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Pediatrics. 2002 Oct;110(4):729-36.

Barriers to booster seat use and strategies to increase their use.

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Division of General Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.



Children who have outgrown child safety seats and been placed in adult seat belts are at increased risk for injury. Pediatricians and other advocates have been called on to encourage booster seat use in these children. The objective of this study was to identify barriers to booster seat use and strategies to increase their use.


A qualitative study consisting of focus groups and follow-up in-depth discussions were conducted among parents and/or children to elicit barriers and strategies to appropriate/best practice child restraint system use. Phase I focus groups (parents and children) identified barriers to booster seat use along with children's self-reported likes and dislikes about booster seats. Phase II focus groups (parents only) identified additional barriers to booster seat use and suggestions for strategies to increase the use of booster seats. In-depth telephone discussions (parents only) were conducted after each phase of focus groups to identify new themes and to explore further previously emerged topics that were not conducive to probing in focus group settings.


This study demonstrated that although knowledge of the benefits and purpose of booster seats is an important issue in promoting booster seat use, it is not the only issue. In particular, differences in risk perception, awareness/knowledge, and parenting style were noted when comparing parents of children in booster seats with those whose children were in seat belts. Media campaigns, improved laws, parenting education, and extending the use of child restraints to older ages were among the strategies suggested by parents to increase booster seat use.


Anticipatory guidance regarding booster seats may be new for many pediatricians. This article arms pediatricians with insights from parents about their perceptions regarding booster seats and how parents think that the booster seat message can be most effectively delivered. Furthermore, it gives insight into how parents make safety decisions for their children and the important role of children in this decision-making process.

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