable, children will place it behind their backs, defeating any
safety benefits the belt system might provide. Studies show that most
adult belt systems do not fit children under 4'9'' and less than 80
pounds.
While booster seats may have backs, or arms that prevent the lap
belt portion of the seat belt from changing position, neither of these
features are required by federal law. In fact, there are no structural
or performance requirements, as such, for booster seats. Booster seats
that are recommended for children who weigh 50 pounds or less fall
within the scope of the existing child restraint standard. However,
most booster seats are recommended for children over 50 pounds and are
not covered by the federal child restraint standard. As a result,
booster seats are, for the most part, not regulated and recommendations
for their use are dependent upon voluntary manufacturer testing with no
government oversight.
III. Steps That Have Been Taken to Improve Child Passenger Safety on
the State and Federal Levels
A. State Laws
Within the last two years, three states have passed booster seat
laws. In March 2000, Washington enacted the first law requiring
children between a minimum of 4 years of age or over 40 pounds and a
maximum of 6 years of age or under 60 pounds to be in booster seats,
and it goes into effect on July 2, 2002. This law was inspired by
Autumn Skeen who is here today to testify. Her son was killed when he
was ejected from a vehicle while his seat belt was on. Even though the
seat belt remained buckled, it did not keep him in the seat.
In September 2000, California passed a law requiring children less
than 6 years of age or less than 60 pounds to be properly restrained in
a child passenger restraint system, effectively requiring booster
seats; it goes into effect on January 1, 2002. In February 2001,
Arkansas became the third state to adopt a booster seat law requiring
children up to age 6 and 60 pounds to be restrained in a child
passenger safety seat, again effectively requiring booster seats, and
the law will take effect later this year. While these states have led
the nation with new booster seat laws, many states are considering
following suit. Between 15 and 20 states have introduced some form of
booster seat legislation this year. Laws requiring the use of booster
seats are important because they better protect children who use them
and educate parents and guardians.
In addition to education, child restraint laws have been proven to
increase use rates. According to NHTSA, restraint use from birth to age
one is 97 percent, and ages one to four is 91 percent. From age five to
15, however, restraint use plummets more than 29 points to 68.7
percent. Additionally, a NHTSA study showed that only 6.1 percent of
booster-aged children were restrained in booster seats. Booster laws
would undoubtedly increase this percentage.
Furthermore, research supports the enactment of state booster seat
laws. The Children's Hospital of Philadelphia and State Farm Insurance
Companies have brought this issue to the forefront of the national
agenda on child passenger safety by creating the largest single
research project in the country and the first comprehensive study
devoted exclusively to pediatric motor vehicle injury. Findings from
this research initiative, ``Partners for Child Passenger Safety,'' show
that 83 percent of children in this country between the ages of 4 and 8
are improperly restrained in adult safety belts. Many of these
children, who should be using child safety seats or booster seats, are
instead prematurely graduated to adult safety belts. This inappropriate
restraint results in a 3.5-fold increased risk of significant injury
and a more than four-fold increased risk of significant head injury.
Advocates supports the adoption of booster seat laws in every
state.
B. Federal Regulation of Child Safety
Although in the last 20 years there has been unequivocal progress
in motor vehicle child safety, with improved child safety seat
protection and adoption of state laws requiring their use, there has
not been a great deal of progress with booster seats. The more we know,
the more we are compelled to act in order to ensure maximum protection
for every child of every age, on every ride in a motor vehicle. NHTSA
has been in the lead on improving child safety in a number of ways. For
example, in a 1995 final rule, the agency required child restraint
manufacturers to determine the recommended use of their restraints in
ranges of height and weight based on testing with different sizes of
child crash test dummies.
More recently, in 1999 NHTSA issued a rule to require a new system
of child restraint anchorages in order to reduce the chances of
incorrect installation of child restraints. At present, child
restraints are secured to the vehicle frame with the vehicle lap belt
or lap/shoulder belt system provided for adult occupants. The new
``LATCH'' system, which stands for ``lower anchors and tether for
children,'' provides a separate set of restraint-to-vehicle connectors
and an overhead tether strap. The requirement, which applies to toddler
restraints, but not to booster seats, is being phased-in and when fully
implemented after September 1, 2002, will require each new vehicle to
have a set of connecting bars that will interlock with matching
connectors on new child restraints. The LATCH system will allow child
restraints to be installed without using an adult lap belt or an adult
lap/shoulder belt. Vehicles are already being produced with ready-to-
use upper tether anchorages that will secure the top of the child
restraint to the vehicle chassis.
Although NHTSA's record on child safety is commendable in many
respects, and Advocates has strongly supported the agency in this area,
the agency has not taken action on other important child safety
initiatives. An opportunity to improve safety for the forgotten child
was provided by Congress in 1991. ISTEA included a provision authored
by the Senate requiring that NHTSA address through regulation the
``safety of child booster seats used in passenger cars and other
appropriate motor vehicles.'' Although Congress conferred broad
legislative authority on NHTSA and intended the agency to take
aggressive action to improve the regulation and safety protection
afforded by booster seats, NHTSA chose to respond narrowly. The only
action the agency took was to delete the prohibition against belt-
positioning booster seats, so that they now can be used without an
overhead tether. This de minimus response by the agency to the 1991
ISTEA requirement squandered an opportunity for comprehensive
improvements in booster seat protection for children ages 4-8 years.
To date, NHTSA has still made only a recommendation that when
children outgrow child restraint seats, at around 40 pounds, they
should be restrained in booster seats until they are big enough to fit
in an adult safety belt, at about 80 pounds and about 4'9'' tall. While
this recommendation is useful, it does little reduce the annual
fatality toll of 5-9 year olds. In 1999, another 500 children in this
age group died as occupants in motor vehicles. This is the equivalent
population of two or three elementary schools. Regulatory action is
needed to address the broader safety concerns of booster seat
performance and use, including expanding the scope of the child
restraint standard to cover booster seats for children who weigh up to
80 pounds.
IV. What Needs to Be Done: Advocates' Recommendations
A. The Rear Seat Environment
It has long been known that the rear seat is a safer location in
most crashes. In recent years this message has been included in the
recommendations to parents from many organizations, including NHTSA.
However, the rear seat of most passenger vehicles is not designed for
the comfort or safety of young children. Manufacturers have largely
been concerned with designing features to accommodate adults. Although
enormous resources have been expended to develop and market
entertainment equipment for children in motor vehicles, particularly in
the rear seat, by contrast little has been done to provide comfortable
seating for children that would enhance safety. Moreover, agency
regulations have also focused primarily on safety performance for
adults, and on requirements for add-on child restraints for children 0-
4 years old. As a result, the rear seat environment is not particularly
friendly for children ages 4 to 8 years old.
Adult seat belts do not fit or properly restrain younger children.
The required three-point lap/shoulder belt systems were designed for
adults and provide crash protection for adults ranging in size,
generally, from shorter females up to tall males. Adjustable upper
anchorages were introduced to improve the comfort and fit of lap/
shoulder belts for adults. But even with the addition of adjustable
upper anchorages, which allow for some movement in the positioning of
the shoulder portion of the belt, adult seat belts do not fit the
average sized 4 to 8 year old child. Moreover, NHTSA only requires
adjustable upper anchorages in the front seat, so only a small
percentage of vehicles even have adjustable upper anchors in the rear
outboard seating positions.
Even when a child is large enough to fit in a lap/shoulder belt,
most manufacturers provide lap/shoulder belts only in the rear outboard
seating positions, where children (and adults) are at greater risk in a
side impact crash. While some manufacturers make lap/shoulder belts
available as options in the center seating position, few provide this
design as standard equipment. Generally, only lap belts are available
for children in the center rear seating position.
Head restraints are also not currently required in rear seating
positions. While rear seat head restraints have become more popular in
recent years, they are still not available in most passenger vehicles
and are not standard equipment. The heads of taller children may rise
above the top of the vehicle seat back, especially if they are using a
backless booster seat. Thus, taller children using backless booster
seats may have no head and neck support in the event of a rear end
collision. At present, few booster seats are designed with backs.
Although the lack of head restraints in rear seating positions is most
certainly a problem for adults, it also poses a severe problem for
taller children since they are likely to have weaker neck muscles than
adults.
Rear seats are primarily designed to suit the comfort and
convenience of adults in terms of both seat angle and depth. Since
manufacturers have moved to angled or sloped seats to improve comfort
for adults, children end up sitting even lower and have less visibility
out of windows than when bench seats were the norm. In addition, the
depth of rear seats, from front to back, is too long for the shorter
legs of children, and particularly the shorter femurs (thigh bones) of
younger children, who cannot bend their legs at the knee if they are
seated with their backs against the vehicle seat back. As a result of
these two design features, children of booster seat age are often
uncomfortable when they sit back in the vehicle seat because they may
not be able to bend their legs at the knee. This discomfort motivates
children to move forward on the seat both to get a better view out of
the front windows because of the slope of the seat, and to sit more
comfortably with their legs bent and feet on the floor. This
positioning compromises the protection afforded by the seat belt and
booster seat.
Finally, the collapse of front seats in a crash also poses a danger
to children in the rear seat. When a front seat back fails in a crash,
it falls back into the space occupied by a child in the rear. Not only
can a child be struck by the collapsing seat and head restraint, but
the front seat occupant can be thrown rearward, over the collapsed
front seat colliding with an occupant in the rear seat with a great
deal of force. Such secondary collisions within the vehicle have
anecdotally been reported as the injury mechanism in a number of deaths
and serious injuries to children. In order to protect all rear seat
occupants, but especially children, NHTSA must improve the seat back
strength requirements in the current vehicle safety standards. The
current federal safety standard for seat back strength has not been
substantially revised to improve seat back performance since the
standard was first adopted in 1971. In fact, NHTSA research and tests
for the proposed amendments to the fuel integrity standard showed that
almost all front seats failed in 50 miles-per-hour rear impact
collisions.
This confluence of design issues makes it all the more important
that manufacturers and NHTSA focus on the plight of the forgotten
child. Since parents are being instructed to place children in this age
group in the rear seat for their own safety, it is imperative that the
rear seat be a safe environment in which comfort reinforces safe
behaviors.
B. Stuck in Neutral Recommendations
Advocates addressed several aspects of the child restraint issue in
our 1999 safety report entitled Stuck In Neutral--Recommendations For
Shifting The Highway And Auto Safety Agenda Into High Gear, which is
available on Advocates' web site at www.saferoads.org. With respect to
child restraints, the report concluded that NHTSA should take action on
the following four recommendations:

1) expand the scope of the child restraint standard to
children who weigh 80 pounds;
2) establish minimum requirements for child booster seats and
belt-adjusting devices;
3) develop a child test dummy that is representative of a 10-
year-old child; and,
4) require that child restraints be dynamically [crash]
tested.

The first three of these recommendations are specifically relevant
to booster seats. The provisions of section 14 of the TREAD Act require
NHTSA to consider these issues as part of a larger rulemaking on child
restraint safety.
C. Child Restraints up to 80 Pounds
NHTSA should expand the scope of the child restraint standard to
children who weigh up to 80 pounds. Advocates wholeheartedly supports
the language in section 14 of the TREAD Act that requires consideration
of protection for children who weigh more than 50 pounds. Advocates has
on many occasions stated that children ages 4 to 8 years old, and
older, are disenfranchised under both state restraint laws and federal
occupant protection requirements. We firmly believe that the current 50
pound weight limit should be raised to 80 pounds and that minimum
performance requirements for booster seats should be regulated by
NHTSA. Additionally, NHTSA should enhance its education and publicity
campaign to disseminate information about the need for, and to promote
the use of, child booster seats.
D. Booster Seat Design/performance Requirements
NHTSA should establish minimum requirements for child booster seats
and belt-adjusting devices. Advocates also supports the initiative in
Section 14 of the TREAD Act to have NHTSA determine the need to
establish minimum requirements for booster seat performance and
structural integrity that are dynamically tested. We realize that
booster seats function differently from infant/toddler restraints, and
are intended to enable children to use adult seat belts to provide
safety protection in a crash. Booster seats may also not be considered
as complex, from an engineering standpoint, as infant/toddler
restraints. Nevertheless, NHTSA should ensure that booster seats
perform this function properly and afford children adequate levels of
safety.
Currently, booster seats are subject to performance requirements
and compliance testing for all child restraints, but only up to the 50
pound limit of the child restraint standard. Booster seats recommended
for children over 50 pounds are not subject to the requirements of that
standard. This means that parents have no means to independently
evaluate the safety of a booster seat for older children and they must
rely on manufacturer recommendations. NHTSA should determine what
performance requirements and safety features, as a minimum, should be
common to all booster seats. For example, since booster seats are
intended to lift children and improve their fit in an adult seat belt,
a requirement might be appropriate to set a minimum height for the
booster seat platform above the vehicle seat. Use recommendations could
be based on this requirement. Also, booster seats without backs may
result in neck or head injuries, especially for taller, older children
whose heads and necks clear the top of the rear vehicle seat back.
Currently, even booster seats with backs are not required to provide
crash protection for the child's head and neck. Booster seats with
improved backs may be necessary to protect taller children from head
and neck injuries. Likewise, belt-adjusting arms should be examined to
determine whether they are necessary to enhance booster seat safety.
The agency should also test booster seat features to ensure that they
do not interfere with safe performance of the seat belt system in a
crash.
In addition, NHTSA should adopt separate injury criteria for
children and adults. More stringent injury criteria scaled for the
bodies of children have already been adopted by NHTSA for the occupant
protection standard which governs safety belts and air bag performance.
The agency should also adopt these more stringent injury criteria for
the child restraint standard. These scaled injury criteria should also
be applied to any extension of the child restraint standard to children
who weigh over 50 pounds.
E. 10-year Old Crash Test Dummy
NHTSA should develop a child test dummy that is representative of a
10-year-old child that can be used in testing booster seats. This was
among the recommendations of the Blue Ribbon Panel on Protecting Our
Older Child Passengers, and Advocates fully endorses this proposal.
While there is already an effort to develop such a test dummy, efforts
should be made to ensure that it is ready for use in the near future.
Adoption of a 10-year-old child test dummy will permit testing at the
upper weight range of booster seat recommendations. Auto manufacturers
will also be able to use the 10-year-old dummy to improve the designs
of rear seats to better accommodate the safety of all sizes of
children.
F. Built-in Booster Seats
Similar to the design of integrated child restraints, booster seats
can be built into vehicle seats. Built-in booster seats would afford
greater stability and protection since the seat is built into the
vehicle seat and attached to the vehicle chassis. Built-in booster
seats would be specifically designed to function with the three point
lap/shoulder belts installed at the same seating position. As more
states enact child booster seat laws there will be a demand for built-
in booster seats. It will make compliance and enforcement of these laws
easier and more effective. Parents, relatives, friends and visitors
will be able to accommodate children as passengers in a safer, more
convenient way.
Thank you, Mr. Chairman, for the opportunity to address these
important issues.
Advocates is prepared to work with the Committee in its evaluation
of the implementation of the TREAD Act and other safety
recommendations, and I will answer any questions you and the Committee
may have.
______

