Motor vehicle collisions continue to be the leading cause of death among children in many jurisdictions around the world. To illustrate, it is estimated that 319 children aged 0 to 14 were killed in the EU in 2012 (Jost et al. 2014), although it was also noted that there was substantial variation in the level of child safety across countries. For example, it was reported that children in Greece had a much greater risk of being a victim as a passenger in a vehicle as compared to children in Switzerland (Jost et al. 2014). In addition, in Spain, there were 37 children killed in vehicles in 2012 and nine of these children were not restrained. Similarly, according to the Canadian Paediatric Society (CPS), many deaths and injuries each year are directly attributed to non-use or misuse of child restraints. Children and adolescents aged 0-19 accounted for 16% of motor vehicle traffic collision fatalities and 19% of injuries in Canada in 2006 (van Schaik 2008). Elsewhere, a review of various studies in the United States estimated that child safety seats that were correctly installed and used for children aged 0—4 years could reduce the need for hospitalization by 69%, and that in the United Kingdom, new rules governing the use of child restraints rather than adult seat-belts for children would reduce child deaths or injuries by 2,000 cases annually (FIA Foundation for the Automobile and Society 2009). It should also be noted that securing one’s child in the vehicle not only makes the child safer, but it increases safety for all persons in the vehicle since unbelted rear seat passengers can become objects that collide with drivers or front seat passengers in a frontal crash (Kidd and McCartt 2014). The European Transport Safety Council (ETSC) and the CPS believe that many deaths and injuries can be prevented through increased enforcement of child restraint provisions, public education and clinician advocacy (ETSC 2006; van Schaik 2008). The importance of proper restraint use among children in vehicles has been clearly demonstrated by several studies over two decades (Markl 2012; Bruce et al. 2011; Grossman and Garcia 1999; Zaza et al. 2001). Research from Belgium and Germany, reported in an ETSC Fact Sheet on child restraints (2006), measured the risks of fatality and injuries death among unrestrained children in vehicles and determined that these risks are substantial. To illustrate: * children that were unbelted or unrestrained were seven times more likely to be killed or severely injured; * the crash consequences of unrestrained children at 50km/h were equivalent to those associated with a 10 meter fall; * that an eight year old child weighing 30kg will be thrown forward with a force 25 times its body weight; and, * without a child safety seat a crash at just 15km/h can be fatal (ETSC 2006). * In a matched cohort study involving children aged 4 to 8 years, unrestrained passengers were 2.8 times more likely to die than those who were restrained with booster seats and seatbelts (Rice et al. 2009). It is equally important that adults (parents, caregivers) correctly use the safety equipment that is available. While securing one’s child by means of an infant seat, booster seat or seat belt is preferable to not using restraints, in order for children to receive the maximum protection the restraints must be used properly. Of concern, this is often not the case. A review of more than 5,000 child car seats were checked by experts in Ireland and it revealed that as many as three out of four seats may be incorrectly installed (Jost et al. 2014). A population surveillance study of child passengers in Canada showed that inappropriately restrained children were still almost twice as likely to be at risk of injury in a collision compared to children who were properly restrained (Santschi et al. 2008). Most recently, as evidence of concern associated with this problem, in November 2014 the United Nations Road Safety Collaboration announced a global campaign for the Third UN Global Road Safety Week, (May 4-10, 2015) on children and road safety (#SaveKidsLives) in order to promote attention to this important problem and also to encourage countries to take action on it to increase road safety among children (See http://www.who.int/roadsafety/week/2015/en/). In order to increase understanding of ways that the use of child restraints can be strengthened, the Traffic Injury Research Foundation (TIRF) conducted a literature review on behalf of the Canadian Automobile Association (CAA) to examine the effectiveness of campaigns that have been previously undertaken to promote child passenger safety. Research focused on educational and promotional campaigns in Europe, North America and other countries that emphasized increased or correct use of a range of child safety devices was included in the review. More specifically, this research related to campaigns on the following types of devices: * infant seats * booster seats; * rear-seat placement of children; and, * safety equipment use in general. (Author/publisher)
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