Child restraint seat being installed correctly

Child injury


Changing the types and design of child car restraints to reduce serious injuries and death


About our research

Our work provides evidence upon which interventions and policies designed to prevent injuries (such as the recent child restraint laws) can be developed. Both the Bilston and the Brown Groups aim to reduce child injury in car crashes by studying why injuries occur and the factors influencing injury outcome. We are currently studying how the detailed ergonomic design of restraints influences whether children use restraints properly, and also how the labelling of child restraints could be improved to make it easier for parents to use them correctly.

The Bilston Group also looks at how the brain, spinal cord and soft organs and muscles respond to the forces during a car accident. We use magnetic resonance imaging (MRI) to measure the stiffness of these tissues to understand the specific injuries seen in children after car crashes.

What we have discovered

Our research has shown that if a child uses the most appropriate restraint for their size, and uses it correctly, their risk of serious injury in a car crash is greatly reduced. Our research was a major factor in the new national child restraint laws introduced in 2009/10, and has led to major changes in the mandatory child restraint standard that covers all child restraints sold in Australia. We led the development of the National Child Restraint Guidelines that were approved by the National Health and Medical Research Council and published in 2013.

The minimum safety requirements of the new child restraint laws are:

  • Birth to 6 months: Must travel in a rear facing child restraint
  • 6 months to 4 years: Must travel in either a rear facing child restraint OR a forward facing child restraint with an in-built harness. If a car has two or more rows of seats, then children under four years must not travel in the front seat.
  • 4 years to 7 years: Must travel in a forward facing child restraint with an in-built harness OR a booster seat. May not travel in the front seat unless all rear seats are being used by children under seven years.

Please refer to our child restraint guidelines for more information, and an easy to understand brochure.

We have also completed research into a new type of shoulder height label on child safety seats, which makes choosing the right sized restraint easier for parents, which is now a mandatory requirement for all new child restraints. Read more…

Our research into accessory child safety harnesses (these are used alone or in combination with booster seats and attach to the vehicle via a top tether strap and to the seat-belt system which is threaded through two loops at the bottom of each of the harness’ shoulder straps) has shown that they don’t offer any benefits above the lap-shoulder belt system. In fact, they put the child at a greater risk of slipping out under the belt in a crash. We found that this type of harness should only be used if the child is sitting in a position in the car where there is a lap-only belt (versus a lap-shoulder belt). We don’t advise parents to use this type of harness with a booster unless the booster has an antisubmarine clip (which will stop the child from slipping out under the belt.)


Children and Off Road Motorcycles

Childhood deaths and injuries due to powered off-road vehicles are steadily increasing in Australia. Most children admitted to hospital following an off-road incident with a powered vehicle, have been using a motorcycle.

Common causes

Children ride motorcycles for recreation, organised sport and assisting with farm activities on rural properties. There have been relatively few detailed studies on the causes of injury among children using motorcycles. The existing data suggests most crashes involving children using motorcycles involve some form of loss of control. This has led to much discussion about what might be an appropriate age for controlling motorcycles since children may have inherent physical and psychological limitations that may limit their ability to safely control these vehicles. In organised motor sports these risks are managed by matching children with appropriate vehicles and riding tasks. However, there is still a lot to learn about how these risks could be managed more broadly, and how injury risks might be best reduced among children under taking these activities.

The existing evidence also suggests injury is more likely among children who do not use protective equipment. However little is known about the extent that children using motorcycles for different purposes are using protective equipment. There is also little known about how well the protective equipment used by children performs in terms of reducing injury.

About our research

We are trying to address some of these unknowns to provide evidence-based solutions to prevent these types of injuries. We have been conducting a prospective in-depth investigation of off-road motorcycle crashes involving children aged 16 years and under who are admitted to hospital due to injuries caused by the crash. We are also conducting surveys of children and their families who regularly take part in off-road motorcycle riding activities but who have not recently been involved in a crash. Importantly we have also begun a program of study to examine the relationship between child development and the riding task.