Disclosure of Federal Grants and Contracts
I, Judith Lee Stone, President of Advocates for Highway and Auto
Safety, hereby certify that Advocates for Highway and Auto Safety has
not received any federal funds in fiscal years 2000 and 2001.
Respectfully submitted,
Judith Lee Stone,
President.
______

Advocates for Highway and Auto Safety

Table 6
Occupant Fatality and Injury Rates per Population by Age Group, 1975-
1999
Age Group (Years)
(Fatality Rate per 100,000 Population)

Year -5 5-9 10-15

1975 4.50 2.71 5.71
1976 4.50 2.56 6.14
1977 4.68 2.83 6.44
1978 4.61 2.66 6.60
1979 4.35 2.84 6.13
1980 4.24 2.67 6.00
1981 3.75 2.43 5.24
1982 3.67 2.22 4.85
1983 3.55 2.33 4.60
1984 3.13 2.33 5.21
1985 3.18 2.36 5.52
1986 3.42 2.30 6.07
1987 3.78 2.60 6.00
1988 3.82 2.64 5.74
1989 3.93 2.92 5.48
1990 3.30 2.50 5.25
1991 3.13 2.39 4.86
1992 2.99 2.41 4.75
1993 3.14 2.35 4.67
1994 3.46 2.35 5.07
1995 3.17 2.46 5.15
1996 3.40 2.34 5.07
1997 3.16 2.42 4.96
1998 3.03 2.60 4.60
1999 2.93 2.54 4.48

______

KEY TO STATE HIGHWAY SAFETY LAW CHART
Graduated Driver Licensing (GDL) Systems--Optimal graduated driver
licensing systems consist of a learner's stage, an intermediate stage
and an unrestricted driving stage. Within each of these stages, there
are provisions that are optimal to providing safe circumstances under
which to develop driving skills. Four of these provisions are #1-4
below. Each state's law is intricate and this chart should serve only
as a guide. To fully understand a state's law, one should review it.

A. Learner's Stage
1. Six Month Holding Period: A novice driver must be
supervised by an adult licensed driver at all times. If the
learner remains conviction free for six months, he or she
progresses to the intermediate stage. In an optimal provision,
there is not a reduction in this amount of time if the driver
takes a driver's education course.
2. 30-50 Hours of Supervised Driving: A novice driver must
receive 30-50 hours of behind-the-wheel training with an adult
licensed driver. In an optimal provision, there is not a
reduction in this amount of time if the driver takes a driver's
education course.
B. Intermediate Stage: While optimally this stage should continue
until age 18, states have been given credit in this chart for having
the following two restrictions for any period of time, i.e., 6 months.
3. Nighttime Restriction: Because a majority of the crashes
involving teens occur before midnight, the optimal period for
supervised nighttime driving is from 9 or 10 p.m. to 5 a.m.
Unsupervised driving during this period is prohibited.
4. Passenger Restriction: Limits the number of teenage
passengers that ride with a teen driver driving without adult
supervision. The optimal limit is no more than one teenage
passenger. Sometimes family members are excepted.
5. Child Restraint Law--No Gaps: A state is considered not to
have gaps in its child restraint laws if all occupants up to
age 16 are covered by either a child restraint law or a safety
belt law.
6. Statewide Red Light Camera Law: Laws vary widely among the
states. While some states require legislation to allow
localities to operate red light running photo enforcement
programs, other states do not require enabling legislation and
laws are passed at a local level. States with an ``X'' in this
column have statewide laws. For more information on state laws
and legislation, see Advocates' intersection safety chart.
7. Repeat Offender Law: Complies with the Transportation
Equity Act for the 21st Century (TEA-21): States with an ``X''
in this column have voluntarily submitted their repeat offender
law to the National Highway Traffic Safety Administration
(NHTSA) for review and have been found to be in compliance with
the provision in the federal highway bill, TEA-21. (Note:
States may have one or more of the repeat offender law
requirements under TEA-21, but only those states that fully
comply with the federal law are listed as in compliance.)
8. Open Container Law: Complies with the Transportation Equity
Act for the 21st Century (TEA-21): States with an ``X'' in this
column have voluntarily submitted their open container law to
the National Highway Traffic Safety Administration (NHTSA) for
review and have been found to be in compliance with the
provision in the federal highway bill, TEA-21. (Note: States
may have one or more of the open container law requirements
under TEA-21, but only those states that fully comply with the
federal law are listed as in compliance.)
9. Unattended Children Law: A person responsible for a child
who is 8 years of age or younger shall not leave that child in
a motor vehicle without being supervised in the motor vehicle
by a person who is at least 14 years of age.
10. U.S. Population: U.S. population data taken from the 2000
state population estimates according to the Population Estimates
Program, Population division, U.S. Census Bureau. Available on-line at
http://www.census.gov/statab/www/part6.html.
(Sources: Advocates for Highway and Auto Safety, Air Bag and Seat
Belt Safety Campaign, American Automobile Association, Federal Highway
Administration, Insurance Institute for Highway Safety, Mothers Against
Drunk Driving, National Committee on Uniform Traffic Laws and
Ordinances, National Highway Traffic Safety Administration, National
Transportation Safety Board, National SAFE KIDS Campaign, state
agencies and U.S. Census Bureau)

