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Booster seats in a bag: A pandemic success


At the American Academy of Pediatrics National Conference & Exhibition, Phyllis Agran, MD, MPH; Erin Malone, MPH; Al Valdez, PhD; Sandra Murray, MD; Jaya Bhalla; Emma Course; Lauren Tabios, MPH; and Sara Brown, PhD, discussed how the research project Clinic in the Park offered booster seats to low-income families during the COVID-19 pandemic.

Under California Law, children under 8 years must be properly buckled. Children aged 8 and older are permitted to use a seat belt if it fits properly. However, research suggests 30.4% of 4- to 7-year-old children are unrestrained or in a seat belt. From 2018 to 2020, this has led to 5 fatalities and 218 injured children under 8 years of age in Orange County, California.

For the Clinic in the Park research project, researchers targeted low-income families, 85% of which identified as Hispanic or Latino. They set up neighborhood distribution hubs, where they distributed the booster seat in a bag, educational materials, and a liability waiver. Educational materials included a self-guided, online 15-minute HIPAA-compliant educational module in both English and Spanish. Content included information on age and size-appropriate protection devices and current California state laws. Participants also completed a 3-month follow-up survey online.

From June 2021 to December 2021, 3 virtual training workshops were held. Eleven organizations participated as distribution sites, which included family resource centers, school districts, law enforcement, and community-based organizations. In total, 125 booster seats were distributed to children 5 to 11 years of age.

According to the results, the reasons the child needed a booster seat varied from the fact that they outgrew the car seat (10%), the booster seat was damaged in a crash or purchased secondhand (16%), the booster seat was needed for a second vehicle (6%), or the child did not have a booster seat and were only using the vehicle seat belt (68%).

The 3-month follow-up electronic survey included 80% of respondents (100/125). Of those, 99% reported that children were using the booster seat, 98% stated that the seat belt fit better with a booster seat, and 100% agreed that children may need to ride in a booster seat until 10 to 12 years of age.

The researchers concluded that the virtual platform was a success—it was cost-saving, convenient, and efficient. It also eliminated access barriers and could be used as a model for bicycle helmets and water safety for parent education.


Malone E, Valdez A, Murray S, Bhalla J, et al. Poster. Boosters in a Bag: A Pandemic Innovation. Presented at: American Academy of Pediatrics National Conference & Exhibition. Anaheim, California. October 7 to October 11, 2022.

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