Objective: To determine differences in adult-child pairs stratified by restraint use, especially where a restrained child and an unrestrained adult were traveling together in a motor vehicle crash.

Methods: Adult (> 20 years) and child (< 11 years) pairs were identified from motor vehicle crash (MVC) data from 1992–2004 and stratified by restraint use: child and adult restrained (BR), adult only restrained (AO), child only restrained (CO), and both not restrained (BN). MVC records were probabilistically linked to inpatient and emergency department (ED) records.

Results: 151,232 adult-child pairs were identified. Most pairs were BR (86%) followed by BN (5%), CO (4%), and AO (4%).  Adults in the CO pairs were younger (55% under 30 years) than BR (40%), BN (39%) and AO (30%) pairs. The children in CO pairs were younger (44% two years or younger) compared to BR (32%), BN (16%), and AO (16%) pairs. Adults were more likely to be injured, treated at the ED, hospitalized and killed CO pairs compared to children. In the CO pairs 44% of adults vs. 20% of children were injured; 13% of adults were treated at the ED vs. 8% of children; 2% of adults were admitted vs. 1% of children; and 0.9% of adults were killed vs. 0.3% of children.

Discussion: These results indicate that while adults may be aware of the importance of restraining children, they often do not use restraints themselves and identify a population in which interventions could be targeted.