Senator Fitzgerald. Ms. Stone, thank you very much. All of
you, thank you for your testimony.
I would like to go to some questions and I would prefer to
kind of keep this free-wheeling and have any of you jump in if
you want to respond to something that somebody else on the
panel is saying.
My first thought listening to all this is, what about a
requirement that automobile manufacturers make the seat belts
adjustable so that they could come down to fit a young child,
perhaps doing that as an alternative to a requirement--have a
requirement that your child be in a booster seat or that he or
she be fastened in an adjustable safety belt that can be
properly fitted for a youngster? Nobody has mentioned that. Dr.
Winston?
Dr. Winston. The problem with that is that the issue is
more thigh length than how tall the child is. The injuries that
we worry about are not as much the injuries to the neck. That
is not where the problem is. The problem is that the thigh is
too short, and the child will slide forward on the seat,
causing the lap portion of the belt to ride up. This will then
make the shoulder portion even more uncomfortable and also will
have the child further far forward, and in the event of a crash
the child will be able to slip out of the belt or move forward
and hit the head.
There are quite a few vehicles that already have adjustable
shoulder restraints.
Senator Fitzgerald. What vehicles are they?
Dr. Winston. I would defer to the manufacturers.
Mr. Shelton. We have a list, Mr. Chairman. I do not recall
any off the top of my head, but we have a brochure we put out
called ``Buying a Safer Car for Child Passengers,'' and in that
brochure we identify vehicles that have adjustable rear safety
belts in them. I believe it is around 20 percent of the new
vehicle fleet have them.
Senator Fitzgerald. Is that right? Okay.
Mr. Shelton. Approximately, off the top of my head. But I
would like to reiterate what Dr. Winston said. One of the
concerns that we would have is one of the main reasons children
need booster seats is because of lap belt fit and an adjustable
shoulder belt does not address the issue of lap belt fit.
Senator Fitzgerald. Well, can the lap belt be adjustable?
Clearly you could make a lap belt that fit a child, right?
Mr. Shelton. It is not a matter of length. It is a matter
of angle and location--unfortunately, there is a compromise
between protection for adults and protection for children.
Dr. Lund. Mr. Chairman, if I could followup on that.
Senator Fitzgerald. Yes.
Dr. Lund. You pose an interesting idea and I think one that
has a lot of merit. Certainly in Europe there is a move in
their new car assessment program to put more of the onus for
how car safety seats for children and booster seats as well
perform in those cars, putting more of the onus on the
manufacturer of that vehicle, asking them to name the child
seat that could be used in a test.
I personally think that as we go forward part of what is
going to have to happen to make sure that booster seats perform
as we on this panel all want them to perform is there is going
to have to be greater coordination between the child seat
manufacturers or booster seat manufacturers and the vehicle
manufacturers to make sure that the boosters or the child seats
are compatible with the seats themselves. So that is one thing.
The onus is going on them.
I would like to also come back and say that one of the
developments that we thought was very positive here, and it is
a shame to see that the public is not picking up on it that
greatly, is the provision by manufacturers of built-in child
restraints.
You talked about making the belts adjustable, and it is
very difficult, as Mr. Shelton said, to adjust the lap belt.
But you can put in a built-in child seat that folds down or
folds up or modifies the seat geometry so that it works.
Senator Fitzgerald. How many manufacturers are doing that
right now?
Dr. Lund. They are available from a number of
manufacturers. We were able to get pictures only of a Volvo. It
was the only one being delivered. But we have the Dodge
Caravan; Daimler-Chrysler provided this in minivans for some
time. You can ask Daimler-Chrysler, but I think that they will
tell you that the uptake on that option by consumers was not
very good.
Ms. Stone. Mr. Chairman, if I could just respond to that
same question. We made some calls around to some dealers just
before this hearing to see and practically none of the dealers
we talked to even knew what they were. So no matter whether
they are available as an option, the dealerships really do not
know about them.
So I think that they are largely unavailable unless they
come as standard equipment.
Senator Fitzgerald. I have never heard of them being
offered and I am someone who has an 8 year old boy and have
been thinking about this issue for years and always on the
lookout for cars that have it as an available option. I have
never heard of it being offered.
Ms. Weinstein. Mr. Chairman, I would like to add to the
discussion. The Safety Board, as I mentioned, made three
recommendations to the auto manufacturers to design the back
seats of cars for children. One of the recommendations was for
built-in car seats; one of the recommendations was for
adjustable upper anchorages.
What we are getting in response on the adjustable upper
anchorages is that the design of the car does not really permit
them to put the adjustable anchorage in the back seat the same
as it does in the front seat. What some of the manufacturers
have done is lowered the retractor anchorage to the back of the
back seat, which does make it fit a little bit better for
shorter adults and taller children.
On the built-in child restraint systems, the manufacturers
are telling us that there is no market out there for them. Our
question back to them is, what have you done to sell them, and
they have not done very much. I think that that is certainly an
area that could solve a lot of problems, including for low
income families, because when they would buy the car the built-
in child restraint would already be there.
Dr. Quinlan. If I could add one other bit, I want to make
it very clear, adjustable upper anchorages alone are not a
solution. It has to be combined with some integrated support
from below. The lap belt is the safety issue for children, for
children in this age range, is the lap belt, the lap belt
riding over the hips, crossing across the tender stomach.
In the violence of the crash, the lap belt wraps around the
abdomen like a rope around a pillow. There is nothing to stop
it until it reaches bone when it hits the back bone, and
finally the child is stopped by the fracture of the spine.
So a lower cushion to boost the child up is absolutely
necessary. Adjustable upper anchorages do not do that.
Senator Fitzgerald. I have an Oldsmobile Aurora that does
not have in the center of the rear seat a three-point lap belt
and my wife does not even want to let me drive my son in my
car. She makes me take him in her car, which has a three-point
lap belt in the center rear seat.
What should parents do who have a car with a rear seat that
does not have a three-point shoulder belt in the center rear?
Would they be better off putting them to one of the outboard
sides, where are at greater risk of side impact collision?
Would anybody care to speak to that issue?
Mr. Shelton. Again, Mr. Chairman--well, not again, but as I
mentioned before we have a brochure for parents who are looking
for a new car. The ``Buying a Safer Car'' brochure for a child
passenger does identify vehicles that have a center lap
shoulder belt standard or optional. In many cases also,
manufacturers will offer a retrofit shoulder belt for the rear
seat, although it is typically for an outboard position, not a
center seating position.
So if you have a car I think you have to use what you have,
which would be to put the child in the outside seating position
using the three-point belt, and the child would be much better
off than putting the child in the center seating position, on
balance.
Senator Fitzgerald. Autumn.
Ms. Skeen. I live in a part of the state that is quite
agricultural. We have more than a 30 percent Hispanic
population. One of the things that I have noticed in the
national brochures is that they are not in Spanish. Certainly,
my concern and one of the reasons that I have pushed for the
law is that I wanted this to not be just safety for the urban
and the well educated and the well to do. My concern is that
you have to be fairly educated to even know that there is a
brochure out there that says that there are certain kinds of
vehicles.
Also, from talking to local dealerships, if you want safety
equipment like that you have to special order. Oftentimes I
think people just sort of go out and buy a car off the lot
almost, not quite on impulse but almost. So as far as
availability, it is not quite out there.
Dr. Quinlan. If I can also add, I would like to use this as
an opportunity to make sure people are aware of the over 14,000
child passenger safety technicians that are out there in the
country right now, who are ready to help with specific child
passenger questions like the one you just asked.
Senator Fitzgerald. Where are they?
Dr. Quinlan. You can go to NHTSA's web site and you can
locate your closest technician by entering your zip code.
Senator Fitzgerald. Are these people typically at car
dealerships?
Dr. Quinlan. Sometimes at car dealerships, sometimes at
hospitals, sometimes at traffic safety offices, law enforcement
agencies.
Senator Fitzgerald. Are these people certified?
Dr. Quinlan. They are trained by NHTSA in a 4-day course
and certified by AAA, and they are a very reliable source of
specific technical information that I really think is
underutilized.
But there are products specific for your case. There is a
seat out there that can go to 60 pounds with just a lap belt,
so a child who is under 60 pounds can get into a Futura 20/60
and can use that, just lap belt in the center, in exactly the
situation you said. So there is a variety of special products
the technicians are the experts on knowing.
Senator Fitzgerald. Dr. Lund, correct me if I am wrong, but
you have been a little bit of a contrarian with respect to the
booster seats. In your testimony you said ``Emphasizing booster
seats is a misplaced priority'' and that what we really need to
do is focus on encouraging the use of seat belts because you
point out that better to be restrained than completely
unrestrained, and we have too many kids in this country who are
completely unrestrained.
But we have got to be concerned, do you not think, about
the kids like Anton, so that there are kids who are restrained,
but who are too small for that three-point seat belt, and in a
serious collision could go flying out the seat? What do we do
about that?
Dr. Lund. Mr. Chairman, I do agree with you. We are all
here because we are all concerned about child passenger safety.
There is no question about that. I think we do need to do
something about the situations such as Anton. This is a case
where the belt has failed him.
The problem that the Institute is dealing with is not that
the adult lap-shoulder belts are perfect or the final answer,
but what I do not want to do is to move to a law that requires
parents to put children in booster seats and a parent goes out
and buys a booster seat because the manufacturer says, this is
a booster seat, so now I am in compliance with the law, and
then we have the child in a booster seat that fits the way that
the Komfort did on Camron and then have that parent later say:
I did not realize that the lap belt coming across the stomach
was a problem; why did not somebody tell me? Why was that seat
available for my child?
The same situation--I do not want to see that happen. The
law does become a way of telling people information about what
is good. They will buy the booster rather than the concept of
proper belt fit.
We have heard a lot about educating the parents the put
children in boosters, but I think where we are right now is we
do know how belts should fit. What we do not know is that all
boosters do that and they do need to be educated on belt fit
and parents need to be educated to shop for the booster, not
just go buy a booster to comply with the law.
Senator Fitzgerald. Well, do you think we should have as a
first step federal minimum standards on requirements for
booster seats, and then once we have those down, once we have
the science behind that, then think about encouraging the
states to adopt mandatory booster seat usage laws?
Dr. Lund. Absolutely, Mr. Chairman. This is--as I said, it
is a misplaced priority, which means a timing issue. We are all
on the same side here.
Senator Fitzgerald. So we have to get the standards here.
Dr. Lund. We have to know what we want parents to use
first.
Senator Fitzgerald. Do you all agree that we ought to have
federal standards that go up to, say, 80 pounds as opposed to
the 50 pounds? Does anybody disagree with that?
[No response.]
Senator Fitzgerald. No.
Dr. Winston, you are anxious to speak.
Dr. Winston. Yes. I think one of the challenges with the
photographs that you saw from the Insurance Institute is those
are children placed in booster seats. They are not children in
crashes. I think we need to think about it. I wholeheartedly
agree that we should have standards for the booster seats. It
is very confusing to the parents that there still are shield
boosters out on the market. There are many different varieties
of boosters and parents get confused.
But the real world experience with children in crashes,
demonstrates that existing belt-positioning booster seats are
exceedingly effective. It is rare to find serious injuries to
children in belt-positioning booster seats in our study. The
same experience is in Sweden. When a child is in a belt-
positioning booster seat, they have many fewer minor injuries
than children in seat belts.
Senator Fitzgerald. Your studies are based on data provided
by State Farm?
Dr. Winston. What happens in our study is that each day we
hear about crashes that are reported to State Farm Insurance
Companies in 15 states and the District of Columbia. With the
appropriate privacy safeguards, State Farm sends information to
the Children's Hospital of Philadelphia, from claims in which
consent to release data was obtained.
We then do onsite crash investigations and in-depth
telephone interviews with parents and have amassed the world's
largest data base related to children in crashes.
Senator Fitzgerald. How many crashes are in that data base
total?
Dr. Winston. So far, we have 137,000 children in
approximately 90,000 crashes.
Senator Fitzgerald. There is no other bigger data base, I
would imagine, that is out there.
Dr. Winston. No.
Senator Fitzgerald. You have a fantastic set of data.
Dr. Winston. We are very lucky. The generosity of State
Farm has been great.
The issue that I am pointing out is that real world data
are more important than photographs. In the first photograph of
the child who was more properly restrained, she would have
moved that shoulder belt behind her back. It was right over her
neck. If you look at that photograph, she would have been
uncomfortable, if the belt had remained over her neck.
But in the event of a crash, when a child is in a belt-
positioning booster seat, the belt would fit well. The child
would remain in the shoulder belt and our data are bearing out
that the children do quite well.
Let us keep in mind how much a booster seat costs. This is
an important issue vs. the cost of a child's injuries. A belt-
positioning booster seat, a backless belt-positioning booster
seat at my retailer, is under $20. That is what we are talking
about here.
One of the challenges with the integrated seats, as much as
I think they are wonderful, is they are quite expensive. These
backless boosters work well and are very effective.
Ms. Weinstein. Mr. Chairman, I would like to point out that
speed is another issue that needs to be considered in this
discussion. In the Safety Board's 1996 study we found that for
children who were in high-speed crashes it mattered whether
they were in the appropriate restraint for their age, height
and weight. The children who were improperly restrained in
high-speed crashes, which we define as a change in velocity of
more than 20 miles an hour, those who were improperly
restrained were much more likely to be killed and seriously
injured.
Dr. Lund. Mr. Chairman, if I might, I would like to
followup on one thing that Dr. Winston said. It is by way of
making sure that we do not think that the better belt
positioning offered by boosters is a panacea for restraint use.
We recently--the assumption is made that if the belt fits
better the child will not move the shoulder belt or will leave
it on. We recently had--our photographer who was involved in
taking these pictures has children in this age group and he
took a week-long trip and he took some of our better fitting
booster seats.
He found that, with the exception of one of them, the
children did move the belts. They wiggled in the booster seats
just as they did on a car seat. They did in fact remove that
and come out from behind the shoulder belt.
So we must keep in mind that this is not a panacea. The
main thing it cannot do, as Kyran Quinlan said, is that if you
get a good booster that moves the child up and positions that
lap belt better, that is the main benefit that we can get.
Senator Fitzgerald. I would like to give, if I could,
Senator Dorgan the opportunity to speak for a moment. He is the
ranking member of this Committee. Then, because of time
constraints, we are going to have to go on to the second panel.
Senator Dorgan, thank you.

STATEMENT OF HON. BYRON L. DORGAN,
U.S. SENATOR FROM NORTH DAKOTA

Senator Dorgan. Mr. Chairman, thank you very much.
I wanted to say to the panelists that we appreciate very
much your being here. As is often the case in the Senate, this
week is very busy with hearings. I have 16 hearings of
committees and subcommittees this week, and I was not able to
be here earlier because I am on the Appropriations Committee
and we are meeting with Secretary Norton right at the moment.
So I am going to go back there.
But I did want to come and say this. I had the opportunity
to review much of your testimony in your prepared statements. I
think your contribution in that testimony is very significant.
Senator Fitzgerald has had an abiding interest in this
subject and, despite the fact that my colleagues and I have
been absent this morning, Senator Fitzgerald and I will work on
these issues with great diligence, especially with Senator
Fitzgerald's leadership. This hearing I hope will help us make
some progress in a very significant area.
I have a 14 year old son and a 12 year old daughter and we
have been through this period. My wife insisted the cars not
move an inch until everyone was belted up and cinched down
correctly in the right car seats and booster seats and so on. I
understand the concerns. I understand the dangers that are
involved with children in automobiles in circumstances where
they are not properly restrained.
I think this hearing is a real contribution. I want to
thank our chairman and thank you for your indulgence. I just
want you to understand why I was not here and why many of my
colleagues are not here, but I think you are making a very
significant contribution this morning.
I thank you for being here and presenting the testimony.
Senator Fitzgerald. Senator Dorgan, thank you very much.
We will take just one more comment from Ms. Stone here and
then we will go on to the second panel.
Ms. Stone. Thank you very much, Senator. I just wanted to
talk a little bit about history repeating itself in part. Dr.
Quinlan mentioned in his testimony about the child restraint
laws being passed starting over 25 years ago. The first one was
in 1978. I was at the Department of Transportation at that
time, as were some others in this room.
It really was an amazing situation, because that was a
movement that was started by pediatricians as well. So we are
glad to see the pediatricians out here again.
What I wanted to say about it is that the states did not
wait for perfect science. The standard was in place, but it was
not the best standard it could be. They went ahead and passed
the laws. No, they were not perfect, but they did pass them.
I really believe that we are at the exact same spot on this
issue with booster seats. I would not want to wait until
everything, all the t's are crossed in i's are dotted, in order
to move forward with state laws, because I think that we can do
a lot of help, do a lot of service to the American people, by
passing those laws and using them as education tools.
I do not know how they will be enforced. I think they will
be difficult to enforce. Any traffic safety law is. But I
really believe that it is time for us to use them as
educational tools, as they were used starting in 1978. That is
how we got where we are today.
Senator Fitzgerald. Ms. Stone, thank you very much for
those remarks. All of you, you were excellent witnesses. I want
to thank you for coming here and participating.
We will now go to our second panel. We will take just a 1
or a 2-minute break and we will come back.
[Recess.]
Senator Fitzgerald. I would like to resume the hearing now.
On the second panel we have three witnesses: Ms. Heather Paul,
Executive Director of the National SAFE Kids Campaign. Ms.
Paul, thank you for being here. Mr. James Vondale, Director of
Automotive Safety Office of Ford Motor Company. Mr. Vondale,
thank you. Mr. Baloga, the President of Britax Child Safety,
Inc., and I think we saw a picture of one of your child safety
seats earlier. Thank you, Mr. Baloga, for being here.
Ms. Paul, if you would like to begin.

