Demographic Patterns of Age- and Size-Appropriate Child Restraint Use in Chicago.

objectiveAge alone is often used to define appropriate child restraint system (CRS) use. Children who lack access to primary care may rely on acute care settings and miss opportunities for anticipatory guidance on child passenger safety. We sought to characterize age- and size-appropriate CRS use among emergency department (ED) and urgent care patients in metropolitan Chicago to inform targets for intervention.

methodsWe conducted a secondary cross-sectional analysis of clinical trial screening data collected from English- and Spanish-speaking caregivers of 6-month through 10-year-old children, January 2021 to August 2022. Caregiver-reported transportation behaviors were linked to electronic health record data. CRS use was categorized as appropriate or prematurely transitioned for age and size. Descriptive statistics were calculated. Chi-square and logistic regression analyses were used to test for child, family, and visit characteristics associated with premature transitions.

resultsOf the 4269 caregivers with matched screening and electronic health record data, 4045 (94.8%) were included and 933 (23.1%) had prematurely transitioned their child. Premature transitions were most associated with child age 2 to 4 or 8+, Black race or Hispanic/Latine ethnicity, and being seen in the ED. Premature transitions differed across child age groups and were most common among Hispanic/Latine and Black children (age <8), families with larger household size (age 8+), and children seen in the ED (age 2-4).

conclusionsPremature transitions are common among children who received acute care in metropolitan Chicago. This population is at risk for crash-related injuries. Child passenger safety interventions targeted to families who seek acute care may benefit specific demographic groups.