Leading child safety experts are calling for regulations around child car restraints to be brought into line with the medical evidence and similar countries worldwide, saying that “a large proportion” of Australian children are being put in danger of life-altering traumatic injuries or death every day due to inappropriate use of car and booster seats.
The calls come as the state and federal ministers for transport undertake a review of Australia’s child restraint rules, which have been condemned as out of step with safe practice guidelines.
Road crash deaths are the leading cause of death for children aged 1 to 13 in Australia, according to the Australian Institute of Health and Welfare. Last year 63 children, aged 0-16, died in road crashes. This has remained fairly stable over the past decade.
Experts warn that many parents who are following the law are inadvertently placing their children in increased danger of catastrophic injury or death.
Warwick Teague, director of the trauma service at the Royal Children’s hospital in Melbourne, said there was “a mismatch between what is permissible by law and what is best practice”.
“Parents at the moment are being given permission to place their children in a kind of car restraint which doesn’t maximally protect them and may in fact, cause them harm.”
Of particular concern to experts are the regulations that allow babies to be moved from a rear-facing to a forward-facing car seat at six months of age, when research shows they should be at least one year old.
Babies under the age of 12 months could be at higher risk of “catastrophic spinal injuries” if placed in a forward-facing car seat compared to a rear-facing one, Teague said, as they don’t have the neck or torso strength to support their large head, which is thrown forward in the event of a crash.
Children are also allowed to be moved out of a booster seat at age seven, even though the majority of children are not tall enough to safely use an adult seatbelt until the age of 10-12. The general guide is a child should be 145cm tall and be able to pass the Five Step test.
This puts children at risk of additional injuries in a crash, because the seatbelt sits across their neck and abdomen, rather than their shoulder and thighs. These injuries can include rupturing the bowel and other organs, breaking the spinal column and severing the spinal cord.
Teague cited the case of an 11-year-old patient of his who was rendered a quadriplegic after a car crash in 2019 in which he was wearing a seatbelt but not sitting in a booster seat.
“Had Sam been supported by a booster seat it’s likely his injuries would have been less severe,” he said.
Sam’s mother, Lisa Farnsworth, said that parents should make sure their child has outgrown the size limit on the booster before they are moved out of it, even if the child complains or is embarrassed.
“Parents need to be firm when their children argue about sitting in a booster seat. Safety should always come first. Tell them that the people in the car care about them the most,” she said.
Teague and other child safety advocates have recommended the government update the law to require booster seats for children until the age of 10 and for babies to stay rear-facing until at least 12 months of age.
“Australia is well behind many other comparable legal and safety systems,” said Teague. “So there are a group jurisdictions who have settled on an age [for graduation from booster seats] and the age they’re settled on is 10 to 12.
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“There are so many ways in which Australia, when you think about our record on other public health measures, we are the world leaders … but on this we aren’t.”
Jason Chambers, general manager of Kidsafe Victoria, said that parents believed they were doing the right thing by following the law, and were often horrified to learn they have been endangering their child.
“A lot of them are quite shocked, they had read the laws and thought they were doing what was safest for their child. That’s one of the reasons that we’re calling for the updates to the laws, to make it easier for parents and carers to understand what’s safest for my child.”
“It’s reasonable that people assume that the laws that govern their actions reflect safe, best practice,” Teague said. In his clinical practice, he has seen cases where the first time a parent learns that their child had been inappropriately, though legally, restrained, was after a devastating car crash.
“We have families who are finding out the truth and the validity of the best-practice safety guidelines, through tragedy. That is a terrible thing. It’s already too much for any family to lose a child or to have that child’s life dramatically redirected by paraplegia, or another devastating injury. But to add the recognition that this is preventable to some degree, that is a really difficult truth.”
Bianca Albanese, a postdoctoral fellow at Neuroscience Research Australia, said a large-scale study she co-authored in 2022 found that 72% of children were in car seats that were incorrectly installed or fitted.
“Making sure there are no major errors in the installation and use of the restraint is extremely important. So having harnesses done up tight and adjusted to the correct level and making sure the restraints [are] installed into the vehicle correctly, that is one of the major risk factors for child injury and death of children.”
Teague said he was pleased to see the state and federal transport ministers commitment last December to reviewing current child restraint laws. “We’ve got traction and we want to celebrate the willingness of the government to move on this.
“The laws must change. [Maintaining] the status quo would be not just unacceptable, but a failure of our shared duty to protect children.”