STATEMENT OF HEATHER PAUL, Ph.D.,
EXECUTIVE DIRECTOR, NATIONAL SAFE KIDS CAMPAIGN

Ms. Paul. Senator, thank you so much. You have done
wonderful work in this area and I think I am a witness to
history here today to see so much attention paid to specifics
of booster seats. I have seen tremendous transformation of this
whole traffic safety community since I started only 7 years
ago. So thank you again.
I am here on behalf of 303 SAFE Kids Coalitions, made up of
firefighters, traffic safety police, public health department
officials. Actually, we are making up some of the core child
passenger safety technicians who you alluded to earlier. I have
Joe Colella and Karen DiCapua here, who are some of the best
technicians in the country. Because of them and so many others,
we have seen this problem of booster seat use from the micro
perspective as well as a macro one.
In regards to the micro one, we have been hands on, have
checked over 160,000 car seats since we began in 1996 with the
first car seat checkups, with a national campaign in place
thanks to the support of General Motors. Ironically, we began
just the same year that Autumn Skeen's son was taken so
tragically, and a lot has happened in the last 5 years.
We have also been with 3200 General Motors dealerships,
training them, having them stage these car seat checkups. In
addition, we have been in the parking lots and the shopping
malls, in the daycare centers, with the UAW, La Raza, and NAACP
in distributing over $5 million worth of free car seats.
So we have seen it all. We have seen the upscale fathers in
their Mercedes sport utility vehicles and we looked at
absolutely the poorest of the poor in remote rural areas, in
the inner city, where the back seat of their cars is a
testament to the state of their poverty. They are pre-1989,
they are in a state of deterioration, they have lap belt only
if they are lucky, if they have just the amount of children who
could even be restrained in that back seat.
When it comes to booster seats, actually it is the same
problem whether you are rich or poor: tremendous
underutilization, as all these other articulate experts have
cited today, and a fundamental cluelessness on the part of
parents on why they think they need them.
We know this through our conducting thousands of car seat
checkups, which take about 40 minutes each. If you think of
that, it is an extraordinary act of public service. Parents say
all kinds of things about boosters through our focus groups and
through the car seat checkups. Why would they use this low-back
booster, for instance, this thing that looks like something
that you just sit tall on in a restaurant? What is so important
about this seat? What, seat belt syndrome? What is that? Why
this seat? Why not an adult belt system? Surely the absence of
that little seat cannot give my child spinal cord injuries, or
cause major internal organ damage that is impossible. Finally:
Why would I use that? There is no law in my state, is there? As
other very responsible parents--we abide by the law--So why on
earth would you ask me to use this?
These are very legitimate questions. So there is an awful
lot we need to do on the public education side. That attitude
and perception on the part of parents segues right into the
other aspect of our work, and you have cited that--thank you so
much--through our recent study. This is the first-ever, in-
depth analysis of current child occupant protection laws across
the country.
It is not a pretty picture, Senator. As you well know, even
Illinois is not doing very well, and I will get to that in a
second.
So we were harsh graders. SAFE KIDS gave half the states
Fs. That is quite extraordinary. Another third earn D's, and
there were other shocking facts. How could children be exempt
in some states because they are nursing when their mother is up
front? How could children be exempt from using restraints in
the back seat or the front seat if they are driving with an out
of state driver with out of state plates? How can they be
exempt from the law if they are simply sitting in the back
seat?
In fact, only two states, California and Washington--and
they were cited here today, and now Arkansas--have a law that
goes only as high, finally, as 5, not to the age of 8, what we
are talking about today. These new laws in California and
Washington do not even take effect until 2002. In fact,
Arkansas, most recently passed, does go into effect this
summer.
Another 11 states dictate a child restraint only up to the
age of 4. So that means the rest of the states fundamentally
say it is just okay to be in an adult belt system.
No state law covers children in a child restraint up until
the age of 8. I am sorry to say, Senator, in the state of
Illinois that children between the ages of 6 and 8 can actually
ride totally unrestrained in the back seat if they are with a
driver over the age of 18. Obviously, that is counterintuitive
and quite absurd.
In our rating of child occupant protection laws we thought
we took some risks with very stringent grading. No good teacher
would stand behind half your students getting F's. But we are
really dealing with the harsh realities of motor vehicle
crashes and killing thousands of children and injuring them
every year. So we know that it matters, so much so that we have
presented a grid to you today--Judy Stone has alluded to it as
well--where 23 states since our report was issued in February,
with Safe Kids' assistance, have moved forward, either
introducing a bill, improving that bill that was already
introduced, or actually enacting a much better law, which is
the case with Arkansas.
So once in a while a stick works as well as a carrot, there
is no question about it.
In terms of the research, we certainly, as an advocacy
group, rely on the facts of groups like Flaura Winston as well
as NHTSA, and we indeed want a universal standard, more
research, heavier crash test dummies when it comes to children
up to the age of 8.
I will also say that the National SAFE Kids Campaign is
affiliated with Children's National Medical Center and there is
a NHTSA-supported siren study there, the only study in the
country that is doing a review, forensic studies of kids in
crashes who were improperly restrained, and Dr. Eichelberger
and his team look at those cases as they come into Children's
Hospital.
There is no question, even though this data base, as is the
problem here, is very small--20, 30 cases--that he sees very
serious injuries from seat belt syndrome that would not be
there, according to his team, if these same children were in
booster seats.
Outside of the issue of demand, which we are talking about
right now namely--the need to better educate parents so that
they ask for these seats, there is also the other side of the
ratio, which is the supply. What does it look like in the
marketplace? How can we mandate, how can we ask parents to
choose a different restraint system if they are not easily
accessible.
It is a changing situation. According to the car seat
manufacturers that I spoke with, only 5 years ago it was a very
grim picture. There was hardly anything out there. In fact
there were less than a half million, booster seats, sold a
year. That now is up to a million seats a year.
Now, that does not put a dent in the roughly 20 million
children between the ages of 4 and 8, that is true.
Senator Fitzgerald. How many car seats are sold each year,
do you know?
Ms. Paul. Twice that amount.
Senator Fitzgerald. Twice that amount.
Ms. Paul. Yes, two million car seats a year according to
one manufacturer who I discussed this with this week. Perhaps
folks from Britax can qualify that, but that is the information
I have.
Also, there is a positive trend in that, more retail space
is being allocated for booster seats, maybe up to one to one,
as many booster seats are on some shelves as car seats.
There is another interesting phenomenon, which maybe you
will speak to this as well, 70 percent of booster seats are
sold by four retailers: Walmart, Kmart, Toys-R-Us and Target.
That is not the best situation. That means that they
potentially have a stranglehold on the nature of the booster
seats available. Really, it might depend on brand managers or
other aspects of retail life that would command exactly how
parents see, perceive them, what education they get onsite as
to what booster seats to choose.
Also, its important to note that relatively the industry is
small. It is a $350 million industry that handles all car seats
in America. The advertising budgets are also small. If we want
public education done, we certainly can not rely on the
manufacturers when they do not even have the money for a
television ad. When is the last time you saw a television ad on
car seats in general? We can get Pokemon ads from Toys-R-Us,
but we are not going to get one on car seats. So therefore the
burden is even greater on advocates like us, as well as the
government, to provide that public education.
So finally, I would say too, as Flaura has, that our 300
coalitions stand ready to help in any way we can. Thanks to the
incredible generosity of General Motors, they have committed to
us for another 5 years, and that we will be checking tens of
thousands more car seats, getting more data. If there is any
way that we can contribute our traffic safety folks in terms of
surveillance, more public education, demonstrations on what
works, how can we get to parents with the incredible
seriousness of an issue that Autumn has revealed so painfully.
So on that note, thank you very much.
[The prepared statement of Ms. Paul follows:]

Prepared Statement of Heather Paul Ph.D., Executive Director, National
Safe Kids Campaign
My name is Heather Paul and I am the Executive Director of the
National SAFE KIDS Campaign. It is my pleasure to testify before the
Subcommittee today. Mr. Chairman, thank you for inviting me to address
this important topic of child restraints for older children and other
critical child occupant protection initiatives. I also want to take
this opportunity to express our appreciation for your sponsorship of
last year's Child Passenger Protection Act and for making child
passenger safety a priority for your Subcommittee. The Child Passenger
Protection Act, passed by the 106th Congress, helped us to refocus on
how we can all protect children when they are traveling on our nation's
roads.
I. History of the National SAFE KIDS Campaign
As you and many Members of the Subcommittee know, the National SAFE
KIDS Campaign is the first and only national organization solely
dedicated to addressing an often unrecognized problem: More children
under age 14 are being killed by what people call ``accidents'' (motor
vehicle crashes, fires, and other injuries) than by any other cause.
For well over a decade, the National SAFE KIDS Campaign
(hereinafter ``SAFE KIDS'') has been focusing on this problem through
the work of its national headquarters and its over 300 state and local
SAFE KIDS coalitions--including thirteen SAFE KIDS coalitions in
Illinois alone. From its inception, SAFE KIDS has relied on developing
injury prevention strategies that work in the real world--conducting
public outreach and awareness campaigns, organizing and implementing
hands-on grassroots activity, and working to make injury prevention a
public policy priority.
The on-going work of SAFE KIDS coalitions reaching out to local
communities with injury prevention messages has helped lead to the
decline of the unintentional injury death rate during the past decade--
a 35 percent decline for children ages 14 and under. However, with one
out of every four children--or more than 14 million children ages 14
and under--sustaining injuries that are serious enough to require
medical attention each year, SAFE KIDS remains committed to reducing
unintentional injury by implementing prevention strategies, and
increasing public awareness of the problem and its solutions.
II. National SAFE KIDS Campaign's Child Occupant Protection Initiatives
Since 1996, SAFE KIDS has partnered with General Motors to develop
and implement the SAFE KIDS BUCKLE UP program to address the needless
tragedies associated with motor vehicle crashes--the leading cause of
unintentional-related death among children ages 14 and under. The SAFE
KIDS/General Motors program is an historic long-term, initiative that
has committed over $20 million to the problem. The partnership's
commitment and longevity are certainly warranted. Consider these
statistics:

In 1998, 1,765 child occupants ages 14 and under died in
motor vehicle crashes. Children ages 4 and under accounted for
33 percent of these childhood motor vehicle occupant deaths.

In 1999, an estimated 272,000 children ages 14 and under
were injured as occupants in motor vehicle-related crashes.

As of November 1, 2000, 98 children were killed by passenger
side air bags. Nearly 89 percent of all children killed by
passenger side air bags were either unrestrained or improperly
restrained at the time of the crash.

A. Alarming Child Safety Seat Misuse Rate: 4 out of 5 Child Safety
Seats Improperly Installed
An integral component of our the SAFE KIDS/GM partnership are Car
Seat Check Up events conducted nationwide by the more than 300 SAFE
KIDS coalitions, together with General Motors dealerships and its
employees. These events are open to the public and provide families
with free, hands on instruction on how to use child safety seats,
booster seats, and safety belts correctly. The events not only occur at
fixed sites like General Motors dealerships, but are also held at
places where families go on a more regular basis, such as shopping
malls and childcare centers. SAFE KIDS is better able to reach these
additional families when we expanded our General Motors' partnership
and created the first ever nationwide Mobile Car Seat Check Up program.
General Motors donated 51 Mobile Car Seat Check Up vans to coalitions
in each state and the District of Columbia. These vans are packed with
child passenger safety literature, tents, cones, child safety seats,
booster seats, and everything necessary to hold a Car Seat Check Up
event at a community venue.
As we have found at these events and reported in our 1999 study,
Child Passengers at Risk in America: A National Study of Car Seat
Misuse, misuse of child safety seats is widespread. It is estimated
that although 96 percent of parents believe they install their child
safety seat correctly, approximately 85 percent of children placed in
child safety seats are actually improperly restrained. Over the past
four years, the National SAFE KIDS Campaign has checked more than
160,000 child safety seats through over 4,000 nationwide Check Up
events and given away more than 100,000 child safety seats to families
in need. Our national numbers are consistent with what we find in Check
Up events in Illinois. In Illinois, close to 200 Check Up events
resulted in over 6,000 child safety seats being checked--with a 90
percent misuse rate. We know that those parents and caregivers who
attend our check up events leave not only with their child safety seat
installed correctly, but also leave with a better understanding about
how to travel with their children safely.
B. Shocking Child Safety Seat Nonuse Rate: 40 Percent of Children
Continue to Ride Completely Unrestrained
Our dealership-based and mobile check-up events have helped address
the alarming misuse rate of child safety seats. Significantly, however,
a full 30 percent of children still ride completely unrestrained. Our
SAFE KIDS/General Motors' child occupant protection program addresses
this problem also. In May of 1998, the United Auto Workers and General
Motors joined the America's Promise initiative by committing $5 million
over three years to purchase child safety seats for families in low-
income communities. The program aims to reduce the 1,800 deaths and
270,000 injuries among children in motor vehicle crashes every year.
Far too often kids hurt in car crashes are not restrained at all.
Special emphasis is placed on serving African-American and Latino
children, who are being killed and injured in disproportionate numbers
on our nation's highways. The seats are being distributed through a
partnership with the National Council of La Raza (NCLR), the National
Association for the Advancement of Colored People (NAACP), General
Motors and SAFE KIDS.
As of March of 2001, a total of 30 NCLR affiliates and five NAACP
branches in 24 different sites have established themselves as ongoing
distribution centers, after receiving training and technical assistance
in child passenger safety from SAFE KIDS coalitions and child passenger
safety experts. Twenty-one additional NAACP branches joined with SAFE
KIDS coalitions to hold one-day child safety seat checkup and
distribution events in September of 2000. Representatives from these
affiliates and branches have distributed over 76,000 child safety
seats, including over 27,000 booster seats, and educated low-income
families on proper use.
SAFE KIDS adamantly believes a properly used and correctly
installed child safety seat is the best way to protect our nation's
children from the dangers of car crashes. We believe, through our
program and with the help of other dedicated child safety advocates and
partner organizations, children will be better protected on our
nation's highways.
III. Most State Child Occupant Protection Laws Have Dangerous Gaps and
Weaknesses
We know the best practices as to how to protect children when they
travel and we know that in order to persuade parents to buckle up their
children, we need to educate them about the benefits of proper
restraint and the consequences of not restraining their children at
all. Most experts agree that strong occupant protection laws, coupled
with consistent enforcement, are a proven way to get children and
adults to buckle up. Yet shockingly, a majority of states have gaps in
their coverage--leaving certain motor vehicle occupants, especially
children, unprotected. Loopholes in child passenger safety laws are
confusing to parents who look to the law for guidance on how to best
protect their children. They also serve as disincentives to law
enforcement by negating the law's intent and failing to give police
officers a clear directive to keep kids safe when traveling. These laws
can leave children lawfully restrained, but woefully at risk.
A. Child Passengers At Risk in America: A National Rating of Child
Occupant Protection Laws
The first child occupant protection law was passed in Tennessee in
1978. Since then, all states have passed laws mandating that children
be restrained in motor vehicles. Disappointingly, the numbers of
unrestrained children injured and killed on America's roadways have
remained alarmingly high for the last two decades, bringing renewed
attention to all aspects of child passenger safety.
The reasons for nonuse and misuse are complex. However, most
experts agree that one key factor has been weak state laws, many of
which have gaps in coverage related to age, seating position, lack of
specific child safety seat use, and other exemptions and insufficient
penalties. Loopholes in child passenger safety laws are confusing to
parents who look to the law for guidance on how to best protect their
children. Weak laws also prevent police officers from adequately
helping to protect children who travel on roads in their states.
Many safety advocates are working toward improving their child
occupant protection laws. To further these efforts, the National SAFE
KIDS Campaign recently completed the most comprehensive analysis of our
nation's child occupant protection laws. We reviewed each existing
child occupant protection law and then measured them against a model
law that we believe provides a benchmark for every state legislature.
Assessments were based on the language of each law, not on its
implementation, enforcement, or other state child passenger safety
programs.
Existing weaknesses and gaps are frightening. Nearly half of all
states earned F's and more than a third earned D's.

