Child restraint system (CRS) misuse is a common occurrence that remains a challenge for the child passenger safety community and caregivers. Particularly alarming is that although recent estimates of CRS misuse are as high as 72 percent(1) other research has found that 90 percent of caregivers are confident or very confident in their installation of a CRS(2). In research published in Injury Prevention this month, researchers at the Center for Injury Research and Prevention at The Children’s Hospital of Philadelphia investigated caregivers’ confidence in one-time CRS installations.

Of the 75 experienced caregivers that participated in the study, 30 percent installed the CRS incorrectly yet reported confidence that the installation was correct. In attempting to understand why this occurred, participants were asked about their prior use of child passenger safety resources such as websites, brochures, primary care physicians, and talking with a friend or relative. Results found that the greater the quantity of resources they were exposed to, the less confidence they had in their CRS installation. “This might suggest that the more caregivers learn about child passenger safety, the more they see it as complicated, difficult, and intimidating-- or that less confident caregivers might be more motivated to seek out resources. Future research will explore the direction of effects as well as the quality of these resources,” said Jessica Mirman, PhD, lead author of the study.

“Future research is needed to better understand how and why certain errors are made during installation so simpler instructions and education can be provided and potential engineering solutions investigated,” said Dr. Mirman. “These can include vehicle manufacturers offering integrated child safety seats or child safety seat manufacturers providing mechanisms for clearly alerting parents about security and accuracy errors during installation. In the interim, child passenger safety technicians do an incredible job of educating parents and caregivers. The child passenger safety community should consider creative ways to continue to provide families with the support they need to avoid common installation errors.”

CHOP has created a checklist of common CRS installation mistakes for parents to check for.


(1) Decina LE, Lococo KH. Misuse of Child Restraints. Washington, DC: Office of Research and Technology, National Highway Traffic Safety Administration; 2004.

(2) US Department of Transportation NHTSA. Child Car Safety. In: US Department of Transportation NHTSA, Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 2012.