Rating child passenger safety laws relative to best practice recommendations for occupant protection

<p><b>Background</b>: State laws regarding child passenger protection vary substantially.</p> <p><b>Objectives</b>: The objective of this study was to develop a scoring system to rate child passenger safety laws relative to best practice recommendations for each age of child.</p> <p><b>Methods</b>: State child passenger safety and seat belt laws were retrieved from the LexisNexis database for the years 2002–2015. Text of the laws was reviewed and compared to current best practice recommendations for child occupant protection for each age of child.</p> <p><b>Results</b>: A 0–4 scale was developed to rate the strength of the state law relative to current best practice recommendations. A rating of 3 corresponds to a law that requires a restraint that is sufficient to meet best practice, and a rating of 4 is given to a law that specifies several options that would meet best practice. Scores of 0, 1, or 2 are given to laws requiring less than best practice to different degrees. The same scale is used for each age of child despite different restraint recommendations for each age. Legislation that receives a score of 3 requires rear-facing child restraints for children under age 2, forward-facing harnessed child restraints for children aged 2 to 4, booster seats for children 5 to 10, and primary enforcement of seat belt use in all positions for children aged 11–13. Legislation requiring use of a “child restraint system according to instructions” would receive a score of 1 for children under age 2 and a 2 for children aged 2–4 because it would allow premature use of a booster for children weighing more than 13.6 kg (30 lb).</p> <p><b>Conclusions</b>: The scoring system developed in this study can be used in mathematical models to predict how child passenger safety legislation affects child restraint practices.