Children are much safer when secured in child safety seats and seated in the rear of the car, says a new study of crash data out of the U.S. Original research findings from Partners for Child Passenger Safety, a research collaboration of The Children’s Hospital of Philadelphia and State Farm Insurance Companies. Partners for Child Passenger Safety (PCPS) is a child-specific crash surveillance system that links insurance claims data to telephone survey and crash investigation data. Since 1998, PCPS has collected information on 173,000 crashes involving more than 260,000 children. Until PCPS was established, little information was available on children in real-world car crashes. The research project produces robust findings that are frequently published in scientific journals and shared with regulatory and industry groups. In the PCPS study population, only 54 percent of children were restrained optimally for their age according to AAP guidelines: 74 percent of 0-to-3-year-olds used child safety seats, 9 percent of 4-to-8-year-olds used booster seats, and 79 percent of 9-to- 15-year olds used lap/shoulder belts. Twenty-three percent of children were seated in the front seat. Within each age group researchers noted a consistent pattern demonstrating the incremental benefits of age appropriate restraint and rear-seating for each age group of children. Increases in risk of injury were observed as children became less optimally restrained and move to the front seat. Front row seating is known to increase a child’s risk of injury in a crash. Several characteristics of children, drivers and vehicles affect the likelihood that a child will sit in the front seat. Older children and children riding as the sole passenger in the vehicle were more likely to sit in front. Children riding in older vehicles, as well as pickup trucks and vehicles without passenger airbags, were more likely to sit in front. These factors varied somewhat with the age of the child passenger. Educational efforts and interventions to promote rear seating should target these groups of children. It has been established that sub-optimal restraint (SOR) of children involved in motor crashes is associated with an increased risk of head injury. The risk of abdominal injury related to SOR has not previously been determined in real-world crashes. PCPS researchers found that SOR more than doubled the risk of abdominal injury compared to optimal restraint. Prevention and education efforts must continue to reinforce the necessity of age appropriate restraint in all children. Among restrained children with intra-abdominal injuries, those who were in SOR were four times more likely to have a hollow organ (stomach, intestine, bladder) injury when compared to those who were optimally restrained. This suggests that the mechanism of injury for hollow organs may be directly related to the inadequate position of the lap portion of the seat belt on the abdomen. These results may be used to improve the design of crash test dummies to be able to evaluate abdominal injuries in children.