Nineteen states allow children to ride completely
unrestrained. For instance, New Jersey's state law permits any
child ages 5 and older to ride completely unrestrained in the
back seat. Pennsylvania's law is even worse--a father can
transport his four year old without safety restraints in the
rear seat. In a crash, these unrestrained children are thrown
violently within the interior of the car or even ejected from
the vehicle all together.

Thirty-four states allow kids to ride completely
unrestrained in certain circumstances by exempting drivers and/
or other responsible parties from compliance with their child
restraint laws. For example, in Idaho and Tennessee a child can
lawfully ride unrestrained if he/she is being nursed or his/her
``personal needs'' are being attended to. SAFE KIDS believes
that a child should never be unrestrained in a moving vehicle
merely because the child, at a moment in time, needs some extra
attention.

According to a majority of state laws, if there are not
enough safety belts for all passengers, children can ride
completely unrestrained. Other states allow children traveling
in cars with out-of-state plates, or being driven by a resident
of another state, to ride completely unrestrained. SAFE KIDS
believes a child born in Louisiana, traveling in Louisiana, but
driven by his out-of-state grandmother still deserves the full
protection of an effective law.

Although all these scenarios are legal, they leave our children in
potentially dangerous, life-threatening situations. Inconsistent state
laws do children a grave injustice. No child in America should be
dependant on the state in which they live for their safety on the road.
SAFE KIDS believes that child passenger safety laws should apply
equally across all of the states and the District of Columbia.
B. Closing the Gaps Across the Map by 2006
This rating of state child restraint laws clearly demonstrates that
child safety needs to be a higher priority for our state legislators,
governors, and citizens. In response, SAFE KIDS and its more than 300
coalitions have launched a five-year initiative to ``close the gaps''
in these laws, helping to ensure that all children are properly
protected while traveling in motor vehicles. SAFE KIDS has provided
individualized, tailored recommendations to each state legislature on
how it can better protect its most vulnerable population and supplied
model provisions to guide them in their efforts. Nationwide, SAFE KIDS
coalitions have been working to upgrade their state child occupant
protection laws, educating families on how to properly restrain their
children, and assisting states in their law enforcement efforts.
Already, at least 20 states have introduced bills to upgrade their law
and three states (Arkansas, Georgia, and New Mexico), in response to
their poor grades, have improved their existing laws--raising their
failing or near failing grades to Bs.
IV. Conclusion
SAFE KIDS believes that a strong law, coupled with effective
programming, is the cornerstone of any state's commitment to child
passenger safety. SAFE KIDS is dedicated to continuing its effort to
both helping parents safely transport their children and assisting
state legislatures with improving their child restraint laws. Today's
hearing, along with the awareness it will produce, will help SAFE KIDS
and other child safety advocates better protect our nation's children.

Senator Fitzgerald. Ms. Paul, thank you very much.
Mr. Vondale.

STATEMENT OF JAMES VONDALE, DIRECTOR,
AUTOMOTIVE SAFETY OFFICE, FORD MOTOR COMPANY

Mr. Vondale. Thank you. Good morning, Mr. Chairman. I am
James Vondale, Director of the Automotive Safety Office for
Ford Motor Company, and I appreciate the opportunity to be here
today to discuss child safety and also booster seats. Ford has
worked for many years to increase the proper restraint use by
vehicle occupants of all ages and, while our overall efforts
will continue, we have increased our focus recently on the need
to further improve the effectiveness of restraint systems for
children aged 4 to 8.
Ford believes that booster seats should be used by children
who have outgrown child safety belts but are too small to wear
the safety belts in the vehicle now. In a crash, poor belt fit
can reduce the protection that the safety belts should provide
against the risk of serious or fatal injuries. Booster seats
help address that concern by raising the child in the seat,
filling the size gap so that the safety belts fit properly.
Booster seats are simple to use and they can be moved
easily, they can be moved easily from vehicle to vehicle.
Unfortunately, as we know, available data shows that only a
small percentage of children aged 4 to 8 use booster seats.
Ford strongly supports the efforts of this Committee and
the other initiatives that can increase booster seat use. In
fact, Ford believes booster seats and child safety are so
important that we launched the Boost America! program in April
of last year. Because of the importance and broad scope of this
undertaking, we partnered with a number of prominent safety-
minded organizations and individuals. Like all of our prior
efforts to increase proper use of safety restraints, we believe
education is critical to increasing booster seat use.
A key component of our education strategy is the
distribution of innovative, professionally developed
educational materials to daycare centers, preschools, and
elementary schools across the country. The Boost America!
program has already forwarded educational materials to more
than 150,000 daycare centers, preschools, and elementary
schools, and through direct financial grants to states and
local programs Boost America has already sponsored more than 60
car seat inspection events in 13 states and the District of
Columbia and Puerto Rico, and we have certified over 300 new
child passenger safety technicians during 20 certification
courses in 7 states.
Additionally, the Boost America! program will distribute
one million free booster seats nationwide. Half a million of
those seats will be distributed to lower income families
through United Way of America agencies around the country. The
remaining half a million seats will be distributed by a voucher
system through Ford Motor Company dealers and our partners. The
vouchers will permit the remaining seats to be obtained at
Toys-R-Us stores.
With your permission, I would like to submit additional
information about the Boost America! program to the Committee
for the record.
In conclusion, Ford Motor Company is a leading champion of
child safety and booster seats. In fact, Ford was the first
vehicle manufacturer to market a child restraint system in the
U.S., beginning way back in 1957. In fact, Ford Motor Company
was the first, second, and third manufacturer to market child
restraint systems in the United States. Ford's Tot-Guard child
restraint was introduced back in 1967 and it was sold by Ford
and its dealers for many years until more modern child
restraint systems became readily available in the marketplace.
Ford's sponsorship of the Boost America! program
demonstrates our firm commitment to dramatically increase the
use of booster seats, and we look forward to working together
with you and with others in the safety community on this very
important safety issue.
Thank you.
[The prepared statement of Mr. Vondale follows:]

Prepared Statement of James Vondale, Director, Automotive Safety
Office, Ford Motor Company
Good morning, Mr. Chairman, Members of the Committee. I am James
Vondale, Director of Ford Motor Company's Automotive Safety Office. I
appreciate the opportunity to be here today to discuss child safety and
booster seats.
Over the past-few-decades, significant advances have been made in
vehicle safety technology, and traffic fatality rates have declined
steadily. Unfortunately, motor vehicle crashes remain the leading cause
of death of children ages 5 to 14 in the U.S. Additionally, while
injuries and fatalities involving infants and toddlers are down because
of new developments in restraint technology, the wide availability of
child safety seats, and aggressive education efforts, injuries and
fatalities among children ages four to eight have declined only
slightly. We are pleased with the progress that has been made to
improve child passenger safety. But, Ford Motor Company is not
satisfied and we continue to put motor vehicle safety, and particularly
child safety, high on our agenda for continuing efforts for
improvement.
Ford has worked for many years to increase proper restraint use by
vehicle occupants of all ages. While our overall efforts will continue,
we have increased our focus recently on the need to further improve the
effectiveness of restraint systems for children. Ford believes that
booster seats should be used by children who have outgrown child safety
seats but are too small to wear vehicle safety belts properly.
According to the National Highway Traffic Safety Administration, a
child under 80 pounds is almost always too small physically to benefit
as much from an adult safety belt alone as the child could benefit if
better positioned by a booster seat. In a crash, poor belt fit can
reduce the protection that the safety belts otherwise would provide
against the risk of serious or fatal injuries. Booster seats help
address that concern by raising the child in the seat, filling the size
gap so the safety belts fit properly. Booster seats are also simple to
use and can be moved easily among different vehicles. Unfortunately,
available data indicates that only a small percentage of children
between the ages of 4 and 8 are using booster seats.
Ford strongly supports the efforts of this Committee and other
initiatives that can increase booster seat use. In fact, Ford believes
booster seats and child safety are so important that we launched the
Boost America! program in April of last year. Because of the importance
and broad scope of this undertaking, we have partnered with a number of
prominent safety minded organizations. Like all of our prior efforts to
increase proper use of safety restraints, we believe education is
critical to increasing booster seat use. A key component of our
education strategy is the distribution of innovative, professionally
developed educational materials to day care centers, pre- schools and
elementary schools across the country. The Boost America! program has
forwarded educational materials to more than 150,000 centers and
schools. Boost America! has already sponsored more than 60 car seat
inspection events in 13 states, the District of Columbia and Puerto
Rico and certified 317 new child passenger safety technicians during 20
certification courses in 7 states.
Additionally, the Boost America! program will distribute 1 million
free booster seats nationwide. Half a million of the seats will be
distributed to lower income families through United Way of America
agencies around the country. The remaining half a million seats will be
distributed by a voucher system through Ford Motor Company dealers and
our partners. The vouchers will permit the remaining seats to be
obtained at Toys-R-Us stores. I would like to submit additional
information about the Boost America! program to the Committee for the
record.
In conclusion, Ford Motor Company is a leading champion of child
safety and booster seats. In fact, Ford was the first vehicle
manufacturer to market a child restraint system in the U.S., beginning
in 1957. Ford's Tot Guard child restraint was introduced in 1967 and
sold by Ford and its dealers for many years until more modern child
restraint systems became readily available in the marketplace. Ford's
sponsorship of the Boost America! program demonstrates our firm
commitment to dramatically increase the use of booster seats and we
look forward to working together with you and others in the safety
community on this important safety issue.

Senator Fitzgerald. Mr. Vondale, thank you very much for
that, and congratulations to Ford Motor Company for the good
work you are doing in this area.
When will you be distributing the one million booster
seats? Over what period of time is that?
Mr. Vondale. That will be distributed shortly, the
distribution period will begin. I believe that will cover about
a 2-year period.
Senator Fitzgerald. It is very important work and I
compliment you and Ford Motor Company for your efforts in this
area. Thank you.
Mr. Baloga, thank you for being here.

STATEMENT OF TOM BALOGA, PRESIDENT,
BRITAX CHILD SAFETY, INC.

