Evaluating child restraint system (CRS) adoption and policy interventions worldwide: a review

Abstract

The global disparity in Child Restraint System (CRS) adoption contributes directly to variations in road traffic mortality and morbidity among children. Despite the proven effectiveness of CRS in reducing harm, its adoption remains inconsistent across regions due to socio-economic, legislative, and cultural factors. This review evaluates global CRS adoption rates, identifies barriers to effective utilization, and explores interventions to enhance usage and legislative compliance, ultimately proposing strategies to improve child passenger safety.A total of 93 articles published between 2013 and 2024 were reviewed, with a focus on CRS usage and intervention patterns, the effectiveness of interventions, and legislative impact across high, middle, and low-income countries.The review highlights a significant gap in CRS usage between high-income and low to middle-income countries, with affordability, lack of awareness, and inadequate legislation as primary barriers. High-income regions showed better adherence but struggled with proper installation and misuse. Intervention strategies, including legislation, public education, and economic incentives, showed varying success in improving CRS adoption.Enhancing global CRS usage requires stringent legislation, comprehensive campaigns, economic support, and innovative technological solutions. Tailored strategies that account for regional socio-economic and cultural norms are essential to achieve widespread adoption and proper CRS use, ultimately reducing child passenger fatalities and injuries.