Risk Reduction for Every Age Buckling children in age- and size-appropriate car seats, booster seats, and seat belts reduces the risk of serious and fatal injuries: Car seat use reduces the risk for death to infants (aged <1 year) by 71%; and to toddlers (aged 1–4 years) by 54% in passenger vehicles.2 Booster seat use reduces the risk for serious injury by 45% for children aged 4–8 years when compared with seat belt use alone.3 For older children and adults, seat belt use reduces the risk for death and serious injury by approximately half.4 Scope of the Problem In the United States during 2013, 638 children ages 12 years and younger died as occupants in motor vehicle crashes,4 and more than 127,250 were injured.1 One CDC study found that, in one year, more than 618,000 children ages 0-12 rode in vehicles without the use of a child safety seat or booster seat or a seat belt at least some of the time.5 Of the children ages 12 years and younger who died in a crash in 2013, 38% were not buckled up.4 Risk Factors for Children and Teens Of the children who died in a crash: More black (45%) and Hispanic (46%) children were not buckled up compared with white (26%) children (2009-2010; aged 12 and under).6 More of the older children (45% of 8-12 year olds) were not buckled up compared with younger children (42% of 4-7 year olds; 27% of <4 year olds) in 2013.4 From 2001 to 2010, approximately 1 in 5 child passenger (<15 years old) deaths in the U.S. involved drunk driving; 65% of the time, it was the child`s own driver that had been drinking (BAC ≥ 0.08 g/dl).7 Most child passengers (<15 years old) of drunk drivers (61%) were not buckled up in the fatal crash.7 Restraint use among young children often depends upon the driver`s seat belt use. Almost 40% of children riding with unbelted drivers were themselves unrestrained.8 Child restraint systems are often used incorrectly. An estimated 46% of car and booster seats (59% of car seats and 20% of booster seats) are misused in a way that could reduce their effectiveness.9,10 Preventing Motor Vehicle Injuries in Children Based on strong evidence of effectiveness, the Community Preventive Services Task Force recommends car seat laws and car seat distribution plus education programs to increase restraint use and decrease injuries and deaths to child passengers.11 Car seat distribution plus education programs are also recommended in a more recent review for increasing restraint use.12 A study of five states that increased the age requirement to 7 or 8 years for car seat/booster seat use found that the rate of children using car seats and booster seats increased nearly three times and the rate of children who sustained fatal or incapacitating injuries decreased by 17%.13