Mr. Baloga. You are welcome, Mr. Chairman. I am Tom Baloga,
President of Britax Child Safety, Incorporated. My company is
located in Charlotte, North Carolina. We are the U.S.
subsidiary of Britax International, Warwick, England. Based on
global sales, Britax is the world leader in child restraint
sales. We have manufacturing and R and D in England, Germany,
Australia, and sales offices in France, Sweden, Finland, and
the Far East, and we have been manufacturing in the U.S. since
1996. So we have a very global perspective on child restraints.
I would like to make three main points in my testimony. No.
1, adult belts are too big for children 4 to 8 years old and
most parents do not know this, and a national child restraint
law would correct this. No. 2, we child restraint manufacturers
must do a better job attracting 4 to 8 year olds to use
restraints. No. 3, Congress has the power to remove an
impediment to education by passing a Good Samaritan law for
child restraint educators.
All over the world, children in child seats are being
protected. Despite everything, child seats are doing an
excellent job protecting children. But we can and must always
do better. Seat belts in vehicles are primarily designed to be
used by themselves to protect adults, not children, and the
reason is that vehicle seat belts are positioned optimally for
adults and therefore they are too big for children.
If vehicles were produced with a wide range of adjustment
for adults and bigger children, as you had asked the question
earlier, there would be a potentially huge problem of misuse by
adults who would never adjust the seat belt to the adult
position. What that means is that if you can accommodate
children and move the seat belt low enough for the child, you
would have a large number of adults who would never adjust it
to the higher position and you could severely compromise
protection.
Most parents wrongly believe that at 40 pounds or 3 to 4
years of age their children can safely use an adult seat belt
and they do not understand that a child's hip bones do not
develop sufficiently until about the age of 7 to 10, and then
the child can be big enough to avoid a lap belt resting against
the soft abdomen, as previous people have testified.
Seat belts must hold a human in a crash via the human's
bone structure. Only strong bone can support the crash loads.
Frontal crash forces can easily make the child's body
momentarily weigh 2,000 pounds. This would be a 50-pound child
experience a 45-g frontal crash, as in, for example, a 30 mile
crash into a bridge abutment.
If a restrained child presses against a seat belt with a
momentarily 2,000-pound force into the abdomen, the child will
suffer lap belt syndrome, which has been mentioned by previous
testifiers. This means severe internal injuries, including
spinal column separation and paralysis. This happens if the
child is too small for the adult belt and the lap belt rides up
on the abdomen.
The problem is not one of available products to protect
children, since there are many restraints on the U.S. market
for children older than 3 years old. The problem is that most
parents honestly do not know adult seat belts are too big for
their children and this false impression is partly due to state
laws that end requirements for child restraint too young.
Most infants and toddlers are being restrained, but parents
find out that state laws for child restraints end at about 3
years of age and they wrongly believe that above this age their
children can safely use the adult belt.
I believe that the same formula for success in getting
infants and toddlers into child seats will work for getting big
kids into restraints. Laws need to be updated as soon as
possible and, since state laws seem to be very slow getting
started, it may be appropriate to consider enacting a national
child restraint use law.
For about 10 years Germany, Sweden and Austria have
required the use of an appropriate restraint device for
children up to 12 years old or less than 1.5 meters in height,
which is about 4 foot 11. This has resulted in a tremendous
number of children being protected and using booster seats.
There is now activity under way to make this a Europe-wide
directive.
A U.S. federal law or strong encouragement for states to
adopt a uniform child restraint law up to 80 pounds would be
very desirable. Recently, the Florida State Senate approved
legislation to require children 8 or younger to ride in a child
restraint and we hope this sparks interest and action by other
states. I hope that bringing attention to this issue can at
least educate parents that adult belts are too big for
children.
We manufacturers must do more. As child restraint
manufacturers, we have an obligation to do even better to make
big kids' seats attractive to kids. There are boosters on the
market now in fabrics of denim, camouflage, and themes for
older kids, like NASCAR racing and so forth. But we
manufacturers need to mobilize our efforts to prove that it is
cool to be restrained. Peer pressure at that age is very, very
important to keep children riding safely.
I believe our industry via our Juvenile Product
Manufacturers Association is ready and willing to do its part
to attract older kids, and I will carry that forward with our
JPMA.
Removing a road block to education. There are many
wonderful organizations like SAFE Kids and volunteers providing
education on proper child restraint use. The majority of adults
want all children to be protected and when they realize the
need they will respond. In the U.S. there is currently a
significant disincentive for more people to become involved in
education on child restraints. Fear of litigation stops many
organizations, volunteers, and sales people from helping
educate adults on proper child restraint use. A Good Samaritan
law for child passenger protection educators would remove this
disincentive and free up tremendous resources to provide
personal education to those who can use it. I have sent a
request to you to respectfully consider sponsoring such
legislation for a Good Samaritan law.
While instructions, labels, flyers, videos, manuals and
demonstrations are important, person to person information with
hands-on guidance is often most effective. It is frustrating to
us as a manufacturer when retailers tell us they are afraid to
provide detailed fitting instructions to consumers because they
fear product liability lawsuits. On the advice of legal
counsel, most retailers forbid their staff from attaching a
child seat into a consumer's vehicle and volunteer advocates
who conduct safety seat checks do a terrific job, but many
admit they operate in fear of litigation.
In closing, I would like to reiterate that products are
already on the market to better protect children and parents
often wrongly believe that adult seat belts are okay after 3
years of age, and updating laws and improving education can
lead to significant improvements to restraints for big kids.
Thank you and I am ready to answer any questions you might
have.
[The prepared statement of Mr. Baloga follows:]

Prepared Statement of Tom Baloga, President, Britax Child Safety, Inc.
Mr. Chairman and Members of the Subcommittee, I am Tom Baloga,
President of Britax Child Safety, Inc. My company is located in
Charlotte, NC and we are the U.S. subsidiary of Britax International,
Warwick, England. Based on global sales, Britax is the world's leading
manufacturer of child restraints. Britax has manufacturing and R&D in
England, Germany, and Australia and sales offices in France, Sweden,
Finland, and the Far East. We have been manufacturing in the U.S. since
1996.
All over the world, children in childseats are being protected.
Despite everything, childseats are doing an excellent job protecting
children, but we can and must always do better.
Seat belts in vehicles are primarily designed to be used, by
themselves, to protect adults not children. The reason is that the
vehicle seatbelts are positioned optimally for adults and they are
therefore ``too big'' for children. If vehicles were produced with a
wide range of adjustment for adults and bigger children there would be
a potentially huge problem of misuse by adults who would never adjust
the seatbelts to the ``adult position.'' Most parents wrongly believe
that after 40 lbs. or 3-4 years of age their children can safely use an
adult seatbelt. They don't understand that until a child's iliac crests
(hip bones) are developed at about the age of 7 to 10 and the child is
big enough to avoid the lap belt resting against the soft abdomen, an
adult seatbelt provides inadequate protection to a young child.
Seatbelts MUST hold a human in a crash via the human's bone
structure. Only strong bone can support the crash loads. Frontal crash
forces can easily make the child's body momentarily ``weigh'' 2,000
pounds This would be a 50 pound child experiencing a 45 g. frontal
crash as in a 30 mph crash into a bridge abutment. If a restrained
child presses against a seatbelt with a momentary 2000 pound force and
the force is going into the abdomen, the child will suffer ``lap belt
syndrome'' which means severe internal injuries including spinal column
separation and paralysis. This happens if the child is too small for
the adult belt and the lap belt rides up on the abdomen.
The problem is NOT one of available products to protect children
since there are many restraints on the U.S. market for children older
than 3 years old. The problem is that most parents honestly don't know
adult seatbelts are too big for their children and this false
impression is partly due to state laws that end requirements for child
restraint too young.
Current State Laws Are Out of Date
Most infants and toddlers are being restrained but many parents
find out that state laws for child restraints end at about 3 years of
age and they believe that above this age children can safely use adult
belts. I believe that the same formula for success in getting infants
and toddlers into childseats will work for getting ``big kids'' into
restraints. Laws need to be updated as soon as possible. Since state
laws seem to be very slow in getting started it may be appropriate to
enact a National Child Restraint Use Law. For about the 10 years
Germany, Sweden and Austria require the use ``an appropriate restraint
device'' for children up to 12 years old or less than 1.5 meter in
height (i.e. 59 inches or 4 ft. 11 in.). There is now activity underway
to make this a Europe-wide directive. A U.S. Federal Law or strong
encouragement to states to adopt uniform child restraint laws up to 80
lbs. or 4 ft. 9 in. would be very desirable. Recently the Florida State
Senate approved legislation to require children 8 or younger to ride in
child restraints and we hope this sparks interest and action by other
states. I hope that bringing attention to the issue can at least
educate parents that adult belts are too big.
Manufacturers Must Do More
We child restraint manufacturers have an obligation to do even more
to make our ``big kids seats'' attractive to the kids. There are
boosters on the market with fabrics in denim, camouflage, and themes
for older kids like NASCAR racing etc. but we manufacturers need to
mobilize our efforts to prove that it's cool to be restrained. I
believe our industry via the Juvenile Products Manufacturer's
Association (JPMA) is ready and willing to do it's part to attract
older kids.
Removing a Roadblock to Education
There are many wonderful organizations and volunteers providing
education on child restraint use. The majority of adults want all
children to be protected and when they realize the need they will
respond. In the U.S. there is currently a significant disincentive for
more people to become involved in education on child restraints. Fear
of litigation stops many organizations, volunteers, and sales people
from helping educate adults on proper child restraint use. A ``Good
Samaritan Law for Child Passenger Protection Educators'' would remove
this disincentive and free up tremendous resources to provide personal
education to those who can use it.
While instructions, labels, flyers, videos, manuals, and
demonstration fixtures are important, person-to-person information with
hands-on guidance is often most effective.
It is frustrating to us when retailers tell us that they are afraid
to provide detailed fitting instructions to consumers because they fear
product liability lawsuits. On the advice of legal counsel most
retailers forbid their staff from attaching a childseat into a
consumer's vehicle. Volunteer advocates who conduct safety seat checks
do a terrific job but many admit that they operate in fear of
litigation.
In closing I would like to reiterate that :

Products are already on the market to better protect
children

Parents often wrongly believe that adult seatbelts are ok
after 3 years of age

Updating laws and improving education can lead to
significant improvements to restraints for big kids.

Thank you and I'm ready to answer any questions you might have.