What we have discovered

Data collection in our in-depth crash investigation study is complete and we have begun to analyse this data. Our cases confirm loss of control as the leading pre-crash mechanism. Our ongoing analysis aims to distinguish the rider, vehicle and environmental factors involved in these loss of control events. Preliminary results suggest inexperience and surface conditions unsuitable for the riding tasks being attempted may play a role. The primary source of injury is contact with the ground and further investigation of the protective equipment being used by young riders is needed.

Data collection in our survey studies is also almost complete. Using this data we hope to establish rider, vehicle and environmental factors that might be protective for loss of control events. We also hope to gain insight into which young riders use protective equipment and what type of equipment is commonly used.

Finally the first step in studying the relationship between child development and the riding task is the construction of appropriate tools to study child development in this context. This work involves a full functional task analysis of off road riding and from this we will identify the physical and psychological domains key to the riding task.


Other types of childhood injury

In collaboration with clinicians at the Sydney Children’s Hospital Network, we are also working to understand the mechanisms of other common forms of childhood injury. Currently this includes falls in children under one, and injury associated with indoor trampoline parks.


Falls are a common cause of childhood hospitalisation. Children under 1 year of age have limited mobility and are likely to fall for different reasons than older children. Preventing these injuries may therefore require a different approach than for older children.

Indoor trampoline parks are increasingly popular. With the increase in growth of these centres, there has also been an increase in the number of children attending hospital following injury at these centres. While a lot is known about how to prevent injury in children using domestic trampolines, and there are existing product standards guiding the safe design of domestic trampolines, trampolines in indoor parks differ in design, manufacture and patterns of use. Injury mechanisms, and preventative strategies are therefore likely to differ somewhat in these two contexts.

About our research

We have studied how children under 1 fall and the types of injuries they receive by reviewing the circumstances of more than 900 hospital presentations involving children under 1 who went to hospital. Using the information we have gathered we are now developing an intervention to try and reduce the risk of this type of injury.

We have also reviewed the circumstances surrounding injury occurring to children in in-door trampoline. We did this using a combination of medical record review and interview of families involved. We are now working with one of the largest indoor trampoline park companies to develop an in-depth study to collect more detailed information about ways to further reduce risk of injury among children undertaking these activities.

What we have discovered

For children under 1, the most common mechanism is being dropped by an adult or falling from furniture, bedding and purpose built baby equipment. Children are more likely to be admitted to hospital if they have been dropped by an adult compared to the other types of common falls. The child’s home is the most common place where these injuries occur, and therefore interventions are needed to reduce the risk of falls in this location.

Unlike domestic trampolines, where the majority of injuries occur from falling off, most trampoline parks injuries occur on the trampoline surface itself. Multiple bouncers or attempting tricks beyond one’s ability are common pre-cursors to injury. There also appears to be some environmental risk factors such as falls onto other objects with thin the park. These differences require new approaches to injury prevention that engage children, their carers and business owners/operators. These findings also suggest there is a need for specific guidelines to eb developed around the construction, environment and operation of these facilities. Our work has been instrumental in the establishment of a new Australian Standard governing these aspects of indoor trampoline parks in Australia.

Good practice in preventing child injury

Preventing injury is the best way to treat the problem of injury among children. However, injury prevention resources are very limited. Injury prevention measures adopted in Australia must therefore be effective and cost efficient. They must also be relevant to the Australian context.


The European Child Safety Alliance has developed a framework for collecting and disseminating best practice guidelines about how to prevent injury among children. This approach has also been adopted in Canada.

When it comes to preventing injury among children, understanding the evidence for what works and what doesn’t work is key to efficient use of limited injury prevention resources. The European Child Safety Alliance conducted a systematic review of the evidence for addressing a broad range of child injury types in 2006, and this was updated by Safe Kids Canada in 2011.

About our research

We have partnered with the European Child safety Alliance, the Sydney Childrens Hospitals Network and Kidsafe NSW to update this evidence. We have collated the most recent evidence for best practice in childhood injury prevention, with particular focus on the profile of childhood injury in Australia. We have also examined options for childhood injury prevention that have maximum

probability of success in the local setting by exploring the practical aspects of transferring policies and programmes from one setting to another .

What we have discovered

We have worked to develop the first Australian good practice guide in child hood injury prevention. This document contains a complete synthesis of the available evidence as well as instructional case studies. This document is an invaluable resource for child safety practioners and advocates throughout Australia.

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