Buckle Up Safely - Pre-school based interventions for appropriate use of child restraints

Road traffic injuries are the leading cause of death and serious injury in Australian children. In NSW, approximately 1000 children aged 0 - 16 years of age are seriously injured as passengers in motor vehicle crashes each year.

Appropriately fitted child restraints are a proven, effective intervention to reduce the rate of serious injury and death amongst child passengers in motor vehicle crashes. Children aged two to five years wearing an adult seatbelt, rather than a dedicated child restraint, are four times more likely to sustain a serious injury in the event of a motor vehicle crash. Further, when child restraints are not used correctly, the likelihood of injury and severity of injury for the child passenger is increased.

Despite the proven benefits of child restraints and the burden of death and injury in child passengers on Australian roads, a large proportion of Australian children are not adequately restrained while travelling in motor vehicles. The majority of children under age 1 initially use rear-facing and then forward-facing child restraints and this adheres to best practice. However, the rate of appropriate restraint use drops dramatically from age two, where children are either using inappropriate restraints for their age, are not using the restraint correctly or are prematurely graduating to adult seat belts. It is estimated that 35-75% of children aged two to seven years are not appropriately restrained.

Amendments to the Australian Road Rules in February 2009 reflect the importance of increasing child restraint use. These require use of a rearward facing child restraint until six months of age, a forward facing child restraint with in-built harness until four years of age and belt positioning booster seat up until seven years of age. The road rules also state that a child should not be seated in the front seat if a rear seating position is available.

The new laws were announced in November 2009 and were effective from March 1st 2010 in NSW.  We can expect that these new child safety restraint laws in combination with enforcement campaigns will increase child restraint use. However without education, instruction on restraint use and distribution schemes, changes to the way children are restrained are expected to be modest.

Buckle Up Safely project

The Buckle Up Safely project is an NHMRC funded trial of an educational intervention aimed at to increase use of child restraints in three to five year olds. The study is being led by a research team from The Injury Division at The George Institute and School of Public Health, Sydney University, Prince of Wales Medical Research Institute, University of New South Wales and Kids and Traffic, Macquarie University. The research team is led by Associate Professor Rebecca Ivers, who is the director of the Injury Division at The George Institute for International Health.


The intervention is multi-faceted and will target centre staff, enrolled children and their parents. The participating centres will receive a workshop about child restraints where carers and parent representatives will learn about importance of child restraints, how they work and receive programming ideas for integrating road safety messages into the curriculum at their centre. Ongoing support will be provided following the workshop and an interactive session scheduled with parents, carers and the children.


It is hoped that through this integrated approach we will convince families about the benefits of child restraints, provide information about the right child restraint for their child and motivate the families to change the way children travel in cars.  Pre-schools and long day-care centres in south-west Sydney, where we know rate of child restraint use is particularly low, are involved.  Subsidised child restraints and booster seats will be made available to address the possibility that additional expense prevents some parents using child restraints for pre-school aged children.


The researchers will evaluate the program using a cluster randomised clinical trial. The rate of correct and appropriate use of child restraints will be measured in centres participating in the program and compared to a parallel group of centres who do not receive the program. This evaluation will provide ‘gold standard’ evidence about the effectiveness of the program. It is hoped that, if proven, this program can form the basis of a sustainable program to support the new legislation and change the way child passengers in New South Wales are restrained in cars.  It is estimated that if all child passengers are optimally restrained between 14-18 deaths and up to 1000 serious injuries could be prevented each year in road crashes nationwide.

Related unit(s): Injury