Senator Fitzgerald. Thank you very much.
Mr. Baloga, are those child safety seats or booster seats
manufactured by your company?
Mr. Baloga. No.
Senator Fitzgerald. No. I do not know if anybody--who put
those up there? Did anybody want to do a demonstration?
Ms. Paul. I turn to Joe Colella. Would you like to see?
Senator Fitzgerald. Well, I was wondering if those were for
demonstration purposes.
Ms. Paul. This low back booster seat illustrates how
parents might dismiss its importance. It really doesn't look so
sturdy, therefore parents might not think it important and
certainly cannot be the difference between life and death or
serious injury caused by an adult belt system. Then there's a
high back boosert that more imitates a front-facing convertible
seat, so that parents see this as a more obvious transition, a
graduation from small child into larger child seat. So there
are some interesting issues of perception.
Mr. Baloga. I can point out the aspects of the booster that
are very, very critical to proper attachment of the seat belt
on the child. These are horns that hold the seat belt down low
so that it does not creep up on the child's abdomen. When
adults sit in a vehicle, the belt is raised up sufficiently so
that the belt lays across the thighs. That is the optimal
position.
On a child who sits too low, it is very easy for the belt
to ride up and that is where the loads of the seat belt are
going the push into the soft abdomen. Of course, the abdomen
has no bone protection. You do not have the hip bones developed
until they are about 8 years old. So these horns artificially
act as the hip bones and they will hold the lap belt down low.
Senator Fitzgerald. So that alone is a booster seat. Most
booster seats that I have seen and the ones that my own son
used, they had a full back to it as well.
Mr. Baloga. Like this, yes.
Senator Fitzgerald. But that is a booster seat, not just a
child safety seat?
Mr. Baloga. Correct. It converts into a booster seat. You
know, the harness can be removed. The lap belt, if you notice
the cutout here, this holds it down low to simulate these
horns. That will hold the lap belt down low. Then I have
possibilities here to slide the shoulder belt in different
locations. There are three possible locations to hold the
shoulder belt in the proper position.
Senator Fitzgerald. Great. Well, thank you very much. That
was a helpful illustration.
I wanted to get back to the issue. A few of you have
mentioned the standards in the European Community and suggested
that they are much tougher than we are here. In fact, some of
the European countries have a requirement that all children
under age 11--did I hear that correctly----
Mr. Baloga. 12.
Senator Fitzgerald. 12?
Mr. Baloga. Yes.
Senator Fitzgerald.--must ride in some child restraint.
Could you tell us a little bit more about the specifics of
those laws in Europe? Apparently the European Union is
considering a Europe-wide standard?
Mr. Baloga. Yes. The age is 12 years old or 1.5 meters,
which is about 4 foot 11. If you are shorter, if you are
shorter than this or you are younger than this, you must ride
in an appropriate restraint. That means either an infant seat,
a toddler seat, or a booster seat.
Senator Fitzgerald. Does the law get more specific than
that? Does it break down the age at which you must be riding in
a booster seat, as opposed to a child safety seat?
Mr. Baloga. No, no. That is taken care of by the European
requirements for the appropriateness of the actual child
restraint, to have group zero, group one, group two, and so
forth. So depending on the weight of the child, you will select
a restraint appropriate for the child. So the law states that
below 12 years old you must be riding in an appropriate
restraint, and then ``appropriate'' is determined by the actual
restraint itself, if you follow the labeling instructions.
Senator Fitzgerald. Do you think we should have a law like
that in the United States?
Mr. Baloga. Yes. I would say 80 pounds would be the weight
limit that I would recommend, 8 years, 80 pounds.
Senator Fitzgerald. Do you think the Europeans are wrong in
going up to 12 years of age?
Mr. Baloga. I think it is too high. I think it is
unnecessary. I think it is a situation where you would be hard
pressed to find an 11 year old who would sit in a booster seat.
I think we should be more realistic.
Senator Fitzgerald. They just do not want to sit in those
seats. They are anxious to graduate out of that.
Mr. Baloga. Which is what I mentioned about we
manufacturers have to do a better job of attracting these older
kids.
Senator Fitzgerald. But the Europeans must have felt they
had some science behind their requirement there, kids up to 12
years old. What is the science behind it? They must be finding
injuries.
Mr. Baloga. It originated in that in some of those European
countries a child 12 years and younger could not ride in a
front seat and that was the origin of it. For many, many years
a child could not ride in a front seat until they were 12. With
the advent of two-seaters and convertibles and so forth, they
needed to make amendments to that. But that is really the
origin, that riding in the front was not permitted.
Senator Fitzgerald. Now, with respect to an appropriate
booster seat in Europe, what qualifies as an appropriate
booster seat and would some of the booster seats on the market
in this country not qualify as appropriate booster seats in
Europe?
Mr. Baloga. As far as meeting the European requirements, I
do not have a good answer because we do not take the U.S.
booster seats and test them to the European requirements. I
know that our Britax seats meet the European requirements.
Senator Fitzgerald. You do sell them in Europe?
Mr. Baloga. Yes.
Senator Fitzgerald. You designed them to meet the European
specifications?
Mr. Baloga. And the U.S., yes.
Senator Fitzgerald. And the U.S. But we only have--what are
our specifications?
Mr. Baloga. Well, when you start with a booster seat below
50 pounds you are automatically required to meet Standard 213,
because Standard 213, the U.S. requirement, goes up to 50
pounds. So for example, our booster seat that goes from 40
pounds to 100 pounds--and we have three models that do that--
they must meet the requirements of Standard 213 anyway.
So we would test them, for example, with a 6 year old child
that weighed--the dummy weighs 47 pounds, and it would have to
meet U.S. requirements. Above that, we would use a European P-
10 dummy that is equivalent to a test for 80 pounds. Then for
100 pounds we would use a fifth percentile female U.S. dummy
that is weighing 104 pounds.
So there are devices for testing and they are capable of
being used for compliance and also for assurances to us as a
company that we are protecting children. We are running these
tests regardless of whether there is a U.S. requirement or not.
Senator Fitzgerald. How many booster seats a year does
Britax sell?
Mr. Baloga. In the world or in the U.S.?
Senator Fitzgerald. In the world and in the U.S. Would you
know?
Mr. Baloga. In the world, probably one million. In the
U.S., we are very new in this market, so we are very small; on
the order of 100,000.
Senator Fitzgerald. Is that right? So most of your sales
are overseas. But you are headquartered here, right?
Mr. Baloga. We are headquartered in Warwick, England.
Senator Fitzgerald. Okay.
Mr. Baloga. We are only in the U.S. since 1996.
Senator Fitzgerald. You are a British company?
Mr. Baloga. Yes.
Senator Fitzgerald. Okay.
Mr. Vondale, does Ford Motor Company collaborate at all
with the manufacturers of the child safety seats and booster
seats? Does the auto industry generally?
Mr. Vondale. Yes, we collaborate with the child seat
manufacturers. In fact, as a part of our Boost America program
we collaborated very closely with several of the
manufacturers--Century. We developed with them the booster
seats that we are going to be distributing across the United
States.
Senator Fitzgerald. Oh, you developed a specific booster
seat for this program?
Mr. Vondale. One of the seats, the high-backed booster, was
developed especially for this distribution and it is available
only through the distribution. The other seat is similar to a
seat that is on the market, but again it was developed and
tested and evaluated very carefully with the two child
restraint manufacturers.
Senator Fitzgerald. So you had your own engineers involved
in that process of designing that seat?
Mr. Vondale. They were involved from the beginning in terms
of the evaluation of that seat, in fact both seats.
Senator Fitzgerald. Ms. Paul, you look anxious to speak.
Ms. Paul. I was just going to say as a sidebar, talking
about the state of child restraints in Europe, we are doing
some work in Brazil now and we have lots of testimony from
other developing nations, and it is a very, sorry situation. 5
percent of kids in Brazil are in car seats and car seats cost
over $200 because of high import tariffs. So the problems are
just so replete worldwide as traffic and urbanization become
the number one way kids are really going to die in the streets.
Senator Fitzgerald. They are putting tariffs on safety
equipment like that.
Ms. Paul. Yes.
Senator Fitzgerald. That does not seem like a good public
policy.
Ms. Paul. No, it does not seem like a good public policy.
Senator Fitzgerald. For Ms. Paul: Do we know that passing
or improving a gap-closing law actually changes behavior? Would
just passage of a law improve the usage of child safety seats?
Ms. Paul. That is a universal question in the halls of
Congress, is it not, oftentimes? There is some evidence and we
rely strongly on--for instance, we know that when you have a
primary enforcement law you can expect that seat belt usage
rates on the average go up by 17 percent. Now, that is adult
use. But then there is research that correlates adult seat belt
use with parents and caregivers using child restraints.
We also know when we look at bike helmet laws that SAFE
Kids has helped pass bike helmet laws in 16 states and we have
seen a 60 percent drop in head trauma from bicycles because of
the use of the helmets. So you can sort of tease out some of
these correlations.
The CDC has also done a study that tracks, I believe, a
correlation between primary seat belt laws passed and a rise in
use by African Americans of seat belts. So we put together
these isolated studies to make a case that laws really matter.
Of course, we know attitudinally they absolutely matter,
because parents say: If there is no law I am not sure I feel
bound to do this.
I will say, too, parenthetically, looking at the 23 states
that are moving ahead in closing those gaps, most include
language that only covers children up to the age of 6. So the
concerns that the Insurance Institute have are valid in that we
should move ahead with research at the same time as we move
ahead with passing booster seat laws. If we are going to demand
8 years of age and 80 pounds, we need good research behind
these laws. Probably the research on booster seat effectiveness
is most needed on older children of higher weights. These are
the children who are much more emotionally independent, they
demand freedom, autonomy, they want to be in that adult belt
system. We know that.
So these are important reasons why we need the research
behind mandates for booster seats of seven and eight year olds.
Senator Fitzgerald. Mr. Vondale, Ford now owns Volvo, is
that correct?
Mr. Vondale. Yes, that is true.
Senator Fitzgerald. I understand that Volvo's web site
regarding its Safety Concept Car states that: ``Today's
generation of rear seats is designed for adults and modified to
suit children. In the Volvo SCC, Volvo cars approach the matter
from the opposite direction and presents a rear seat that is
designed first and foremost for children, while functioning
perfectly well for adults, too. Both the seats in the rear of
the SCC have electrically adjustable seat cushions that can be
varied vertically. This is done so that the rear seat can be
altered to suit all those children who have outgrown rearward-
facing child seats. The seat cushion height is adjusted
steplessly to exactly match the child's height and with due
attention to belt geometry, comfort, and forward visibility.''
Is Ford considering incorporating this feature into its
regular Ford cars as opposed to its Volvo subsidiary?
Mr. Vondale. Senator, one of the advantages of having Volvo
as one of Ford's brands now is our ability to use the strength
of Volvo's safety reputation and safety expertise to develop
new concepts and new ways to address these issues. So we are
working with Volvo to, as a concept car, to evaluate those
types of systems.
Certainly one of our plans with Ford Motor Company is if
these systems are in fact proven out and they are feasible,
then they can be considered for cascading through the other
Ford brands. Right now we are working with Volvo on those types
of concepts and we think that it does have some promise.
Senator Fitzgerald. Are those adjustable seats available on
the market now with Volvo, or is that just a concept?
Mr. Vondale. That is a concept car. In fact, I was handed a
note: The concept car will be here on May 7th, and we probably
will be able to share that information with you. But it is a
concept car.
Senator Fitzgerald. Will it be here for an exhibit on May
7th? Okay. But that is not offered in any production model,
then, yet, these adjustable seats?
Mr. Vondale. No. That is a very new and----
Senator Fitzgerald. Revolutionary.
Mr. Vondale.--revolutionary concept that is being explored
as a part of the Volvo concept car.
Senator Fitzgerald. I guess my question, just to followup
on that a little bit, would be, if we were to go forward and
mandate booster seats or greater booster seat usage, that would
clearly be one way of addressing this whole issue. But do you
think the technology will be out there that we can actually
mandate that the cars themselves have seats that are adjustable
to fit children?
Now, in the past panel the panelists did not seem to think
the mandating any requirements in the cars was the way to go
because they thought it was too difficult. Clearly, the car
seat or booster seat industry would probably prefer us the
require booster seats. After all, there is some self-interest
in this. If we mandate booster seats, that is going to mandate
buying your product.
But I do not know if that is the right thing to do for our
kids in this country.
Mr. Baloga. Senator, when my son Matthew was born we looked
for a built-in child restraint and could have bought one from
Chrysler at the time. The question that we asked was, will it
accommodate an infant? The answer was no, because infant
restraints have to be rear-facing and they are very complicated
to build into a seat and bulky, so that is out of the question.
Then the second issue was, if we buy a vehicle with a
built-in child restraint we also have to buy a portable
restraint because when grandma and grandpa and our relatives
take the child we would then be expected to give them our car,
which is rather inconvenient. So the practical issue is built-
in restraints have been available and the public has decided it
is not convenient.
You also have to sit on the restraint when it is folded in,
which makes it very hard and uncomfortable. While I would grant
you that technologically it is not impossible to design a
system, at this point it is just not practicable to do so. From
the issue of the relatives transporting children, you would
have to buy a portable restraint anyway.
Senator Fitzgerald. But any kind of federal mandate it
seems to me could be written in such a way so that a parent or
a caregiver is complying with the law if they have got their
child in the required safety restraint, whether it is built
into the car or it is portable and it is basically a booster
seat.
Mr. Baloga. Yes.
Senator Fitzgerald. Would Ford have anything to add here?
Mr. Vondale. Senator, I think just looking at the booster
seats that are presented in front of us it is pretty clear that
particularly the backless booster seat is a clear example of a
very simple seat that we have found is very effective in
addressing the issues here, and that is also very affordable to
the customer and one that can be moved from vehicle to vehicle.
All of those kinds of things are very important to customers.
Senator Fitzgerald. Is the backless booster seat as
effective as one with a back?
Mr. Vondale. When we have looked at both backless and high
back, we find that the backless booster seat works very well in
vehicles that have a sufficient high back behind the child. We
want to make sure that the child's head and neck are protected.
In those vehicles, particularly much older vehicles, where the
back seat is much lower, you would want to consider a high-
backed booster seat. So I think that is the real issue of
choosing between a backless booster and the high-backed
booster, is the neck protection that is available to the child
in the vehicle that it is being used in.
Senator Fitzgerald. The ones that you are going to be
distributing as part of your campaign, they have a high back?
Mr. Vondale. We are distributing both. We have a backless
booster that will be available for vehicles that have a
sufficiently high back seat to help protect the child's neck
and head, and then we will have high-backed boosters for those
vehicles that need the high back, extra height protection.
Senator Fitzgerald. Are you doing any advertising campaign
to demonstrate the availability of your, or publicize the
availability of the seats you will be giving away?
Mr. Vondale. As I said, there is a strong educational
program that is going forth. We are using United Way and their
network to help get to those people who are of lower income. We
think that is a very effective way, rather than advertising, to
get directly to the people who need these seats.
As a part of the Ford Motor Company and our partners' give-
away--for example, AAA and others will be involved with us--
yes, there will be communications to let customers know about
the availability of this program.
Ms. Paul. I think you have also hit on the complexity that
has not been really worked out yet as to what the protocol is
to determine exactly which low-back, high-back seat is best,
considering all the variables of car seat dimensions and a
child's weight and size, and the fact that when you talk
about--and many people get this wrong--a give-away program, you
just cannot give a low income mom a seat and expect her to know
what to do with it. So then we are back to the trained
technicians who need to be certified by at least 4 days of
training and hundreds more hours of hands-on experience, being
able to guide them best, to then help them put that seat in
right.
So it is a really complicated business.
Mr. Vondale. That is a good point. One of the other reasons
we are using the United Way is the agencies there will be able
to work with the people who are getting these seats, to give
them information, so that they make the right choice and the
seat fits properly.
Senator Fitzgerald. Well, with that I want to thank all of
you. Both panels have been wonderful. I really appreciate your
interest and willingness to come here to Washington to testify.
I am hoping that some good will come out of this. I think we
have learned a lot here.
For the most part, I think all the witnesses have given
pretty clear direction on what we ought to be doing. We will
take all of your full written statements and put them in the
record, and we will look forward to continuing to work with you
on this very important issue.
Thank you all very much for being here. Thanks. With that,
I am going to adjourn this meeting.
[Whereupon, at 12:23 p.m., the Subcommittee was adjourned.]
APPENDIX

