Child Passenger Safety Resource Provision Among Crash-Involved Children in Pediatric Emergency Departments

Ashley N. Downs, MPH
Rachel K. Myers, PhD, MS
Christina Labows, MPH
Isabella Tullio, MPH
Jennifer McCain, MD
Emma Sartin, PhD, MPH

Despite advances in child passenger safety interventions and restraint recommendations, motor vehicle accidents remain a major cause of injury and death for children in the United States. Further, gaps in restraint use and access to injury prevention resources persist. Understanding patterns of restraint status and referral to child passenger safety resources documented during medical evaluations following motor vehicle crashes present natural opportunities for improving education and intervention. The purpose of this study was to characterize documentation of restraint status and dissemination of child passenger safety resources among crash-involved child passengers using electronic health record (EHR) data.

Data on child passengers (0-18 years old) who sought medical evaluation following a motor vehicle crash from 1/1/2018-5/23/2025 were retrospectively extracted from two tertiary, level 1 pediatric hospitals’ EHR. We used International Classification of Diseases, 10th Revision, (ICD-10-CM) codes from Emergency Department (ED) visits to identify eligible patients. Data regarding the crash, injuries, and medical care were abstracted and descriptively analyzed. We summarized restraint status (restrained, unrestrained, unknown/other) and provision of child passenger safety resources during the ED encounter (e.g., referral to web-based education, provision of a new car seat).

As of May 2026, 482 crash-related visits from 2018-2025 were abstracted. While most patients were noted to be restrained (75.9%), 14.9% were unrestrained, and 9.1% had an unknown or other restraint status documented. Overall, 28.6% of patients had information regarding provision of child passenger safety resources noted in the EHR. These included: provision of informational diagrams or video links, referral to a community-based car seat check, or distribution of a hospital-provided new car seat. Approximately 1 in 5 patients, regardless of restraint status, received any child passenger safety resources. Rates of receiving information differed by restraint status, with restrained patients more likely to receive resources or new car seats compared with unrestrained patients (29.5% vs. 22.2%, respectively).

We observed that only a small proportion of patients received child passenger safety resources, including unrestrained patients, who may represent a higher-risk population. Findings highlight an opportunity to strengthen hospital-based injury prevention education and interventions to continue efforts to improve child passenger safety. Ongoing evaluation of child passenger safety education and resource dissemination efforts may help to identify barriers in accessing child passenger safety resources and inform strategies to improve hospital-based injury prevention efforts for children involved in motor vehicle crashes.

1. Describe patterns of child restraint use among pediatric patients involved in motor vehicle crashes using electronic health record data.
2. Evaluate differences in rates of sharing child passenger safety resources based on restraint status.
3. Identify potential gaps for child passenger safety counseling in pediatric emergency care settings.