Lap and shoulder belts have been required in rear outboard positions since 1989. A recent congressional mandate encouraged the requirement of a lap and shoulder belt in the center rear seat position. This study utilized Data from the Partners for Child Passenger Safety study, a large-scale child-focused crash surveillance system, to quantify changes in seating patterns for children in vehicles that already have this feature compared to those which do not and measured the safety benefit associated with the provision of a shoulder belt in the center rear seat position. The data demonstrate that the presence of a shoulder belt in the center rear seating position influences seating practices only when there is a single child occupant in the vehicle. Belted children in the center rear of vehicles equipped with a lap shoulder belt are at an 81% reduction in risk of injury than those belted in the center rear equipped with a lap only belt. The data suggest that by requiring lap shoulder belts in the center rear, benefits would be realized to belted children, specifically the 4-8 year old group.