Prepared Statement of The National Association of Governors' Highway
Safety Representatives
Introduction
The The National Association of Governors' Highway Safety
Representatives (NAGHSR) is pleased to submit testimony to the Consumer
Subcommittee on the issue of child passenger safety. NAGHSR is a
nonprofit association representing state highway safety agencies. Its
members are appointed by their governors to administer federal
behavioral highway safety grant programs, develop the annual state
Highway Safety Plan, and implement highway safety programs in the
state. NAGHSR focuses on the behavioral aspects of highway safety such
as impaired driving, failure to use occupant restraints and child
passenger restraints, excessive speeding and aggressive driving,
distracted and fatigued driving, and unsafe bicycling, walking and
motorcycling.
Overview of the Problem
Research by the National Highway Safety Administration (NHTSA) has
consistently shown that occupant restraints are the most cost-effective
way to prevent deaths and injuries in motor vehicle crashes. Hence, the
failure to properly restrain drivers and occupants of a vehicle,
including children, is a priority issue for NAGHSR members.
Unrestrained children in motor vehicle crashes are an especially
troublesome, often tragic, yet preventable problem. However, it is
important to keep the problem in perspective. Inadequate occupant
protection is still overwhelmingly an adult problem. According to 1999
data from the Fatal Analysis Reporting System (FARS), children aged
nine and under represented only 3 percent of occupants killed in a
motor vehicle crash and 5.4 percent of occupants injured in such
crashes. Children nine and under killed in a vehicle who were
unrestrained represent only 2.9 percent of the total unrestrained
occupants.
Additionally, ensuring that children are placed in restraints is a
far bigger problem than ensuring that the restraints are used properly.
According to 1999 FARS data, 55 percent of fatally injured children
ages four to nine are completely unrestrained. Restraint use for
children from birth to age one is 97 percent, and ages one to four, 91
percent. From age five to 15, restraint use plummets to 68.7 percent.
Hence, a major focus of state occupant protection efforts for children
is to make sure that children are restrained and that they are kept in
appropriate restraints for as long as possible before being moved to
safety belts.
Generally, state child passenger protection programs have three or
four components: legislation, public information and education
programs, enforcement and child safety seat clinics and fitting
stations. Although legislation is a very important component, it is
only one element of a comprehensive approach to child passenger safety.
Without education and enforcement, legislation alone will have a
limited impact upon behavior.
Legislation
Two states had enacted booster seat laws prior to the 2001
legislative session. In 2000, Washington was the first to enact a
booster seat law which requires children up to 6 years old or 60 pounds
to be restrained in booster seats. The law will take effect July 1,
2002. California subsequently enacted a law that would require children
up to 6 years old or 60 pounds to be in booster seats. California's law
will take effect Jan. 1, 2002.
During this year's sessions, the states have been very active on
the legislative front. Many states have pending legislation that would
close the gaps in child restraint laws or specifically require older
children to be restrained in booster seats.
There are two distinct problems with the drafting of state booster
seat legislation. First, all state child restraint laws require that
children be placed in child restraint systems that are consistent with
federal safety standards (FMVSS 213). (See attached Arkansas law which
is typical of how state laws are written.)* However, the current
federal child restraint standard only covers safety seats for children
49 pounds or less. Hence, by referencing the federal standard, state
booster seat laws encourage parents to put children into boosters that
are untested and potentially unsafe.
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* The information referred to was not available at the time this
hearing went to press.
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Further, by referencing the federal standard such laws are put into
a legal ``grey'' area. A good defense lawyer could easily mount a
challenge to such a law in court because there is no federal standard
for child restraints for children 50 pounds or above. In order to
rectify this situation, the National Highway Traffic Safety
Administration (NHTSA) must raise the standard for child restraints and
do so as quickly as possible.
Secondly, there is currently no consensus on the appropriate age or
weight for booster seats and hence, it is difficult to know how to
write a state law. Some states have used a 6 year old or 60 pounds
limit. Others have higher limits. The difficulty with a limit based on
age or weight is that there are always exceptions. A standard child
passenger safety seat may better serve children who have reached the
age limit but not the weight limit. Larger children who have reached
the weight limit but not the age limit may better suited to a booster
seat. A number of researchers and child safety advocates believe that
the best test for children is a ``fit'' test. If the child can sit in a
booster seat with his/her legs bent over the edge, with the lap belt
low on the hips, and with the shoulder belt properly positioned across
the chest, then that seat is right for the child. It is difficult,
however, to write a fit test into state legislation. NHTSA should
reconvene its Blue Ribbon Panel on Child Restraint Usage and encourage
it to take the lead on the development of research-based guidelines for
use of booster seats.
There are also concerns about mandating booster seats in states
that have large low income populations. These populations typically own
older vehicles with lap-only belts in rear seats. Booster seats are not
compatible with and cannot be used with such vehicles. Retrofit kits
for older cars are expensive and scarce. Child restraint manufacturers
should be encouraged to develop booster seats that can be properly used
with lap-only seat belts.
Despite these difficulties, many states have forged ahead with
booster seat legislation because they are concerned about the safety of
young children and want to take every precaution to protect them.
NAGHSR conducted an informal poll of its member State Highway Safety
Offices (SHSO's) the week of April 16 and 33 states have responded to
date. Of the 33 respondents, 14 states have introduced booster seat
laws this session. Of those, one was enacted (Arkansas) and one was
killed (Maryland). The remainder are still pending. Individual state
responses are as follows:
Arkansas--legislation enacted in February that would require
children 6 years of age or at least 60 pounds to be in an age-
appropriate child passenger safety seat. The law will go into effect
this summer.
Colorado--booster seat bill may be introduced next session.
Connecticut--legislation is pending that strengthens existing CPS
law.
Delaware--booster seat bill is pending.
District of Columbia--current child restraint law is being re-
written and strengthened. A booster seat bill is expected to be
introduced shortly.
Georgia--legislation introduced to strengthen child safety seat law
and mandate booster seat use. Booster seat portion not accepted by
legislature.
Hawaii--booster seat bill pending. The legislature enacted a
booster seat bill that would require children to be in booster seats if
they are under 80 pounds or 8 years old. The bill is awaiting the
Governor's signature. It would go into effect Jan. 1, 2002.
Iowa--bill pending which would raise the age of child restraint
coverage to 5 and would require children age 13 or younger to be
restrained in any seating position in a vehicle.
Illinois--booster seat bill is pending.
Kansas--booster seat bill introduced. Senate passed bill but no
action has been taken by House. Passage unlikely.
Louisiana--booster seat bill is pending.
Maryland--booster seat bill passed Maryland Senate 41-4 but killed
on House floor.
Massachusetts--booster seat bill is pending.
Missouri--Senate bill passed but House action is uncertain. Passage
unlikely.
Minnesota--Booster seat bill introduced but stalled in committee.
New Hampshire--may file a booster seat bill later this spring.
North Carolina--will hold a study commission on the issue this
year; expect to file a booster seat bill in 2002.
New Jersey--booster seat bill is pending. Bill also requires
children 8-18 to wear safety belts in any seating position in vehicle.
New Mexico--current CPS law strengthened, effective 7/1/2001.
Oregon--booster seat bill is pending.
Rhode Island--booster seat bill pending; chances of passage are
very good.
Texas--booster seat bill is pending.
Vermont--booster seat bill is pending.
Clinics and Fitting Stations
Every state has trained Child Passenger Safety (CPS) technicians
who are certified in NHTSA's four day standardized training curriculum.
The course includes three days of classroom instruction and one day of
hands-on training and student evaluation. There are strict standards a
student must pass before he/she can become a certified technician.
Technicians learn about and are evaluated on booster seats as part of
their standardized NHTSA training.
State Highway Safety Offices are the primary financial supporters
of technician training. They pay for technician training from a variety
of federal sources: Section 402 State and Community Highway Safety
grants (23 U.S.C. 402); Section 157 incentive grants to increase seat
belt usage (23 U.S.C. 157); Section 405 occupant protection incentive
grants (23 U.S.C. 405); and Section 2003(b) child passenger protection
incentive grants (Section 2003(b) of TEA-21). According to NHTSA, there
are more than 15,000 trained CPS technicians, and more are being
trained every day.
Every state also conducts CPS clinics on a regular basis. The
clinics are special events held during a fixed period of time on an
identified date. At a clinic, trained technicians check the proper
installation of child restraints, hand out information about child
restraints, and educate parents and caregivers on the proper type, use
and fit of child restraints. Correction of booster seat installations
and booster seat education are a big part of state CPS clinics. The
clinics are typically held in conjunction with safety fairs, at grocery
stores or pre-schools, at local retailers, hospitals, or day care
centers, etc.
States may also conduct a select number of special events each year
focused on booster seats. Utah, for example, conducted 150 clinics in
both rural and urban areas last year. At least one special event
focused on booster seats. Parents with children aged 4-8 were
encouraged to attend, and special booster seat education was provided.
Low cost or no-cost booster seats were also given to attending parents.
Nearly every state also has permanant fitting stations. These are
places with a trained technician open to the public on a regularly
schedule basis. A parent or caregiver can make an appointment and bring
his/her vehicle and child restraint for an inspection by a trained
technician. As with the CPS clinics, booster seat education is an
integral part of the fitting. The fitting stations are typically car
dealerships, fire stations, local police departments, county health
departments, etc. Some states operate mobile fitting stations (usually
a retrofitted bus) which can provide child safety seat and booster seat
inspections in less densely populated areas of a state.
Most states also give child restraints (including booster seats) to
low income families. Last year, Utah distributed approximately 3,500
booster seats to needy families. Delaware's Office of Highway Safety is
presently coordinating a number of booster seat distributions for low
income families with such partners as the federal Women, Infants, and
Children (WIC) program, Head Start, PTA's, elementary schools, and
pediatricians.
Even small states actively promote booster seats at their CPS
clinics and fitting stations. Montana, for example, conducts clinics
all year long in the seven largest counties and several of the smaller
counties. The state also operates twelve fitting stations. At almost
all of these forums, booster seats are included in the process to
educate parents about child safety seat usage and installation.
The Section 2003(b) program is a major source of funding for both
fitting stations, CPS clinics, and child restraints (including booster
seats). This program was authorized under TEA-21 at $7.5 million for
2000 and 2001 only. The 2003(b) program, which is an earmark out of the
obligation limitation for federal-aid highways, should be funded at
$7.5 million each year for the remaining two years of TEA-21.
Public Information and Education
In addition to fitting stations and clinics, every state also has
an educational program aimed at informing parents about the proper use
of child restraints, including booster seats. States typically provide
education through public service announcements, websites, banners,
posters, brochures, special contests and media events, press releases,
videos, or through classes for parents. States may also conduct CPS
workshops and summits to keep trained technicians apprised of the
latest developments in child passenger safety, including booster seat
safety. The technicians, in turn, use the updated information when they
communicate with parents at fairs, clinics, fitting stations, and the
like.
Some State Highway Safety Offices have special educational programs
for targeted populations. Connecticut, for example, has a safety
program specially geared toward the Latino population to teach them
about the importance of child restraints, including booster seats. In
Georgia, an aggressive outreach program was implemented to raise
awareness and increase child restraint use (including booster seat use)
in designated low-income, minority and rural Georgia communities.
Georgia is also partnering with minority organizations, minority
sororities and fraternities, historically black colleges and faith
communities to host minority health fairs and help educate the minority
community about the need for child restraints, including booster seats.
The Oklahoma highway safety office is funding a full-time traffic
safety educator through the Latino Community Development Agency. The
educator will hold twenty workshops in English and Spanish to educate
parents about child restraint use, including booster seats, and will
distribute printed materials as well.
Maryland's educational program is typical of those found in most
states. The Maryland Kids in Safety Seats (KISS) program is the primary
educational resource for child passenger safety. Information is
provided to parents about child restraints and booster seats through a
partnership with social clubs, day care centers, preschools, elementary
schools, the health care community, and other community organizations.
Another component is the ``Prescription for Your Child's Safety,'' a
partnership between the Maryland Chapter of the American Academy of
Pediatrics, the Maryland Highway Safety Office, and Maryland Safe Kids.
The program, which has reached more than 3,000 family practitioners and
pediatricians in the state, provides a check-off form for doctors to
use with families. The form provides guidance to doctors on appropriate
child restraints, including booster seats. The Baltimore City Community
Traffic Safety Program, in partnership with the Baltimore Safe Kids
Coalition, has offered a Give Kids A Boost program for the last several
years for city residents. When children are brought to specified
locations to visit the TIKEmobile, they can receive an immunization
booster shot as well as a free booster seat. Parents are also given
assistance with installation of all child restraints.
NAGHSR and its members have also been an active participant in the
Ford Motor Company Boost America! Campaign. This $30 million campaign
is intended to raise public awareness about the importance of booster
seats and has three parts: an educational component, a booster seat
distribution component, and a grant component. The State Highway Safety
Offices will be a key partner in the booster seat distribution
component. A half a million booster seats will be given to low income
families. The booster seats will be disseminated at press events that
will be held in a different state each week for the next year. The
SHSO's will help organize these events, and state-funded child
passenger safety technicians will be on hand to disseminate the seats
and offer installation advice.
Once a state enacts a booster seat law, the state typically
undertakes an educational campaign to notify parents of the new law.
Washington, for example, used its Child Passenger Safety Teams--located
in 30 of 39 counties--to get the word out. The SHSO has also developed
booster seat public service announcements for both radio and
television. The office is also developing an interactive educational
video for kids of booster seat age. Additionally, the SHSO is working
with broadcast companies and radio stations who are sponsoring booster
seat events.
Enforcement
Since there are no booster seat laws currently in effect, the
states have not yet undertaken special booster seat enforcement
efforts. Rather, states typically enforce child restraint laws as part
of their regular enforcement waves and biannual enforcement campaigns.
In Michigan, for example, booster seat use is a prime message in all
occupant protection enforcement campaigns. As more and more states
enact booster seat laws, it can be expected that states will undertake
special enforcement efforts to increase usage rates.
Summary of Recommendations
In summary, all states are conducting a number of activities to
promote booster seats. In order to maximize state efforts, however, the
following should be undertaken:

NHTSA should upgrade FMVSS 213 to cover restraints that can
accommodate children up to 80 pounds.

NHTSA should reconvene the Blue Ribbon Panel on Child
Restraint Usage and develop uniform guidelines on the use of
booster seats.

Manufacturers should be encouraged to develop booster seats
that are compatible with lap-only belts for use in the rear
seats of older vehicles.

Congress should extend the funding for the Section 2003(b)
program which is slated to expire at the end of FY 2001.

Thank you for the opportunity to submit the views and
recommendations of the National Association of Governors' Highway
Safety Representatives (NAGHSR).